Seanad Éireann debate -
Thursday, 13 Jun 2013

Vol. 223 No. 14

Adjournment Matters

Health Promotion Issues

Senator Jillian van Turnhout

I thank the Minister for facilitating me and coming into the House. It is an extremely busy day but we both know stroke awareness is very important to both of us. This is national stroke awareness week, with this year's focus on the Irish Heart Foundation's Act FAST campaign, which was launched in 2010 to increase public awareness about the early signs of stroke and encourage speedy medical intervention. I welcome Mr. Chris Macey from the Irish Heart Foundation to the Gallery. Under an Adjournment motion in January last year I raised the issue of stroke rehabilitation services and the Minister knows I have raised it with him several times at the health committee.

An estimated 10,000 people suffered a stroke in Ireland in 2012 and the same number are expected to suffer a stroke this year. Approximately 2,000 die as a result of stroke, making it Ireland's third biggest killer. Stroke is the single most significant cause of severe disability and up to 50,000 people are living in our communities with disabilities as a result of strokes. In addition to the devastating impact stroke has on the sufferer and their families, the financial costs are huge. The Economic and Social Research Institute, ESRI, estimated that in 2010 the direct annual cost of stroke was €557 million of which as much as €414 million is spent on nursing home care and there is nothing to indicate that this cost has fallen in the past three years.

In the face of these stark figures, the Irish Heart Foundation's Act FAST campaign is a commendable initiative which warrants State support. The campaign, while still in its infancy, has been a resounding success, particularly in raising public awareness of stroke warning signs through the first three letters of the acronym FAST, as follows: face, has the person's face fallen on one side?; arms: can the person raise both arms and keep them elevated?; and speech, is the person's speech slurred?

The most recent Irish Heart Foundation's Attitudes and Behaviour study found that there had been a 190% increase in awareness of these warning signs. This increased awareness, along with the rapid development of the 24-7 thrombolysis services nationally by the HSE's national stroke programme, has contributed to a 400% increase in the numbers receiving life-changing, clot-busting treatment and it has helped cut death and disability rates from strokes significantly, against demographic and international trends.

However, the last letter of the acronym, arguably the most important one since it is the call to action, namely, "T", time to call 999 if one sees any of the signs, has not had the desired impact. Just over half of the respondents surveyed said they would call an ambulance. Speedy medical intervention is imperative if we are to limit the detrimental impact of stroke. The average stroke destroys 2 million brain cells every minute, which means the quicker one gets emergency treatment, the more of one's brain can be saved. The knock-on effect is reduced risk of death or severe disability and a considerable financial saving to the State.

The Irish Heart Foundation is entering a new stage of the campaign where there is clearly room to improve on awareness of the timely medical intervention, and it needs State support. In addition to financial assistance, there are other supports at the disposal of the State, such as providing advertising sites in high footfall areas of Government buildings and properties and maybe examining a way of reimbursing the 23% they have to pay in non-returnable VAT for the campaign, which is proving to save lives and improve the quality of life, and is also saving the State money. I would like the Minister's reassurance that both financial and alternative means of supporting the new phase of the Act FAST campaign are being positively considered.

Minister for Health (Deputy James Reilly)

I thank the Senator for raising this important issue and raising awareness in the week that is in it. She is right about the figures; they are staggering. Some 10,000 strokes a year is very serious. We should acknowledge the growth in public awareness of stroke warning signs, as the Senator has outlined, and the improvements noted and confirmed recently by the HSE. The FAST campaign coincided with a major development of stroke services nationally, including an increase in the number of stroke units around the country from six to 27 and the expansion of 24-7 thrombolysis treatment from a small number of hospitals mainly in urban areas to all hospitals that treat stroke patients. The FAST campaign has assisted health services to maximise the impact of the stroke service improvements. The HSE has advised my Department that it provided €268,000 last year and €308,000 this year to the Irish Heart Foundation to help with its various health promotion activities. Like the Senator, I welcome the foundation's presence here.

Such improvements in stroke services were envisioned in the policy document Changing Cardiovascular Health: Cardiovascular Health Policy 2010 - 2019 which was launched in 2010. This established a framework for the prevention, detection and treatment of cardiovascular diseases, including stroke, which seeks to ensure an integrated and quality assured approach in their management, so as to reduce the burden of these conditions.

