Deputy Pat McCartan has been given permission to raise on the Adjournment the failure of the Government to appoint a medical officer to the prison service.
Adjournment Debate. - Prison Service Medical Director Appointment.
I am much obliged to the Chair for the opportunity to raise this very urgent matter. It is all the more urgent in view of the reply given to me in answer to Question No. 52 on the Order Paper of Tuesday 10 November of this year in relation to offenders in St. Patrick's Institution. The Whitaker report is regarded as a milestone in the history — if any — of penal reform in this State. It represents the culmination of a campaign begun in 1972 by persons concerned with penal reform who pursued relentlessly an issue calling for the comprehensive investigation of our prison service. It invited and received submissions from all quarters of society concerned with the question of our prisons and their modernisation. It was welcomed on its publication in a short time. The committee of inquiry were appointed on 31 January 1984 and published their report in July 1985. The report has been with the Minister and his Department since then and it was circulated to Members of this House this year.
Its conclusions are very comprehensive and the way in which it dealt with all aspects of penal reform was welcomed by all parties and persons concerned. It represented a careful, considered and monumental contribution to the history of reform in our penal system. When it was presented to the Minister of the day, Deputy Noonan of Fine Gael, he agreed to proceed with one of its most central and important provisions, namely, the appointment of a medical director to supervise and advance health services within the prisons. It was agreed that this would be embarked upon without delay in advance of Department consideration of the full implications of all the report's provisions. That consideration is ongoing, and it accentuates the great need for the appointment of such an officer. Irrespective of whatever came out of the Government's deliberations about the Whitaker report or what fundamental changes, if any, would be introduced into our prison system, one position that needed to be filled as a matter of urgency was that of medical director.
It is interesting to look briefly at what was suggested by way of definition of the role of the medical director in the report. I refer to the Report of the Committee of Inquiry into the Penal System, briefly known as the Whitaker report, at page 66, paragraph 7.20. I quote:
To ensure the provision of an adequate overall health service in the prisons and places of detention, we see the need for strong central direction. We recommend that this should be provided by a Medical Director. His/her primary responsibility should be to ensure that the health needs of all prisoners are met adequately.
Its final paragraph in the area of health services on the next page, paragraph 7.21, says:
On balance, we believe that the Medical Director should be a highly qualified psychiatrist with experience in forensic psychiatry. The Director should be located in the central administration and be accountable directly to the Director of the Prison Service.
It proceeds then to salaries and other matters. The clear intention was that this person would be very central to the whole development of the prison service and in particular the medical services. The reasons were outlined in the report in brief. I quote now from page 65, paragraph 7.15:
Fundamental to the well-being of prisoners and to their personal development is the provision of adequate and effective health care.
The report goes on to highlight the areas that need development and attention. It indicates the need to develop psychiatric services for prisoners, to look after the requirements of below average intelligence prisoners, to rehabilitate drug and alcohol abusers, to treat and rehabilitate sex offenders and, finally, the most urgent recent development, to deal with the problem related to the increased detection of AIDS sufferers and carriers of AIDS antibodies among the prison population. The report highlights the growing problem of medical-related discontent among prisoners being exacerbated by overcrowding, lack of educational facilities and lack of facilities to train and keep prisoners occupied.
These problems were central to Dr. Whitaker's recommendation that a medical director was essential. The problems have continued and have created even greater challenges for the prison service since the report was compiled. Prisoners carrying AIDS or AIDS antibodies initially were moved to Arbour Hill. Problems developed there with regard to prison staffing and the prisoners then had to be moved back to a unit within Mountjoy Prison where problems arose with regard to, for example, their proper dental treatment. An issue then arose in regard to the use of the unit at Dundrum. Would it be used for the purposes of the Department of Justice or of the Department of Health? This multi-million dollar facility is still unused. The decision on when to open Wheatfield Prison is in part influenced by the difficulties the Minister has in finding proper medical staff to look after the inmates who will ultimately be detained there.
The report also identified the problem of the conditions under which medical officers work. It recognised that many of the medical officers then employed by the prison service were attempting to cater for all the health needs of prisoners and to establish adequate liaison with professionals in associated services with whom they seldom had contact. The appointment of a director with overall responsibility would make matters easier.
Central to the whole issue of caring for prisoners is the aftercare follow-up service. Prisoners with personality, psychological and medical problems should have a follow-up service outside, working in liaison with the medical officers and their staff. The report called for a director who would give strong central direction to the improvement of the health services.
