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Dáil Éireann debate -
Tuesday, 14 May 2019

Vol. 982 No. 6

Saincheisteanna Tráthúla - Topical Issue Debate

Services for People with Disabilities

As Fianna Fáil's spokesperson on disability, I thank the Ceann Comhairle for selecting this issue. It is both topical and serious. I acknowledge first the fantastic work RehabCare does for 3,000 people in 117 locations nationally. The centre most familiar to me is in Bantry in south-west Cork. I acknowledge sincerely the fantastic work that is done there. I understand that after many requests by RehabCare, the Minister of State, Deputy Finian McGrath, the Minister for Health, Deputy Simon Harris, and the HSE met representative of RehabCare last week. I understand also that there will be a further meeting tomorrow. I hope sincerely that it will resolve matters and ensure these vital services can continue to operate. Behind every service user is a family and I ask the Minister of State to keep that in mind as he meets these people. I suggest humbly that the Minister of State brings his cheque book with him when he tries to resolve this issue.

The Minister of State and I are good friends at this stage given our ongoing engagement and discussion on people with disabilities. Our RehabCare service in Cavan-Monaghan is no different to the wonderful services the Minister of State will have seen and it includes the services at the Holy Family School and in Analee View respite centre in Cootehill. There is a broad range of facilities, including the centre in Bailieborough where there is a RehabCare centre. There is also one in Cavan. Cavan-Monaghan might have one of the largest service user bases in the country. Again, we see people with disabilities being sidelined and not being viewed as a priority. I am not talking about the Minister of State in that regard as I know he has a deep understanding of and appreciation for people with disabilities. He knows the importance of respite and rehabilitation care, whether provided in day service or residential settings. These are services without which families cannot function. Families depend on them. Most families are providing a 24-7 service themselves for 12 months a year. Respite care, day services and residential care are very important, including for adults with disabilities. It was most unfortunate to see last week how far staff and management were pushed in having to write to families to tell them services were on the verge of collapse. I hope the Minister of State has come to the Chamber today with positive news from which families can take some comfort.

I thank Deputies Murphy O'Mahony and Smyth for raising this important issue. I know they care passionately and genuinely about disabilities. They have campaigned for and supported developments for the last number of years. I thank them for giving me the opportunity to outline the position in relation to RehabCare. The Government is committed to providing services and supports to people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in A Programme for a Partnership Government and it is guided by two principles, namely equality of opportunity and improving the quality of life for all people with disabilities. Significant resources have been invested by the health sector in disability services over the past number of years. This year alone, the Health Service Executive has allocated €1.9 billion to its disability services programme, which represents an increase of €346 million since 2016. This is the highest ever level of funding in the history of the State. I thank my colleagues opposite for their support in that regard. I recognise that support.

I acknowledge the important services and the commitment to people with disabilities and their families provided by the staff of the Rehab Group. The Rehab Group provides short-term and long-term services to young people and adults with physical, sensory and intellectual disabilities, mental health difficulties, autism and acquired brain injury. Services are co-ordinated through Rehab's three service delivery divisions, RehabCare, the National Learning Network and Rehab Enterprises. RehabCare provides health and social care supports to about 3,000 adults and children each year, enabling them to become active members of their own communities, achieve life goals and experience new opportunities. The National Learning Network provides a range of flexible training courses and support services for some 5,000 students, including jobseekers and people with an illness or disability, from age 16 upwards who need specialist support in 50 centres around the country. The National Learning Network provides a wide range of vocational training and education programmes which are funded by SOLAS, as well as rehabilitative training, funded by the HSE. Rehab Enterprises does not receive funding from the HSE. The Rehab Group is funded by the HSE under section 39 of the Health Act and operates in all nine HSE CHO areas. Services are provided through a service arrangement which is signed on an annual basis and reviewed continually. The 2019 budget allocation for the Rehab Group is €56.1 million, which is €1 million more than in the previous year.

Last Tuesday, the Minister for Health, Deputy Harris, and I held a joint meeting with Rehab and the HSE. I have met representatives from the Rehab Group and many families of service users personally over the last three years also. Arising from reported financial challenges, Rehab and the HSE have committed to work intensively with a view to understanding the group's financial position and cost base. My primary concern is to ensure continuity of disability services for service users and their families, delivered in line with strong governance mechanisms in a cost-effective and equitable manner which is consistent with care and support needs.