I could go through the rest of this but I would much prefer to talk about prevention. In this country we have a long history politically of engaging in expensive developments. They are necessary, and politicians are always very pleased to open a new wing of a hospital or an MRI scanner but have been reluctant in the past to invest in public health initiatives that can save many more lives. When we look at the causes of stroke we see our old enemies again: tobacco is a major cause of stroke and if we could keep our children and the next generation from starting on this habit it would be a lot easier than trying to get them to quit and would prevent a huge number of strokes per year.

Obesity is another issue which leads to diabetes and hypertension, which is well known to be associated with stroke. The issue of alcohol must be mentioned also because it has peculiar properties with regard to blood pressure. It is known to cause vasodilation peripherally so one would imagine it would drop one's blood pressure, but it causes vasoconstriction which causes one's blood pressure to go up. It is a risk factor also.

Many of our figures relating to stroke are preventable if these areas are tackled. Earlier I mentioned the Government's commitment to healthy Ireland. I am the Minister for Health but I often feel as though I am the Minister for ill-health because all we speak about is disease and illness when what we need is to keep people well. The Department of Health cannot do this alone. It needs the Department of Justice and Equality to keep our streets safe so people can exercise. It needs the Department of Finance and the manner in which it taxes and incentivises certain types of behaviour. It needs the Department of the Environment, Community and Local Government to give us safe, well-lit places at night to exercise. We also very badly need the Department of Education and Skills on board and I know the Minister, Deputy Quinn, is very committed to this area.

This is about developing healthy lifestyles early in life which will stay with people. Early habits are the hardest to break. This has also been proven with regard to tobacco. If one does not start smoking before the age of 21 one is unlikely to take it up. We know this industry goes after our children. It wants to replace with new recruits those who have died, including the 5,200 who died from tobacco related illnesses this year, and those who give it up, and these new recruits are children. According to a survey 78% of smokers stated they started smoking before the age of 18. It is wonderful we have a new stroke programme and we are saving a life a week, and I am told the new initiatives we have undertaken save a life per day. While all this must be done to help those who fall ill now, we must look down the road and realise the actions we take now could save the next generation from much hardship and grief. If we do not tackle the obesity epidemic among young people and the rising epidemic of diabetes we may very well be the first generation to bury the generation behind us which is an appalling thought. No parent wants to be at his or her child's graveside.

Senator Jillian van Turnhout

I support the Minister on the preventive measures on tobacco, alcohol and obesity. Strokes are Ireland's third biggest killer and I ask the Minister to give consideration to the financial assistance I have suggested and perhaps consider other measures such as using public buildings for billboard spaces or reimbursing the 23% VAT. This is a public health awareness campaign and one could argue the State should be running it. Perhaps there is a way the Government could support it such as refunding the 23% VAT to the Irish Heart Foundation.

Deputy James Reilly

I am very happy to state we have cross-Government support for these initiatives, particularly the healthy Ireland initiative. I will have to engage with my colleague, the Minister for Finance, to achieve the VAT reimbursement the Senator seeks. This is not the only area where I feel VAT needs to be examined, as we also have VAT on condoms and vaccines. There is no VAT on tablets or liquid medicine but because vaccines are in injectable form they are subject to VAT. I would like to discuss a range of areas with the Minister. We are in very constrained financial times and it is difficult to seek to reduce the Exchequer return in any real sense.

We must get the people of Ireland and Europe off their addiction to nicotine but we also need to get the governments of Europe off the addiction to the income which tobacco products bring.

Hospital Waiting Lists

Senator David Cullinane

I thank the Minister for coming to the House. I have raised the issue of long outpatient waiting times at Waterford Regional Hospital a number of times in the House. My party health spokesperson, Deputy Caoimhghín Ó Caoláin, sought from the HSE a full breakdown of the figures on all of the departments and specialties at the hospital in respect of outpatient waiting times to see exactly how long people wait to see a consultant and get into the system. It is fair to state that once people get into the system they get the very best treatment in our acute hospital services, and certainly Waterford Regional Hospital is a strong performing hospital where people get the very best treatment when they are in the system.

The figures released to us by the HSE show that a total of 28,479 people in the south east who depend on Waterford Regional Hospital are on outpatient waiting lists waiting to see a consultant. Of these, 11,338, which is 40% of the total number, have been waiting for longer than a year and 20% have been waiting for more than two years. The Minister has often said in the House that he wants all of the hospitals to meet the target he sets and that he will be very tough with the managers of the hospitals to ensure the targets are met. The problem is not getting tough with managers of hospitals. In some respects the problem is capacity and the fact we do not have enough consultants or staff to cater for the need.

