Leaders' Questions

Deputy Micheál Martin

As the Taoiseach is aware, obesity is a major issue affecting children and adults across the western world. It requires a societal response and full range of interventions. I propose to focus on those who are morbidly obese, particular morbidly obese public patients who need urgent intervention in the form of bariatric surgery. Clinicians have stated that morbidly obese people need this type of surgery to save their lives. The Minister for Health, Deputy James Reilly, has rejected calls by Professor Donal O'Shea of St. Vincent's University Hospital to restore bariatric surgery to the hospital. Only 20 operations have been carried out at the hospital this year and it does not have funding to perform any more life-saving operations. The 200 people on the waiting list for bariatric services at the hospital have been clinically assessed and the course of action designed for them by clinicians is to have this form of life-saving surgery carried out.

The Minister has been dismissive of the calls for the restoration of this surgery. The Minister stated that prevention is better than cure. He also stated that in its wisdom, St. Vincent's decided to perform the 20 operations in the first five months of the year. I do not know whether it occurred to the Minister that this decision by the hospital was made not merely "in its wisdom". Clinically, it decided it wanted to save lives and perform those 20 operations. It needs to perform more of them.

This is a callous and dismissive response to a serious issue for those patients involved. It is not good enough to say, as the Minister is saying, that it is tough on a patient that he or she is now morbidly obese, he cannot and will not do anything for the patient, and the next operation will be in 2015. The simple question I have to put to the Taoiseach is how many lives have to be lost before the Government will get the message, intervene and do what is right in terms of the prioritisation of life over death.

The Taoiseach

I regret if the language used by the Minister, Deputy Reilly, in referring to the process by which 20 important surgical interventions were carried out, was deemed to be callous or uncaring by Deputy Martin. I would be certainly sorry about that.

I noted this report. Deputy Reilly also stated that one does not have sufficient resources available to do every operation that one might like to do and for that reason, I understand that the clinician involved, who is a skilled person, carried out the 20 operations in the first half of this year. I am not competent to say on what basis they were prioritised or whether those who were on the waiting list are in a more serious condition than those who were operated on or whatever, but I believe, as Deputy Martin does, that prevention is better than cure.

This is an issue that has arisen over the past years. Despite the fact that there is a huge voluntary movement in terms of health initiatives on such important issues as diet, activity and exercise, the Minister made the point that there is not an endless resource for this operation or any other. He also made the point about the extraordinary level of commitment that is required for essential drugs, where, for instance in regard to hepatitis C, there is a 95% curable rate with what will be developed in AbbVie in Sligo. In these cases, while the moneys are not there now to perform all the operations that might be deemed to be necessary by the clinicians, I am sure it is possible for the clinician expertise to be able to ask what can be done for the patient in the meantime pending an operation.

Deputy Martin will be aware that given the circumstances that apply, patients have unfortunately had to wait for a very long time for many different kinds of operations and still do - much too long in many cases. The Deputy refers to this case. Unfortunately, this is an issue that has to be dealt with by these clinicians. Pending a clinician's assessment of the necessity for an operation, I am sure that advice to otherwise deal with the problem is available. Clinicians know best about the urgency of carrying out an operation, if it is to be a life-saving operation, and I am sure it is on that basis that they prioritise them.

I hope the 20 operations carried out this year have been successful. The Minister made the point that if one takes funding from other priority areas where operations are required, one does not do any favours to those others with different ailments. It is simply a case of not having funding available to be able to do all that one needs or might like to do just now. In the meantime, I would hope that the expertise of the clinicians will be available to those who are deemed to require an operation carried out at some stage.

Deputy Micheál Martin

I put it to the Taoiseach that he insults those who are morbidly obese when he states that prevention is better than cure. We are referring here to patients who could be 20 or 24 stone, facing imminent organ failure. One would not say that to a heart patient, nor to a cancer patient. We have developed those services, such as cancer services, where we want immediate intervention based on clinical assessment.