RehabCare has agreed not to issue a notice of termination, pending the outcome of this intensive work with the HSE. The Minister and I have committed to meeting RehabCare and the HSE tomorrow, Wednesday, 15 May, at 5 p.m. The answer is that I am pushing this agenda very strongly and I thank the Minister for his support.

I am glad the Minister of State acknowledges the fantastic work done by RehabCare but he is still not answering my question. I know it is difficult to pre-empt the meeting tomorrow but I was hoping he would state that he will continue to fund this fantastic organisation. I am a bit disappointed with his response. Does the Minister of State think that the HSE could provide the services that RehabCare provides and is he prepared to state that the HSE would provide a better service?

As my colleague, Deputy Murphy O'Mahony stated, what RehabCare does for people on the ground is magnificent. It is in no small way a relief and a support for families. As we would say in Cavan-Monaghan, the Minister of State's response was watery. We have nothing tangible to take back to our families or to the management of RehabCare across Cavan-Monaghan. I appreciate that it may be difficult for the Minister of State to provide anything concrete ahead of that meeting tomorrow. However, I would ask that everything be done to ensure that these services continue and that there will be no break in the day service or the residential service. In recent times, people with disabilities and service users in places such as Steadfast House in Carrickmacross have been hit with ongoing charges in respect of their daily services, whether it be to get their bus or their lunch. There seems to be all these sneaky ways of introducing charges that take away from the little bit of social protection these people enjoy. I reiterate the point that RehabCare is providing a fantastic service and everything should be done to ensure that this continues.

I thank Deputies Niamh Smyth and Murphy O'Mahony again for their support on this issue. I support RehabCare and I am supporting it in government. That is my clear position. I also agree strongly that my job is to look after people with disabilities. I am not interested in any other aspect of the issue. The families are my job. Of course we need tangible results and I am hoping to get them tomorrow.

I mentioned the HSE's 2019 budget earlier. This year, €1.9 billion has been allocated to the HSE's disability service programme. That is an increase of €346 million during the lifetime of this Government. This will fund the provision of a wide and complex range of services and supports to people with disabilities. Additional funding this year is being focused on a number of priority areas as a result of ongoing demographic changes and the fact that population is increasing. These areas include: the expansion of community disability services to meet the needs of school leavers; the 100 new therapy posts to address the assessment of need waiting lists for children with disabilities; personal assistance and home support service hours; and residential and respite places. At our meeting last Tuesday, which was difficult and direct, both RehabCare and the HSE remained committed to working together intensively with a view to making substantive progress in arriving at a solution in respect of this issue. The Minister and I are working closely together on this issue. I have also raised it at Government level. A further meeting is scheduled to take place tomorrow and I hope major progress will be made in respect of the genuine concerns the Deputies have raised. As stated, my focus is on the people with disabilities and their families. I want to see the funding going there and I want to see them get maximum support.

Medicinal Products Availability

I am glad that this issue was selected, which is important to the people of Kilkenny. I mean no disrespect to the Minister of State but I was hoping that the Minister for Health would be present because it is relevant to his brief. The first thing I want to do is obtain a commitment from the Minister of State that he will bring this matter to the Minister's attention.

This issue relates to pembrolizumab, a drug that is available for the treatment of patients with certain cancers in this country. Patients with a particular type of cancer are not able to access the drug, making this another example of the two-tier health system with which, unfortunately, we are all too familiar. Deputy McGuinness and I want to refer specifically to John Holmes, a Kilkenny man who has had to resort to having friends and family establish a fundraising committee in order that he can access the drug pembrolizumab. There are regular fundraisers throughout Kilkenny to try to fund his treatment. It is not nice for anyone to be diagnosed with any type of illness, not to mention having then to go out and fundraise in order to pay for one's medication. Ironically, pembrolizumab is manufactured in Carlow, one of the counties bordering Kilkenny. The drug is not available to Mr. Holmes but it is available to certain other patients. We are seeking a firm commitment from the Minister that he will meet Mr. Holmes and his fundraising committee to discuss the matter, that he will examine the position and that he will not offer some sort of watery reply whereby he states that he will come back to the matter and then kicks the can down the road.

