Other Questions

Patient Redress Scheme

Gerry Adams


6Deputy Gerry Adams asked the Minister for Health if he has yet to achieve a mechanism, as promised in the Programme for Government, to compensate those women who were excluded, a significant number of these on age grounds alone, from the Lourdes Hospital redress scheme; and if he will make a statement on the matter. [8342/12]

I thank Deputy Ó Caoláin and his party leader, who may have gone up to the Gallery, for raising this matter. While we have our issues of dispute, we also have our areas of agreement and this is one area in which we were both involved prior to last year's general election. I am committed to finding a mechanism to compensate those women who were excluded on age grounds alone from the Our Lady of Lourdes Hospital redress scheme. My proposals for dealing with this sensitive situation are at an advanced stage. My Department is in discussions with the Office of the Attorney General and it is my intention that, barring any significant legal impediments, the proposals will be brought to Government in the near future.

I want to ensure that a robust and accessible mechanism is put in place to fulfil the Government's commitment to the women involved. I am working to bring this about and there will be consultation with Patient Focus on the matter.

I acknowledge the Minister's reply and I want to stay in a positive vein. I welcome the Minister's reaffirmation of his and the Government's commitment to ensure that the excluded 35 women are to have their cases not only acknowledged, but also properly compensated. I recall that we shared a platform on 25 January 2011 along with the Minister of State, Deputy Jan O'Sullivan, when a commitment was made. That was reiterated in the programme for Government and the Minister has made it again in a meeting with representatives of Patient Focus and some of the women who were subjected to some of the terrible atrocities carried out by Mr. Michael Neary in Our Lady of Lourdes Hospital in Drogheda. I understand that arising from that there was an expectation of an ongoing engagement and a letter was sent to the legal representative for the women on 3 November which stated that proposals had been formulated by the Department. That was a particularly straight statement and the Minister's response indicates his proposals are at an advanced stage. I ask him to clarify the position.

I thank the Deputy.

I ask him to take on board that the Patient Focus representatives and the women themselves have not yet been engaged with by the Minister or his departmental officials on the enactment of the proposals. There is real concern that the commitment in the programme for Government refers to the age grounds alone. Of the 35 women excluded, 29 were excluded on age grounds alone. However, there were six others of the 35, including two who lost children in very distressing circumstances and under the same hand-----

I thank the Deputy.

-----for whom the absolutely unnecessary procedure was carried out without consultation with them and-or their husbands.

I call on the Minister to reply.

We seek clarification and certainty that we will not now exclude anybody else from among this number.

I thank the Deputy.

We have always spoken about 35 women.

The commitment in the programme for Government is very clear and it defines the people concerned who were excluded on age grounds alone. In further meetings with Patient Focus I gave an undertaking to review the other cases and that review is ongoing. The Deputy has asked for some certainty and clarity on how much longer this process will take. Having spoken to officials no more than ten minutes before I came in here, my understanding is that it will be in the next few weeks. I would hope there would be engagement with Patient Focus and that the recommendations could be brought to Cabinet. I hope that clarifies matters for the many women who suffered at the hand of an individual who was clearly dysfunctional and did untold damage to many people's lives. As a past member of the medical profession that is something about which we are all deeply ashamed.

In the words of the Patient Focus spokesperson, Shelia O'Connor, all of these women, without exception, underwent negligent, damaging and unnecessary gynaecological procedures. While I welcome the certainty the Minister is sharing with us today on the 29 women, excluded from the redress scheme as established following Judge Maureen Harding Clark's deliberations as they were over 40 years of age. Regarding the other six cases I appeal to the Minister to leap the final hurdle here. Let us do it in a clean and full way leaving nobody hurt behind. All of these women, without exception, have gone through a dreadful experience that has impacted on their lives every day since and will continue for all their days in the future. My appeal is that the Minister would leave nobody out at this final hurdle.

