Joint Committee on Health and Children debate -
Thursday, 11 Dec 2014

Health Services for Irish Communities in UK and USA: Discussion

Chairman

Apologies have been received from Deputies Peter Fitzpatrick and Ciara Conway. I welcome those who are following our proceedings on the Oireachtas channel and online. The subject of this meeting is health services for the Irish communities in the United Kingdom and the United States of America. This is our first meeting with the new Minister of State at the Department of Foreign Affairs with special responsibility for the diaspora, Deputy Jimmy Deenihan, whom I welcome before the committee. The Minister of State is accompanied by Mr. Ciarán Madden from the Department of Foreign Affairs and Trade. The committee is also pleased to welcome a number of advocates for Irish emigrants in Britain and America. Dr. Mary Tilki is chair and Ms Jennie McShannon is CEO of Irish in Britain. Dr. Tilki is a recognised advocate on health issues among the Irish community in Britain and Ms McShannon has more than 20 years of experience in a range of projects supporting vulnerable members of the Irish community in Britain. Mr. Brian O'Dwyer is a distinguished New York lawyer and highly influential activist on behalf of the Irish community in the USA, continuing the great tradition of his late father. I also welcome a good friend of mine, Mr. Mike Carroll, who is a member of the Irish-American Bar Association of Attorneys and the Emerald Isle Immigration Center in New York, as well as being very involved with an Cumann Lúthchleas Gael. I pay tribute to all of the witnesses for their collective efforts on behalf of the Irish diaspora. I also welcome the following individuals in the Visitors Gallery: Mr. Cody McCone, who has come from the United States; Ms. Emer Rocke from the Department of Foreign Affairs and Trade; Mr. Brian Farren; Mrs. Linda O’Shea Farren; Ms. Sara Carroll; and Mr. Liam Byrne.

Before I invite the Minister of State to make his opening contribution, I remind witnesses and members about privilege. Witnesses are protected by absolute privilege in respect of their evidence to the committee. However, if witnesses are directed by the committee to cease giving evidence on a particular matter and they continue to do so, they are entitled thereafter only to a qualified privilege in respect of their evidence. Witnesses are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person by name or in such a way as to make him or her identifiable. I remind members of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against any person outside the Houses or an official by name or in such a way as to make him or her identifiable.

As we are dealing with health issues today, it would be most appreciated if we could confine our remarks to issues pertaining to health.

Minister of State at the Department of Foreign Affairs and Trade (Deputy Jimmy Deenihan)

I am delighted to be here. I am also pleased to be joined by Dr. Mary Tilki and Ms Jennie McShannon from Irish in Britain, and Mr. Brian O'Dwyer and Mr. Mike Carroll from the Emerald Isle Immigration Center in New York. I am delighted to be sitting next to Mr. O'Dwyer. His family have made an extraordinary contribution to public life in New York and the USA, and they have been unstinting in their support for everything Irish, both on the island of Ireland and in America. His uncle, William O'Dwyer, was mayor of New York between 1945 and 1950. He was in attendance as mayor on the celebrated day when Cavan beat Kerry in the Polo Grounds in New York. He was also instrumental, with John "Kerry" O'Donnell, in securing Gaelic Park from city land, an arrangement that continues to exist. Mr. Brian O'Dwyer's father, Paul O'Dwyer, was president of the New York city council. All three individuals have made major contributions to Ireland over the years. I also acknowledge Mr. O'Dwyer's colleagues, Mr. Mike Carroll and Mr. Cody McCone.

The primary objective of the emigrant support programme, which is run by the Department of Foreign of Foreign Affairs and Trade, is to address the needs of disadvantaged and vulnerable Irish emigrants. Its areas of work that are most relevant to today's discussion are: supporting equitable access for Irish emigrants and community organisations to statutory and voluntary services; promoting the development of responses from the voluntary sector which reflect the diverse needs of the emigrant Irish community; and supporting the professional development of the Irish abroad voluntary sector and encouraging best practice and capacity building. Since taking my position as Ireland's first Minister of State with responsibility for diaspora affairs, I have had the opportunity to visit many of our Irish communities in traditional areas of emigration, including London, Luton, New York, Philadelphia, Brisbane, Melbourne, Sydney and Perth.

I have also visited some of the newer Irish communities in Dubai, Abu Dhabi and Kuala Lumpur. In all of these locations I have witnessed the emigrant support programme at work. I pay tribute to Dr. Tilki, Ms McShannon, Mr. O'Dwyer and Mr. Carroll and the many others like them who work day in and day out to help to improve the lives of Irish people all over the world. Without people like them, the work the Government does and the funding provided by the emigrant support programme, ESP, for organisations that provide vital services for Irish communities would not have the impact that they do.

The emigrant support programme works in partnership with organisations such as Irish in Britain and the Emerald Isle Immigration Center across the globe. The main focus of the programme is to support the most vulnerable and marginalised members of the Irish community overseas. In the main, the funding provided under the programme enhances the lives and well-being of the people it supports through outreach services for the elderly, the lonely and the vulnerable and through the provision of health services such as those provided for individuals suffering with mental health issues. In general, it does not provide services directly, but it enables people to access the services to which they are entitled locally.

In the past ten years the emigrant support programme has provided over €114 million for more than 200 organisations in more than 20 countries. Most of the funding has been spent on welfare services, with 72% of the total budget allocation between 2009 and 2013 going to this area. In Britain the figure is even higher, with a total of 86% of the moneys granted to Britain going on welfare services. This funding has had a direct impact on the health and well-being of many thousands of Irish emigrants during the course of the past decade. Although cultural and heritage projects are not directly related to health, the recent Clinton Institute report on supporting the next generation of the Irish diaspora highlighted the therapeutic impact of culture on the Irish diaspora as a whole. It creates an environment in which people can celebrate and be proud of their Irish identity.

In order to give a sense of the depth and breadth of the emigrant support programme and the type of work it supports, I will highlight a number of projects which are supported. While not all of them provide direct health services, these culturally sensitive programmes contribute greatly to both the physical and mental health of some of our most vulnerable country men and women. Monica's Place in Birmingham specialises in taking care of elderly Irish men with significant alcohol issues in the Birmingham area. It provides accommodation in three residential houses and also assists this vulnerable group with practical, social and emotional support to meet their physical and mental health needs.

The emigrant support programme supports a number of housing associations in the United Kingdom, for example, Innisfree Housing Association, in providing homes for vulnerable Irish people. The programme also provides funding for a significant number of elders groups in the United Kingdom, the United States and elsewhere that provide outreach services, meals, companionship, education, arts and crafts and music, as well as other practical health initiatives such as keep fit classes and specialist groups for those coping with Alzheimer's disease. Dr. Tilki has done a lot of work in the area of memory loss and the Cuimhne programme run by Irish in Britain is a wonderful example of this. It was for this and much more of the work done by her that Dr. Tilki received a Presidential Distinguished Service Award for the Irish Abroad in 2013. The primary aim of the elders groups is to ensure the older members of the community do not become isolated or withdrawn and that they remain as active and healthy as possible throughout their later years.

Welfare centres in Australia provide support for the full range of the Irish community there, from the older emigrants to the young people who travel around Australia as backpackers. When I was in Australia recently, I had a chance to meet the people who run these centres and hear first-hand the stories of the people, young and old, whom they help. Also while in Australia, I met a group called Irish Families in Perth. This group came into being to provide support for families newly arrived or moving to Australia. With more than 2,000 members, it helps young families to integrate into life in Australia, while at the same time, encouraging them to be part of the vibrant Irish community there.