Orthopaedics at Waterford Regional Hospital is a good example where the clinical director and the consultants who work in the sector will say if they are asked that twice as many referrals come to the hospital than there is capacity to treat. The target set by the Minister is a national guarantee that no patient will wait for longer than one year to see a consultant. Unfortunately this is not the case. To give the Minister a flavour of the areas involved, in dermatology 49% of patients have been waiting more than 12 months, the figure for general medicine is 37%, for ophthalmology it is 32%, for orthopaedics it is 44% and for pain relief it is 53%.

I know the Minister cannot micromanage everything that happens in the health service and he cannot comment on individual cases, but recently I dealt with a stroke victim who is having difficulty getting gallstones removed. She has been waiting for months to see a pain specialist. She has no speech whatsoever but has been waiting for months to see a pain specialist. Another person had a biopsy done on one of her glands and on two occasions she was booked into the hospital for elective surgery to have the lump removed but the procedure was cancelled on both occasions. A number of elective surgeries have been cancelled at Waterford Regional Hospital this year. The reason is very simple; it is capacity. We have closed a ward and two surgical theatres. The hospital gets full quickly which means there is no capacity to carry out elective surgeries. This means they are cancelled which creates havoc with waiting times. As the Minister knows it is very difficult on patients who are building up to having a procedure done and then it does not happen.

As the Minister is here he might also comment on plans to expand cardiology services at Waterford Regional Hospital. One of the hooks on which the Higgins report was sold to the people of the south east was that we would have a 24-7 cardiology service, but the Higgins report mentions enhanced cardiology services. Will we have 24-7 cardiology services? How will the Minister make it a reality? My main question is on the outpatient waiting times and the fact that unfortunately the targets set by the Minister are not being met.

Deputy James Reilly

The targets were only set this year and my promise to the people is that nobody will wait longer than a year by the end of this year. We are the first Government to measure the number of people on outpatient waiting lists. The total number is 386,000 people, but we see 200,000 people at our outpatient clinics every month and I believe we will be able to deal with this problem as we have dealt with the other problems. After the urgent and cancer patients are dealt with the longest waiters will be looked after. The true scandal for me is not the 386,000 people which no previous Government acknowledged or measured, but that more than 16,000 people have been waiting for longer than four years.

I thank the Senator for raising this matter and for the opportunity to update the House on the significant progress being made on outpatient waiting times as a result of the measures introduced by my Department, the special delivery unit and the National Treatment Purchase Fund. Access to acute hospital services is a priority for me and the Government. Hospitals have responded impressively to this challenge, in the face of considerable pressure.

This is due to the hard work done by clinical and managerial leaders in individual hospitals, coupled with comprehensive and coherent strategies and programmes enacted by the special delivery unit, working with the National Treatment Purchase Fund, the HSE, the hospitals, the men and women who work on the front-line of the health service and supported by clinical programmes.

With specific reference to outpatients, the National Outpatient Service Performance Improvement Programme 2012-2015 has commenced implementation. Current improvements include: validation of current outpatient lists; the standardisation of current referral management processes; improved turnaround times for categorisation of referrals; the utilising of clinic capacity effectively through booking of pre-planned appointment slots; configuring specific clinic templates to address varying requirements of different specialties; improvements in the discharge planning process; reducing the do not attend rates by patients; and identifying, understanding and resolving long-standing organisational behaviours, culture and attitudes towards the provision of outpatient services. These measures are being implemented for waiting lists in all specialties.

Underpinning all of these work streams is the availability of patient level waiting time data in all hospitals providing an outpatient service. The data has been systematically collated by the NTPF and is publicly available on its website. As I said, the maximum waiting time target for 2013 of 12 months for a first-time outpatient appointment.

The SDU and the NTPF will shortly publish outpatient waiting times by specialty which will add further to the visibility and transparency of waiting times in our health system. It is hoped that the publication of data will commence by the end of this month. Already this work has identified orthopaedics, ENT and ophthalmology as the services which, nationally, are most at risk of not achieving access targets.

Ultimately, each hospital must systematically achieve maximum waiting time targets each year by matching capacity with demand, eliminating inefficiencies in the patient pathway, ensuring the strict chronological management of patients of equal clinical priority and implementing the recommendations of the clinical care programmes. Establishing hospital groups will further facilitate hospitals in addressing waiting lists. These Groups will see small and larger hospitals working together as teams, in conjunction with their academic partners, to enhance innovation and effectiveness in service development and delivery.