Clearly the case was urgent and it was responded to with a sense of urgency. What has happened in the meantime? Apparently two attempts were made by the previous Government to fill the position. Advertisements were placed in the national newspapers and interviews took place but no suitable person was found. We have never had a full explanation as to what exactly went wrong. Did too few people apply? Were the wrong kind of people canvassed? The report stated it would benefit the service if the holder engaged in some medico-legal practice and had a link with a university department.
The committee believed the appointment of a competent and committed director with leadership qualities would go far to promote a high level of morale in the medical service and bring about a significant improvement in the overall standard of health care throughout the prison system. I wonder whether the salary is adequate to attract someone with an academic background and contact with a university department which is so essential to the whole idea of developing the criminology and penalogical notions behind the improvement of health services. Such a person would have the opportunity to address these questions and plug into the research facilities available at that level. The person appointed would also need a psychiatric background in view of the central role of that type of service in our prisons. The report identified the need to develop all these areas and aspects of the medical service. It is clear that no serious progress can ever be expected in any of these areas unless a director is appointed to bring forward in an ordered way the whole area of prison reform.
The present situation is unacceptable. A Government with all their ingenuity and resources simply cannot come into this House and say they cannot find a person suitably qualified to meet the requirements. They must offer the necessary terms to make the position attractive. It is crucial that the position be filled, no matter what salary is required. It is up to the Government to make the commitment and to ensure that the resources are available. It is incumbent on the Government to take whatever steps are necessary to make this appointment, particularly where they are providing a service for people who are detained against their will as a form of punishment.
A disturbing factor is the general belief in the prison service and among some sectors of the community that the embargo on public service recruitment is impinging on this appointment to a greater extent than any non-availability of suitable personnel. It is believed the recent Government decision to refuse to appoint new staff is impeding the appointment of a director or prohibiting any future consideration of such an appointment. Is it the position that the Government have formally abandoned any efforts to find a person to fill this position?
I referred earlier to the reply to my Question No. 52 on 10 November last. I had asked the Minister about the death of a young man in St. Patrick's Institution. It seems quite clear from the reply that the Minister is not in any way addressing the recommendations of the Whitaker report. He suggests that because of the cutback in the workload of the chief medical officer for the Civil Service he is in a position to involve him in the role originally envisaged for the director of medical services within the prison service. With no disrespect to the person concerned, this man clearly has a very important job in the Civil Service and this type of transfer and part-involvement in the prison service is no substitute for the appointment of a director.
I appeal to the Minister to clarify precisely the Government's position with regard to this appointment. I would ask him to indicate whether the Government accept the urgency of the situation as reflected in the report and in the response of the then Government. Are the Government prepared to make a serious effort to locate a suitable person, either inside or outside this country? Will the Minister pursue the matter, recognising the urgency of the situation and aware of the increasing pressures which will inevitably build upon the medical staff in our prisons who are working under intolerable conditions? They must be aided in the way envisaged in the Whitaker report.
Regarding the comments made by Deputy McCartan on the Whitaker report, it is not correct to suggest that nothing has been done in relation to that Report of the Committee of Inquiry into the Penal System. Since it has been published its findings have been taken into account as appropriate in dealing with various prison issues, including the appointment of a medical director. What tends to be overlooked is that many of the recommendations contained in the report, for example in the personnel area, were in line with developments already underway as part of the on going process of prison administration. In considering the report, changing circumstances have to be accommodated. For example, when the committee carried out their inquiry, AIDS-related problems were not a significant issue.
I should like to make it clear that the committee set out a number of general approaches and principles which should be adhered to. In saying that I am not criticising that approach, far from it, but it would be misleading to characterise the report as a detailed blueprint for the future operation of the prison service which simply requires a series of "yes" or "no" decisions on my part or that of the Government.
In January 1986, the then Government approved the immediate appointment of a director of medical services for the prisons. The background to the decision was the escalating medical problems among the prisoner population, especially following the identification of numbers of prisoners as being antibody positive to the AIDS virus. The Whitaker Committee had recommended such an appointment in order to provide co-ordination of medical services at central level.
