Adjournment Matters

National Asthma Programme

Senator Averil Power

I welcome the Minister of State to the House. The national asthma programme was developed in 2010, modelled on a successful pilot project carried out by the Asthma Society of Ireland. The aim of the programme is to bring about a reduction in asthma deaths by 90% over ten years and a 10% reduction in hospital admissions, out of hours and emergency department visits over three years. This programme has already been a successful pilot.

It is now three years since the inception of the programme, but it has not been officially signed off and patients are not enrolled to take the programme forward. As a result of the commitment not being given to this initiative, emergency admissions for asthma patients increased in 2012 by 20% from the previous year. This is unfortunate, because asthma is an extremely manageable condition. There is no reason somebody whose asthma is being managed properly and who is on proper medication should find himself or herself being brought to hospital or suffering from an acute attack. We have the medicine to prevent this and we have the procedures by which asthma can be managed, but unfortunately patients are not engaged in proper asthma management programmes like those that are standard practice in other countries.

I have tabled this matter today to urge the Minister of State to ensure that in next year's budget, priority is given to the roll-out of the asthma management programme put forward by the Asthma Society of Ireland. I urge him to ensure that the necessary staff are provided and that the 17 clinical nurse specialists required for the roll-out of the programme are recruited. The programme must also be included in the HSE's service plan. The Asthma Society of Ireland also raised the issue of the new GP contract. GPs are an essential point of access to the health service and they are the people those with medical conditions see most frequently. It is essential to ensure that all GPs are properly trained in this regard and that they give priority to helping people manage their asthma. As the Minister of State is aware, approximately 470,000 people in Ireland have asthma - one out of every ten adults and one out of every five children. People with asthma make up the largest chronic disease group in the country. The majority of those affected are under 14 and their quality of life is badly affected by the condition.

Other issues that must be examined include education on the condition. The Asthma Society of Ireland provided me with some excellent materials it has developed for schools. We need to ensure the education system and teachers are given greater training on managing this, particularly PE teachers. Many young people only develop asthma in their teens and the PE teacher could well be the first person with them when they have an exercise induced attack. There is a need for action across the board on this issue. Resources are also needed and if these are put into the right area and into prevention and management of asthma, this would save the health service significant moneys over time.

As matters stand, people unnecessarily find themselves on nebulisers, etc., in emergency departments. This would be avoidable if resources were put into the primary care area. Other European countries, such as the UK and Finland, have shown how this can be done. They have advanced the primary care model and patient self-management, through having GPs train patients in how to manage their condition and to manage it with a peak flow meter and to respond when they realise they are in trouble. In Finland, a similar programme to that proposed by the Asthma Society of Ireland resulted in a 90% reduction in deaths, an 85% reduction in hospital admissions and a 50% reduction in the cost of treating each patient.

I tabled this matter to highlight this issue for the Minister of State. I acknowledge we are heading into the budget process and that there are many priorities for next year in the Department of Health. However, I stress that smart investment in this area can save significant money and can also save lives.

Minister of State at the Department of Health (Deputy Alex White)

I thank Senator Power for raising this issue. It is good to have support and as Minister of State with responsibility for primary care, the more support I have from all sides of the House in regard to resources and the expansion and enhancement of primary care, the better. I agree with and thank the Senator for her remarks in that regard.

The national clinical programme for asthma, which commenced in 2011, is one of a number of chronic disease programmes established in the HSE's clinical care directorate aimed at bringing a systematic approach to changes in how services for patients are delivered. The national programme is included in the HSE's 2013 operational plan. Implementation of the programme is ongoing and will continue in 2014. The overarching aim of the national asthma programme is to reduce the morbidity and mortality associated with asthma in Ireland and to improve clinical outcomes and the quality of life of all patients with asthma. A key component is improved management of people with asthma in primary care, thereby avoiding emergency attendance at GP, out-of-hours services, hospital emergency departments and in-patient admission services.

In the first year of programme implementation, there was an 8% reduction in acute hospital bed days for acute asthma. The target for the national asthma programme is a further fall by 10% or more per year over the next three years, through implementing the programme's asthma guidelines and model of care. The national asthma programme is developing a national model of care for asthma, with an implementation plan which will detail how physicians, nurses, and other health care professionals will work with engaged patients to make the clinical decisions most appropriate to their circumstances and which will collaborate with specialist colleagues in providing a safe, seamless patient experience within the health system in Ireland. This is a key deliverable aspect of the national asthma programme for 2013.