Time is of the essence. We need a definite commitment that he will meet the fundraising committee and that he will consider the matter and come up with a solution in order that John Holmes can get access to this vital drug because it is working and, thankfully, he has seen results from it. Obviously, it costs approximately €5,000 per session so treatment is out of the reach of most people.

John Holmes began to have investigations into his health in 2010 when it was established that he had cancer. From 2010 to today, he has been battling cancer. He has had chemotherapy and he has had various invasive surgeries. Professor John Crown has recommended that he undergo an aggressive form of chemotherapy. That has all happened and now it is being recommended that he be treated with pembrolizumab. The local community and John have been out begging for funds to fund the 30 infusions of pembrolizumab he needs at a cost of €5,111 each. Nobody can afford this. This man will die if he does not receive the treatment needed to give him an extension of his time. The Government can provide the answer by assisting Mr. Holmes in accessing the pembrolizumab.

I have asked the Minister to meet the family and to meet John Holmes. We tabled this matter in the belief that the Minister would come to the House and provide an answer. It is a sad reflection on the Government that the Minister is not here to answer the question being put to him by Deputy Funchion and me. That is a disgraceful way to treat the family. I ask that the Minister of State request an immediate meeting between John Holmes and the Minister, that he take immediate steps to remove VAT from this drug and that he ensure that the drug is made available to John, who has a unique type of cancer and who requires this drug immediately.

I have asked the Minister to meet the family and to meet John Holmes. We tabled this matter in the belief that the Minister would come to the House and provide an answer. It is a sad reflection on the Government that the Minister is not in here answering the queries that are being put to him by Deputy Funchion and me. That is a disgraceful way to treat the family. I ask that the Minister of State request an immediate meeting between John Holmes and the Minister, that he take immediate steps to remove VAT from this drug and that he ene sure that the drug is made available to John, who has a unique type of cancer where he requires this drug immediately.

I thank Deputies Funchion and McGuinness for raising this very important and serious issue. The Deputies described in great detail the sad case of John Holmes.

I wish to inform the Deputies that pembrolizumab is available to public cancer patients in Ireland for a number of licensed indications and is included on the HSE reimbursement list for some of those indications. Furthermore, pembrolizumab is currently being assessed by the HSE, using the criteria as set out in the Health (Pricing and Supply of Medical Goods) Act 2013, for a number of other indications for which it has received marketing authorisation.

The Deputies will be aware that the Oireachtas has put in place a robust legal framework in the Health (Pricing and Supply of Medical Goods) Act 2013. This Act gives full statutory powers to the HSE to assess and make decisions on the reimbursement of medicines, taking account of a range of objective factors and expert opinion as appropriate. The Act specifies the criteria to be applied in the making of reimbursement decisions which include the clinical and cost effectiveness of the product, the opportunity cost and the impact on resources available to the HSE.

In line with the 2013 Act and the national framework agreed with industry, if a company would like a medicine to be reimbursed by the HSE, it must first submit an application to have the new medicine added to the reimbursement list. Reimbursement is for licensed indications which have been granted market authorisation by the European Medicines Agency or the Health Products Regulatory Authority.

HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds on the advice of the National Centre for Pharmacoeconomics, NCPE. The NCPE conducts health technology assessments, HTAs, for the HSE and makes recommendations on reimbursement to assist decisions. It uses a decision framework to assess systematically whether a drug is cost effective as a health intervention. Clinical trials for various immunotherapies, including pembrolizumab, are ongoing globally for a range of other possible indications which may receive marketing authorisation in the EU over the next number of years. Each of those indications will be considered for reimbursement as market authorisations are granted and applications received by the HSE.

The Deputies will be aware that as an exceptional measure, the Government made a decision in May 2018 to put in place a package of support measures for women and families affected by issues related to CervicalCheck. These measures included medicines which might not be approved for reimbursement, including pembrolizumab, once they are prescribed by the treating clinician. The establishment of such a comprehensive support package reflected the impact of the lack of disclosure of the result of clinical audit and the ensuing controversy on individual women and their families. In January 2019, after careful consideration of the situation which had arisen in respect of patients with cervical cancer who were not encompassed by the terms of the support package agreed by the Government for those affected by the CervicalCheck clinical audit non-disclosure issue, it was agreed the HSE would put in place arrangements to facilitate access to pembrolizumab for cervical cancer patients on a case-by-case basis in public hospitals when a treating clinician determined this to be in the patient’s best interests. The Minister for Health has no role in how doctors manage or the care of individual patients. All prescribing decisions are entirely a mailer for the treating clinician, in line with patient safety protocols and the Medical Council guide to professional conduct and ethics.

