Dáil Éireann debate -
Thursday, 11 Feb 2010

Vol. 702 No. 1

Adjournment Debate.

Cancer Screening Programme.

Deputy Jimmy Deenihan

The HSE south relocated the initial diagnostic and surgical symptomatic breast care services from Kerry General Hospital to Cork University Hospital, CUH, in October 2008. At the time, Professor Tom Keane made a commitment that follow up mammography screening for those patients who had undergone surgery at CUH would be carried out at Kerry General Hospital, KGH, and that the necessary facilities, including the provision of a new digital mammography machine to be purchased following the decommissioning of the existing machine, would be put in place for that purpose. This occurred in March 2009.

Women who had undergone surgery at CUH and who were then obliged to travel to Cork for follow up care began to contact me with regard to the promised digital mammography unit in Tralee. In response to their concerns, I wrote to both the hospital network manager of the HSE south and the general manager of KGH seeking an update on the replacement of the mammography machine. On 28 May 2009, the General Manager of KGH indicated that a digital mammography unit would be installed in the following few weeks and that the service would then recommence. On 3 June 2009, in a response from the hospital network manager of the HSE south, I was informed that:

[F]ollowing decommissioning of the existing digital mammography machine at KGH, a new digital mammography machine has been purchased at a cost of €340,000 by the NCCP and technical plans are being finalized for its installation and commissioning at KGH. This work will take approximately three weeks to complete. Mammography radiography staff from CUH will attend at KGH on a weekly basis, as required, and a digital link will also be installed which will enable scans to be reported by Consultant Radiologists at CUH. Mammography radiography staff from Cork University Hospital, CUH, were to attend at Kerry General Hospital, KGH, on a weekly basis, as required, and a digital link would also be installed which would enable scans to be reported by consultant radiologists at CUH. This, however, has not happened.

This week in The Kerryman, Marisa Reidy wrote:

Four months after the HSE announced it was making space within the radiology room at Kerry General Hospital for a long-promised mammography machine, it has emerged the executive is still no closer to installing the cancer-screening unit. The news comes almost eight months after the HSE wrote to The Kerryman confirming that a new digital mammography machine would be installed and commissioned in KGH within “three to four weeks” — and almost a year and a half since it first promised such facilities would be made available to the women of Kerry.

Despite assurances from the HSE last October that the machine would be operational once additional space had been created within the radiology room, KGH is still no closer to having the machine installed. Following another query from The Kerryman this week as to the status of the long-awaited machine, it emerged that the required space has still not been created, as a contractor assesses what the HSE terms this “specialist programme of works.”

A HSE letter sent to The Kerryman this week, advises, “that a contractor has now been secured to carry out the installation works required for this project which will comprise creation of additional space within the radiology department to accommodate the size of the new unit. As this is a relatively specialist programme of works, the selected contractor is currently liaising with technical services at Kerry General Hospital to comprehensively scope and confirm the programme of works required,” the letter concluded.

The HSE would not be drawn on an exact date for installation, but moved to assure the public that once installed, mammography radiography staff from CUH will attend at KGH on a weekly basis, as required, and a digital link will also be installed which will enable scans to be reported by consultant radiologists at CUH.

This matter has gone on for far too long. There were major protests in Kerry against the removal of this unit to CUH. Eventually, the people of Kerry accepted it on condition that after-care services would be provided immediately at KGH. This has not occurred despite these commitments. It is most unfair on the large number of Kerry women who must go to Cork for surgery and, in the future, for screening, which is a simple 20 minute procedure.

Minister of State at the Department of Health and Children (Deputy John Moloney)

I am replying to this Adjournment matter on behalf of the Minister for Health and Children, Deputy Harney, who cannot attend the Chamber this evening due to a prearranged appointment.

The national cancer control strategy was clear that to achieve better cancer prevention, detection and survival, there should be eight specialist cancer centres, each serving a population of approximately 500,000. In the HSE southern region, CUH and Waterford Regional Hospital have been designated as the cancer centres.

The first priority for the HSE's national cancer control programme, NCCP, has been the transfer of breast cancer diagnostic and surgical services to the eight centres. As part of this process, these services were relocated from KGH to CUH in October 2008. On 1 December last, the remaining services in the region were amalgamated into the new regional cancer centre at CUH. These included the South Infirmary symptomatic breast service, the Mercy University Hospital pathology service and BreastCheck surgery.

