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Dáil Éireann debate -
Tuesday, 23 Feb 2010

Vol. 703 No. 1

Adjournment Debate.

Hospital Procedures.

I thank the Ceann Comhairle for this opportunity to raise this matter on the Adjournment of the House but it is a disgrace on the part of the Government that we should have to return to the issue of symphysiotomy by way of an Adjournment debate. An inquiry into this barbaric practice should already have been held, reported and acted upon. It is shame on the Minister for Health and Children and her Department, for refusing to do so.

I understand that the Minister is announcing tonight that she is to ask the Institute of Obstetricians and Gynaecologists to carry out a review and report on the practice of symphysiotomy. I await the Minister's full statement but if that is the extent of what is being done, it is not good enough. The institution responsible for the abuse is being asked to investigate itself. It is not a proper inquiry, although it is clear its establishment has come about as a result of pressure on the Minister to act. That pressure for a proper inquiry needs to be maintained.

The RTE "Prime Time" programme of 18 February 2010, made a compelling case for an inquiry. It included new evidence. One of the most extraordinary pieces of evidence was one that did not take a great deal of research to uncover. This information was about the number of symphysiotomies actually carried out. The Department of Health and Children was asked for and supplied a figure which it said was incomplete because the Department did not have all the relevant health board reports. Yet, a reporter from "Prime Time" was able to go the National Library of Ireland — which has the relevant reports — and find the correct figure which was three times the Department's estimate. This is a very sorry and embarrassing state of affairs for the Department.

People commented to me after the programme that it confirmed that not only should Michael Neary have been struck off the medical register — as he was — but he should have been brought before the courts. Interviewed on national television he accused the abused and traumatised survivors of symphysiotomy of being motivated by what he termed the "smell of money".

It was a sickening sight. This is the man who carried out numerous mutilations of women through unnecessary hysterectomies. The programme revealed he is implicated in the symphysiotomy scandal as well. This alone merits full inquiry.

I call on the Minister for Health and Children to act immediately to establish an inquiry into this scandal. It should be headed by a competent and independent figure from outside of the medical establishment. It is time for the Minister to stop shielding the medical establishment and start acting on behalf of our citizens who were victims of this barbaric practice.

I wish to quote in full and put on the record of the House an open letter to the Minister published today in The Irish Times.

Symphysiotomy is an 18th-century childbirth operation that effectively unhinges the pelvis by severing the pubic bones. The surgery was revived here in the mid-1940s for religious reasons and carried out, reportedly, without consent. More than 100 casualties survive today.

The Minister for Health has declined to accede to calls for an inquiry, most recently from the Joint Oireachtas Committee on Health.

Her refusal rests on advice supplied by the Institute of Obstetricians and Gynaecologists. Wrongly, the institute has led successive Ministers to believe that symphysiotomy was done out of medical necessity, that the surgery was a norm for obstructed labour until 1960, that results were "excellent" and complications "rare".

Symphysiotomy was never a norm, however. Ireland is the only country in the developed world where symphysiotomy was widely practised during the 20th century.

More than 1,000 of these operations were performed here from 1944 to 1984.

The surgery left babies dead or damaged and mothers with genital and pelvic injuries, persistent wounds and other infections; and sexual, marital and family difficulties. Many report decades of depression, impaired mobility, incontinence and chronic pain.

Symphysiotomy was a blatant abuse of authority and of medicine, one that showed a callous and cavalier disregard for mothers and babies.

For the Minister to persist in refusing an independent inquiry into this mutilating operation is to make a mockery of patient safety and to deny these women justice.

Like other victims of institutional abuse, they, too, are entitled to truth, validation, redress and closure.

The letter was signed by a long list of people from a cross-section of roles in society but I ask the House to note that three of the Deputies present in the Chamber were signatories to this letter: I signed the letter as Sinn Féin spokesperson on health and children, as did Deputy Arthur Morgan, in whose constituency many of the victims reside and the Acting Chairman, Deputy Jan O'Sullivan.

I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney, who is unable to attend this evening. I thank Deputy Ó Caoláin for raising this important issue.

Symphysiotomy is a medical intervention that is now very rarely used in Ireland. It is an obstetric procedure and is a matter primarily for the Institute of Obstetricians and Gynaecologists to advise and lead upon. Accordingly, the Minister for Health and Children has asked the institute to prepare a report for her concerning the practice of symphysiotomy in Ireland. She has asked that the report would provide the institute's assessment of the circumstances in which symphysiotomy was carried out in Irish obstetric units; indicate what protocols or guidance existed over the years to guide professional practice; specify when the practice changed and why it changed at that time in Ireland.