In the United States the emigrant support programme is an important partner in the work of Irish immigration centres across America such as the Emerald Isle Immigration Center, including its umbrella organisation, the Coalition of Irish Immigration Centres, CIIC. These centres, similar to those in Britain and Australia, provide outreach services for those who are vulnerable, including the elderly and those with substance abuse issues. A key role for the centres is providing support for the undocumented Irish who are rendered vulnerable by their status, which can have a negative impact on their physical and mental well-being. I am delighted that President Obama recently took executive action on the issue of immigration reform, allowing those who meet the criteria and register to be protected from deportation and given temporary legal status. Applications for this programme will open in six months. While this will by no means resolve the issue for all of the undocumented Irish, it will help a considerable number of them. Those living without documentation have lived with the stress and strain of their situation. I have spoken recently to Irish people living in the United States who have created employment there, who are paying taxes but who are living in constant fear of a knock on the door from the authorities. They live in constant fear that their families will be broken up. They live, too, with the fear of being in an accident or requiring medical treatment they cannot afford. I hope this action will bring some relief for such families. I acknowledge the work of people such as Mr. Billy Lawless, Mr. Ciaran Staunton, Ms Celine Kennelly and others in America, as well as Mr. O'Dwyer, in influencing the decision.

For those who do not qualify under President Obama's action and to ensure a long-term resolution of this issue, the Taoiseach, the Minister for Foreign Affairs and Trade, Deputy Charles Flanagan, and I will continue to press for comprehensive immigration reform by way of legislative action, as will the embassy and consulates in the United States. Since the announcement, the immigration centres, in conjunction with the embassy and consulates, have held public information sessions with immigration lawyers to provide people with as much information as possible and avoid any situation where people could be taken advantage of. I strongly urge people in the United States seeking information on the changes to contact their nearest immigration centres as a first step. These immigration centres have received €1.3 million in funding from the emigrant support programme in 2014 and over €12 million since 2004, showing the depth of the commitment successive Governments have had to Irish immigrants in the United States.

I am very concerned about the mental health of Irish emigrants. This issue has come up during the consultation process for the diaspora policy review and also in the recent report on the emigrant support programme. The programme supports a number of mental health projects, primarily in Britain, that provide counselling services for those in distress. Organisations such as Immigrant Counselling and Psychotherapy, ICAP; Console which has in recent years expanded its services to the United Kingdom; New Horizons, and Mind Yourself provide vital services for the people concerned. The Coalition of Irish Immigration Centers in the United States has done much work in this area, including the roll-out of suicide prevention training using the QPR – question, persuade and refer - steps across the immigration centres they represent. The GAA is also playing a role in raising awareness and providing support for those who need it. When I was in Perth recently, I launched, with Mr. Liam O'Neill, the GAA's striving and surviving in Australia resource, which is online and has attracted much attention.

I am delighted to announce that we are, for the first time, providing funding for Pieta House to support its work internationally among emigrants. Pieta House will this week receive a grant of $90,200, or €72,258, to help to introduce its crisis intervention services in the United States for those considering suicide and self-harm. It will pilot the project in conjunction with the three main Irish centres in New York, namely, the Aisling centre, the New York Irish Center and the Emerald Isle Immigration Center which Mr. O'Dwyer and Mr. Carroll represent. I recently visited the three centres and recognise the work of the directors, Ms Siobhán Dennehy of the Emerald Isle Immigration Center, Mr. Paul Finnegan of the New York Irish Centre and Ms Orla Kelleher of the Aisling centre.

This pilot project will create a Pieta room in the New York Irish center and will be the main point of referral for Irish people in crisis in the New York area. In addition, Pieta House will work with the GAA to bring the Pieta Mind Your Buddy campaign to GAA clubs in New York.

Once again, I am delighted to appear before the committee to discuss how the health and well-being of our emigrants is at the core of the work of the emigrant support programme and the Irish abroad unit in my Department. It is fundamental to much of what we do and as the first ever Minister of State with responsibility for the diaspora, it gives me great pleasure to be in a position to highlight the work that is supported by this programme and bring focus to the issues that impact on the lives of our families overseas.

Chairman

I thank the Minister of State. All of us will join him in welcoming the announcement of funding to Pieta House. I invite Dr. Tilki to make her opening remarks.

Dr. Mary Tilki

I thank the committee for the privilege of telling members about the health needs of the Irish community in Britain and what we, as an umbrella organisation, Irish in Britain, are doing about it.

Despite many Irish people being successful and leading healthy and fulfilling lives in Britain, there are still many concerns about the poor health of the Irish community. Although there are problems with statistics because of the way in which data about the Irish are collected and aggregated into the overall white ethnicity category, our recent analyses of the 2011 census in the UK shows us continuing evidence of poor health among Irish people in Britain. Irish people in England have among the highest levels of limiting long-term illness, LLTI, and self-reported poor health and Irish Travellers have even worse patterns of LLTI and self-reported poor health. The Irish have an older age profile with a median age of 53 compared with 42 for the general British population and this is also significantly older than other minority ethnic groups. While age explains some health problems, it does not explain all the ill-health and premature mortality.

There is excess and sometimes increasing mortality among Irish men and women from heart disease, hypertension and stroke and the Irish have the highest mortality rates from cancer in the population. Patterns of ill-health improve across generations but some of this ill-health is still transmitted into the second and third generation, which is unusual because migrant groups usually revert to the pattern of the host population within a generation. We are, therefore, very different in this regard. There is evidence that material hardship, occupation, lifestyle and age all play a part in poor health but they do not explain the full picture. There is limited knowledge about uptake of screening, access to GPs, hospital services and treatment outcomes because of the failure of the UK Government to collect or analyse data about the Irish. A major part of our work is representing this issue to the department of health, the NHS and the government in general. We have an opportunity because there is a great deal of reorganisation and reform going on in the health service. That can be a barrier but also an opportunity. Ms McShannon will outline how we are dealing with that.

Irish people have the highest mortality rates from most cancers in England and Wales and unlike patterns in wider society, they are not declining as quickly. Sadly, there are still some cases of increasing mortality. There is evidence that even where the incidence is similar to that of the general population, mortality rates are still higher, which suggests there are barriers to treatment. Recent figures from the London Health Observatory, which are only for London, show high admission rates for most cancers than would be expected for the city's population. Some of these figures would be replicated in other cities.

Smoking rates are declining slowly in the Irish community and there are issues around obesity, nutrition and alcohol, which mainstream health programmes are not addressing. These programmes get at some sections of the community but not all. Research and our work with clients demonstrates that fear and beliefs about cancer, and embarrassment, particularly about reproductive and excretory organs, stop people from accessing help and benefiting from early diagnosis and treatment. We work with community organisations to raise awareness of cancer and to get people talking about it and learning the value of early diagnosis. I attended a cancer conference on Tuesday and I am pleased that the Secretary of State for Health announced a focus on early diagnosis and one year survival rates from cancer. We hope to get some benefits from that in the not too distant future.

However, apart from people's beliefs and failure to access services, we strongly suspect that because many Irish live in areas of multiple deprivation, they are not getting the timely or effective treatment they deserve. We hear repeatedly of people fobbed off by doctors or being misdiagnosed, often around alcohol, and of people who do not have the confidence, health or strength to assert their needs and get what they deserve. Much of our work is with the NHS Clinical Commissioning Board, Public Health England and various cancer charities to get more information about the Irish community and to analyse data. I had a short conversation with the NHS national clinical director for cancer services. He is a nice Irishman, Mr. Sean Duffy, and I hope we have him on side to address some of these issues.

As the Minister of State mentioned, we have great concerns about mental health and long-term illness relating to depression and anxiety. There is research evidence that second generation Irish people who grew up in material hardship and who had parents in poor physical health or psychological distress show greater psychological problems than children of non-Irish parents. Alcohol is always a sensitive issue in our community. We have high patterns of abstinence but also patterns of binge drinking and alcohol misuse. There is also evidence that patterns of heavy alcohol use transfer from one generation to the next. We as organisations must address that and we have had a number of programmes about it.