Professor O'Shea made a good point when he stated that because the Minister does not take it seriously enough, obese patients were subject to the last remaining acceptable discrimination. The Minister does not get it that this is a life-saving operation. This is not a lifestyle choice for those concerned right now. It is an urgent surgical intervention that is required to prevent loss of life.

We prioritise in the health service. One always would prioritise in terms of life-saving surgical interventions vis-à-vis non-life-saving surgical interventions.

An Ceann Comhairle

A question, please.

Deputy Micheál Martin

The Minister has chosen not to do this on this occasion. There are other areas where he is spending millions of euro-----

An Ceann Comhairle

We are over time.

Deputy Micheál Martin

-----in terms of providing medical cards to those who will be healthy and young, but he has taken that choice. There is a small number of patients here. There are 200 on a waiting list right now. The Minister has it within his capacity to address this problem if he stopped insulting patients.

An Ceann Comhairle

Would Deputy Martin put his question?

Deputy Micheál Martin

The Minister should stop saying to them that it is tough that they are morbidly obese and that prevention is better than cure. That is not good enough.

Deputy Paul Kehoe

The Minister did not say that.

Deputy Micheál Martin

That is what is being said.

An Ceann Comhairle

Deputy Martin should put his question.

Deputy Micheál Martin

In reality, that is what is being said.

Deputy Paul Kehoe

That is what Deputy Martin is saying.

Deputy Micheál Martin

I ask the Taoiseach to engage with the clinicians involved here. Will he meet them? Will he work out with them and the hospital a solution to this which will ensure that the life-saving surgery that is required happens? It can happen, and the Taoiseach knows it. It happened with the discretionary medical cards, even though we had to press for change in that area for two years. The Taoiseach can implement change here too if he intervenes effectively and appropriately.

The Taoiseach

I am not sure whether the heat is getting to Deputy Martin but it is wrong for him to stand up here and state that I insulted patients who have a problem because they happen to be morbidly obese.

What are called "bariatric services" are provided in two public hospitals, St. Vincent's here in Dublin and Galway University Hospital, and that forms part of the HSE's overall response to this problem. In the case of St. Vincent's Hospital, where Professor O'Shea operates, this service was originally provided by St. Columcille's Hospital.

Deputy Micheál Martin

I know all that. That is in the note that was just handed to the Taoiseach.

The Taoiseach

In the context of the reconfiguration within the hospital group, the service was transferred to St. Vincent's last year.

Deputy Martin stated the Minister prioritises patients. This is a matter for clinicians and medical expertise. Specific funding was made available to provide continuity of service. Typically, St. Columcille's carried out 20 cases per year. We are advised by St. Vincent's that it provided in excess of that this year to date. With regard to University College Hospital in Galway, I understand it treats on average 50 cases per year-----

Deputy Micheál Martin

I told the Taoiseach that last week.

The Taoiseach

-----and it is not anticipating any reduction in service levels this year.

Here is an important point for Deputy Martin. While a definite clinical need exists for those with chronic obesity, bariatric surgery is required for a minority of obese patients, 2% of the population. The vast majority require clinical treatment that is both hospital based and community based, and the HSE will continue the further development of this service, in 2015 and beyond, within the overall context of this service in the planning process.

Deputy Martin made the point that these are life-saving operations. On that basis, I would assume that the clinicians, who know best here, would prioritise which of the patients need to be dealt with most urgently. The Deputy asked me to meet the clinicians and he referred to the discretionary medical cards issue. In many cases, the persons who are now receiving back their discretionary medical cards have conditions and challenges that will last all their lives, and they may live for a long time - we hope that such be the case.

Deputy Michael Healy-Rae

The Minister took those cards off them.

An Ceann Comhairle

We are over time.

The Taoiseach

In these cases, it is a matter for the clinician-----

Deputy Micheál Martin

At the same time, the clinicians are saying it.

The Taoiseach

-----to prioritise, on his or her expertise, who should be treated next.

Deputy Micheál Martin

They have. They cannot see anybody until 2015.

The Taoiseach

I am sure Deputy Martin does not expect the Minister to start taking funding away from other priority cases, such as cancer or leukaemia-----

Deputy Micheál Martin

I am not saying that.