The Minister has asked the institute to have the report completed by the end of April. I understand that the institute has indicated it will examine the practice of symphysiotomy as requested by the Minister and that it is willing to meet with the group representing those who have had the procedure. Symphysiotomy has been superseded for many years by Caesarean section and the Minister is satisfied that current medical practice in this regard is not in need of review.

The Minister is committed to ensuring that the greatest possible support and services are made available to women who continue to suffer the effects of having undergone this procedure. The women concerned continue to receive attention and care through a number of services which have been put in place including the provision of medical cards to all survivors of symphysiotomy patients who requested them; the nomination, since 2003, of a liaison officer for a patients' group comprised of women who underwent a symphysiotomy procedure; the availability of independent clinical advice for former patients by liaison officers who assist in co-ordinating the provision of services to those patients; the organisation of individual pathways of care; and the arrangement of appropriate follow-up, including medical assessment, gynaecology assessment, orthopaedic assessment, counselling, physiotherapy, reflexology, home help, acupuncture, osteopathy and fast-tracked hospital appointments. I understand that to date, 125 women have availed of some or all of the services offered by the HSE. I refer to the refund of medical expenses related to symphysiotomy in respect of medication or private treatments and the establishment of a triple assessment service for patients at Cappagh Hospital, Dublin in January 2005. A support group facilitated by a counsellor was set up in 2004 in Dundalk and Drogheda for women living in the north-east region.

The Minister has been assured by the HSE that it will continue to monitor and oversee the provision of necessary support services for women. In doing so, the HSE is committed to being proactive in seeking out and offering help to women who had symphysiotomies and who may wish to avail of the services offered by the HSE.

Public Transport.

On Sunday next, 28 February, Bus Éireann will bring a long list of what it euphemistically describes as timetable and route changes into effect. This is part of a cost-cutting plan which will mean that the service between Dungarvan and Mallow provided on Mondays, Thursdays and Saturdays, will cease. This service currently leaves Dungarvan at 9 a.m., returning to Dungarvan at 3.40 p.m. and leaving Dungarvan again at 5.30 p.m. for Tallow. It returns to Dungarvan at 6.10 p.m. to connect with the Dublin and Cork services. These services stop at Cappoquin and Lismore. My colleague, Deputy Sherlock, will describe the service in his constituency.

The National Bus and Rail Workers Union has come up with a proposal that would allow this service to be retained one day a week, on Thursdays, at no cost to the company other than that associated with making an additional bus available. The Dungarvan driver, who links with Clonmel and Waterford, would switch his rest days from Wednesday and Thursday to Tuesday and Wednesday. His colleague in Clonmel would switch his leave days from Sunday and Tuesday to Sunday and Monday, thereby having back-to-back rest days, which is what Bus Éireann is always trying to achieve for its drivers. Under the new arrangement, the Dungarvan driver, who is a spare driver one day a week, would work on that day. If the union proposal is accepted, the people of west Waterford will have a service one day a week, at least. I understand that an average of between 90 and 100 passengers use the service each day. While many of these passengers hold free travel passes, Bus Éireann is paid to carry them.

This measure represents the final reneging on the commitment, outlined in the January 1976 notice of termination of train services on the railway line between Mallow and Waterford via Fermoy, that new road passenger services would be provided as an alternative for passengers. If Bus Éireann shows the ability to think outside the box and focus primarily on the needs of passengers, it will be possible for a one-day service to be provided. I ask the Minister of State, Deputy Moloney, to ensure that the Official Report of this debate is passed on to Bus Éireann tomorrow. Time is running out on this issue.

This is an issue of fairness and connectivity. Those who benefit from this route do not have their own means of transport. As most of them are isolated, they rely on the route to access essential services they cannot access other than through Bus Éireann. Many of those who travel on the 366 route cannot avail of a supplementary service under the rural transport programme. We are seeking to achieve the retention of the service in some way, even if it means a reduction in the service to one day a week. We strongly believe this route should be subject to a public service obligation. It was put in place to supplement the loss of railway infrastructure. While that may be deemed to be an historical debate, the principle still applies. If this route is taken away, a significant number of people, most of whom are elderly, will be cast further into isolation. A lady who attended one of my clinics two weeks ago was visibly upset about the loss of this route. When one speaks about access to services, one always wishes to bear in mind the notions of a national spatial strategy and intergenerational solidarity. If we are to axe routes that allow for connectivity, we will do a disservice to older people. We will marginalise those who do not have their own transport and therefore rely heavily on services of this nature as they travel to where they want to go each day.