The breast care unit at the Regional Cancer Centre South is now the largest in the country. It is expected it will see more than 10,000 patients annually and diagnose approximately 520 symptomatic patients with breast cancer. The HSE's most recent performance report shows that the service is 100% compliant with waiting time targets for new patient referrals, which set out that 95% of urgent referrals should be seen within two weeks.

The Government provided €5.75 million to develop the centre at CUH. This development includes diagnostic clinics and treatment facilities incorporating mammography imaging services, ultrasound, pathology-laboratory services, patient waiting areas and support services. Additional consultants, nurses, radiographers, medical scientists and administrative staff were appointed to the new centre.

Women in the Kerry area who are referred to the CUH symptomatic breast service travel to Cork for their initial assessment. For the majority, they will not have a diagnosis of breast cancer and will require no further follow up treatment in Cork. Where a woman has a diagnosis of breast cancer which requires surgery, the operation will also take place in Cork. For women who may need financial assistance with the cost of travel to the breast service at Cork, as at the other centres, the NCCP provides funding through the Travel2Care scheme, administered by the Irish Cancer Society. In the case of women who require chemotherapy, this can and is being delivered in Kerry in accordance with protocols set out by the multidisciplinary team based in Cork. The breast care nurse based in Kerry links with the multidisciplinary team meetings at CUH on a weekly basis.

Follow-up mammography for patients of the CUH symptomatic service who have undergone surgery will also be carried out at KGH once the necessary facilities and resources are put in place for this purpose. Following decommissioning of the existing mammography machine at KGH, a new digital mammography machine has been purchased at a cost of €340,000 by the NCCP. Technical plans for its installation have been developed and a contractor has been secured to carry out the installation works required, specifically the creation of additional space within the radiology department to accommodate the new mammography unit. This will include a digital link and integration with the systems at CUH.

As this is a relatively specialist programme of works, the selected contractor is currently liaising with technical services at KGH to scope and confirm the programme of works required comprehensively. Until the follow-up mammography service is in place in Kerry, women in the region will continue to have follow-up mammography provided at CUH.

The new mammography service at KGH is specifically for the provision of follow-up mammography for patients of the CUH symptomatic service. Screening mammography is carried out only by BreastCheck, the national breast screening programme. BreastCheck began screening in County Kerry in April 2009 from a mobile digital screening unit using digital mammography. Screening in the county will continue until first-round screening has been offered to the approximately 13,000 women aged between 50 and 64 in Kerry. However, any woman, irrespective of age, who has immediate concerns or symptoms should contact her GP who, where appropriate, will refer her to the symptomatic services.

The completion of the transfer of breast cancer diagnostic and surgical services to the eight cancer centres is a major milestone. It enables us to be confident that the service being provided is in accordance with international best practice. This is crucially important in ensuring women diagnosed with breast cancer have the best possible chance for positive outcomes.

Deportation Orders.

Deputy Alan Shatter

I raised the plight of the child in question in a parliamentary question to the Minister for Justice, Equality and Law Reform on 10 December 2009.

On 16 August 2009, the Nigerian mother of this child was arrested in Dublin Airport for evading a deportation order. She was deported on 1 September. Her four-year-old son, who was born in the State, was temporarily placed in care on 16 August, and the HSE properly made an application to the children's court under the Child Care Act 1991 for directions on the child's welfare. The child was properly cared for, and prior to the airport incident, was never apart from his mother. The Children's Court, required to make decisions protecting children's welfare, found he should not be deported.

Despite this, the Minister went ahead with the mother's deportation. Since August the child has been cared for in four different temporary fosterage arrangements with at least three different HSE social workers involved with the child. There is little doubt the mother was in the State illegally and had since 2005 evaded deportation. While this was unacceptable, it was not the child's fault and he should not be punished for it.

The Minister justified the unacceptable treatment of this child on the basis that he is not an Irish citizen and that a majority in 2004 voted for a constitutional change to ensure children born to foreign nationals residing for a short time in the State would not automatically acquire citizenship. I do not believe that those who voted in favour of constitutional change had anticipated that the State would kidnap a child from his mother in Dublin airport and simply deport the mother without regard to consequences for the child. Once the future care and welfare of this child became an issue that required a decision of the Children's Court, deportation of the mother should have been postponed to facilitate all issues relating to this child's welfare being given proper consideration.