I believe I have made my position clear and in so far as I can offer certainty, the certainty I have offered is that in the coming weeks we will be engaging with those who were excluded on age grounds and that I will bring proposals to Cabinet to bring a very stressful situation for them to an end as soon as is practicably possible. Regarding the people who are outside that, whom the Deputy is calling for to be treated in the same way, there are legal considerations that the Attorney General is examining at the moment. I am not in a position to give a commitment there other than to say that review is ongoing. I cannot pre-empt what the Attorney General's findings will be. I am very happy to say that the situation of those who were excluded on age grounds alone will be resolved in the very near future.

Hospital Staff

Catherine Murphy


7Deputy Catherine Murphy asked the Minister for Health if, in view of the potential additional cost to the Health Service Executive because of the European Temporary Agency Directive, the arrangements that have been made to cover front line staffing by other means; his plans to introduce any initiatives whereby minimum numbers of front-line staff are kept constant; and if he will make a statement on the matter. [8292/12]

The HSE's national service plan 2012 commits to significantly reducing the volume of agency staff usage, with a target reduction of up to 50%. The plan also notes that the transposition into Irish law of the temporary agency workers directive will increase the unit cost of agency staffing. The service plan contains a commitment that overtime and agency staffing are not to be used to support service levels beyond those agreed in the plan or to substitute for staff losses.

I have no plans to specify minimum staffing numbers for front-line services. The impact of staff reductions, and particularly those occurring before the end of the present grace period, together with reduced financial resources, represents a significant challenge for the health system. The HSE's national service plan 2012, which I recently approved, sets out the actions to be taken to address this challenge. The executive is seeking to mitigate the impact of the retirements on front line services by: using the provisions of the public service agreement to bring about greater flexibilities in work practices and rosters, redeployment and other changes to achieve more efficient delivery of services; delivering greater productivity through the national clinical programmes to reduce average length of stay, improve day of admission surgery rates and increase the number of patients treated as day cases; and some limited and targeted recruitment in priority areas to help limit the impact of retirements on front line services.

The HSE service plan states that continuing the current number of temporary agency staff would result in an additional cost of €30 million, which is substantial. How will this happen? It is not that we would wish that there would be a level of service in each individual hospital but that we would make it happen. Essentially I do not see how that can be done without setting a floor below which we cannot fall. That is the kind of thing that gives some certainty. Whether in an acute hospital or a general hospital, the ratio of beds to staff is critical. For example, in the case of nurses if it falls below a certain threshold problems arise. I cannot understand why there is no deliberate policy to try to keep it at a basic level. I am not arguing with the Minister about efficiencies or roster changes. They will deliver something. However, there is a level below which the service should not fall because the service cannot be delivered below that. This is the central point that concerns me about how it should happen.

I thank the Deputy opposite for raising this and I accept her concerns. However, different areas require different skill mixes. There is some rather bad mismatching of some of our services at the moment. I was examining our situation vis-à-vis nursing ratios to health care assistants in some of our community nursing units. In some cases the ratio is not even 1:1 and there are more nurses than care staff. The Royal College of Nursing in the United Kingdom recommends a nurse to health care assistant ratio of 1:2.5 for long-term nursing care units. Many areas have different staffing ratios and one would need to examine each area individually to set the limit under which one would not be prepared to go. A one-size-fits-all approach throughout the system is not possible. There will be different ratios for emergency departments, cardiology, intensive care, paediatrics, ICU in paediatrics and so on. Different ratios apply in these cases. This is work we could do and it should be done. We will consider it.

There is a significant issue in respect of the skill mix in the country. There are varying ratios of medical and nursing staff in various emergency departments. Often it is suggested that one is not comparing like with like and that it is a question of comparing apples and oranges because of the complexity of injuries and disease that some departments deal with vis-à-vis others. However, the bottom line is that agency staff are remarkably expensive and, as someone who has worked in hospitals, I am aware that they present a problem in respect of continuity of care. I would far prefer to see and to make it our policy that where we recruit staff for replacement, they will be new, permanent staff. Issues have been raised with me in the past about whether many retirees will be coming back into the system. This is not our intention and it will be very much the exception rather than the rule.