I assure Deputy O'Shea that I will ensure a transcript of this debate is passed on to the relevant officials. In line with a recommendation in the Deloitte report, Bus Éireann is engaging with Pobal, the HSE, the Irish Wheelchair Association and the Departments of Education and Science and Transport to co-ordinate the better integration of services provided by Bus Éireann, the rural transport programme and the HSE. Several pilot schemes have been undertaken in the Louth-Meath and Sligo-Leitrim areas. These pilots will be evaluated by May 2010 with a view to mainstreaming across the country. The services being piloted include "collect and connect" commuter services, where passengers are collected at their door and brought to an interchange point to connect to scheduled services. Nine pilot schemes have been undertaken in the north east and north west. Hospital feeder services will be piloted in conjunction with the HSE. Bus Éireann and rural transport services feed into a Bus Éireann town service that connects to the local hospital for clinic appointments. Three pilot schemes in Navan, Drogheda and Dundalk hospitals are under discussion with the HSE. Bus Éireann is discussing a proposed pilot in Cork city — for Cork University Hospital — with the HSE. Bus Éireann is also seeking synergies with the school transport scheme. Two areas in the north east — the Stamullen-Drogheda area and the Navan-Trim-Nobber area — have been identified for further analysis, subject to discussions with the HSE, as possible partners for pilot projects.

Efforts are being made to better co-ordinate disability services. Increased co-ordination between the Irish Wheelchair Association, the rural transport programme and Bus Éireann is aimed at reducing service duplication and increasing fleet utilisation. I understand a pilot project has been completed in the north east between Flexibus and the Irish Wheelchair Association. Bus Éireann is working on increased co-ordination of ticketing and fares between Bus Éireann and the rural transport programme. It is also working on better information for a range of passenger groups, including older people. Combined leaflet drops have been completed in the north east and north west. I understand from Bus Éireann that the process has been extremely positive to date. The level of commitment and energy that has been brought to the process by all partner groups is encouraging. It is clear that many synergies can be created between the partner groups. Evaluation of the pilots has been delayed to allow time for the remaining projects to be completed. I understand this is due to happen in May 2010. The potential for and value of mainstreaming the initiatives across the country will become clearer at that time. The Deputies may raise the matter of Bus Éireann service cuts at that stage.

Gangland Killings.

I thank the Ceann Comhairle for allowing me to raise this urgent matter on the Adjournment. I refer to the brutal murder of a young man, Mr. Daniel Treacy, as he went about his business at a busy premises in Limerick early yesterday morning. This killing is extremely worrying for those who live in the immediate Caherdavin area, including many elderly people. It is a great tragedy for the immediate Treacy family, including Daniel Treacy's young family.

I would like to raise a number of points with the Minister, Deputy Dermot Ahern. I am glad he is here tonight. Although extra gardaí were assigned to Limerick on foot of the Fitzgerald report, the resources of the Garda have been drained by aspects of the fight against crime such as witness protection, ongoing investigation and escort duty. Withdrawal of many gardaí from community policing duties has led to a reduction in information gathering and surveillance. We need extra Garda resources in such areas. In the past year, we lost 49 gardaí through retirement. I am glad the Minister replaced one chief superintendent, four inspectors and ten sergeants who retired last year. The problem is that our resources are being drained in terms of dealing with the fight against gangland crime The Garda in Limerick has one of the best murder detection rates in the country. It has solved two thirds of all gangland-related murders. However, difficulties with gangland crime continue. Will the Minister provide the extra gardaí to ensure community policing which will allow people feel safe going about their daily lives?

An operation on the same style of Operation Anvil needs to be put in place. This would complement the outstanding work done by the Limerick Garda. While the armed response unit is in place with extra personnel drafted in from Cork, such an intensive operation would deal with the gangland issue head on as happened in Dublin.

There are concerns the Garda is not being provided with sufficient resources to implement the provisions concerning membership of a criminal gang and surveillance contained in the Criminal Justice (Surveillance) Act and the Criminal Justice (Amendment) Act. Will the Minister update the House on their implementation?