The count me in census, covering inpatient mental health admissions between 2005 and 2010, repeatedly demonstrated high admission rates among Irish people aged over 50 and this is often related to physical disability as well. We have evidence of poor mental and physical health ill-health in men from approximately 50 onwards, leading to them having to leave the labour market. Many of them then get into a vicious cycle of inactivity, depression and alcohol use. Some of our activities are about addressing those. Ms McShannon will also address this.

The Minister of State referred to the high levels of suicide and there is good statistical evidence from the UK that the rates are not coming down as they are in the general population. There is much work to be done in this regard.

The Irish have an old age profile and this, along with a number of other factors, predisposes them to dementia. Irish organisations frequently deal with older people with memory loss or those who care for older people with memory problems.

Our Irish organisations are frequently dealing with older people who either have memory loss, think they have memory loss or are caring for people with memory problems. We do not have great diagnosis rates in the UK but I imagine Irish diagnosis rates are probably even lower. The figures the Alzheimer's Society uses to calculate prevalence suggest that there might be approximately 10,000 Irish people in England with dementia which is undiagnosed. I believe this underestimates the impact of the high levels of cardiovascular disease in the community. Social isolation related to poverty and where older Irish people live enhances the risk and also confounds the ability of older Irish people to get help. We also know that Irish Travellers, who have very low life expectancy anyway, appear to be suffering disproportionately from young age dementia.

As Irish people are white and speak English, their need for culturally sensitive care is not widely recognised. Although older Irish people have spent decades in England, things such as the Troubles and discrimination led many to lead quite insular lives in closed communities. There is widespread recognition that migrants from the Caribbean, India, Pakistan and other parts of the world need culturally sensitive care in old age, particularly when they have dementia, but there is not the same widespread recognition that Irish people deserve culturally sensitive care. This can make for a very lonely and frightening experience for somebody who is old, particularly somebody who is old with memory problems, when they are in hospital, a care home or often in their own home with help from external services.

The staff cannot or cannot be bothered to understand Irish accents or to learn to pronounce Irish names and they have little knowledge of the culture or the background of the people they are looking after, often making stereotypical assumptions about them. Family carers caring for somebody in their own home have the right to request a care worker who is Irish but are often treated as being racist if they ask for that, whereas it is generally accepted that somebody from India or Pakistan would be entitled to a care worker from that cultural background. Dementia is obviously frightening for people. When people cannot speak, their emotions and their sense of what is happening around them becomes even more important. It is particularly important that people with memory problems are cared for in as familiar an environment as possible and that activities such as reminiscence or cognitive stimulation take account of their culture. They require volunteers and staff who understand something of their background and that if an older person is agitated or difficult they might be recalling some point in their lives, such as a very difficult childhood, abuse in institutions or things people have suppressed for many years, for example, the unmarried mothers or people who have left Ireland because of their sexual orientation. We do not wish to be prescriptive about that, but it helps if people understand and generally Irish members of staff do.

The Minister referred to Cuimhne, the Irish memory loss campaign. We have already trained approximately 100 volunteers in different parts of England to make them more aware of dementia and how to communicate confidently with Irish people. We are working with several organisations to help them become more dementia friendly. Innisfree Housing Association has already been mentioned. We have been fortunate recently, through Jennie McShannon's good efforts, to be able to attract £68,000 of three year funding for a part-time volunteer co-ordinator to recruit older volunteers as what we will call "Cuimhne champions" to champion the cause, help our organisations become more dementia friendly and help older people in our Irish community. We are also leading the work with Brent local authority in outer London, the local authority that has the highest population of Irish people and, indeed, other immigrants. There are three Irish organisations in Brent and we have been working with other minority ethnic communities, groups such as the Alzheimer's Society, Age UK and a very big inter-faith group to try to make that borough more dementia friendly.

There is a great deal more to be done but time precludes me talking about that. Jennie McShannon will be able to say more about what we are doing to address some of these issues.

Chairman

Thank you for attending the meeting today and for your informative presentation. Does Ms McShannon wish to make some brief remarks now or will she wait until the questions and answers?

Ms Jennie McShannon

I will wait.

Chairman

I welcome Mr. Brian O'Dwyer and invite him to make his opening remarks.

Mr. Brian O'Dwyer

I thank the committee for its kind invitation. I have served for many years as the chairman of the Emerald Isle Immigration Center. It is located in Queens and the Bronx, New York, from which we provide all forms of legal and social services to our Irish immigrants. This year we celebrate the 26th anniversary of the centre. I acknowledge the presence of my colleagues Mr. Mike Carroll and Mr. Cody McCone, who have worked with me over the years on behalf of Irish immigrants and Ireland in general.

I am delighted that this committee, by this invitation, has signalled to the island of Ireland its concern for the immigrants, both documented and undocumented, living in the United States. Since the committee's kind invitation, profound events involving many of our immigrants have taken place in Washington, D.C., and I will use a portion of my time to explain the significance of those events.

On 20 November, President Obama announced a sweeping executive action of US immigration policy that will have monumental effects on many Irish Immigrants living in the US. For years the president has urged Congress to enact comprehensive immigration reform and, in fact, the US Senate passed a comprehensive Bill that met with extensive bipartisan support. Unfortunately, despite that Bill and despite the fact that if presented to the House it would have passed, the leadership in the House of Representatives blocked the Bill from being considered. As a result, the action the president took was not as far-reaching as we would have liked, but was probably the best he could do legally.

President Obama’s action will benefit those Irish living in the US for more than five years and who have children who were born in the US. Those eligible Irish living in the US will have the ability to register for the programme, pay their taxes and pass a criminal background check. They in turn will be given deferred action for three years, which means that they will be able to work in the US and be free from the fear of deportation. We believe this action will possibly affect as many as half of the undocumented Irish living in the US. While current estimates of 50,000 undocumented have been suggested, my experience tells me that there are far more than that currently present in the US and that when we start processing the requests for executive action we will see much greater numbers than have been previously postulated.

Of course, President Obama’s action is not all for which we would hope. It does not benefit those who have recently arrived in the United States or those who do not have American born children. There are many who have been in the US for over five years without children. It is an executive order, which means that the next president can rescind it, and it is not a pathway to citizenship. While not yet explicit in the president's action, we believe that the deferred action will allow our immigrants an ability to travel home for humanitarian reasons. We will be working with the White House along with other immigrant groups to assure the broadest possible permission to travel for those affected by the president’s order.

All members of this committee are aware of the stress and prolonged heartbreak that have beset our immigrants when they have been unable to travel home to attend to dying or sick parents or siblings. Probably the most heartbreaking part of my work and the work of the immigration centre is to tell an immigrant that they cannot go home to their mother's funeral.

We are confident we will be able to alleviate this stress for many of our undocumented immigrants. As I stated, we will work diligently with the Executive department - President Obama's office - to ensure travel permissions are as broad as possible and, at a minimum, the 50% of Irish immigrants affected by the order will be able to go home for humanitarian reasons.

I thank the Taoiseach and Department of Foreign Affairs and Trade for their tireless and effective advocacy and support for Irish immigrants in the United States. I also publicly acknowledge and thank the Irish ambassador to the United States, Ms Anne Anderson, for her work on the issue of the undocumented. Since her arrival to the United States, she has made this issue a core priority. The consul generals in New York, including the current consul general, Ms Barbara Jones, have been vital partners in our work.

I am especially grateful to the Minister of State, Deputy Jimmy Deenihan, the Chairman, Deputy Jerry Buttimer, and the many Members of the Dáil and Seanad who have travelled to the United States to champion the cause of the Irish in the US. Without them, this important step would not have been taken. I also thank all the political parties in the Oireachtas for their continued support of the Emerald Isle Immigration Center. I am pleased to note that support for Irish emigrants to the United States has never been the subject of political debate on this island and for that I am also grateful, as are all the Irish immigrants living in the United States.