The post was advertised in September 1986 by the Civil Service Commission on the basis that an appointment would be on contract for an initial two year period. The Civil Service Commission indicated that they were unable to recommend a candidate for appointment. The post was readvertised in January 1987 as a permanent appointment. The Civil Service Commission were unable to recommend a candidate for this competition either. In view of the poor response to the two competitions, it is considered that there is no point in readvertising the post at this stage. However, I will be keeping the matter under review.
In discussions with officials of my Department, the Chief Medical Officer for the Civil Service has indicated that because of a reduction in his workload due to the decrease in recruitment and the lack of promotions in the Civil Service generally he is now in a position to take a more active role in providing medical advice to the prison service. While it has always been part of his duties to act as medical adviser to the prison service his overall workload had been such that he could be of only very limited assistance in this area up to now.
Medical officers and Governors were informed last month of the new arrangement and that the chief medical officer would be providing advice to the Department on medical and health matters as they affect the prison service and would be liaising between the medical officers and the Department. I am pleased that the Civil Service Chief Medical Officer can now take a more active role in relation to the prison service.
One of the most difficult problems with which the prison service has had to contend in recent times has been the identification of a number of offenders as having come into contact with the AIDS virus — that is, that they have been found to be HIV positive. I think it important to point out that the emergence of offenders with AIDS antibodies was simply a reflection of what had been happening in the outside community and, give the high number of drug abusers who are committed to prison by the courts, it was inevitable that AIDS-related problems were going to arise in the prisons at some stage.
It would, of course, have been helpful if a director of medical services for the prisons had been in place to assist in devising strategies to cope with AIDS-related problems in the prisons. However, in the absence of such an appointment arrangements were made to ensure that the necessary expert medical advice was available, particularly in the initial stages of dealing with this problem. Specifically, detailed consultations took place with the deputy chief medical officer at the Department of Health charged with dealing with the AIDS problem nationally.
Subsequently, a special doctor was appointed as medical officer to deal with the medical needs of HIV offenders and, obviously, where hospital tests or treatment is required, this is arranged. The medical officer has indicated he is more than satisfied with the facilities which have been made available to him at the prison by way of surgery and equipment.
The House will appreciate that offenders who find themselves in this unfortunate situation need a lot more than just basic physical care and, accordingly, a wide array of support services are made available to them. These include psychological, psychiatric, welfare and chaplaincy as well as assistance from community-based groups such as Coolemine and Anna Liffey. A multi-disciplinary approach is taken to improve the co-ordination of services to these offenders.
From the outset, representatives of the various disciplines were brought together to devise effective strategies for dealing with AIDS-related problems and in October of last year over 200 people with a special interest in these problems attended a two-day seminar organised by my Department on "AIDS — Implications for the Irish Prison Service" which was addressed by medical experts from abroad, among others. Since then attendance at various seminars and conferences which could prove helpful to the various disciplines in contending with these problems has been sanctioned regularly.
I hope it will be clear to the House that, notwithstanding the difficulty which arose in relation to the post of medical director, all that can reasonably be done to deal with AIDS-related problems in the prisons is being done. In this connection I am happy to say that there is fairly widespread acceptance among those familiar with the AIDS problem generally in this country that the level of services available to offenders at the very least match those available in the community.
On the question of suicides which have taken place in the prisons the House will appreciate that the circumstances in which a person decides to take his or her life are varied and complex and, consequently, the Deputy will appreciate that I cannot accept that the absence of a Medical Director would have been a factor in any of the unfortunate deaths which have taken place over the years.
May I put a question to the Minister?
Normally I would not give permission but on this occasion I agree to the Deputy putting one question.
Will the Minister confirm that the arrangement now being entered into with the Chief Medical Officer of the Civil Service is a temporary one until times are better or until a Medical Director can be found? Will the Minister tell us that this does not represent an abandonment of the proposals contained in the Whitaker report?
I should like to refer the Deputy to the earlier part of my reply where I said I was keeping the matter under review. I told the Deputy that in view of the poor response to the two competitions it was considered there was no point in readvertising the post at this stage but I pointed out that I will be keeping the matter under review.
It seems to me that none of the efforts to make appointments were during the time the Minister was responsible for the Department. I hope that the Minister will in the near future put a better shoulder to the wheel in looking for such an official because there is no doubt that there is a man or woman available.
I should like to tell the Deputy that if I am satisfied that the present arrangement is not working to the high level to which I want it to work the matter will get my immediate attention.
The Dáil adjourned at 8.55 p.m. until 10.30 a.m. on Thursday, 19 November 1987.