The question of mobile telephones in Limerick Prison also arises. The pilot project to block the use of mobile telephones in Portlaoise must be extended to Limerick to stop gangland operations being directed by prisoners there. The restriction of the movement of gangland criminals in certain areas on the evidence of a chief superintendent in certain areas would also assist. Anyone caught in the possession of an illegal firearm should not be granted bail. The fact the Tetra system is up and running in the Limerick division is to be welcomed. However, extra resources are needed there, namely extra gardaí on the ground. Existing resources are being drained in dealing with and fighting gangland criminality which are taking from other services such as a Garda presence in immediate areas. Yesterday's shooting worried many elderly people in Caherdavin on the Ennis Road as it occurred in a public place and against a young man going about his daily routine.

If Customs and Excise was given the resources needed to prevent the entry of illegal drugs into the State, it would cut the oxygen supply to these criminal gangs. Will the Minister provide extra resources and personnel to the Limerick Garda division to deal with this scourge of criminality and allow the law-abiding people in Limerick to live in peace?

I share Deputy O'Donnell's concern, and that of all right-thinking citizens, about the importance of combating gangland crime in Limerick and in other parts. The Garda Commissioner shares that concern and my determination that this type of criminality be confronted with all the resources at our disposal.

I strongly condemn the recent killing in Limerick. The Garda has made significant progress in its investigation. Arrests have been made and the House will appreciate it would not be appropriate for me to go into any further detail in this respect.

Considerable resources will continue to be put into containing and pursuing criminal gangs in Limerick. An additional 103 gardaí have been deployed to Limerick since December 2006, bringing the total strength there to 635 at the end of 2009, the highest number ever deployed in the Limerick division. By comparison, at the end of 1997 there were 423 gardaí, only two thirds of the most recent figure. Limerick is the most policed area in the country.

The Garda Commissioner and I are aware of the importance of community policing. An Garda Síochána is committed to the community policing ethos, particularly in Limerick where there are 88 officers dedicated to it. The number of such gardaí in the Limerick division has increased by 138% over the past three years. We must accept, however, community policing is not a panacea for addressing the most serious types of crime but it does make a real contribution.

An Garda Síochána is delivering a robust and determined response to crime in Limerick, underlined by the reduction in the number of cases of murder and manslaughter in Limerick in 2009 to three compared to seven in 2008. There have been convictions and persons charged in respect of eight of these ten cases. The rate of detection and conviction is better in Limerick than in any other area.

The number of incidents where firearms have been discharged in Limerick has also decreased considerably from 103 in 2007 to 28 in 2009, a decrease of 73%. The number of persons found in possession of firearms has also decreased from 42 in 2007 to 33 in 2009, a decrease of 21%. An Garda Síochána has recovered 168 firearms in the past three years.

It was partly against the background of the difficulties in obtaining evidence in cases of organised crime that last year I introduced the Criminal Justice (Surveillance) Act and the Criminal Justice (Amendment) Act. It is wrong to claim the legislation is not being utilised. I shudder to think of the situation we would be in if the legislation had been delayed or diluted as some Members advocated. I hasten to add Deputy O'Donnell did not but his party did ask for the legislation to be delayed.

The Criminal Justice (Amendment) Act is more about the person behind the person pulling the trigger. The resources to utilise the legislation are available and, since it was enacted, the Garda has utilised it to build up cases against those involved in gangland crime. Due to the legislation's provisions some files are already with the Director of Public Prosecutions and more are being prepared for submission to him. I share the frustration at the time which inevitably must elapse before legislation enacted by the Oireachtas results in successful prosecutions under it. However, I am confident that over time this legislation will be seen to have been a vital turning point in the fight against gangland activities.

Despite the pressure on the public finances, the Government has prioritised allocations for front-line policing and recently approved 170 Garda promotions as a derogation from the moratorium on promotions. I am continuing to put forward significant proposals for legislation, including the Criminal Procedure Bill 2009 and the Criminal Justice (Forensic Evidence and DNA Database System) Bill 2010 which will see the establishment of a national DNA database.

Gangland activity is inextricably linked to the drugs trade. While deadly violence between gangs is highlighted, we cannot forget the misery which these gangs wreak silently in our community. The Garda, of course, liaises fully with Customs and Excise which has primary responsibility in the prevention of the importation of illicit drugs.

Customs and Excise is not adequately resourced.

Today, it had a successful operation in my hometown against smuggled cigarettes. The Revenue Commissioners continue to upgrade equipment and technology in the fight against illicit imports of drugs. Last year saw the delivery of a second purpose-built customs cutter as a further response to drugs importations and other smuggling via the coastline and of a second X-ray container scanner at ports.