Additional information not given on the floor of the House

The Deputies may also be aware that on 29 March 2019, the VHI sent a circular to oncologists advising them that it was extending cover to a number of new cancer medicines, including pembrolizumab. This decision by the VHI applies only to private care for VHI private patients in private hospitals and will have no impact on the provision of care in public hospitals. The effect of the VHI decision will be that VHI private patients in private hospitals may have access to a medicine not yet available in the public hospital system. A number of the medicines or indications which the VHI has now decided to cover are at various stages of the HSE assessment and reimbursement process in accordance with the provisions laid down in the 2013 Act.

It was not worth including in the record the additional information not given on the floor of the House. The Minister of State did not address the question.

I should have said earlier that Deputy Aylward had sent his apologies for his absence.

With respect, the Minister of State's reply is a load of nonsense. We know about the women with cervical cancer. We are all well aware the medicine is not one on trial or that has not been approved by the HSE. It is available for a number of types of cancer but not for the cancer John Holmes has, which has been diagnosed as a metastatic neo-endocrine tumour. He has been forced to fundraise for the drug and the HSE can see that the drug is working. Providing access to the drug makes sense. It is available through the HSE for other cancer patients and has been clinically shown to work. What is preventing John Holmes from accessing it?

We need an urgent meeting with the Minister. Common sense is needed but it is utterly lacking. All the scripts and paperwork being presented to deal with the matter do not do so. The campaign group has been in contact with the Minister and has requested a meeting, as has Deputy McGuinness on our behalf. It is important the matter is not kicked down the road. I know how the House operates, where in two months we will be speaking about the same issue. The man in question does not have that time and we need a commitment this week that we will have a meeting with the Minister.

What the Minister of State has outlined has nothing to do with the question that was asked. He should be ashamed of himself. He was asked a specific question about supporting Mr. Holmes in the context of a cost of €5,111 for 30 treatments of the drug. All the Minister of State did, however, was give us a history lesson. The Government is cold and callous if it can stand back and watch the likes of John Holmes die when all he needs is the Government's permission to allow what Professor Crown has said Mr. Holmes needs, namely, to be given pembrolizumab. That is a simple instruction to the Minister to follow the medical need of Mr. Holmes, but the Government has refused to do that. Not only that, but the Minister of State has put this waffle on the record.

Will the Minister meet Mr. Holmes? Will the Government remove VAT from the drug? Will it assist the man to live or will it let him die? That is the question. The Government did the same in the case of young Isaac Brennan and Spinraza. The same argument was made in the Chamber, where the Government stated it would wait and see. Last week, the HSE made the decision to push out again the date for the final decision.

The Deputy's time is up.

On a point of order, a Cheann Comhairle, it is a disgrace that a Minister of State would use that script in the Chamber and fail to address a question about a man who is seriously ill. The Government can be described as cold and callous.

With respect, Deputy McGuinness-----

The Government is being seriously disrespectful to Mr. Holmes by not responding properly or adequately to the requests made of it.

I fully accept this is an inordinately difficult problem for two representatives of someone in a gravely ill condition. Nevertheless, I do not see the name of any patient on the notes before me.

Mr. Holmes met the Minister. I sent a text message to the Minister and asked him to meet. I sent him a note in Deputy Funchion's presence but he ignored it. How will people build respect and trust for politicians when this nonsense is put on the record and when the real issues of Mr. Holmes and Isaac Brennan are not addressed in the Parliament?

To be clear, I reiterate that the name of Mr. Holmes or of anybody else does not appear on the subject matter before us.

Nor does any of the nonsense the Minister of State has outlined.

I reject many of the allegations that Deputy McGuinness has made. The House knows my position on the issue. It is important that pembrolizumab is available to public cancer patients in Ireland for a number of licensed indications which have been assessed in line with the 2013 Act. Clinical trials are ongoing globally for a range of other possible uses which may receive marketing authorisation in the EU over the next number of years. Each of those treatments will be considered for reimbursement as the market authorisations are granted and applications are submitted to the HSE for decisions.