I have listened to many of the Minister's replies recently. He has referred to dealing with this at an individual hospital level. However, the problem must be dealt with across the spectrum. I fully agree with Minister about a mismatch in services. This is obvious not only in front line services in hospitals but in other services such as speech and language therapy and occupational therapy services. There may be long waiting lists in one place and shorter waiting lists in another. One cannot simply move a person from Cork to Donegal if they have no wish to go but what if that is where the mismatch arises? I fully accept that there are different requirements whether for intensive care or accident and emergency departments. I fully accept the point made by the Minister in this regard. However, this is and should be measurable in terms of the historical information about the level of patient care in each department in a given hospital and the number of beds. I do not understand why a more targeted approach was not taken in respect of the redundancy package. It could have delivered a better outcome.

Deputy Murphy has raised an issue about the distribution of services at times. One need not go as far away as Donegal to find the issues. One need only consider the difference in the services for children with autism in Dublin, north and south, and the disparity in place. I have made it clear to those running the services that they must consult with the Minister of State, Deputy Lynch, and then come back with a plan that gives everyone a service rather than a Rolls Royce service for some and no service for others.

Another contention relates to safety. Dr. Philip Crowley is in charge of patient safety in the HSE. He is on the transitional programme as well to ensure any arrangements arrived at are safe. Our primary concern is to have a safe service and inherent in this is the idea that below a certain level is not safe and above it is safe. Any review must examine the case of each individual hospital and this is being done as part of the overall exercise, although not in the formal sense of figures being available for examination. However, I imagine if I seek them, I will get them.

The HSE has admitted that it has created a reliance on an unaffordable level of agency staff in recent years to maintain service provision. Some €200 million was spent last year on agency workers. The HSE has targeted a 50% reduction in the current year. Earlier this afternoon the Minister stated he would not lift the recruitment embargo, yet he has referred to a greater flexibility. We do not understand how this comes into play. The Minister has never spelt out how this greater flexibility offsets the intended and signalled cuts, the departure of some 4,200 staff from the health services by the end of this month which the Minister has acknowledged. Given a 50% cut in agency staff how will front line service provision be maintained? Will the Minister explain to the House and to the health spokespersons what his greater flexibility means and how it translates?

I will answer the last question first. It is straightforward. There is a moratorium on staff recruitment. Therefore, no new staff can be recruited. However, I have already informed the House that we are recruiting staff and this is where the flexibility lies. It will arise in areas where it is essential to replace staff to maintain a safe service. For example, Deputy Kelleher raised the issue of staff in Limerick. Some 16.5 whole time equivalent midwives are going but 15 new people are coming in. This is taking place in maternity hospitals because it is an area at risk and we have identified it as such. Emergency departments are another at-risk area. More new consultants are being hired in some areas.

There was a debate last night on stroke care in Ireland and it will continue tonight. Deputy Murphy was one of the sponsors of the motion. Many new staff are being employed in the stroke programmes to bring about a far better stroke service that will save lives and a considerable amount of money as well. The important thing is for us to save lives and reduce morbidity, a negative side effect. The policy of a moratorium has had unintended effects in terms of incentivising expensive operational options such as using agency staff and we will redress this.

Eating Disorders

Jerry Buttimer


8Deputy Jerry Buttimer asked the Minister for Health if he will provide and update on the work of the special action group in obesity; the initiatives he plans to implement to tackle the issue of obesity; and if he will make a statement on the matter. [8385/12]

I thank Deputy Buttimer for raising this important and topical issue. The prevalence of overweight and obesity has increased at alarming speed in recent decades, to the extent that the World Health Organisation terms it a "global epidemic". I saw an alarming slide produced at a talk I attended on the spread of obesity. It traced the spread throughout the USA starting in the 1960s. State after state became coloured in red. The disease has become widespread throughout the USA, Europe and Ireland.