Waterford is a busy hospital. It is a cancer centre, hub for the southeast renal service, provider of invasive cardiology services and a regional trauma centre including an emergency department, ear, nose and throat and ophthalmology. Given the level of activity, it is no surprise that midway through the year work is ongoing to accurately measure and validate outpatient waiting lists and to match these to capacity, taking into account the clinical needs of patients.

With regard to the specialties that the Senator mentioned, these services are delivered not just in Waterford Regional Hospital but in a range of outreach hospital and community clinics in the southeast. I acknowledge that the numbers are high at 2,814 for dermatology, over 4,000 for ophthalmology, over 5,000 for orthopaedics and over 6,000 for ENT. However, these numbers are being proactively tackled by the hospital with the assistance of the HSE.

I am pleased to advise that a candidate is in clearance for the third new post of consultant dermatologist, following the appointment of the second new post on 1 March 2013. A candidate is also in clearance for the replacement post of consultant orthopaedic surgeon at the hospital, following a consultant resignation. Finally, one consultant ophthalmic surgeon replacement post will be advertised shortly and a second replacement post is also being processed.

All of these appointments will lead to significant improvements in their respective services, particularly in respect of waiting times. Coupled with management plans, revised governance arrangements and additional clinics or clinical reviews in specialties such as regional orthopaedics, regional ENT and opthalmology, l am assured that the hospital is making every effort to ensure the 12 month target is achieved by November 2013.

Acting Chairman (Senator Michael Mullins)

I thank the Minister.

Senator David Cullinane

I thank the Minister for his response. I share his view that hospital management has responded impressively. He has acknowledged that the figures for opthalmology, orthopaedics and ENT are very high. I welcome the announcement of the new and replacement consultant posts. If the new posts do not allow the hospital to reduce its waiting times and numbers, is the Minister in a position to say whether extra posts will be made available? Capacity is important in order to allow hospitals reach their targets.

Perhaps he can answer my concern about the provision of 24-7 cardiology. It is a major issue for people in the southeast. I hope that he will positively address the matter. A commitment has been given to enhance such services but what does that mean?

Deputy James Reilly

I shall address the question posed by the Senator. A commitment has been given to enhance cardiology services and it will be honoured.

With regard to outpatients, one of the underlying principles of the Government is that the patient should be treated at the lowest level of complexity that is safe, timely, efficient and is as near to home as possible. In many instances, throughout the health system, including Waterford, patients are being seen by consultants who could be seen by GPs, GPs are seeing patients who could be seen by nurses and nurses seeing patients that healthcare assistants should be seeing. I do not know whether Waterford hospital has adopted the same approach as Cork hospital but I have no doubt that it will adopt the measure. In Cork, all orthopaedic referrals were screened by its physiotherapy service and that unit was able to deal with 50% of the referrals without going near the orthopaedic team. That reflects the inability of a GP to get a service for a patient who cannot afford private care. The same applies to the mental health service when trying to access counselling.

I wish to point out a number of things. GPs are well aware that if they refer a patient with a recurring sore throat to an ENT surgeon that it is likely to lead to a tonsillectomy. However, if GPs refer patients to a paediatrician the patients are much less likely to receive a tonsillectomy. Therefore, we need to measure what we are doing, why we are doing it and the outcome for patients. The information will help to considerably improve hospital waiting times. Delays are caused by the way the system is organised. Let me give the simple example of people who do not arrive for appointments. I have asked the HSE to put in place a system of collecting mobile telephone numbers in order for patients to be sent a text the week beforehand. A patient is asked to send a return text consisting of a Y or N to indicate if they will attend. If he or she confirms their attendance then they shall receive another text on the morning of the appointment. If the patient does not turn up then, having confirmed that he or she would attend, then there should be a compulsory charge of at least €25. Their non-attendance will have wasted the appointment and deprived somebody else.

A corollary of that is respect. I do not believe that a system that demands 30 people to turn up for an appointment at 9 a.m. shows respect for patients. It clearly indicates that the system and time is more important than that of a patient. That is not correct if we want a patient centred service. There must be a mutual understanding between those who provide the service and those who use the service. It must be conveyed that healthcare is a limited resource and has an impact on other people in our communities, our families and our friends. We all have a responsibility to use healthcare in an appropriate fashion. We, as service providers, must treat people with respect by not calling 30 people to attend at the one time. Instead, they should be given staggered appointment times thereby greatly improving the situation.