In response to my Dáil question on 10 December last, the Minister stated:

An application has now been received from the court appointed guardian ad litem of the child in question requesting that the deportation order in respect of his mother be revoked to allow her to re-enter the State to be reunited with him. This application, made under section 3(11) of the Immigration Act 1999 as amended, is under consideration at present and a decision will issue shortly.

I am not aware of any decision yet having been made.

There is a total disconnect between the approach taken by the Department of Justice, Equality and Law and the Garda in the arrest and deportation of the mother and the retention of her child and the approach prescribed in the Children First: National Guidelines for the Protection and Welfare of Children, which emphasise that it is generally in the interest of a child's welfare that he or she be brought up by his or her parent or parents and when separated from them, that all necessary steps be taken to effect family reunification.

From a child welfare perspective, the disastrous events that occurred are indefensible but from a State cost perspective, thousands of euros of taxpayers money have now been spent by the HSE in maintaining a child in care who could still be residing in the State with his mother and by the Department of Justice, Equality and Law Reform and the HSE in legal representation before the Children's Court.

The continuing situation can only do profound damage to this young boy's immediate and long-term welfare. The longer it goes on the greater the damage to the child's capacity as an adult to make and maintain bonds or attachments. This situation can properly be described as child abuse or as inhuman and torturous treatment by the State of an innocent child. It is an exact contradiction of what the Minister, Deputy Dermot Ahern, stated on the steps of Government Buildings on the day of publication of the Murphy commission report. On that occasion, he was critical of the church's cover up of clerical abuse and of its motivation to avoid scandal stating that "the welfare of children counted for nothing". His criticism was hollow as clearly in the Minister's view the welfare of this child also counts for nothing and is of no value and no concern. The Murphy commission report also addressed what the Minister described, on its launch, as "the failings by agencies of the State". This case classically and starkly illustrates yet another failure by State agencies to give priority to the welfare of a child.

This Minister, who is never slow to defend himself, has at no stage made any public response to questions raised by me in an article in The Irish Times on 22 December last and I can only regard this as an implicit acknowledgement by him that this mother and child should not be treated this way. I call on the Minister, in these exceptional circumstances, to allow the mother of this child return to the State to care for and bring up her son here, in the overwhelming interests of the child’s welfare. The Child Care Act 1991 gives priority to the protection of the welfare of children, as did the child protection guidelines of 1999 and as do the December 2009 newly-published guidelines. The Minister should prioritise the welfare of this child and bring this sorry and tragic episode to an end. He should allow the mother return to Ireland and the child to be reunited with his mother and removed from the care system. A child is currently in care who does not require the care of the State and is only getting such care because the State has deported the child’s mother. It is an extraordinary and scandalous situation.

Deputy John Moloney

By way of responding, the Minister for Justice, Equality and Law Reform, Deputy Dermot Ahern, is keeping faith with the statement he made on the steps of Government Buildings that day. The issue is one of reuniting the mother with the child, I may be able to explain that.

I preface my reply by reminding the House that the Minister dealt with this matter in some detail on 10 December 2009 when he responded to an oral parliamentary question from Deputy Shatter on the same matter. I am aware of the opinion piece Deputy Shatter wrote for The Irish Times in support of his case on the same subject. In that article, it would appear that Deputy Shatter largely ignored the facts of the case as they had been presented by the Minister in response to the earlier parliamentary question.

The case in question is that of a Nigerian woman who arrived in this State in August 2005 and claimed asylum at that time. Her son was born in this State just two days after her arrival here but, based on the provisions of the Irish Nationality and Citizenship Act 2004, he is not an Irish citizen. The woman, two days after the birth, included her son in her asylum application meaning that any decision taken in her case applied equally to him. Arising from the refusal of the asylum application, she was notified, by letter dated 25 October 2005, that the then Minister for Justice, Equality and Law Reform proposed to make deportation orders in respect of herself and her son and she was invited to submit written representations setting out reasons deportation orders should not be made. Representations were submitted on her behalf at that time.