Obesity affects all age groups of the Irish population. Of particular concern is the rising level of obesity among young children. Recent figures from research commissioned by the Department of Children and Youth Affairs found that an alarming figure of one in four children are overweight or obese at 3 years of age. Everyone knows that obese children have a high chance of becoming obese adults.

Last year I established a special action group on obesity chaired by my Department. The group includes representatives from the Department of Children and Youth Affairs, the Department of Education and Skills, the Health Service Executive, the Food Safety Authority of Ireland and Safefood. Its remit is to examine and progress several measures to address the complex and multi-factorial problem of obesity. Alone no single initiative will reverse the trend, but a combination of measures should make a difference. The special action group is concentrating on a specific range of measures including healthy eating guidelines for the Irish population; restricting the marketing of food and drink high in fat, sugar or salt to children; nutritional labelling; calorie posting on restaurant menus; the promotion of physical activity; and the detection and treatment of obesity. The group will work with other Departments in a cross-sectoral approach to help halt the rise in overweight and obesity. I take this opportunity to welcome the work of Senator Eamonn Coghlan on physical fitness and its value.

As part of the group's plan, earlier this month I launched a national consultation to seek opinions on the best way of putting calorie information on menus. This is an initiative I announced late last year when I wrote to fast food outlets and cafes requesting that they begin including calorie information on their menus. The consultation being conducted by the Food Safety Authority of Ireland is an opportunity for consumers and the food industry to give their views on how information on calories on menus can be best implemented in Ireland. The consultation will close at the end of February and the results, when analysed, will inform the next steps in the process.

Additional information not given on the floor of the House

All the initiatives being considered by the special action group on obesity will form part of the development of a wide ranging public health policy framework which is being developed by my Department.

The aim of this initiative - Your Health is Your Wealth: A Policy Framework for a Healthier Ireland 2012-2020 - is to develop a high-level policy framework for health and well-being to cover the period 2012-20. It will address the broad determinants of health and health inequalities through our health services, community and education settings. It is anticipated that the review will identify a number of key lifestyle policy issues such as smoking, alcohol and obesity where further action is required. It will identify practical ways to strengthen working between sectors to promote and protect the health and well-being of all sectors in our society. The aim of this process is to engage leaders and policy makers across Government and society to recognise that improving the public's health is the responsibility of all sectors of society and not just the responsibility of the public health workforce.

I thank the Minister for his response. I agree with him that there is a need for collaboration and a multiagency approach with regard to obesity. The figures he has given are alarming, particularly the figure relating to those under the age of three. The Minister is correct to say that no single measure will address this problem.

With regard to the posting of calorie information on menus, the Minister said the consultation period ends at the end of this month. Will he give us a brief outline of what he hopes to do following the consultation period? The Minister mentioned Senator Coghlan, who has pioneered the issue of obesity in the Seanad. Is it possible the Minister will consider appointing an obesity czar?

Most of the big food chains have responded with regard to posting calorie information. I congratulate those contributing to debate on this issue in a progressive fashion and I look forward to meeting them in the not too distant future. Those who have responded include McDonald's, Kentucky Fried Chicken and others. People are entitled to make informed decisions. If they do not know the calorie content of what they are eating, they are not in the position to make that decision and are only guessing at the calorie content. The information needs to be posted. I commend McDonald's on starting to do that.

The responses of the various food chains will inform the debate and we also intend to bring in a voluntary code. However, if people do not adhere to the code and it does not prove fruitful, we will legislate. We are entitled to protect the well-being of our children and have a duty of care to do so. Equally, citizens are entitled to know what they are eating. The Food Safety Authority of Ireland will help establishments with the work. We do not expect small cafes to have the resources to measure the calorie content of everything they produce and the Food Safety Authority of Ireland will have a major role in doing that. We will be realistic about this. It is tough enough in business without putting additional costs on people. However, posting the calorie content of the food along with the price is not too much to ask.

