Dáil Éireann debate -
Tuesday, 17 Jun 2014

Vol. 844 No. 1

Topical Issue Debate

Accident and Emergency Department Waiting Times

Deputy Seamus Kirk

I thank the Ceann Comhairle for giving me an opportunity to raise this most important issue for the constituency of Louth and east Meath. Earlier today, there were 32 people on trolleys at Our Lady of Lourdes Hospital in Drogheda. That figure, which represents an increase of 25 on yesterday's figure, is almost double what it was last Friday. These figures are recorded and monitored by the Irish Nurses and Midwives Organisation. No other hospital in the country has as many people on trolleys today as Our Lady of Lourdes Hospital. University Hospital Limerick was in second place with 22. Given that there are 210 patients on trolleys across the country as a whole, it is clear that Our Lady of Lourdes Hospital accounts for one in seven patients on trolleys. The figures compiled by the Irish Nurses and Midwives Organisation indicate that 1,855 people spent time on trolleys between January and April of this year. This compares with a figure of 1,397 for the same period in 2013.

Last week, this House debated the overcrowding and the cramped conditions at University Hospital Limerick. I am pleased this week to have an opportunity to raise the very serious problems at Our Lady of Lourdes Hospital in Drogheda. We are continually receiving complaints from our constituents in counties Louth and Meath, and from people further afield, about the serious problems with accident and emergency facilities at the hospital. The Irish Association for Emergency Medicine has mentioned the possibility of accident and emergency department closures this summer, as budgetary measures aimed at making savings in the general health area take effect. The association has warned that accident and emergency units will face a perfect storm if staffing meltdown is accompanied by the possibility of closures. This is extremely serious.

I am glad the Minister for Health is present to respond to what I have to say. He is quite familiar with Our Lady of Lourdes Hospital, which is just down the road from his own constituency in Fingal. I am sure a few of his constituents have had cause to use the accident and emergency facilities at the hospital. As he will be aware, the hospital's huge catchment area extends not only across counties Louth and Meath, but also to the north of County Dublin and the south of County Monaghan. Perhaps some people have to come from further afield to Our Lady of Lourdes Hospital in Drogheda. The reality is that the accident and emergency facilities at the hospital are overcrowded and the level of staff cover is seriously inadequate. I predict that a very serious crisis will arise at the hospital sooner or later when it proves impossible to admit patients to the hospital in emergency situations because an adequate level of staff to cater for their immediate needs is not available.

Our Lady of Lourdes Hospital is one of the busiest hospitals in the country. While people who ring my constituency office accept that the hospital is fine or excellent when they get into mainstream treatment there, they are concerned that it has become a huge challenge to get through the accident and emergency department. The whole concept of requiring people who are more than 80 years of age to lie on trolleys for ten or 12 hours at a time is simply unacceptable in this day and age. We all accept that savings and curtailments are necessary, but certain areas need to be prioritised in that context. I suggest that the area of accident and emergency should be a clear priority within the health service. People receive excellent care in the mainstream hospital service after they have finally overcome the huge challenge of coming through the accident and emergency unit. As I said earlier, I am pleased that the Minister is here to take this Topical Issue because he is quite familiar with the problems at Our Lady of Lourdes Hospital in Drogheda. I appeal to him to ask the HSE immediately to examine the adequacy of staff cover at the hospital. We know that measures are clearly needed to address this problem immediately.

Minister for Health (Deputy James Reilly)

I thank the Deputy. In common with many hospitals, Our Lady of Lourdes Hospital in Drogheda has experienced an increase in attendances at its emergency department in the current year. For hospitals like Our Lady of Lourdes Hospital that serve populations with significant numbers of high acuity elderly patients presenting with complex co-morbidities, the requirement to admit patients is similarly high. The nature of these patients' needs may require longer than average lengths of stay. Patient experience times at Our Lady of Lourdes Hospital are roughly in line with national patient experience times. Approximately 70% of patients are discharged home or admitted within six hours. Some 81.4% of patients are discharged home or admitted within nine hours. Despite the increases I mentioned at the outset, the number of patients waiting for ward bed accommodation has decreased by 15.4% in the last three years. The Deputy quite rightly pointed out that it is unacceptable to have patients on trolleys for eight to ten hours. While I agree with him, he should acknowledge that such waiting times represent a huge improvement on the waiting times of three or four days that were experienced when he was in government.