The Taoiseach

-----that are deemed by clinicians to be urgent as well.

I am sure the Deputy is not asking for that.

Deputy Micheál Martin

No.

The Taoiseach

Seventy cases are being dealt with: 50 in Galway and 20 in St. Vincent's on a priority basis.

Deputy Micheál Martin

Some 200 are on the waiting list. Patients will die.

The Taoiseach

If the service is community-based and hospital-based, I am sure that the specialist information and expertise from the clinicians is available to those patients who are going to need these operations in due course.

Deputy Gerry Adams

The Ombudsman for Children, Ms Emily Logan, will shortly publish a report detailing her findings and recommendations on the circumstances in which two children were wrongly taken from their families in Tallaght and Athlone last October. The children - a girl aged seven and a wee boy aged two - were taken from their parents who are members of the Roma community, after it was reported that they might not be the families' own children. These claims were totally and completely unfounded. There appeared to be no other reason for the children being taken from their families other than that they were fair-haired and members of the Roma community. DNA tests subsequently proved that the children were indeed members of their families.

I am sure the Taoiseach will appreciate that this was a highly traumatic experience for the children and their families. It was also an abuse of process and a direct attack on the constitutional and human rights of the children and their families. In my view, this happened because of a prejudiced and racist opinion of the Roma community. As our society becomes more diverse we need detailed integration strategies for the Roma community in Ireland and for other communities.

The Athlone family still does not know where their child was taken that night. They are suing the State for breach of constitutional rights, false imprisonment, neglect, damages for mental distress and possibly defamation. Will the Taoiseach make it clear that he does not intend to waste taxpayers' money defending this case? On behalf of the State, will he apologise to these two families?

The Taoiseach

I thank Deputy Adams for his question. The report commissioned by the Ombudsman for Children, Ms Emily Logan, was received by the Minister on 2 April. On the advice of the Attorney General, certain legal matters had to be attended to prior to the publication of the report. These have all now been resolved and the report was brought to the Government this morning. It was approved by the Government for publication. The Minister will do that at 4 p.m. today.

This is a commendable report by the Ombudsman for Children. It points out that there are a number of recommendations that need to be accepted, dealt with and fulfilled. The Minister will deal with this at a press conference at 4 p.m. Copies of the report have been laid before the House and the Minister will publish the report at a press conference with Ms Logan. In advance of the press conference, the Minister is meeting with the families concerned. I understand that the Acting Garda Commissioner is meeting separately with the families.

The State will provide the families with every support to overcome these events. The upset they endured and the stress that was caused over those few days last October and since then should never have occurred in this or any other jurisdiction. My Government colleagues and I are determined that such events will never happen again.

As the Deputy will be aware, the report recommends that an apology should be provided by the Minister for Justice and Equality. The Minister will do that. The report sets out a number of recommendations. The Government has accepted the findings of the report and its recommendations in full. On that basis, an implementation group will be established by the Minister to monitor the situation and see that the recommendations are acted upon.

The Department of Justice and Equality is currently leading a cross-departmental review of Ireland's migrant integration strategy. The Government is committed to ensuring that the review results in a more effective approach to Roma integration in Ireland, recognising the distinct challenges that the Roma community faces, including language, translation, mentoring and understanding. All of these things are important.

It is not acceptable that these events should have happened to these families or any other families in this jurisdiction. The Minister will publish the report and the Government has accepted all of its recommendations. An implementation group is being established to implement those recommendations. The Minister is currently meeting with the families, as is the Acting Garda Commissioner. There will be a full press conference with the Minister and the Ombudsman for Children at 4 p.m.

Deputy Gerry Adams

I thank the Taoiseach for his answer. I welcome the meeting between the Minister, the Acting Garda Commissioner and the two families. These incidents took place against a backdrop of scandalous media coverage of the Roma community. The two cases in this jurisdiction are clear examples of racial profiling by the Garda Síochána and the State. Under the Child Care Act, gardaí must have reasonable grounds for believing that there is an immediate and serious risk to the child before taking such action. Yet, as the Taoiseach has acknowledged, no such risk existed in these cases. If it did, why were the children with blonde hair and blue eyes taken away? Why were all the children not taken away if there was a risk to the children in these families?