On the question of an obesity czar, that is something we are considering. An interdepartmental group is working on this and we may look at Deputy Buttimer's suggestion to appoint a well-known person to this role.

It is important to have cross-party and cross-sector collaboration on this. The Minister is correct to say that no single measure will address the issue of obesity and the Joint Oireachtas Committee on Health and Children, of which Deputies Kelleher, Ó Caoláin and Regina Doherty are members, will prioritise this issue in the next month or so. I agree that people are entitled to know what they are eating and the calorie content of that food. People must also be responsible for their choices and individual actions.

I had a lot to say on this issue last night in the context of the Private Members' debate on stroke. It is clear an obesity epidemic faces society and that the epidemic in the United States has moved on to Europe and to the United Kingdom in particular. We have a habit of copy-catting what happens there. Any efforts made to reduce obesity here will get cross-party support and I encourage the Minister, who spoke passionately last night on this issue, in that regard. There is no short term political gain in this, but there is an obligation on everybody to ensure we put this information in place in order to protect the future generation.

Will the special action group on obesity focus on children in primary and second level schools? The earlier we start to make an intervention, the better. We need to involve the Department of Education and Skills and other agencies because there is always a risk with the presentation of such information that we might stigmatise some people, particularly young people who might be overweight, which could contribute to other health related problems as they grow older. The greatest care must be employed in promoting fitness and good health with a particular focus on obesity.

I acknowledge the great cross-party co-operation there has been on this issue. As we are aware, obesity plays a significant role in stroke, high blood pressure and diabetes. It is worth repeating what I said last night, that if we do not address this issue, we may well be the first generation to bury the generation that follows us. In my earlier career as a GP, I never saw young people with type 2 diabetes, but now it is commonplace. This is frightening.

I agree with Deputy Ó Caoláin that we need early intervention education in primary and secondary schools because eating habits form early in life and are difficult to break. Hence the high incidence of obese adults who were obese as children.

Hospital Waiting Lists

Robert Troy


9Deputy Robert Troy asked the Minister for Health the reason waiting times for adults waiting for elective treatments increased by 55% from 15,728 to 24,394 in the period April to November 2011; the reason waiting times for adults and children waiting for elective treatment increased by 47% from 18,319 to 26,910; and if he will make a statement on the matter. [8376/12]

It is very important to clarify immediately the correct information with regard to numbers waiting for procedures and the average waiting times. Waiting times have certainly not increased by 55%. I think the Deputy may have got confused between the increase in numbers waiting and the length of time patients are waiting. Between the end of December 2010 and 2012 the numbers waiting over 12 months fell by 80% for adults and 98% for children.

The correct figures for adults and children waiting for treatment in April 2011 was 24,179 and in November 2011 the figure was 26,832. This is an increase of 11% not 47%. The number of adults waiting for treatment was 21,851 in April 2011 and 24,403 in November 2011, an increase of 12% not 55%.

I have been absolutely clear that my priority for inpatient treatment is to deliver an equitable service within the resources available. For that reason, other than for cases of clinical urgency and cancer cases, I have introduced a strict policy of chronological management of inpatient waiting lists so those waiting longest are treated first. In July, I announced that no patient would wait longer than 12 months for treatment and that it was the responsibility of individual hospitals to meet this target. I am happy to say that all hospitals, bar two in Galway city, achieved this. We will now move to a nine months target by the end of this year.

I have also acknowledged from the outset that targeting those waiting longest would inevitably mean a modest increase in waiting times for some patients. This is inevitable because resources and capacity are limited. The median waiting times for April 2011 was 2.6 months, in November 2011 it was 2.7 months and in December 2011 it was 2.8 months. I would prefer if this could be avoided, but the average increase is a matter of days for many people, as opposed to years for some people.