I have outlined some of the ideas that are being put in place. As hospital groups come together their scale will allow them to buddy up with national and international partners to develop new ways of organising and delivering care. Dr. Susan O'Reilly, Director, National Cancer Control Programme, has stated that better organisation and management can result in a 10% better outcome for the patient. That is important.

Acting Chairman (Senator Michael Mullins)

I thank the Minister.

Garda Investigations

Senator Trevor Ó Clochartaigh

Glacaim leis go bhfuil an tAire ag tógáil na ceiste seo. Tá mé buíoch go bhfuil sé anseo.

About two months ago, we heard about a scandal relating to a former head of a summer college who also worked in other capacities where he had access to young people. The man has since passed away. Apparently, serious allegations were made to various State agencies and arms of the State over the past 40 to 50 years. The earliest allegation made against the individual dates back to 1955. The individual worked with a number of different State organisations, the VEC is one of them, and other organisations who received funding from State funded systems. The Minister for Justice and Equality has taken the matter seriously. He has called for three internal inquiries to be conducted by the HSE, the Department of Education and Skills and his Department, respectively. He also wants the Garda Síochána to internally investigate the allegations made about the individual and actions taken.

A certain amount of time has elapsed so I shall ask the Minister the following questions. What engagement has taken place with the three agencies regarding internal investigations? What timescale is envisaged?

We have let some time pass before asking the question of what engagement there has been with those three agencies regarding the internal investigations, the timescale envisaged and how far back the organisations will look, taking into account that some of the allegations date back to 1955 and that there were court cases pending that were never fully heard. We are also aware another settlement was made outside of court and different organisations were involved. Quite a large number of victims have come forward to the media in this case, some publicly and some anonymously, but I know of at least 11 people who are claiming to have been abused by this individual. That abuse seems to have been widespread, judging by reports.

The terms of reference for the investigation are important, with questions over who will investigate and what manner of investigation will be carried out. Will there simply be a review of the files held by the organisations or will it cover all correspondence and look back at any payments that might have been made to any of the individuals who have claimed that they were abused by this man?

This is a serious issue. I am in contact with a couple of the individuals who were abused and they are distraught. They want to get some sort of closure and answers about how a man who was apparently abusing children since 1955 was allowed to continue in positions of power and authority, and continued abusing until very recently. I look forward to the Minister's response.

Deputy James Reilly

I am speaking on behalf of the Minister for Justice and Equality who regrets that he is unable to be present due to other business. On behalf of the Minister, I wish to thank the Senator for again raising this important matter.

As the Minister has previously made clear, the allegations regarding the person in question are very disturbing. He would again encourage anyone in any situation who has been abused to come forward to report his or her concerns, and to avail of the counselling which is available from the HSE or from one of the voluntary groups working in this field. As Minister for Health, I would equally encourage people in these situations to express their concerns and speak to the professionals available to help them. I know that is difficult.

The preliminary report which the Minister received from the Garda authorities set out how in 1997 a criminal investigation was instigated into allegations of sexual abuse, which led to the person in question being charged with numerous counts of sexual offences. As the Minister outlined at the time of the Senator's earlier inquiry, he is advised that judicial review proceedings were taken by the accused for reasons related to delay in the bringing of complaints, and that arising from these proceedings, the prosecution fell. The Senator will appreciate that the bringing of prosecutions and their management is a matter for the direction of the DPP, who makes independent decisions having regard to the circumstances of the case in question. The Minister has no role in this process and, quite properly, is not in a position to explain decisions of the director.

More recently, arrangements had been made by gardaí with a further injured party to take a statement but this had not taken place prior to the person in question's death. Concerns expressed in connection with the suggestion that the person in question was seeking to visit schools to promote a book were also under consideration at the time of the death.

The examination which the Garda Commissioner has directed be carried out concerning the procedures surrounding the handling of the complaints against this person is at an advanced stage and a report will be submitted to the Commissioner in the near future. As far as the terms of reference of this examination are concerned, these would be a matter for the Commissioner but he has already indicated that the focus will be on whether any lessons can be learned from the handling of the above complaints and subsequent investigations. As this is an internal Garda examination it would not be the normal practice for such reports to be published. However, the Minister will examine in due course how any key findings might be put into the public domain and will engage with his ministerial colleagues on the outcome of the examination.