We will count on the groundwork we have in place and will seek additional funding from the Government to ensure we are in a position to help as many Irish applicants as possible from the date the scheme opens in May 2015. We calculate that, between May of next year and the end of the current Administration, we will help thousands of potential applicants in New York city and across the east coast of the United States. Our vision will include the enhancement of current services to ensure legal resources are available at every level and our social service delivery can be maximised to meet possible further growth. I will take a moment to explain what this will entail. It is our belief that when the executive action comes into force, many of our people who have been trapped in cash jobs which are below their skill levels will be able to secure employment or training that correspond to their skill levels. Once this measure is implemented, our job will be more complex than simply processing immigrants who can take advantage of the executive action and will involve training and finding work that was previously unattainable because of immigrants' undocumented status.

Unfortunately, the undocumented are not eligible for public assistance, although they may receive benefits necessary for their health and survival. This means that while they are covered for visits to emergency rooms in the case of catastrophic illness, routine medical procedures are not covered. As members are aware, the individuals in question tend to postpone or defer completely preventative care and treatment for minor medical issues, thus placing themselves at risk of experiencing even worse health outcomes. The Emerald Isle Immigration Center has been able to work with the city and State of New York to secure free health care for children. Many Irish immigrants mistakenly believe their children do not have medical cover because they do not have green cards. Regardless of status, all children are covered by the State of New York for all types of medical care. It is important that we get this message out to the community.

Similarly, the elderly are also eligible for all types of medical care, irrespective of status. Our job is to ensure they are provided with complete access to medical care, even where they do not have documentation. Unfortunately, immigrants who do not fall into these two categories - the elderly and children - experience substantial problems in this area.

The centre's meals on wheels programme has borne great fruit. Using a large group of volunteers, our centre in the Bronx provides daily hot meals delivered directly to elderly people. The initiative provides a sense of companionship as someone will look in on the elderly every day, thus allowing them to maintain their dignity while living at home. We would like to expand the programme in the Bronx and extend it to Queens. When the electricity supply was cut off in the Bronx during Hurricane Sandy our volunteers climbed 12 flights of stairs every day to look in on the elderly until power was restored.

Recently, we were able to help a 64 year old man who had been working as a cook in the Bronx. He suffered an accident, was unable to work and had no insurance. We were able to get him admitted to hospital for surgery. Unfortunately, he did not have access to social services or physiotherapy but we were able to find a way for him to return to Ireland and receive the support of his family to help him recover. Unfortunately, repatriation is one of the only ways we can help immigrants with certain types of injuries.

Sadly, the issue of suicide, to which the two previous speakers referred, is ever present in our immigrant population. Unfortunately, the Irish community in Queens has experienced several suicides and many such deaths are not reported as suicide. One suicide is one death too many. The considerable success the centre has achieved in this area has gone unreported. We take the issue of mental health very seriously and our social workers in the Bronx and Queens have been very successful in intervening at an early stage to provide health supports. We welcome the initiative taken by the Minister of State, Deputy Deenihan, in providing additional resources to the community to deal with this serious problem and look forward to collaborating with partner agencies and the wonderful team of consular staff in New York in this regard.

The Emerald Isle Immigration Center appreciates the interest, assistance and support of the committee. I urge each and every member to visit one of the centre's offices in the Bronx and Queens. I believe they would be impressed with the hard work and outreach done by our staff and volunteers. I hope they will take the opportunity to visit us.

The health issues of the community are extensive due in no small part to the lack of health services provided to the undocumented. However, with the committee's help we, at the centre, are meeting these challenges. President Obama's action, by providing employment and thus health insurance, will go a long way towards alleviating many of these problems. The ultimate solution, however, is to regularise the status of each and every Irish immigrant in the United States. It is time, once and for all, that the sign "Irish need not apply" was ripped down from the borders of the United States. Go raibh míle maith agaibh.

Chairman

I thank Mr. O'Dwyer and the organisations engaged in this area in the United States for the tremendous work they do. It is important that the joint committee hear from Ms McShannon. I invite her to make some brief remarks.

Ms Jennie McShannon

I thank the joint committee for inviting us to this hearing. I will make some concluding remarks which will draw on the comments of Dr. Tilki.

She referred to the need for us to continually engage the policy makers and people who influence decisions and to our work within the community to address these health concerns. It is very much a continuous job. The regular turnover of policy makers in specific health areas makes it a difficult task. It is also made more difficult by the fact that it is increasingly difficult to secure funding for or generate discussion about the lack of access to services for the Irish and other ethnic groups.

In response to these health and interlinked social care issues, we need a combined approach. This entails continual lobbying of the various government departments, such as Public Health England, and of the parliamentary committees, such as the all-party parliamentary groups on dementia, cancer or cardiovascular disease, to press for Irish health concerns and to make the case for the Irish dimension to be included in policy and practice. We also work closely with the leading not-for-profit organisations in the United Kingdom, such as Bowel Cancer UK and the Alzheimer's Society to enable and pressurise them to make the case for us.

We work extensively with the local Irish community press, Irish TV and radio in Britain to raise awareness of health concerns within the community, starting conversations that are usually avoided within the community and paving the way for more open dialogue and action on the more serious health issues. A large part of our work, especially that funded through the emigrant support programme, is to work directly with the front-line Irish support services to develop their capacity to provide health focused initiatives and to challenge poor access at a local level, working in partnership with local health charities and developing activities which reduce the health risks. Many of the more professional organisations that make up our membership are dogged in their efforts to engage local health commissioners and commissioning groups and go to them armed with the data, the reports and the health fact sheets we can provide to them.

I know time is limited, but I would like to re-emphasise how important it is that we harness our culture and that our support is a way of generating better health. We can harness our culture as an end in itself. Bringing Irish people together in cultural settings appropriate to their age and interests contributes to their well-being in itself, but it is also a means to an end. It is a way to get people together initially, but it is also a way to get them then to avail of the many activities beneficial to their physical and mental health.

Our organisation, Irish in Britain, works in partnership with the front-line Irish cultural and community support services to create what we believe is a full and comprehensive response to these long-standing and emerging health needs. We are primarily funded by the Irish Government in the face of a chronic lack of funding alternatives in Britain. We work together to do our best. The Irish voluntary and community sector which makes up our membership is extremely grateful to the Government for its sustained support, despite the difficult economic times Ireland has been through.

Deputy Billy Kelleher

I welcome the witnesses and thank them for the important work they do. Sometimes the work done for Irish people abroad, particularly in advocating for people who have fallen on hard times, goes unappreciated here. I refer also to the work in the context of the legal loophole that has caused significant misery for undocumented Irish people in the United States and the continual campaign on that. Perhaps when Mr. O'Dwyer has finished working on that in the US, he will come to Ireland where we also have issues in regard to how we deal with some of the immigrants to our shores. Unfortunately, there might be work to keep him busy for a long time.

There have been consistent waves of emigration to the United Kingdom and the United States. In more recent times, we may have applauded ourselves and appeased our consciences somewhat by assuming and telling ourselves that those emigrating now are better educated and can sustain themselves in Britain, Australia or the United States. However, there is always a cohort that slips through that net. It happens in Ireland and is bound to happen elsewhere.

In regard to the profile of our emigrants, the witnesses have pointed out that the Irish community in the United Kingdom is getting elderly. Many of those people who emigrated in the 1950s, 1960s and 1970s would have gone into the types of occupation where there was little health and safety awareness at the time. I refer primarily to the construction industry. I assume our witnesses see many of these emigrants come towards the end of their lives in poor mental and physical health. Many of them had poor educational standards and many of them may now feel isolated because their peers have moved on or passed away. In that environment, is there more we can do to support Irish communities and centres abroad? What can we do to assist those people who are on the verge of falling away from society completely?