I welcome the Minister's statement that the figures may be a divergent view of his opinion of the correct figures. This is the kernel of the issue because there seems to be some difference of opinion between the HSE and the Department with regard to the method and calculation process, particularly in the context of the special delivery unit. This question was asked of the special delivery unit and when asked to explain the figure for people waiting 12 months, which seemed inordinately high, the Department said the figure of 14,000 was set by the special delivery unit in July and was based on the number on the list in December 2010 who, if they had remained on the list, would have been waiting for 12 months for care at the end of the year. That is just a mathematical fact. If these people had been on the list for 12 months or longer, they would have been waiting for 12 months or longer. Nobody stated they would definitely be on the list after 12 months and some of them would have been taken off the list if the special delivery unit had never been established. We will give time to the special delivery unit and we welcome any intervention in ensuring that we can drive down waiting lists. May we get absolute clarity on the basis of the figures? There seems to be a difference of opinions, at the very least.

I will be very clear. The special delivery unit was formed in June and became operational in September 2011. At that time the number of patients waiting longer than 12 months if they had not been treated by the end of December 2011 would have been 14,000. I have no doubt that had the special delivery unit not taken the action it had, we would have many thousands of people waiting longer than a year for treatment. That is unacceptable and it is inequitable. It is not nice for anybody to wait but it is far fairer that many people wait a few extra days as opposed to some people having to wait several months or years.

I will relate something I did not have to hand last night. Since the beginning of January this year there have been, on average, 50 fewer people on trolleys every day. That is six weeks of ongoing, consistent and measurable improvement in the number of people on trolleys. There are still far too many people on trolleys but we are making progress despite a reducing budget. I do not believe any other health service in the Western world has improved quality of service - as shown by the stroke units coming on stream and the improvements they have already brought about - against a backdrop of reducing budgets. I congratulate all those involved.

The special delivery unit should not be taking credit for the massive reduction in the waiting lists. Many of those people would have been treated anyway, regardless of whether the special delivery unit was running. The idea that the special delivery unit decreased the number of people waiting from 14,000 to just short of 500 is not right. Many of those people would have received treatment anyway. If we are to have a serious benchmark of productivity in a unit we welcome and hope will succeed, we would want to start on a proper basis rather than trying to massage figures to show productivity is better than it is in reality.

Nobody is attempting to pretend that activity is any better than it is. This is measurable and real. I hope the Deputy is not disputing the Irish Nurses and Midwives Organisation trolley count, which is also very real.

I never mentioned that.

Earlier, with sotto voce, the Deputy mentioned the word “could” and left out the word “if” from a gentleman’s statement. I put it to the Deputy that many of the 14,000 patients may have been treated anyway but I am not so certain that would have been the case.

Hospital Procedures

Seán Crowe


10Deputy Seán Crowe asked the Minister for Health if he will establish a scheme of redress including health benefits and entitlements, for victims of the practice of symphysiotomy in hospitals here; and if he will make a statement on the matter. [8335/12]

Gerry Adams


30Deputy Gerry Adams asked the Minister for Health if he will establish an independent commission of inquiry, outside the control of the Institute of Obstetrics and Gynaecologists, and his Department, into the practice of symphysiotomy in hospitals here; and if he will make a statement on the matter. [8334/12]

I propose to take Questions Nos. 10 and 30 together.

My Department has just received a draft report from the independent academic researcher appointed to complete a report into the practice of symphysiotomy in Ireland. I have asked the Attorney General to consider the draft report and subject to her views, I propose to make the draft report available for consultation by interested parties. The draft report will then be finalised by the academic researcher, taking account of the consultative process and any legal considerations. I will consider the full report when it has been finalised, and I will then make decisions regarding the appropriate next steps.