The special delivery unit has worked intensively with management and staff at the hospital. A variety of initiatives which address many of the needs of the local population have been introduced. A cross-sectoral group that will focus on frail and vulnerable elderly patients, with representatives from the community, private nursing homes, the acute sector and groups such as Alzheimer's disease carers, has been established. The HSE is seeking to expedite the recruitment of nurses, particularly for the emergency department and for critical care. Internal medicine services have been reconfigured to enable acute medicine assessment unit physicians to manage all acute medicine assessment unit and short-stay medical unit patients. An additional acute medicine physician has been recruited to further extend these services. Twice-weekly medical census meetings and once-weekly surgical and orthopaedic census meetings, led by the clinical director, have been introduced. At these meetings, an overview of each inpatient's care takes place and potential impediments to their discharge are discussed. Ten private nursing home beds have been purchased for the provision of orthopaedic rehabilitation following hip fractures. This service also utilises a physiotherapist. It has significantly reduced orthopaedic patients' length of stay at the hospital.

Our Lady of Lourdes Hospital is making progress in implementing all elements of the emergency medicine programme. Practice changes and patient pathways that have been put in place for acute medicine remain very effective. A recent audit undertaken by the quality and patient safety audit validated the hospital's full compliance with the acute medicine programme. The overall length of stay in medicine, surgery and orthopaedics is well within the targets set nationally and by the clinical care programmes. Our Lady of Lourdes Hospital recently got planning permission for the second phase of its planned expansion, which will provide an enlarged emergency department and 60 en suite single accommodation rooms which are fully compliant with the strategy for the control of antimicrobial resistance in Ireland. The hospital is actively bringing NCHD rosters into compliance with the requirements of the European working time directive. Medical on-call rotas have been reduced from 24 hours to 12 hours.

The hospital, supported by the special delivery unit, is continuing to actively seek improvements in the provision of patient care. Current priorities include the improvement of patient clinical pathways, the optimisation of the use of the acute medicine unit and the movement of patients to lower acuity beds at other facilities, such as Louth County Hospital, when his or her condition is sufficiently stable to do so.

Consideration is also being given to nurse staffing of the day ward and transition lounge.

Special delivery unit liaison officers continue to engage with the hospital on these operational issues, as a result of which I expect to see further improvements in access to appropriate care in a timely manner. The Department of Health and the Health Service Executive are focused on implementing the Government's reform programme for acute hospitals, including the organisation of these hospitals into a small number of groups, each with its own governance and management, to provide an optimum configuration for the delivery of high-quality, safe patient care in a cost effective manner.

Deputy Seamus Kirk

I find it very difficult to accept the Minister's assertion that patient experience timelines at Our Lady of Lourdes Hospital are broadly in line with national timelines. That is not what I am hearing in my constituency office, where people are complaining about the extraordinary length of time they are spending on trolleys there. I am appealing to the Minister to give special attention to the hospital's accident and emergency unit to see whether he and his Department, working with the HSE, can improve patient waiting times and remove as many people as possible, as quickly as possible, from trolley accommodation.

Deputy James Reilly

I assure the Deputy that his desire is my desire. I do not want people spending any longer on trolleys than they must. I do not want to see the numbers of patients on trolleys increasing. We are moving to the use of patient experience times because those figures can highlight where people do have to wait prolonged periods on trolleys, which is unsatisfactory.

The newly appointed director of hospitals at the HSE, Dr. Tony O'Connell, comes to us from Australia, where he worked in New South Wales and Queensland. In both instances, he made a huge impact in improving quality of care and waiting times for patients. I am meeting him and Mr. Tony O'Brien tomorrow. The Dublin north east hospitals group, which includes Our Lady of Lourdes Hospital, will be part of the focus at that meeting. The Deputy may be aware that Dr. O'Connell was chief executive officer of the Dublin north east hospitals group before being promoted to director of hospitals.