The Senator will appreciate that the other inquiries being carried out into this matter are not taking place under the auspices of the Minister for Justice and Equality, so he is not in a position to comment on them. However, it is envisaged that on their completion there will be co-ordination between the various Departments involved to see what lessons might be learned. The dreadful accounts of abuse in this case, and the testimonies of those who have gone public with their experiences in recent months, bear out the lessons we have learned from other inquiries and investigations in recent years.

It is imperative that we have in place the strongest possible child protection measures. The Minister would like to emphasise that since taking office this Government has transformed child protection arrangements in Ireland and is pushing forward with further major improvements. We now have revised Children First guidance, which is to be put on a statutory footing by the Minister for Children and Youth Affairs, and which sets out excellent standards and procedures involving reporting of allegations to the authorities and training to support this process. These standards are complemented by the Criminal Justice (Withholding of Information on Offences against Children and Vulnerable Persons) Act 2012 and the National Vetting Bureau (Children and Vulnerable Persons) Act 2012, both introduced by the Minister for Justice and Equality. Moreover, the arrangements for inter-agency working at all levels have been strengthened, supported by the ongoing reform of children and family services in the HSE and the work to establish a child and family support agency. The Garda Síochána also has in place a new and comprehensive policy on the investigation of sexual crime, crimes against children and child welfare.

As far as the particular sector in question in this case is concerned, the Minister is assured by his colleague the Minister for Arts, Heritage and the Gaeltacht that there are clear and robust child protection procedures in place in Irish summer colleges and in households accommodating students. These involve, inter alia, each college authority being required to develop and implement a written policy to prevent any form of child-abuse, bullying or anti-social behaviour during courses. In addition, the Department of Arts, Heritage and the Gaeltacht, in cooperation with CONCOS, the umbrella organisation for the colleges, assists with the training and coaching of college employees with regard to the implementation of Children First guidance, both inside and outside the classroom, and in the households where the students are accommodated. All households providing accommodation for students in the Gaeltacht and all employees of Irish summer colleges are checked with the Garda vetting unit.

This transformation of child protection arrangements has been motivated by the very disturbing lessons we have learned from the past. If there are further lessons to be learned from this case, or indeed from others, the Minister is determined that this will be done. For this reason, he believes that the Garda review should be allowed to proceed and its results considered carefully. He will also engage with his ministerial colleagues on any lessons they feel can be learned as far as their respective organisations are concerned.

On behalf of the Minister I would like to again thank the Senator for raising this important issue and will certainly share the points he has made with the relevant Ministers.

Senator Trevor Ó Clochartaigh

I welcome that reply. It is good to hear the Garda Commissioner's investigation is at an advanced stage and we welcome that report coming out as soon as possible. The Minister says he has no jurisdiction over the other investigations but I might tapaigh an deis because one of the other investigations relates to the HSE. I will not spring it on the Minister but perhaps he might go back to the HSE because an internal review regarding this individual was to be carried out, with an internal investigation of whether any allegations had made over the years against this person. Perhaps the Minister might raise this with the HSE and correspond with me on it. I will refer to the Minister for Education and Skills about the investigation by the Department.

Deputy James Reilly

On behalf of the Minister I would like to thank the Senator again for his remarks and will share all of his views with the relevant Ministers. I will certainly come back to the Senator vis-à-vis the HSE and its investigation. The Minister for Justice and Equality has indicated that subject to consultation with the Garda Commissioner, he will examine how any key findings from the Garda review might be appropriately put into the public domain and will engage with this ministerial colleagues on any lessons to be learned from the perspective of any of the other organisations in question.

I would like to reiterate the Minister's expressions of sympathy with all of those affected and his hope that they will be able to avail of the counselling assistance which is on offer. I join with the Minister in offering that sympathy.

We want our children to be safe. It is a terribly sad reflection on previous Irish life that so many children were left in such exposed conditions that people could take advantage of them, and that the mechanisms did not seem to be in place to deal in a speedy fashion with those individuals who would take advantage of children in order to prevent them having numerous victims. Sadly, that is the history and legacy we have, but as the Minister has pointed out, we must learn from those mistakes and ensure that in the future, matters are dealt with in such a way as to put child protection to the fore.

The Seanad adjourned at 5.30 p.m. until 2.30 p.m. on Tuesday, 18 June 2013.