An Garda Síochána will continue to respond appropriately and forcefully to developments in Limerick and will have the full support of the Government, and I expect the House, in so doing.

Water and Sewerage Schemes.

I am grateful to the Ceann Comhairle for giving me the opportunity to raise this important issue on behalf of the people of Mullinahone, County Tipperary. Initially, I was reluctant to put the matter down on the Adjournment but eventually was forced to do so because of the severity of water shortages in Mullinahone. In the past ten years during the summer months, but also the winter, the area suffers desperate water shortages. The locals have lobbied the local authority and it has been raised at council meetings. At times the water is off for a two-week period. People in Ballydonnell and Jamestown are extremely badly affected. We all know water is a scarce resource and those who have a good water supply do not realise the value of it. People who are paying water rates, many of whom are in rural areas, are extremely frustrated with the service. I wish to bring to the attention of the Minister of State that the county council contacted the Department of the Environment, Heritage and Local Government on several occasions. It has applied for new pipes to be provided in the area. There is a difficulty with the Fethard and Burncoat supply scheme, a new scheme that will be introduced in 2012. A new layer of pipes needs to be installed in the Mullinahone area for that scheme to be successful. South Tipperary County Council applied for water mains replacement in 2008. In 2009 the Department of the Environment, Heritage and Local Government requested further information. This was submitted in October 2009 and the council is now under fierce pressure to carry out remedial works but cannot do so unless the Department sanctions €8 million to replace the pipes.

When a new round of funding is announced, which I expect shortly, the Mullinahone area must be given particular attention. Officials in the Department want to help. I request the Department of the Environment, Heritage and Local Government to sanction the money on behalf of the people of Mullinahone. This is an urgent request.

I apologise that the Minister for the Environment, Heritage and Local Government cannot be present and I thank Deputy Tom Hayes for raising this issue. A significant range of water services projects have been progressed in South Tipperary in recent years, with the support of substantial Exchequer funding from the Department. Almost €25 million has been provided to South Tipperary County Council by the Department of the Environment, Heritage and Local Government through the water services investment programme and the rural water programme in the period 2005 to 2009.

Schemes carried out in this period in South Tipperary included the completion of a water conservation scheme in Fethard and the progression of the initial stages of the water conservation programme countywide. This countywide programme involves putting water management systems in place to monitor water use and losses throughout the supply networks. This work will allow the council to develop a water rehabilitation strategy that will form the basis for the next stage of water conservation programme for South Tipperary County Council.

The water services investment programme is currently under review to ensure that capital expenditure under the programme is more focused on priority schemes to meet national environmental and economic objectives. Last year local authorities were requested to submit assessment of needs for water and sewerage services in their areas, including water conservation, to the Department and these are currently being examined. In conducting their assessments, local authorities were asked to prioritise schemes and contracts over the coming years based on key environmental and economic criteria.

An important aspect of the new water services investment programme for 2010-12, which will be published shortly, will be the targeting of investment on water conservation. It does not make economic sense to provide for further water supply capacity in areas with unacceptably high levels of unaccounted for water. According to the report service indicators in local authorities 2008 published last November by the local government management services board, the most recent figures indicate that 55% of treated water is unaccounted for in south Tipperary.

The Government has spent €130 million nationally on various water conservation measures over the past seven years. The new water service investment programme will build on existing investment in water conservation, which has largely focussed to date on putting in the water management systems to allow for active leakage control and better planning of mains rehabilitation. This work provides the platform for the integration of water conservation investment into the wider programme and a very substantial scaling up of activity in this area.

Local authorities have identified more than €300 million in contracts to commence over the period 2010-12, with further schemes to be progressed through planning in that timeframe. The Minister for the Environment, Heritage and Local Government will make this funding available as part of the next water services investment programme. This acceleration of the water conservation programme will allow for some 650 km of mains to be rehabilitated and will make real inroads into addressing leakage levels in local authority systems.

In this context, South Tipperary County Council has submitted proposals to the Department of the Environment, Heritage and Local Government for water mains rehabilitation works for the areas of Mullinahone, Fethard town, Killenaule, Clooneen and Drangan. I understand that a decision will be conveyed to the council as soon as possible in light of the publication of the water services investment programme for the period 2010-12. The Minister thanks Deputy Tom Hayes for raising the matter.

The Dáil adjourned at 9.05 p.m. until 10.30 a.m. on Wednesday, 24 February 2010.