Everything will be done to improve the situation in Drogheda and identify the reasons for the increase in the numbers of patients on trolleys. The SDU has visited the hospital in the past and listened to suggestions from staff for service improvements, taking on board those which made immediate sense, asking for a better price on the provision of certain services and dismissing proposals that did not make any sense financially. That review encompassed such issues as community nursing facilities, home help provision, home care packages and even community intervention teams to deliver intravenous antibiotics to patients at home so they would not have to stay in hospital for long periods, thereby freeing up beds to allow for more admissions from the emergency department. I assure the Deputy and the people of Drogheda and the Dublin north-east region that everything will be done to ensure they have a safe, efficient and effective service and that patients do not spend any longer on trolleys than is absolutely essential.

Medicinal Products Availability

Deputy Regina Doherty

I tabled this matter for discussion arising from a meeting I had last Thursday, together with my colleague, Deputy Jerry Buttimer, with two beautiful ladies who are multiple sclerosis sufferers and who were accompanied by Mr. Tom Curran, partner of the late Marie Fleming. The meeting was to discuss their concerns that the drug they are currently taking to alleviate the symptoms of MS, Fampyra, will no longer be available free of cost as a result of its manufacturer, Biogen, being refused access to the general medical services scheme by the Health Service Executive. Having tabled this matter for discussion yesterday, I learned this morning that Biogen has reapplied for inclusion in the GMS scheme, which is great news. I also welcome the indication last week by the Minister of State, Deputy Alex White, of his openness to a new application by Biogen and his acknowledgment of the serious impact the refusal of its application is having on some of the 8,000 MS sufferers in this country.

People have experienced an incredibly positive impact on their condition from taking this drug and are now in fear that they will no longer have access to it in the coming weeks. Will the Minister give an assurance today that he will ask the HSE to fast-track Biogen's application for inclusion in the GMS scheme? In the meantime, it is my intention to ask the company publicly to continue to provide its product free of charge, for the duration of the application process, to the people on whom it is having such a positive impact. The two women I met last week - I am sure the Minister has heard similar testimony from other Deputies - spoke movingly of the impact the drug has had on their health. One of them is younger than me and has a young child. I have been unable to stop thinking of her description of being able, for the first time ever, to plait her daughter's hair. It can seem like a small and insignificant thing to people like me to be able to brush our children's hair every day and make their lunches, but to this woman it was an enormous achievement. Now she faces the prospect of once again being unable to do it because she cannot afford to pay for the drug. Moreover, without access to this medicine, she will be unable to work and will be entitled to a €785 per month disability benefit payment. She is young and full of vitality and wants to return to work.

I am asking for the Minister's commitment that he will request the HSE to fast-track this process. In the period until that process is completed, I will ask the company to continue to provide the drug to those people who are already availing of it under the GMS scheme.

Deputy James Reilly

I thank the Deputy for raising this important issue which relates not only to the specific drug to which she referred but to a range of medicines. I understand the manufacturer of Fampyra - a brand name for fampridine - has indicated to the HSE that it intends to submit a revised application to include the drug under the community drugs schemes. The HSE will consider the application on receipt, in line with the agreed procedures and timescales for the assessment of new medicines. The Deputy has indicated that the company submitted a revised application today.

The HSE has statutory responsibility for decisions on pricing and reimbursement of medicinal products under the community drugs schemes in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013. The HSE has already considered an application for the inclusion of Fampyra in the GMS and community drugs schemes. This application was considered in line with the procedures and timescales agreed by my Department and the HSE with the Irish Pharmaceutical Healthcare Association, IPHA, for the assessment of new medicines. In accordance with these procedures, the National Centre for Pharmacoeconomics, NCPE, conducted a pharmacoeconomic evaluation of Fampyra and concluded that, as the manufacturer was unable to demonstrate its cost effectiveness in the Irish health care setting, it was unable to recommend the reimbursement of the product. The report is available on the NCPE's website.

The HSE assessment process is intended to arrive at a decision on the funding of new medicines that is clinically appropriate, fair, consistent and sustainable. In these circumstances, the HSE has not approved the reimbursement of Fampyra under the community drugs schemes. I understand studies are ongoing to assess the wider impact of the drug on both walking ability and quality of life for persons diagnosed with MS. I acknowledge the Deputy's clear testament in this regard. The results of these studies will contribute to the evidence base demonstrating the clinical effectiveness of Fampyra, which can be used to support future applications for its inclusion on the lists of reimbursable items supplied under the community drugs schemes. In this context, it is open to the manufacturer at any time to submit a new application to the HSE for its product's inclusion. As we have heard, it did so this morning.