I have been to New York, London, Liverpool and elsewhere many times and when visiting Irish bars or communities one can sense there is a cohort of people in a desperate situation. I have noticed, particularly in the past number of years, that more people are dying abroad with no family support. Sometimes we are contacted, mainly by people in rural areas, such as west Cork or Mayo, asking if we can do something for these people. It is sad to see that people reach the end of life and have no support or family around for them. This is not a criticism of the Irish centres abroad, but an observation of the fact that we need to do more on this for people who have fallen on hard times. These emigrants have removed themselves from society and their own communities and then seem to have dropped out. How are we to keep in contact with them? Often they drift from bedsit to bedsit and it is difficult to keep in communication with them. How are we to do that?

Reference was made to the health of the second generation Irish community in the United Kingdom. I am concerned by what was said. We all accept that young people go abroad, where they may work and play hard, and that their health outcomes might not be what they should be. However, second generation family members are falling into that same trap. What is the reason for this? What observations would the witnesses make in that regard? Is it something inherent in the Irish make-up? Mention was made of the Caribbean, Pakistani and Indian communities, which do not seem to follow the same pattern and whose second generation picks itself up quickly.

In regard to mental health, there is no point pretending all is well. There have been stains on us in terms of how, for example, we dealt with young girls who got pregnant outside of marriage or people of different sexual orientation and the stigmas attached to that which caused these people to leave Ireland. I assume and hope emigration for these reasons has slowed down and that there is not the same level of these people going abroad or that not as many people are presenting in the United Kingdom with these challenges. It was not always to better their lives that these people went to the United Kingdom but to avoid bringing shame on their families.

Can the witnesses give us some advice on what we can do? Our record on what we have done to help those abroad is not great. We have not embraced our emigrant communities as much as we should, other than through nostalgia, in terms of hard core support.

Deputy Caoimhghín Ó Caoláin

I join in welcoming all of the panel. I also welcome the Minister of State, Deputy Deenihan, and wish him well in his new role. Having heard about the extensive travel he has embarked on, we could all be envious, but I know and acknowledge that he is doing important work. I wish him continued success in all he undertakes.

Deputy Jimmy Deenihan

Deputy Ó Caoláin would be criticised for travelling whereas I would be criticised for not travelling.

Deputy Caoimhghín Ó Caoláin

I never get to travel. It was a pleasure to hear the presentations from Irish in Britain and the deputation from the United States. I will address the points in the order they came. Dr. Tilki was first. The health profile that Dr. Tilki has shared with us of the Irish in Britain is concerning. Sadly, it reflects the story at home in many ways. Dr. Tilki outlined the probable factors in her presentation, but are there any other factors we should consider? She suggested those outlined were not the only ones. Are there any other factors that contribute to these statistics?

Dr. Tilki's presentation addressed not only what might be seen as the immigrant community, she referred to second generation Irish as well. This was reflected by Mr. O'Dwyer too. It is singularly important. These people feel every bit as Irish as we who have been born on this island do and that needs to be acknowledged. They are often, although not always, Irish passport holders and very proud of their parental roots. They identify and empathise with all that we are and it is important that we address their issues and needs in this overall discussion.

We have discussed supports from home. Could Dr. Tilki and Ms McShannon outline the position from a British experience? What supports does the host central government provide in terms of the critical work that Irish in Britain is doing, given that the organisation deals with people who are resident on the island of Britain? Obviously that Government has a major responsibility.

What is the level of engagement between Irish in Britain and the local authorities? I notice that Irish in Britain is engaging with Brent Council. I gather this is in the context of the Cuimhne Champions, a mighty undertaking. It is inspirational and something we should consider at home. I am dealing with dementia in my family. Many of us have this experience, particularly given an ageing population, although the problem presents in younger years for some, all too sadly. I was greatly taken by the reference to Cuimhne Champions. Will Dr. Tilki give us a sense of the engagement with local authorities? Is there funding or support? Is there an awareness, a realisation and an acceptance of the critical work Irish in Britain does for people who are domiciled in certain areas for which local authorities are responsible?

Mr. O'Dwyer referred to the Obama initiative. It generated great interest at home; there is no question about that. I accept what Mr. O'Dwyer said about the US President being constrained by virtue of the political reality that he has to work within, but this is subject to a timeframe. Some 50% of the undocumented will become documented. Does Mr. O'Dwyer have any concerns for what might be down the road? It is a major step. It is not coming in until May but perhaps not everyone who can qualify has made up their mind. What about parents of US-born children? What are the consequences for them? Are there downsides? Are there fears in terms of Mr. O'Dwyer's knowledge and engagement with people in Washington? It would be great if he could assuage any such fears for us today. This is what I want to be addressed above all. Of course the truth is the most important thing and we must deal with the facts.

Mr. O'Dwyer referred to New York and free health care for children. I was not aware of this. Up to what age do the authorities there regard children as children? Here it is up to age 18 years. Does it apply up to age 18 there too? Does this apply anywhere else in the United States or is New York unique? Is this replicated in other major population areas?

Mr. O'Dwyer referred to a 64 year old in the Bronx. I spent a short time working in London many years ago. While there I met several older Irish people who were at a loss in their lives and in advanced years. In the decades since, I have always remembered their yearning to return home. This former chef to whom Mr. O'Dwyer referred sought to be and was successfully repatriated to Ireland. I wish him every blessing in his agreed settlement at home. Have there been other cases? Is this something Mr. O'Dwyer encounters from time to time? I will put the same question to Dr. Tilki and Ms McShannon. Is this something that presents at Irish in Britain? I know of it personally from a period when I worked in London. I knew people who would have loved to be able to come home but did not have the wherewithal to do so. Is that part of what Irish in Britain does at a local level? My thanks to the deputations.

Senator Colm Burke

I thank the Minister of State, Deputy Deenihan, for his contribution and for the important work he is doing. I thank all the people who presented this morning. I will comment on Irish people who have gone abroad in the past 25 or 30 years. A vast number of people in the professional area are now working in the United States, the UK and throughout the world. What level of support are we getting from people who are doing exceptionally well in the UK? I have in mind in particular people who have gone there in the past 20 years. A member of my family worked in a hospital in London between 1991 and 1994. The entire staff in the hospital, including nurses, consultants, junior doctors and the cleaning staff, were Irish. The Irish in Britain representatives painted a picture here but there is another picture of people who have done extremely well as a result of going abroad. What level of engagement is there with the people who are doing well, especially those in the upper end of the socio-economic groups? Could we do more to make them aware that people who went in different times, for example, in the 1940s, 1950s and 1960s, need support? They did not have the same educational qualifications and did not get the same opportunities.

There is another interesting issue. We always hear about the person who has died in the United States or the UK and of someone trying to track down relatives in Ireland who will benefit from the estate. I have come across several cases in my legal office involving people who have left Ireland and who would benefit from Irish estates but I cannot track them down. We do not seem to have a mechanism for tracking Irish people in the UK or the United States. It is like trying to find a needle in a haystack. In one case I had to keep money on deposit for seven years because we could not track down the relevant person. In the end we failed over a seven-year period to track down the person. It is a two-way process.

Another issue is the matter of getting information to Irish immigrants who are in the United States illegally. What can we do from an Irish point of view? If we have relatives who are in the US and we know they are there illegally, how can we help to get the relevant information to them, if they are afraid to try to look for information themselves? What processes can we set up to help in this area and to help the relevant organisations transmit this information? We have a part to play in the same way as the organisations that are doing major work in this area. What can we do? Are we doing enough in this area? Where can we start making progress to help the organisations in this area?

Deputy Catherine Byrne

I welcome the witnesses, in particular the Minister of State, Deputy Deenihan. I have not read Deputy Ó Caoláin's notes because it was the first thing I said. I am delighted to see the Minister of State here. He was very passionate about his previous job in the Department of Arts, Heritage and the Gaeltacht and I know the passion he has for people who live abroad, in particular Irish people. It was obvious during his time as Minister of State in the Department of Arts, Heritage and the Gaeltacht. I wish him every success because he is in the right place.