Of course I will convey the Deputies' message to the Minister for whom I am stepping in today. I reject Deputy McGuinness's personal allegations against me. I always convey the views of Deputies to the Minister. Deputy McGuinness should show some respect. I hope that as a result of the process, pembrolizumab will become available for more indications in the years ahead. I will convey the other points raised by Deputies, in respect of Mr. Holmes and the VAT issue, to the Minister, which is as much as I can currently do.

I had also requested a meeting with the Minister.

I will convey that message to the Minister. There is no problem in that regard.

In the light of the extreme urgency of the case the Deputies describe, will the Minister of State request an urgent response from the Minister? It would be appreciated by all concerned.

There is no problem in that regard.

Home Care Packages Provision

The House will be aware that serious challenges face the planning and provision of home care supports and services. The deficits have a serious impact on the quality of choices people make, if they are able to make any, about how they receive the care they need. The people who need the care are among the most vulnerable in society and it is the moral responsibility of the State to care for its most vulnerable citizens in their time of need.

Deficits and challenges facing the health system are complex. From my direct work with older people and their families in counties Sligo and Leitrim, south County Donegal and north County Roscommon, however, I know that older people do not receive the quality of home care support services they need to maintain their health and well-being, to allow them to continue to live independently within their homes and communities and to avoid or delay hospital residential care stays. Home supports are critical for older people but it is clear that families do not receive affordable home care supports of an adequate quality.

The Citizens' Assembly dealt with the issue and the findings were clear. A total of 99% of members wanted the Government to expedite the current commitment to place home care on a statutory footing. Life expectancy is rising and people aged above 65 can expect to live into their 80s, with two thirds of these years lived disability free.

The number of people aged over 85 is projected to double in the next 20 years. The number of people aged over 65 will increase by 59%. This will create capacity challenges and has been well signalled. The ESRI report on health care projections noted the demand for home care packages will increase by between 44% and 66% by 2030 and the demand for home help hours will increase between 38% and 54%. The health service capacity review also flagged this.

Older people can sustain an independent lifestyle at home if they receive appropriate and timely quality physical and psychological supports. The absence of available supports impacts fundamentally on the range of choices available to older people. Without access to home care supports some older people are forced to move to residential care settings, which are often not their first choice. This undermines their human right to live with dignity and independence. We know we need a large injection of funding in home supports to enable the service to meet its yearly growth in service users.

The HSE national service plan for 2019 provides for a target of almost 17.9 million home support hours to be provided to 53,000 people. Despite the significance level of service provision, demand continues and the waiting list will persist and rise. At the end of March, 519 elderly people were on waiting lists for home care in community healthcare organisation area 1. The average time spent on waiting lists for home care supports for non-priority cases is at least 3.3 months. The average home care package is now six hours a week and not, as we all thought previously, ten hours. Fewer hours are now being spread more thinly per client every week, with an increase in the provision of short 30 minute slots. There is not much one can achieve in 30 minutes.

There is an absence of legislative entitlement to home support and a lack of transparency and accountability. There is limited access to packages due to chronic underfunding and the eligibility criteria for supports remain unclear. The overall lack of the provision of supports is the key issue. My office is contacted by families and people needing to remain in hospital or who need to go to a nursing home because there are no supports at home, to where they want to return. This is a serious deficit. I know of one case where a man has been between hospitals for more than a year. His home, which was not appropriate for him, has since been converted and now has a downstairs en suite bedroom, for which the HSE provided a hospital bed and a wheelchair. The man cannot be sent home as there are no carer hours in the area. It is far more expensive to keep him in a nursing home or hospital rather than provide a few hours to the family so this 93 year old man can come home.

I thank Deputy Scanlon for raising this important issue. I am taking this matter on behalf of my colleague, the Minister of State with responsibility for mental health and older people, Deputy Jim Daly. The Government's core objective is to promote care in the community so that people can continue to live with confidence, security and dignity in their own homes and communities for as long as possible. A wide range of services are provided, including home supports, day care and residential care, through direct service provision and through voluntary and private providers.

Improving access to home support is a priority for the Government. Over the past four years we have seen a considerable increase of nearly €140 million in the budget, which has grown from €306 million in 2015 to almost €446 million in 2019. More than 53,000 people will receive more than 18 million home support hours this year, including intensive home care packages to 235 people. Despite this significant level of service provision, the demand for home support continues to grow. The allocation of funding for home supports throughout the system, though significant, is finite and services must be delivered within the funding available.