I assure the Deputy that I, and the HSE, fully understand that patients are very anxious that this product be made available under the community drugs schemes. The HSE will consider the manufacturer's revised application in line with the agreed procedures and timescales for the assessment of new medicines so that the matter is addressed and dealt with as quickly as possible.

Deputy Regina Doherty

In its report, the NCPE stated that it had not managed to prove the cost effectiveness of the drug against the 8,000 patients using it. However, all 8,000 MS patients do not need to use it; it is applicable only to one third of them. Perhaps that message was lost in translation, in which case I hope it will be clearly heard in the new application process.

The Minister indicated that the new application will be considered "in line with the agreed procedures and timescales for the assessment of new medicines". Will he indicate what the standard timescale might be? Is there any way we can speed it up in this case given that the drug in question will no longer be available free of charge to patients from the end of June?

That will have a serious impact. One of the ladies I met last week told me it is the difference between her making it to the bathroom and not making it. This has a really serious impact on these people's lives which is why I again call on Biogen to continue to fund these drugs for the people currently receiving them until this process between it and the HSE can be brought to a conclusion.

Deputy James Reilly

Again, I thank the Deputy. I would like to make a few general points. The Irish Pharmaceutical Healthcare Association and the Irish pharmaceutical sector are very important to this country, but we have a problem in that we have a very limited budget. We have just exited a bailout and the pressures of the health budget are well known. In the context of Fampyra, there are more than 7,000 people with multiple sclerosis, and at a cost of €6,000 each, it is €42 million per annum, which is an awful lot of money. For how many of these people will this drug be successful?

I would like to see the pharmaceutical industry engage in risk sharing so that in situations where there is a drug which we can prove by way of a blood test, a biopsy or an independent clinical assessment of the activities of daily living, such as walking distances, that it really improves the situation for patients, we will pay for those patients. However, what about the two thirds or the four fifths of patients for whom it does not work? Are we to pay from them also? Where is the role of the industry in this? Why does it not join us in terms of sharing the risk and if it does not work, let us negotiate what we will pay for those, if anything at all?

For a long time patients have looked to the Government to provide care and it is our duty to provide it, but I would like to appeal to patient groups to join the Government to ensure the new medicines which become available are made affordable for us to provide to our people and that the pharmaceutical industry engages in risk sharing in regard to these very expensive and sometimes hugely effective drugs that can have a life changing impact on people's daily activities which, as a doctor, I fully accept. However, I appeal to the pharmaceutical industry to engage with the health service in a way that these drugs become available at an affordable price for those who can avail of them and will benefit from them and that we look at some other way to deal with the high risk to the system for all those who use these drugs but do not get any benefit from them.

Crime Levels

Deputy Michael Conaghan

I thank the Ceann Comhairle for the opportunity to address this matter. I would like to start by quoting a letter I sent to the former Minister for Justice and Equality, Deputy Shatter, on 29 August 2013.

Dear Minister

I wish to refer to gang slayings in the city. These are occurring with a regularity that now breeds acceptance. This is proof to the criminals who profit from these barbarous acts that it is their will alone that determines the limits to this behaviour.

Paralleling the criminals' acceptance at these new norms that they have established to serve their own ends is an acceptance by civil society that a frightening new layer of brutality has become an integral part of contemporary urban life.

Decent people are silently seething that their communities, which act as a backdrop to these shootings, are being redefined by criminal behaviour to an extent that civic pride and community wellbeing is being undermined.

The government now must demonstrate that the will of the 99 per cent can prevail. Slaying at the whim of these criminals must be stopped. Limerick offers a glowing example of how the tide can be successfully turned.

Deputy Dowds and I had a meeting with the former Minister, Deputy Shatter, after that but there was no discernible outcome.

The subject matter of this letter - gun crime - was brutally illustrated last Friday evening when a young child in Cherry Orchard was hit by gun fire. How ironic that any child should be in danger on his own doorstep. The very place where he should feel safest was attacked. A sanctuary was breached. Little Sean is still in hospital and, hopefully, he will soon be back home safe and well. Of course, we wish to send him our best wishes. Gun fire in the proximity of children is quite a frequent occurrence in the city. Recently when children were being dropped off at a crèche in Donaghmede gun fire erupted. This is a reckless practice which must be halted.