I was saddened to hear some of the contributions, which made me think of my family, in particular my two aunts who left Ireland near the end of the Second World War. They lived in Coventry all their lives and were part of the local community, as well as the island. When my last aunt died a number of years ago, I went to her funeral in Coventry. One regret we have as a family is that we never took her back to Ireland to bury her because at the time there were many complications around doing that. I always felt that my mother had a better lifestyle during her life at home because she had connections in terms of family and friends, and a shoulder to lean on. When I visited my mother's grave in Palmerstown, I realised that relatives have constant contact with loved ones by visiting graveyards. I am sure the same happens all over the country, not just at Christmas or Easter. The Irish have a great respect for those who have died, in particular family members. I often feel saddened that I do not visit my aunt's grave.

I had the opportunity of visiting the Oblate Fathers in Inchicore. I was a member of the youth overseas group to Lourdes. I visited many Irish centres in Liverpool, Holyhead, Leeds and London and was always struck by the wonderful work done by the Oblate Fathers. I do not know whether the witnesses' organisations link with religious organisations. When I was Lord Mayor of Dublin I spent time in San Jose - it was probably the only time I left the country as Lord Mayor because I am not a great traveller - and visited some of the Irish centres there and in San Francisco. I saw the same problems there as I did in England. I was struck by the fact that most connections came from GAA clubs or local pubs. After that, there was only the centres. I always felt there was a need there.

Dr. Tilki mentioned alcohol and addiction. We have the same addiction here in Ireland, in particular among older people and those who have come from very poor backgrounds and live in poor areas of cities. It is generational and it is difficult to break the cycle. Many countries now have major problems with young people binge drinking. The fear is that the next generation will require many liver donations, something doctors told the committee some time ago.

I thank the witnesses for meeting us. We had a lovely get together and it was nice to be able to talk to people on a one-to-one basis. I sat beside Mr. Carroll's daughter.

Mr. Mike Carroll

Her name is Sarah.

Deputy Catherine Byrne

She is a very beautiful girl and I am delighted to say she will be in the Houses for a while.

Why do the older Irish living aboard have so many health problems? Can that be attributed to the fact that many Irish people who left the country had a Catholic background? I was struck by the fact that it was said many health problems stemmed from people not wanting to expose their private parts. That is sad because people are ill. Is that the psyche of older people who were reared in Catholic families? In my mother's final weeks, my two brothers had to bring her to the shower because she had Alzheimer's disease. I was struck by how she would have felt about that, but she did not know what was happening. We were very privileged to be able to have her at home and assist her.

What connections do the new Irish abroad have with the older population abroad? Mr. O'Dwyer might answer that.

Deputy Sandra McLellan

I welcome the witnesses and thank all the organisations for the tremendous work they do. I wish the Minister of State, Deputy Deenihan, well in his new role. I had a lot of engagement with him in his previous role as Minister of State at the Department of Arts, Heritage and the Gaeltacht, and I know he was very passionate about that. I am delighted he is here before us today and that we have the opportunity to discuss these issues across the diaspora.

Many issues have been covered. I want to touch on one or two health issues. The presentation stated that smoking rates are declining slowly in the Irish community, which has to be welcomed. I wonder why that is happening. There are major issues around obesity, poor nutrition and alcohol, and lifestyle and health are connected to that. We all know people who come from poor socio-economic backgrounds are generally in poorer health.

Barriers to treatment were mentioned. What type of screening programmes are available to the Irish community? There is a very strong link between alcohol and cancer, and we had a briefing session on that in the House last week.

The witnesses discussed some tranches of funding in the presentations. From where do they get their funding? The funding mentioned was minute.

With regard to the undocumented Irish, they are covered for emergencies or catastrophic illnesses, but not for routine procedures. I did not think they were entitled to any health cover. It was said that children are entitled to receive medical care. That is news to me because I often wondered what families did if they or their children were sick. It is interesting to know that they are entitled to medical cover. I would not have known that. I understood that was the case in New York; I do know if it applies across the United States.

The case of a 64 year old man who had been working as a cook, and was helped to repatriate and return to his family, was mentioned. Do the witnesses repatriate people who do not have families to return to? Where do they go? A person of 64 years of age does not qualify for a pension. Some people who return from abroad have difficulties accessing services here because they have been away so long and do not have entitlements. If they do not have families to return to, do the organisations ensure that they will be assisted financially or will be entitled to benefits and housing in the State? I am curious about that.

Chairman

We will begin with Ms McShannon. Some of the questions were not asked directly.

Ms Jennie McShannon

We will swap between us. In regard to the work that can be done, the Irish voluntary and community sectors are very proactive in engaging as much as they can in terms of reaching the community. Deputy Kelleher referred to the older generation becoming more isolated at the end of their lives. A major issue for us is that there so many local Irish centres.

Localism and locality are important to them. Their ability to travel decreases over time and this is evident in Irish clubs and community centres, particularly those in the north of England where people used to travel across the shires to attend a big Irish community centre. These centres have seen a decrease in footfall, mainly because people are ageing and less able to travel. It is important, therefore, that local services adapt. For example, Cricklewood Homeless Concern, now called Ashford Place, a facility with which many members are familiar, previously heaved with Irish people, but as they have aged, they have become less confident and many are unable to leave their homes. It is important to consider providing outreach services for such persons. The London Irish Centre previously conducted all of its services from the centre, but it now runs 17 lunch clubs and provides day care services around the city, while much work is still done in the centre.

I have spoken to some of the large social care providers and there is an emphasis on working with people on end of life planning and care. We have just started what we call a little Irish support partnership across infrastructure to help people to consider making wills and legacies. In part, this scheme is a way for people to feel supported by Irish community organisations; it is about getting people to think about end of life care and burial arrangements. We try to help them to think about what happens when they become ill.

On mental health, it was mentioned that some people had left Ireland owing to pregnancy, their sexual orientation and so on, but these issues have diminished in many ways. Irish society now promotes greater inclusion, which we welcome. Members have noted that the Irish now arriving are better educated and have high expectations of success in Britain. They are well received as an educated global commodity and do not face the same prejudice and discrimination in Britain that Irish people endured in the past. Much of this is due to the peace process in Northern Ireland, the positive relationship between Britain and Ireland and the young Irish people who travel to Britain. We are very proud of these young people, but there is a risk in assuming that they are all thriving. The Minister of State, Deputy Jimmy Deenihan, referred to services such as the immigrant counselling and psychotherapy service, ICAP, Mind Yourself and Irish Community Care Merseyside in Liverpool, through which we have seen that some young Irish people arriving in Britain are unprepared for the cultural differences they experience. Many do not realise how isolating it can be to live in a city like London and, while furthering their careers, some feel anxious and depressed. The research we conducted with the London Irish Centre in 2012, which specifically targeted the group we call the thriving young Irish, as opposed to the old and vulnerable, showed all of this. It is important that services adapt and are provided in different ways. It is not always a matter of providing advice and welfare services; it is also about social engagement and inclusion.

Chairman

Do young people engage in the same way as previous generations did in the 1960s and 1970s? If not, is there a way to reach them? How is the gap bridged?

Ms Jennie McShannon

It is very important that we approach different groups in different ways. Places such as the London Irish Centre and the Irish Centre Birmingham aim to engage people culturally and use social media and networks. Communities used to engage based on from where members had come and to where they had moved - I refer to societies such as the Leeds Mayo society and the London Leitrim society. Now as people are more likely to meet based on their career choices, it is very important that Irish community support services engage with business and arts networks. It may sound cheesy, but things like Father Ted events attract people to Irish centres because these centres are often perceived as serving only the vulnerable and the old. If we get people through the doors, we can find ways for them to engage and feel culturally comfortable in order that they feel at home and do not need to explain themselves. We want them to know that these services are available in order that they can avail of them if mental health difficulties arise such as anxiety and suicidal ideation. Mind Yourself has organised a lesbian, gay, bisexual and transgender, LGBT, group and Irish film and dance classes with a modern twist.