Preliminary data indicates that during the first quarter of the year 4.2 million hours were delivered nationally, 4,411 new clients commenced the service and 6,238 people have been assessed and are waiting for either new or additional home support services. I acknowledge that in some cases access to the service may take longer than we would like. However, the HSE has assured the Department that people on a waiting list are reviewed as funding becomes available to ensure that individual cases continue to be dealt with on a priority basis within the available resources and as determined by the local front-line staff, who know and understand the clients' needs and who undertake regular reviews of those care needs to ensure the services being provided remain appropriate.

The allocated home support budget for community healthcare organisation area 1, which covers Cavan, Donegal, Leitrim, Monaghan and Sligo in 2019 is €44.3 million. This is an increase of approximately €4.5 million on last year’s allocated budget. While the overall aim is to be as responsive as possible to all applications, delays can occur. According to the HSE, currently the home support budget for the Sligo, Leitrim and west Cavan region is experiencing demand in excess of the funding available. Preliminary data shows 205 people are waiting for new or additional hours. In this context, those clients who are assessed and who are not provided immediately with a service are prioritised based on the clinical assessment and are placed on a waiting list for a resource as it becomes available. The number of people waiting for funding for home support services reflects a point in time. While the existing home support service is delivering crucial support to many people throughout the country, it is acknowledged that the service and access to the service need to be improved to better meet the changing needs of our citizens. This is why we intend to establish a statutory scheme for home support services that will improve access to the service on an affordable and sustainable basis while also introducing a system of regulation that will ensure public confidence.

There is a specific commitment in the programme for Government to introduce uniform home care services so all recipients can receive quality support seven days a week. The Minister of State is right that every year the funding has increased but it is still not sufficient to meet the demand that exists. The Minister of State spoke about 205 people waiting. That is actually 205 families waiting for some help and support so they can bring their loved ones home, where they want to keep them and where they want to be themselves, and where they can be looked after. We all know the cost of nursing home care. It is €1,000 or €1,200 a week. The sum of €100 a week would keep people in their homes with the support and help of their families. Quite honestly, it is economic madness not to provide the funding. I agree the funding has increased but not sufficiently to look after these people. It is small money when we compare it to the cost of the children's hospital, which I agree has to be built and is badly needed. When we consider we are over budget on the children's hospital by €450 million or €500 million, I believe €5 million would solve the home help problem nationally. It would allow people to have enough home help and home care to look after their loved ones at home. The Government owes it to these people who have worked all their lives, paid their taxes and reared their families. Now they are being left without support or help. It is wrong. Some people wait for three and a half months. It is disgraceful and the Government should do something. We are not speaking about millions or billions of euro. We are speaking about small money of €4 million or €5 million to sort out the problem for the people.

I thank Deputy Scanlon and I take his point on the economic argument. There are strong indicators that it is the sensible thing to do. We also have a situation where people now live longer than they have ever done in the history of the State. Success in improved health and extended life expectancy has been achieved in recent decades and every year there is an increase of 20,000 in the over 65 population. There is an obvious need to provide high quality and flexible services that not only best meet the needs of individual clients, but also reduce pressures elsewhere on the health system. This is another argument. Social care services, including home care, day care and respite, are an important component in enabling people to remain living at home and participating in their own communities. They also provide valuable supports to carers.

We are aiming to improve home support services so people can remain living with confidence, dignity and security in their own homes. While the existing service is delivering crucial support throughout the country, I recognise that home support services need to be augmented to better meet the changing needs of our citizens. The Department is engaged in a detailed process to develop a new stand-alone statutory scheme for the financing and regulation of home support services. This is a point on which the Deputy spoke strongly. This scheme is a key action under the Sláintecare implementation strategy, along with improving and developing supports in the community. I will raise the Deputy's valuable points with the Minister of State, Deputy Jim Daly.

Residential Institutions Redress Scheme

This is an incredibly important issue, so I thank the Minister for coming in to respond to it today. Today in the Dáil, the Taoiseach said the State could have acted, but did not. It was a very welcome comment. He also said the abuse compensation scheme was not working, which was also a very welcome and significant comment.