The speed of intervention in these two cases was in marked contrast to other cases. Just a week before these incidents, the Ombudsman for Children revealed that the HSE failed to intervene over several years after a child made multiple allegations of rape. Another report revealed that 4,100 children assessed by the HSE as needing intervention had to wait for more than three months.

I welcome the Taoiseach's answer If we are to be serious about social integration, however, all the proper processes and procedures, such as training and education, need to be put in place for public servants, including An Garda Síochána. As a gesture to those people who have come to our shores and particularly those who have suffered this injustice, the Taoiseach should apologise - as the Minister will - to the families on behalf of the State.

The Taoiseach

Yes. I do not have any problem with that at all. I do apologise to those families, and particularly the children, who had to put up with these events. As I said, the report recommends that the Minister for Justice and Equality should make an apology to the families. The Minister will do so. These kinds of events should not happen to anybody in our jurisdiction. Nobody can afford to stand over that or can stand over it.

It is important to recognise that a good deal of progress has been made over the last period. For instance, all of those people who have come to our shores, have been here for a number of years and want to become Irish citizens are now formally given that opportunity at an official civil ceremony with a member of the Judiciary present. All the proper protocols are put in place so that people from other countries who come here can have Irish citizenship bestowed upon them. I appreciate that very much. In previous years, they had to attend the District or Circuit Court. Between cases of assault or theft being heard, they had to make a case to say they were there to become an Irish citizen. That stressful position has been taken away and people are now given proper accommodation and a ceremony to grant them Irish citizenship.

As regards the cases referred to by the Deputy, a good deal of work must be done by the Garda Síochána, society as a whole and our education system in mentoring and understanding the languages and different cultural backgrounds that these and other people come from. That is all part of the process. While it is unfortunate that this has happened, the State is amenable to accepting the full report and all its recommendations, as well as issuing an apology. In meeting the parents and having a press conference with the Ombudsman for Children, Ms Logan, the Minister will do that. Ms Logan's report was completed speedily, efficiently, competently and comprehensively.

Deputy Gerry Adams

Will the Taoiseach fight the legal case, if one happens?

An Ceann Comhairle

I call Deputy Catherine Murphy.

The Taoiseach

I understand one of the solicitors will consider suing the State and that is a matter for them.

Deputy Catherine Murphy

Today, representatives of the Commission for Energy Regulation were due to attend the Joint Committee on the Environment, Culture and the Gaeltacht to outline the water charges plan.

I have just come from that meeting. The representatives were not able to enlighten the committee because Irish Water did not submit its plan to the commission in time. It was reported in Saturday's Irish Independent that the promised free allowance for children of 38,000 litres per annum is being reviewed by Irish Water, which appears to think it is overly generous. Judging from what its representatives said at the committee meeting, the CER seems to agree with Irish Water. The Irish Independent article also reported that usage rates will be critical in determining how much families will pay when the bills arrive next January.

Prior to the local elections, the Taoiseach promised to provide price clarity to voters because he wanted them to be informed when they went to the polling stations. He stated that the average bill for a household would be €240 per year. However, the election was hardly a ringing endorsement for Fine Gael or the Labour Party, and the exit polls identified water charges as a key issue. I do not think that the need to invest in water services and to conserve water is in doubt but Irish Water is a juggernaut that keeps ploughing through the stop signs. The Government gave a commitment to eliminate quangos and that culture but we have an inflated super-quango in the form of Irish Water. The ESRI estimates that each household will pay €65 to cover staffing costs before a drop of water is produced. The overheads are gigantic and it is difficult to see where the investment will be found. The Minister for the Environment, Community and Local Government has indicated that investment will need to double from €300 million to €600 per annum. Households are already struggling to pay utility bills. This is a runaway train but a runaway train can be stopped if there is the political will to do so. Given the response in the local elections and the fact the public have clearly identified this as a key issue, will the Taoiseach listen to what the people have said and halt this runaway train?