A committee member raised the issue of support from the British Government and this is a difficult one for us. In 2008 there was a change in government policy on funding ethnically-specific services and prior to that year it was easier for Irish organisations and organisations working with ethnic minority groups in Britain to access funding. The move away from this policy has been quite definite; therefore, we try to encourage our member organisations which are independent of us but work with us to seek local authority funding and grants for specific services. Members will know that funding is limited; therefore, there is an over-reliance on the emigrant support programme. A major concern is that when the British authorities consider the issue of immigration, they tend not to see Irish people as immigrants. We have campaigned, lobbied and raised awareness, in tandem with local groups, to get funding, but Irish groups are often the last to get it and the first to lose it.

Chairman

In her presentation Ms McShannon referred to a failure to collect and analyse data about Irish people. What is the reason for this failure and is it linked with what she has just said?

Ms Jennie McShannon

There is a partial link. The collection of data can relate to health services such as targeting obesity in the Irish community. Irish people are seen as white and English-speaking and an unintended consequence of the peace process is that they are no longer considered to give cause for concern. This belies the fact that there are underlying vulnerabilities. The British authorities no longer believe it is as necessary to engage with the Irish community in Britain.

Deputy Billy Kelleher

I apologise as I must leave the meeting to speak to an amendment to the Water Services Bill in the Dáil. I will try to return.

Chairman

A photo is to be taken at the end of the meeting. We will let the Deputy know when this is to happen.

Dr. Mary Tilki

Deputies Billy Kelleher and Caoimhghín Ó Caoláin asked about the very poor health of the second generation and there is no simple answer. Some have done phenomenally well in terms of education - even people from very poor backgrounds take pride in education and many have done well. Others have not thrived and some people in poor and disadvantaged communities were not proud to be Irish because of the discrimination they faced. Some schools made great efforts to get children to use Irish accents. In poor and less confident communities racism and discrimination were woven into people's lives and the Troubles had a significant impact in this respect. Some Irish parents were not confident and did not instil confidence in their children. Some Irish people in Britain formed bad habits and we can be very judgmental about their smoking and drinking, but the circumstances in which they lived explain a lot.

On Deputy Caoimhghín Ó Caoláin's question, discrimination played a big part in people keeping their heads below the parapet and thus not availing of health services. Those who accessed health and social services often faced discrimination.

For example, one might go to a doctor with any kind of health problem only for the first question to be how much does one drink and how much does one smoke and to be told that were one to give those up, one would be fine. While these are quite legitimate questions for a professional to ask, not as the first question. Moreover, people's accents were made fun of and people were blamed and judged for their poor health behaviour and poor health and that does not help. Another point when talking about men is that it was a very macho culture, particularly in the building industry. One's confidence was about how many of yards of a trench one could dig in a day or how many bricks one could carry on one's hod and if one had a health problem, one would be a weakling to give into it. There is something about that.

Deputy Catherine Byrne asked about the role of Catholicism and the role of religion. It played a part that was highly positive for some people but it has played a very negative part. We are embarrassed about our naughty bits with people saying there is no problem and we are very familiar with this. However, for the older generation in particular, it often was easier and they had more confidence in praying to St. Anthony, St. Jude or whoever that they would get better. They would invest rather more in that than in going to a doctor who perhaps was less than sensitive. The other side of it is that many people got great help and support through their personal faith and through their religious practices. While it is easy to knock the others, we must recognise that.

As for what else, Ms Jennie McShannon has a list of things I must say.

Ms Jennie McShannon

One issue was on volunteering among professionals and its impact.

Dr. Mary Tilki

Senator Colm Burke asked what support and what engagement we get from the professional migrants. In many cases, they could be more aware of what is happening. Ms McShannon made the point that they do not wish to engage with what they perceive to be an old or traditional Irish culture. However, once they are aware of the position of those who came before them or indeed the second generation, many of them are willing to help and to give their support. We have professional networks in different cities, including Manchester, Leeds and London. Many of our organisations also are recruiting people from professional backgrounds to their boards, that is, from legal, financial and human resources backgrounds because in some cases we have issues with governance in our more traditional organisations and therefore are bringing in people. Many young lawyers and people with expertise in the field are doing pro bono work - one who comes to mind initially actually works with Birmingham Irish groups and is helping people with industrial injuries, asbestosis, symphysiotomies and things like that - they are doing a lot of good work. Moreover, through the Cuimhne projects, we hope to recruit more people - not just from health backgrounds because they often have negative views about dementia - but from professional backgrounds who would be sufficiently confident and articulate to champion the cause and to present information. We hope to recruit more of those people as part of this volunteer programme. As I mentioned, some of the new Irish have very few connections with the older Irish population because they perceive them as being older, more traditional and having nothing to do with them. Another point that is worth making is that some of the older generation have a fairly negative view of the second generation. They often are referred to as plastic Paddies although, as Deputy McLellan noted, they were brought up very much in an Irish culture and are proud of their heritage. They often are highly offended by an older generation who call them plastic Paddies. We actually use those people a lot more.

In response to the other question on what screening programmes are available, there is a three-year cervical screening programme from about the age of 16 or 17 onwards. There is mammography from the age of 57 until the age of 73. I have friends who are GP-practice nurses who tell me that when an Irish woman comes into the practice for whatever reason, they push her down on the table and try to get her through that screening process because Irish women are reluctant to make appointments. While prostate screening also is available, Irish men are very reluctant in this regard but we are working on that at present. Bowel cancer screening is available in the United Kingdom where one gets a little packet through the post but again, Irish people throw it in the dustbin and do not wish to have anything to do with it. The facilities are there, although they are not perfect and are not necessarily very sensitive. However, we need to do more work about getting people to take them up and use them. As for the cancer and alcohol links, it is a sensitive issue in our community - I am as sensitive about it as anyone else - because we are labelled drunks and all the nasty things that go with that. Sometimes, health authorities are frightened to do anything about it, so we must make that link. The link between alcohol and suicide is recognised quite widely in the majority population but as nobody makes the same link with Irish people, there is much more work to be done in that regard.

Finally, on the question the Cathaoirleach asked about the NHS statistics, data about the Irish are collected for many things. Information is not available on cancer registries or on GP practice records although it is getting better. However, what happens to the data that are collected is that the Irish are aggregated into a big amorphous "white" category within which the poor health of the Irish is lost. The problem is that quite often, ethnicity is perceived as a black thing, a skin colour issue, not about people from other migrant groups and we are working hard to change that. I always am harping on about it and nagging and pestering people but in all honesty, it is a very big issue for providers to deal with and if they forget about it, it gives them a little bit of scope. When we have made progress, it can be very good but then one gets a new officer, a new ethos or something so one must start all over again.

Chairman

I thank Dr. Tilki. I now call Mr. O'Dwyer.

Mr. Brian O'Dwyer

I have just a few remarks and to pick up on the point made by the previous speaker, we have that problem in the United States of being categorised as white and therefore not having any problems at all. On the immigration issues in particular, we have tried hard to broaden the immigration issue to ensure it is not looked at as being merely a Latino issue. We were very pleased the other day when the President referred to the problems and made his remarks in Chicago that it was not a Latino issue but that there were many undocumented Irish and Polish immigrants. That really broadened the debate considerably, although it is particularly galling for an Irish-American to be listed as an Anglo. I have indicated to those who have called me an Anglo that generations of Irish men and women have died and shed blood not to be called that and I was not about to be called an Anglo in the United States.

There are a few things I wished to talk about and Deputy Kelleher asked about the best way in which we reach out to the elderly. There are two things we do that are important for us. One is the meals on wheels programme I mentioned. It is a very important programme because the volunteers visit elderly people in their homes. We know, of course, that it is difficult for people to reach out when they have problems. That is part of the Irish ethos but if somebody is coming into their homes, they will reach out if something is wrong and that person will be told.