I wish to refer to a linked matter, namely, to a fear people have that their area can be somehow defined by the occurrence of brutalising incidents such as that which happened in Cherry Orchard last Friday evening. In that regard, I would like to say a few words about Cherry Orchard. Some 30 years ago, when people first moved into this new estate, there were only houses. The streets, footpaths and street lighting were unfinished. It did not have shops, a school, a church, facilities, a bus service and playgrounds. Some 30 years later, through the efforts of residents, the area has been transformed and, with the assistance of Dublin City Council, there are splendid parks and very good playgrounds. It has one of the most pioneering schools in the country, St. Ultan's, a youth orchestra which regularly performs at the National Concert Hall and one of the country's leading amateur soccer clubs, which is regularly visited by scouts from English league clubs, is based there.

All of this is the outcome of dedication, commitment and hard work by the people engaged in community building, the people of Cherry Orchard and the parish priest, Fr. O'Connor, over a 30 year period. Cherry Orchard needs the Minister's help. It needs more gardaí and more resources to counter some of the activities which have been referred to.

I would like the Minister to consider visiting Cherry Orchard to meet the people, which they would like, and to talk directly to them and discuss how serious outstanding issues can be tackled by them with her support.

Minister for Justice and Equality (Deputy Frances Fitzgerald)

I thank Deputies Conaghan and Ó Snodaigh for raising this important matter. I would like to record my outrage at the appalling incident last Friday where a young child was shot at Croftwood Gardens, Ballyfermot. As the Deputies know, a major Garda investigation is under way. I spoke to the acting Garda Commissioner about this incident when I met her yesterday and she assured me progress is being made with all necessary resources deployed. An Garda Síochána is determined to bring to justice those involved and I know it has the full support of the local community in identifying the perpetrators. Clearly, anyone who has information which could be helpful to the Garda should pass this on immediately.

I am further advised that a Garda liaison officer has been appointed to assist the family and that an incident room has been established in Ballyfermot Garda station to investigate this incident which is being overseen by a senior investigating officer.

As the Deputy rightly said, gun crime represents a real challenge for policing and poses significant potential for harm in the community, in this case, unfortunately, in the form of very serious injuries to a young child.

Garda strategy for tackling gun crime involves targeted and intelligence-based operations, often disrupting and preventing incidents before harm is caused, as well as detecting and prosecuting those involved. Much of this work goes unheralded but it is carried out with great determination by the men and women of An Garda Síochána, who can themselves face great risk in taking on armed criminals.

The robust Garda response to violent crime has led to firearms offences decreasing last year by 7%, and the number of crime incidents in which a firearm was involved was also down, by more than 7%. However, I accept all the points made by Deputy Conaghan on the horrific nature of the incident. The precise deployment of resources is a matter for the Acting Garda Commissioner. I have discussed the policing situation in Ballyfermot in general terms with her and been assured that the Garda is working with the community and providing the best possible support on the ground. I am informed that at present there are 198 gardaí in the Clondalkin-Ballyfermot district.

The sale and possession of legally held firearms in this jurisdiction is highly regulated. However, my Department is currently conducting a review of firearms legislation after which I will engage in broader consultations ahead of preparing any legislative changes arising from the review. Ahead of completion of the review, I would point out that our criminal law already rightly provides heavy penalties for weapons offences and mandatory minimum penalties are in place for certain firearms offences. The Garda also has considerable powers available to it in tackling serious and armed crime, and they have been supplemented further by the recent DNA database legislation which has just been passed in both Houses. The Bill was completed last week in the Seanad. When established, the DNA database will have the capacity to link suspects to unsolved crimes using forensic evidence, and will greatly assist the Garda in investigating crime.

The acting Garda Commissioner is aware that if she believes other legislative measures or steps would assist in tackling armed and serious crime they will be given the most serious consideration by me. I take serious note of the views expressed by the Deputy during the debate. Our thoughts are with the family of the young victim of this shooting. We are concerned with the well-being of the family during this very difficult period and look forward to the recovery of the victim. I visited St. Ultan's in the past. I am very struck by the range of initiatives and work that, as Deputy Conaghan, rightly pointed out, has been done by the community of Cherry Orchard in the past 30 years and the significant community work in which everyone engages. Deputy Conaghan is familiar with the work the Garda is doing with local youth groups. The local youth diversion programme has proved very successful. There are also two major Garda operations in the area: Operation Hybrid and Operation Domino, which are both designed to provide a proactive response to organised crime in the Dublin metropolitan region.