The Taoiseach

I listened carefully to what the people have said. As Deputy Catherine Murphy is aware from living on the edge of the great conurbation of Dublin, the vast majority of the people are living in a situation where there is no room for any flexibility in terms of water supply. It is costing the taxpayer €1.2 billion to provide water services throughout the country. Some 40% of that water leaks away into the ground. This is not a runaway train. This is a commercial State body with specific terms of reference to borrow money in the markets off the Government balance sheet in order to provide the necessary investment for infrastructure for water, businesses and consumers for the next 50 to 100 years. We have not been able to compete in the way we should because of the lack of investment over many years.

The policy position from Government has been and is very clear, that is, the average household charge to the regulator will be €240 per year, or €60 per quarter. Every child is to be free in terms of water usage. The assessment carried out by Irish Water is one thing. The assessment carried out by the previous Government would give a higher usage rate of water per child. The important issue is that the direction given to the regulator by the Government is clear. The average meter charge is €240 per year and every child under the age of 18 years is to be free. The regulator will set out its assessment of the usage rate per child in the coming period. The direction from Government is very clear. Every child will be free and the average meter charge will be €240 per year.

In the Deputy's constituency the pressure for high volume pristine water for businesses and consumers alike is very strong. There is no room for messing around with the supply of water. We had this in Ballymore Eustace last year and this city almost came to a standstill, with people having to use water at night only. Given our geographic location, average rainfall per year and reservoir capacity, we should be in a far better position. Over the next decade or 20 years, Irish Water will be in a position to provide investment for infrastructure for consumers, business, industry and all the different sectors of society to bring our standards to the level at which they should be but where they have not been for a long time.

Deputy Catherine Murphy

The Taoiseach keeps repeating the same mantra about the investment required. Mr. John Tierney outlined to us that in the region of €10 billion will be required over the next 20 years. We heard from the Minister, Deputy Hogan, that the level of investment is to increase after 2016 from €300 million to €600 million per annum. That frightens the daylights out of people because they already see what bills they are facing and they know they cannot manage at present. We are told that the investment will save billions of euro for the State. That is because the cost will be transferred to the citizens, who will be turned into customers in the process.

Deputy Pat Rabbitte

Would the Deputy like it to be privatised?

Deputy Catherine Murphy

To add insult to injury, Irish Water hired a public relations firm to brainwash people into acceptance. This reminds me of a book by Noam Chomsky and Edward S. Herman entitled Manufacturing Consent: The Political Economy of the Mass Media. The advice given to Irish Water was to start off by describing water as free and then say it costs money, and that by charging for water people will be persuaded to value water and pay their water bills. This is the strategy of manufacturing consent. However, there is a real problem in this regard. Where will the investment be found given that the Government has bled dry the vast majority of the population, who cannot even pay their utility bills and who will struggle to pay the bills issued to them from next January? The amounts that are proposed to be taken from them will barely cover the running costs of Irish Water. Where will the money be found for the additional investment?

The Taoiseach

As the Deputy is aware, Irish Water was established for the purpose of borrowing money to invest in providing proper pipe works and treatment plants and fixing leaks. Almost 20,000 people are on boil water notices every day. Some of these have had to buy or boil water for as long as a decade. We hope that in County Roscommon in 2015 this issue will be eliminated from a number of major schemes. The Environmental Protection Agency has advised that remedial action is required on 16% of supplies that are at risk, most of which are in Dublin city and Cork. One million people live at risk every day because of this situation. There are significant supply constraints in this city, as I pointed out in regard to the difficulties in Ballymore Eustace last year, and 40% of the water leaks away. Some 36% of water treatment plants failed to meet the EPA's effluent standards in 2011 and the European Commission has launched a pilot infringement case against Ireland in regard to 80 treatment plants. The taxpayer does not have the resources to provide the investment for all of these matters to be dealt with properly. That is why Irish Water, as a commercial State entity keeping this system in public ownership, will be able to borrow money on the markets-----

Dáil Éireann debate - Tuesday, 1 Jul 2014

Leaders' Questions

Dáil Éireann debate -
Tuesday, 1 Jul 2014