Following the consideration of her case under the relevant statutory provisions, deportation orders were signed in respect of mother and son on 23 November 2005 and notified to them by registered letter dated 29 November 2005. They failed to present to the Garda National Immigration Bureau, GNIB, as required, and were therefore classified as persons evading deportation. They continued to evade their deportation for more than three and a half years until, on 16 August 2009, mother and son were apprehended by officers of the GNIB at Dublin Airport. Following questioning by the immigration officer and checks on the relevant Garda database, they were identified as persons who were evading deportation.

At this point, the mother was arrested and detained and she was conveyed to the Women's Prison, Dóchas centre. As this prison had limited facilities for children, and in accordance with well established procedures, the woman in question was given the option of putting her son voluntarily into the care of the Health Service Executive, HSE. She refused to do so and as a result the arresting garda was left with no option but to execute his powers under section 12 of the Child Care Act 1991 to secure appropriate care for the child.

In accordance with HSE procedures, that body sought and was granted an emergency care order on 17 August 2009, at which point the child was placed in the care of the HSE. An interim care order was subsequently granted on 24 August 2009. The Deputy will appreciate that all aspects of the case relating to the child's care are the responsibility of the HSE, however, the Minister for Justice, Equality and Law Reform has no evidence to suggest that the welfare needs of this child have not been or are not being met.

Given that the woman in question and her son were the subject of valid deportation orders, arrangements were made to have them both repatriated to Nigeria by chartered flight on 1 September 2009. On this date an application was made by the HSE to have the interim care order lifted to allow the child to accompany his mother to Nigeria. The application was refused by the District Court and the child remained in the care of the HSE. As a result, the woman in question was repatriated without her son.

Deputy Alan Shatter

That is what should not have happened, and the District Court reached that decision based on the child's welfare.

Deputy John Moloney

I will put it this way, if the mother's intention was to be reunited with her son, she had every option to allow her son travel to Nigeria either way.

Deputy Alan Shatter

The court obviously agreed with her that it was not in the child's interests.

Deputy John Moloney

I would have thought that the child's interests would have been with the natural mother in her home country, Nigeria.

Deputy Alan Shatter

The court made that decision.

Deputy John Moloney

Since her deportation on 1 September 2009, representatives of the bureau have made sustained efforts to communicate with the woman in question in order to facilitate the return of her son to Nigeria. However, she has refused to co-operate meaning that her son must remain in the care of the HSE until that position changes.

Deputy Alan Shatter

The District Court will not allow the child go back to Nigeria.

Deputy John Moloney

No.

Deputy Alan Shatter

The District Court will not allow the child travel to Nigeria.

Deputy John Moloney

In fact, I understand, during one telephone call with a Garda representative she indicated that she did not wish for her son to be reunited with her in Nigeria.

Deputy Alan Shatter

The District Court judge does not either.

Deputy John Moloney

I would have considered that the mother's wish would have been first, for the maternal part of this response.

Deputy Alan Shatter

The child is just a pawn in all of this.

Deputy John Moloney

The court appointed guardian ad litem of the child in question has submitted an application to have the mother’s deportation order revoked to allow her to re-enter the State to be reunited her son. I understand this application is under consideration by Department officials.

It must be emphasised that the woman in question could at any point bring closure to this situation by accepting the repatriation of her son. To date, she has refused to facilitate this in Nigeria. I find it difficult to understand the position she has adopted. It would have to be assumed that she is hoping that while the child remains in this State, her chances of returning to, and remaining in, this State are enhanced.

The fact remains that she arrived in this State as an asylum seeker and had all of her protection-related needs considered in detail at all stages of the statutory process. It is difficult to credit how a person whose case has benefited from such detailed consideration could now hold the State's immigration laws in such contempt and, as such, the Minister does not share Deputy Shatter's view that the solution to the problem is to have her returned to this State. To do so would only serve to encourage many others to flout the system in similar fashion.

Deputy Alan Shatter

The Minister is pre-judging the consideration he alleges his officials are giving to this. The Minister's conclusion is that the child stays in care——

Deputy John Moloney

The Minister acknowledges that the priority should be for the child to be with his mother in her home country.

Deputy Alan Shatter

——indefinitely because——

Deputy John Moloney

We should not use the situation. The facts remain——

Acting Chairman

I thank the Minister of State.

Deputy Alan Shatter

The Minister is using this child.

Acting Chairman

I regret I must move on.