Deputy Michael Conaghan

I thank the Minister for her response which was very knowledgeable and informed. I am aware she has direct experience of visiting the area and has visited the school. People come from all over the country because of the innovations in the school and its comprehensive curriculum and orchestra. It is the one place in the city where children go to school with a schoolbag in one hand and a violin case in the other. Would the Minister consider meeting a small group of residents for an exchange of views? It would give her an insight into how strong the feeling is about the dreadful matter that took place. I accept the Minister has a very busy schedule but perhaps she would consider it.

Deputy Frances Fitzgerald

I would be happy to do that. It would be important to meet with the community. I understand that for a community which has taken such proactive steps itself to build itself up how very disturbing what happened on Friday night is and how concerned people are about what took place. I spoke to Fr. Gerry today and I know the community is rallying around. I am satisfied from my discussion with the acting Garda Commissioner that everything possible will be done by the Garda to support the community and to follow up and make sure that justice is seen to be done in response to the crime.

Human Rights Issues

Deputy John Halligan

Today is the 55th day of the mass hunger strike of Palestinian administrative detainees in Israeli prisons protesting against their ill treatment and internment without trial or charge. Their conditions are deteriorating daily. Approximately 80 hunger strikers have been hospitalised and many are in grave danger of losing their lives. The Israeli state is now trying to pass legislation that will allow the force-feeding of the strikers which prisoners have labelled a form of torture. Amnesty International and other groups around the world have said the same. The latest update I received some minutes ago from Palestine is that the Bill has passed the second and third reading in the Knesset and may very well be introduced into law by Monday.

It is the longest mass hunger strike among prisoners in Palestinian history and the hunger strikers remain steadfast in their demands to end the policy of administrative detention. I ask the Minister to condemn Israel’s widespread use of administrative detention which is in violation of the Fourth Geneva Convention which states that internment can be used "only if security of the detaining power makes it absolutely necessary". Amnesty International has called Israel’s administrative detention arbitrary detention that fails to fulfil the international criteria for a just trial, and inhumane and degrading and it notes that Israel uses it to suppress the legitimate and peaceful activities of activists.

I have been informed that the 80 detainees who have now been taken to hospital had intrusive body searches. The cells in which they were kept were below basic standards. I believe those who have been taken to hospital have been shackled hand and foot to their beds. That is an outrage and an appalling human tragedy.

The Tánaiste and Minister for Foreign Affairs and Trade, Deputy Gilmore, has constantly spoken on the inhuman treatment of the Palestinian people in general. Israel appears to listen to no one. As of 2008, Israel was in violation of 30 UN Security Council resolutions and 60 UN resolutions. The manner in which Israel treats the Palestinians would not be tolerated from any other state in the world. It is appalling and unacceptable. Given this country’s record in condemning human rights violations around the world, the time has come for us to call in the Israeli ambassador and make it clear to him that we will not accept people, some as young as 17 years of age, being arrested without charge, interned without charge and tortured. Prisoners have a right not to accept food under protest yet the state has gone so far as to commence the introduction of a law to force-feed the detainees. Ireland is a country that has always stood up for human rights around the world and condemned the Israelis. It is not good enough to simply show our concern, as some have suggested. We must express our condemnation.

Minister of State at the Department of the Environment, Community and Local Government (Deputy Jan O'Sullivan)

I thank Deputy Halligan for raising this issue which I am taking on behalf of the Tánaiste and Minister for Foreign Affairs and Trade, Deputy Gilmore.

The Government has consistently made clear its concerns about the use of administrative detention by the Israeli authorities. This is a practice which Israel has resorted to for many years and the numbers so detained have fluctuated according to the prevailing security situation on the ground. Some 190 Palestinians are held in administrative detention. The hunger strikes by Palestinian prisoners which began on 24 April were directly prompted by what the prisoners claim was Israel's failure to make progress in reconsidering the use of administrative detention, particularly following the conclusion of the last Palestinian hunger strikes in 2012.