In particular, at the Bronx office we have set aside a place for the elderly to drop in. We have a knitting group and Barry's tea which is the greatest therapy there is. They come in, have a cup of tea and feel at home with each other. This has had a major impact on our community in the Bronx. They would not come in to ask about a problem, but once they are in there, if there is a problem, we will know about it. If they come in, we can help them.

I want to talk a little about the immigrants who are coming now. While we can say many of them are better educated, we can also say many of the people who come are in particular need of social services, whether it be around sexual identity or just a question of not getting along at home and having a difficulty with mental problems. Unfortunately, as we say, our immigrants do not leave their problems at home when they come to New York. They come with these problems and it is up to us to try to deal with them through our social services. Because of the federal nature of the United States, we get no funding from the US Government. We are very fortunate to be in New York city, as are most of the other centres to be in cities that value and treasure their immigrant populations. We get about half our funding from New York City Council and the New York city Mayor's office which have been extraordinarily supportive of the work of the association. The Irish American caucus in the city council has been particularly good, even with the change of administration.

I note in response to Deputy Caoimhghín Ó Caoláin that we can get our people covered to age 18 years. This does not happen in all states, but they include New York, Massachusetts and some other states. It is because New York is reaching out to immigrants and has a very different view on all levels, including health and education, of the undocumented from that in Texas or South Carolina, for example. Higher education is available to our people in the City University, to which we have reached out, with in-state tuition. This has allowed them to go back to school, even without documentation.

The Deputy has rightly put his finger on what our next problem is going to be. By nature of being undocumented, our people are very wary of the government. Even when we had the Morrison visas and amnesties in the past, many of them did not even register for fear of being put on some sort of government list. Our first job is to ensure anyone who applies for the programme will not be in a worse shape at the end of three years. We have asked the government for and I am positive we will receive assurances that if a person applies for deferred action, the deferral will be kept confidential and people will not be put on a list for deportation if the next President, no matter who he or she might be - she I hope - comes down and------

Chairman

The committee could not take a position on that issue.

Deputy Caoimhghín Ó Caoláin

It sounds good to me.

Mr. Brian O'Dwyer

No matter who he or she might be, he or she will not be able to take back the Executive action and even if he or she were to do so, we are assured that those who had applied for it would not be put on some priority list for deportation.

I note in reply to Senator Colm Burke one thing that I should have mentioned which I take the opportunity to mention now. Unfortunately, when these programmes come down, there are numbers of people who will seek to take advantage of our immigrant population and advertise, "I can get you a green card" which, of course, they cannot. They will assert that they can get someone citizenship and that all that person need do is come up with a payment of $5,000 or $10,000. We have worked very hard with the Attorney General of the State of New York and the prosecutors in the Governor's office to clamp down on this. There is actually a new law in New York that makes it a felony to misrepresent immigrant services. What Members of the Oireachtas can do in their constituent services is to tell people to come to the centres. We are providing free advice and regular educational programmes for our people. We have had three already as this rolls out which were well attended.

We are now on a dual track, one part of which involves advocacy in the Executive branch to ensure that whatever we can get done will be done to the maximum extent possible when the regulations come out. At the same time, we are engaging in information centres to ensure the full story gets out as to who will be eligible, how they will be eligible and how they can apply. A lot of this has yet to be determined. Pub talk can be very destructive in an immigrant population. I am aware that every Member of the Oireachtas receives regular telephone calls from parents or siblings asking what this means and what they should do. The important thing to say is that the Irish Government - I thank the Minister of State, Deputy Jimmy Deenihan, and the Government - has provided these centres with resources to take care of the population. It is important that people get the right answers by going to the centres and they should be told to listen to nobody else. It is when they listen to others that they get into terrible trouble.

Deputy Jimmy Deenihan

I thank the Chairman and the committee for organising this discussion. It is very important from the point of view of the diaspora and the Irish nation reaching out and talking to each other. I hope it will set a precedent for the future that we can have further discussions such as this. Certainly, I am more informed than when we started. I thank Dr. Mary Tilki, Ms Jenny McShannon and Mr. Brian O'Dwyer for their well informed contributions. They hit all of the important subjects and we have all learned from the exercise. I note also the people involved in the emigrant support programme, including Mr. Ciarán Madden, Ms Emer Rocke and my officials, as well as Ms Celine Byrne. They have all been involved in the programme for a number of years and it has been very effective.

To answer a few questions, Deputy Sandra McClellan said the funding did not appear to be too generous. I have been in the Oireachtas a long time and was not aware that the funding was as generous as it had been, notwithstanding the financial challenges in recent years. To the end of 2013, the Government had spent €114 million on the emigrant support programme. At the end of this year, it will have spent €126.1 million.

The UK was the main beneficiary because, obviously, more people go to there as it is easier to access. Up to the end of 2013, the UK received €84.2 million and the US was next with €19.7 million. Australia received €2.3 million. The Irish taxpayer through the Irish Government has been generous despite the challenges we face here in various areas. That should be acknowledged, and I acknowledge previous governments' contributions. I hope that we are retaining it and I hope to increase it as things get better here. That is very important.

I will refer briefly to a few issues. The first relates to inter-generational connections among Irish communities overseas. I have noticed that myself, and I have seen some really good connections. I will certainly be making a greater effort to encourage younger Irish people to get involved in the various organisations and centres. Our ambassador in London, Dan Mulhall, held a meeting of young Irish groups in the embassy. Perhaps Ms McShannon might comment on that. This meeting is a start. I visited London recently and would like to thank all those people for the very generous and warm welcome they gave me. It was uplifting and positive and certainly makes one want to do more for the organisations over there because they are so positive and committed. The next time I visit, I will try to connect with the younger Irish generations over there, in New York and other centres around the world. There is a really strong commitment from the younger population in Australia.

I will mention a few initiatives about Irish people coming back and being supported. Safe Home, in which a former Member of this House from Mayo, Dr. Jerry Cowley, is very much involved, has been very successful. The Aisling project, which brings people back for holidays here, is very positive. I visited that centre in London. An issue that has consistently come up is the question of how we communicate with our diaspora. I am launching a new diaspora strategy shortly. We will be addressing that issue. During my visit to London, I launched a very good website called Craic It London by a girl called Catherina Casey. This has proven to be quite successful in providing information. I also launched a website for the Aisling Project. Apart from the centres, the emigrant organisations are responding and providing this information online.

In conclusion, I am delighted to be here. I will be launching the strategy shortly and a number of points raised here will be addressed in it. I may come back in the future to discuss the strategy with the committee but there will be an emphasis on health and providing information for our diaspora and for people to make better lifestyle decisions in areas like looking after their fitness and ensuring that they avail of services. One of the prime purposes of the emigrant support programme is to support organisations to ensure that people are aware of the services to which they are entitled, regardless of whether they are in London, New York, Manchester, Liverpool or Melbourne.

Chairman

I thank the Minister of State and the witnesses for the interesting and valuable discussion this morning and for being available to us. As the Minister of State said, it has been the beginning of what I hope is a future conversation where we and the Oireachtas Committee on Foreign Affairs and Trade can work together with the diaspora strategy and the issue of health and well-being of our emigrant population and our diaspora. It is important to acknowledge the work of the emigrant support programme and thank it. As we have all said, there are families that are hugely dependent on, are supportive of and grateful for the work it does. I will not name individuals but I thank them for the work they do. We can all provide testimony of families that have issues with people who have gone missing or who cannot come home - issues that have hugely upset family life. Hopefully, this committee can continue this discussion and broaden it.

I remind members that there will be a photograph at the end of the meeting and that next Tuesday's meeting is divided into two parts. Part one is the HIQA report on the national ambulance service where we will be joined by the members of the HSE and the second part of the meeting will deal with care home settings and the television programme on Áras Attracta on RTE last Tuesday night. We will hear from Pat Healy, national director of social care at the HSE and, hopefully, other members of the HSE as part of our response to that programme.

The joint committee adjourned at 11.47 a.m. until 5.30 p.m. on Tuesday, 16 December 2014.