This is a topic in which I have a deep personal interest, having worked closely for a number of years with the lads from VOCADS and Creagh Lane in Limerick. To be honest, I am absolutely disgusted at how survivors of historical child sexual abuse have been treated by Fine Gael and by previous Governments. These men are currently barred from accessing compensation for the horrific abuse they suffered and the Government has steadfastly stood in their way of justice. Last July, the Government was defeated by 84 votes to 44 on a Dáil motion which sought to allow victims of primary school sexual abuse to seek redress on the same basis as victims of residential institutional abuse. The Dáil instructed this Government, by a large majority, to change how this scheme operates, but in the arrogant approach that is the trademark of this Fine Gael Government, it ignored it. This, of course, is because Fine Gael knows better than everybody else.

This Dáil motion outlined how the State’s ex gratia redress scheme, set up after Louise O’Keeffe won her European Court of Human Rights case in 2014, could be amended to include victims in cases who could not prove a prior complaint. It would only cost about €15 million, which is not that much in the grand scheme of things. The prior complaint interpretation of the Louise O’Keeffe judgment is total nonsense and the Minister knows that, as did previous Ministers. It was designed by officials and lawyers to lock survivors out and keep the compensation bill down for the State, hoping that many of them would die and would not be able to access the compensation. It is a despicable approach to take with survivors of child sexual abuse.

The fight against the State which the men from Creagh Lane have had to put up has been shocking. They were subjected to the most horrendous sexual abuse as children in Creagh Lane national school in Limerick but denied redress due to barriers put in place by Fine Gael. Some of these men have shared their stories publicly. One, who was abused at the age of eight, said: "School was about survival, I’d be looking at the teacher thinking "just stay away"". Another, who was abused at the age of six said: "I was screaming and had to be tied into a buggy with a rope to be brought to school. The children never spoke about it, we just kept our heads down and our mouths shut". I know most of these lads personally, and many had never spoken about their abuse for years, with families and friends unaware what they went through. This Government has forced these men to protest outside the Dáil gates, to try to get their story highlighted in the media, to travel to Brussels to highlight their injustice in the European Parliament and to have a Dáil debate which the Government has ignored.

Louise O’Keeffe was dragged through the courts before she got justice and compensation, and it seems this Government is content to do the same to the remaining survivors who were locked out of the redress scheme. The Government’s handling of this situation has been shameful. It is clear it does not understand the hurt and stress it is causing to survivors. The abuse these men suffered as children ruined their childhoods and left a terrible scar on their lives. The Government needs to show compassion to these people. Can it please stop fighting these survivors of child sexual abuse in court, and provide them with the compensation that will allow them to get justice and move on with their lives?

On 7 July 2016, the then Minister for Education and Skills, Deputy Bruton, told my colleague, Deputy Mary Lou McDonald, that payments had been made and that they would continue to be made under an ex gratia scheme. That is clearly not the case. The Minister told "RTÉ News" at the weekend that no one had been paid. Can he clarify this? It cannot be both and either payments have been made or they have not. Which is it?

I thank the Deputy for raising this important issue and I acknowledge the Deputy's intervention with the Taoiseach today. The legacy of sexual abuse against children, whether in residential institutions, in day schools or in any other setting, is appalling. The Government calls on those who have evidence of prior complaint of abuse to bring that evidence forward in an open and transparent way to the appropriate authorities. There is an onus on all those who have information or knowledge in relation to child abuse that may bring closure to a survivor to come forward with that information.

Prior to the Louise O’Keeffe case to the European Court of Human Rights, ECHR, the domestic courts, up to and including the Supreme Court, had found that the State had no liability for day school abuse as it was not the owner or manager of the schools and, while it paid school teachers, it did not employ them. The European Court of Human Rights found on the facts of the O’Keeffe case that the responsibility of the State was engaged in certain circumstances. A central facet of this case was that there had been a prior complaint of abuse in respect of the teacher who abused Ms O’Keeffe. In 2015, the State responded to the ECHR judgment by setting up an ex gratia scheme to specifically address the position of persons who had discontinued their proceedings against the State the wake of a number of High Court judgments and the Supreme Court judgment in the O’Keeffe case. In 2017, an independent assessor, retired High Court judge, Mr. Justice Iarfhlaith O’Neill, was appointed to assess applications declined under the scheme. As of today's date, 50 applications have been submitted to the scheme, 45 have been declined and the remaining five cases have not yet been determined. A total of 20 applicants have sought an independent assessment. The assessor’s decisions are awaited in respect of these cases. I look forward to receiving the assessor’s decisions on the cases and his findings will be abided by.