Israel is undeniably faced with serious security challenges and therefore may have recourse legitimately in exceptional circumstances to special powers. However, there are clear grounds for concern that administrative detention is being used in some cases to suppress legitimate dissent and protest. The instances of repeated extensions of detention orders can also mean individuals may be detained for prolonged periods, even several years, without ever having charges laid against them. The use of intelligence material as sole evidence for the decisions by military tribunals can result in denial of access to prosecution evidence to the detainees and their legal representatives. Any system in which a person can be imprisoned for years with no means to challenge the basis of their detention is clearly unacceptable.

Ireland has repeatedly drawn attention to these concerns with administrative detention both directly with the Israeli authorities and in discussions at EU or UN level, including in the UN Human Rights Council last March where our national statement under item No. 7 made clear our long-standing concerns about this practice. Ireland has also raised this issue in EU discussions on the Middle East and ensured the EU also has explicitly criticised on several occasions in recent years, the excessive use by Israel of administrative detention. There has been a significant reduction in the use of the practice by Israel in recent years but the problem remains a serious one. We will continue to make known our concerns about the practice overall to the Israeli authorities at all appropriate opportunities.

There have been repeated protests by Palestinian detainees in recent years over the use of administrative detention. In common with our EU partners, we have encouraged the parties to engage in negotiations which address the legitimate complaints of the detainees and to avoid any provocative actions which would risk the health or life of the detainees. Our missions in Tel Aviv and Ramallah remain in contact with civil society groups dealing with prisoners' rights, including the issues of administrative detention and hunger strikes, as well as working with our international partners to support progress on these very difficult issues.

The use of hunger strikes is a very dangerous tactic which we cannot encourage. It is notable the Israeli authorities have responded to recent hunger strikes in a manner to avoid the death of any prisoner. They are clearly alert to this danger but there must always be a very strong risk, particularly with repeated hunger strikes, that the authorities will eventually conclude that they must make a stand, and refuse to compromise further. This is perhaps a particular danger at this moment when the Israeli Government and public are, understandably, strongly focused on the abduction of three teenagers who are still missing and whose safe return we all hope for.

It is the case that a draft Bill to permit the force feeding of hunger strikers has been submitted to the Israeli Knesset. However, no final decision on its approval has yet been taken by the Knesset. The Israeli Medical Association has declared, as have several human rights groups, that force-feeding is in breach of medical ethical standards. There is some expectation that any possible new law might be challenged in the Israeli courts on the grounds of its constitutionality. We would strongly urge the Israeli authorities to refrain from the force-feeding of hunger strikers in the event of parliamentary approval of this proposed law.

Deputy John Halligan

I welcome the Minister’s comprehensive response to this serious issue. It is appropriate there are several former Israeli soldiers, Breaking the Silence, in Dublin today who gave a presentation as to how they were forced to treat Palestinians and violate their human rights. Ireland never stands idly by and always opposes the violation of human rights. The chances of Israel paying any attention to us, however, are remote when it is already in breach of over 90 UN and UN Security Council resolutions. It is important, none the less, that we make it known to the Israeli ambassador to Ireland and the Israeli Government that we will not tolerate the force-feeding of hunger strikers and the detention of individuals without charge. From the information I received today, I note some of those hunger strikers, even though they are critically ill, are being constantly asked to eat. When they refuse, their guards eat the food in front of them. It is appalling what is happening in these hospitals in Israel.

I condemn the recent abduction of three Israeli students and hope they are returned safely. I condemn all violence from all sides. The history of violence against Palestinians by Israeli forces has been well-documented by various Ministers for Foreign Affairs, from Deputy Martin to Deputy Gilmore and others. I am happy the Minister of State, in her response, condemned what Israel is doing. However, we need to be steadfast in our support of human rights. People have a right to protest without being arrested, shackled to their beds and being force-fed. If the legislation in question is passed in the Knesset, it should be condemned.

Deputy Jan O'Sullivan

It is important we use all the ways we can to raise this issue through the EU, the UN or directly with the Israeli Government, as well as the group visiting Ireland referred to by Deputy Halligan, which is obviously condemning it and doing everything it can to change the system. I will bring Deputy Halligan’s views to the attention of the Tánaiste and Minister for Foreign Affairs and Trade, although he is well aware of them. Ireland will use every opportunity to address this issue.