I am very conscious of the distress that this procedure has caused to a number of women in the past and recognise the pain that this issue has caused to those affected by it. The Government is committed to dealing with it sensitively, so that if at all possible, closure can be brought to those affected by it. In the first instance, it is important to make sure that the health needs of those who have had a symphysiotomy are met quickly and effectively. With this in mind I am committed to ensuring that the greatest possible supports and services are made available to women who continue to suffer effects having undergone this procedure. The women concerned continue to receive attention and care through a number of services which have been put in place. These include the provision of medical cards, the availability of independent clinical advice and the organisation of individual pathways of care and the arrangement of appropriate follow-up.

The provision of these necessary support services for women is monitored and overseen by the HSE, which is committed to being proactive in seeking out and offering help to women who underwent a symphysiotomy.

Will the Minister agree that this barbaric act should never have been carried out in the first place? What we are looking at is a decreasing cohort because of the age profile and there is a need for great urgency in addressing the issue. They have been grievously wronged and the least that can be done for them is for these women to benefit from a redress scheme, including health benefits and entitlements. As noted in his reply, it may be the Minister's understanding or assumption that all of these people are in receipt of health benefits and entitlements but the contrary is the case, they are not all in receipt of such services and this is a serious matter. I met these people in recent weeks and I can indicate that such services do not apply across the board.

The key question for each of these women is whether the Minister will establish a truly independent inquiry. Will he put a timeframe on the Attorney General's consideration and when does he expect to be in a position to announce specific details of a redress scheme that will address the needs of these women?

I reject the Deputy's contention that this was a barbaric act, although its use in certain circumstances may well transpire to have been utterly inappropriate. It was a standard procedure at one time and it was reintroduced to certain Irish hospitals in the 1940s as a clinical response to the limitation imposed by specifically Catholic religious and ideological circumstances. The primary reasons were the fact that contraception and sterilisation for the prevention of pregnancy was illegal, and the safety of repeat Caesarean sections in the period was unproven. The method was used in the majority of cases as an emergency response to obstructed labour in women suffering from mild to moderate disproportion, and as such it was an appropriate clinical intervention. It was never proposed as an alternative to Caesarean section, rates of which rose steadily in the 1950s and 1960s. It was a safer intervention in cases of mild to moderate disproportion, with a minimal maternal mortality rate and a lower foetal mortality rate than Caesarean section at the time.

It was an exceptional intervention used, on average, in 0.35% of deliveries in the Coombe and National Maternity hospitals, where the usage was highest. However, the persistence of the procedure at Our Lady of Lourdes Hospital in Drogheda until 1984 runs contrary to its decline elsewhere in the country from the middle 1960s and I have little doubt that it was used very inappropriately in several instances. That is why the report is being currently compiled and why the Attorney General will study it. When it comes back to me I will be in a better position to respond.

Has the Minister any idea of the timeframe for the Attorney General's consideration? Will he again address the core issues of the needs of these women? Will he recognise the age profile of the greater number of them and that there is a need to be expeditious? We must see redress in place and we must have a full public and truly independent inquiry rather than an exercise carried out by the profession in question.

I have given the Deputy the most comprehensive answer I can. I will add only that where this procedure was used inappropriately - there were instances, apparently, where it was used after a baby's delivery, which is utterly disgraceful - it will be examined by the Attorney General, with action taken to redress the issue for the women who went through unnecessary pain. There were consequent mobility issues, discomfort, upset and difficulty in living their lives thereafter. I know people who had that procedure and have sadly passed on. I am aware of the dysfunctionality it caused them in their daily lives. It impaired their ability to do an ordinary day's work, to look after their children and to have any enjoyment of life. This serious issue has all sorts of legal ramifications. It would be wrong of me to pre-empt the report. It would be wrong and irresponsible of me, on behalf of the State, to pre-empt what the Attorney General will have to say.

Written Answers follow Adjournment.