It is important to recognise that the scheme is addressed to a specific cohort of historic, discontinued day school sexual abuse cases which were impacted on by the ECHR judgment in the O’Keeffe case. I am aware that survivors of day school abuse are pursuing cases through the civil courts and are receiving settlements, either through the courts or on an out-of-court basis. The judgments have been secured against the actual abuser and-or the school management or patron. In the latter case these have generally been religious congregations. The Department is also continuing to receive notices of discontinuance, reflective of the fact that the domestic courts will not find the State liable where there is no evidence to support that liability. In addition, the State Claims Agency has, to date, made settlements in 22 cases many of which also involve authorities responsible for schools. In these cases, more than half the compensation paid has come from non-State parties. This is reflective of the shared liability in these cases.

We have learned from our dark history of child abuse and put in place a set of measures to enhance child protection and make sure abuses of the past cannot recur. We are constantly reviewing these measures and strengthening them, wherever possible. As part of this ongoing process of reviewing child protection measures, significant developments include the following: the creation in 2012 of a criminal offence where a person fails to disclose to the police information in relation to certain serious offences, including sexual offences against children and vulnerable persons; the introduction of statutory vetting arrangements for people involved in working with children and vulnerable adults, including those working in schools; and the enactment of the Children First Act 2015.

As part of my Departments ongoing work to improve child protection measures across the education sector, the Department’s inspectorate introduced child protection and safeguarding inspections in February 2019 as a new form of specialised child protection inspection. These child protection and safeguarding inspections are designed to check that school boards and staff members are implementing the 2017 child protection and safeguarding procedures and will provide a further level of inspection in primary and post-primary schools.

I thank the Minister for his response. He confirmed that nobody had been compensated under the redress scheme. I echo the comments of the Taoiseach, which are very important. He said the State could have acted but did not, and he also said the compensation scheme was not working. The Minister is new in this Department and I hoped he would take a different approach from that taken by his predecessors. I wrote to him on 23 October to congratulate him on his appointment as Minister and to ask him to meet survivors of abuse which occurred at Creagh Lane national school in Limerick, as a priority. It should be one of his top priorities but neither he nor anyone from his Department bothered to reply to my letter. He should meet with these men and listen to their horrific stories and hear, at first hand, the horrendous abuse they suffered as children at the hands of their teacher, which has been proven in court. It may then dawn on him that something needs to be done about it.

It is scandalous how these men have been treated by Fine Gael. It ought to be ashamed if it intends to continue this approach. I do not want the Minister's reply to me to be about a previous scheme or any other scheme. He knows the story. He knows this Government is blocking these men accessing the redress they deserve. Their childhoods were ruined by paedophiles and their lives scarred by the abuse. The very least they deserve is to be treated with dignity and respect and to be provided for in respect of the hurt and loss they have suffered because of the failure of the State to protect them when they were children. They do not want to empty words or sympathy. They want the Minister to take action. I reiterate my request to the Minister in October last year that he meet myself and one or two of the lads to discuss this matter.

I again thank the Deputy for raising this issue. When discussing this issue it is difficult to articulate the thoughts and sentiments of people who have experienced it. It is not only that their youths were stolen, what happened has had a massive impact on their adult lives and it continues to impact on them. I take this matter seriously. I await receipt of the former High Court judge, Mr. Justice Iarfhlaith O'Neill's report of the 20 cases, following which I will form my own judgment. I am also interested in the recommendations he will put forward on conclusion of his deliberations, which will be accepted in full. It is important to put the latter point on the record.

It would be remiss of me not to reiterate the Taoiseach's comments that this scheme is not working, in that of the 50 applications only five are due for assessment, with the remaining 45 not having been refused. As I said, there is something wrong with this scheme and we need to consider how we can put things right. This is the least we can do to bring peace to people who have borne and continue to bear such a heavy weight. I believe that we can do that collectively. Like many other people in this House who have requested that I meet with particular survivor groups - I have met a number of them at this stage - Deputy Quinlivan has asked me to meet the lads from Limerick at some stage in the future and I am happy to do that.