As 85% of asthma is managed in primary care without the need for hospital specialist services, the national asthma programme is undertaking work to look at providing a yearly programme of assessment for asthma at primary care level. The model of care will focus on the following: "Asthma Check" outlines the step-by-step process for implementation of guideline-based asthma management in primary care, to deliver optimal outcomes for patients, with the aim being to facilitate the implementation of best practice asthma guidelines in primary care in order to improve asthma control; improving access to hospital-based specialist asthma service from primary and secondary care services, through scheduled or rapid access asthma services and access to specialist asthma therapies; improving links through clinical nurse specialists and asthma nurse specialists within the community services; developing and implementing a standard referral pathway to asthma services; developing structured assessment and review protocols throughout the system; establishing uniform discharge protocols; facilitating access to accurate asthma diagnostics; and examining solutions to develop and subsequently implement an asthma database register linked into all care levels, namely, GP, community pharmacist and hospital.

Implementation of the model of care by clinicians and managers is and will be supported by a range of documents describing care pathways, clinical guidelines and other decision-making tools. A draft model of care has been circulated to the programme's clinical advisory group for its feedback. This will be incorporated in the document and approval sought for external consultation. It is expected that the model of care will be published by the end of this year.

The programme for Government provides for the introduction of a new GMS general practitioner contract with an increased emphasis on the management of chronic conditions. It is envisaged that the new contract, when finalised, will focus on prevention and will include a requirement for GPs to provide care as part of integrated multidisciplinary primary care teams. Officials in the Department are working with the HSE with a view to drawing up and agreeing a new contract. The appropriate arrangements for chronic disease programmes will be considered as part of the new GMS contract.

The level of funding available for the health budget for 2014 has not yet been determined. The HSE is currently engaged in the estimates process. When the national clinical programme for asthma's model of care has been completed, an assessment can be made on how it will be implemented in the acute hospital and primary care system and what resources, including nursing resources, will be required.

I agree with the tenor and the direction of the Senator's observations and remarks this evening on the issue. I understand the importance of providing the kind of services and supports in primary care that she has outlined. I met representatives of the Asthma Society of Ireland last Friday. I had a very good meeting with them, during the course of which many of these issues were raised, and I was able to give them my assurance that everything that can be done will be done in order to advance the kind of services and requirements that I believe are necessary.

Senator Averil Power

I thank the Minister of State for the positive tone of his reply. I welcome the fact that he met with representatives of the society last week. This is a very important issue and I am glad that it is a priority for the Minister of State heading into the budget process. I am encouraged by his response. The Minister of State mentioned that it is hoped that the model of care will be prepared before the end of the year. Will that be finalised early enough for the first phase of implementation to begin next year? I am conscious that the budget is in October and if proposals are to feed into that budget process, they need to be completed quite quickly. Nonetheless, I welcome the positive note that the Minister of State has brought to the issue this evening.

Deputy Alex White

We are moving that on as quickly as we possibly can.

Internet Pornography

Senator Deirdre Clune

I thank the Cathaoirleach for selecting this matter, which is the issue of child pornography and child abuse material, and ensuring that we introduce controls in the area. This has come to the fore following Prime Minister Cameron's speech yesterday in the UK. It has been discussed previously in this House. He addressed many issues yesterday. The Minister for Justice and Equality agreed in this House to do what he can to ensure that our obligations under the directive on combatting sexual exploitation of children are implemented. I understand he is engaging with Internet service providers so that we can get to the position where such material can be blocked.

It is a very serious issue. Every image of a child that we see in such a situation is a crime. Anybody who looks at such images is perpetrating a crime. The enormous growth of the Internet and its potential has certainly added to this. It has probably not got much attention until recently, but it was addressed by the UK Prime Minister yesterday. We need to see action on it and we await the Minister's statement as to how he proposes to proceed in that area.

The issue of obnoxious or extreme pornography and violence and simulated rape situations was also raised. I understand that such material is blocked in this jurisdiction, whereas it has not been blocked in the UK for technical reasons. Legal pornography should also be restricted. My generation would know of the likes of Playboy , adult movies and the 9 p.m. watershed on television, but such material is also on the Internet and there are no restrictions on it. It is available to children at home on their laptops, iPads and PCs. We can only begin to imagine the potential. Children are vulnerable. They need to be protected in their formative years, because pornographic images such as these can actually distort their view of a sexual relationship. It can be very difficult for them. It should not happen and we should control it.

The Minister for Communications, Energy and Natural Resources said on the radio today that this issue had not been raised with him before in this House. It has been raised with the Minister for Justice and Equality, but I do not know if it has been raised directly with Deputy Rabbitte. I know that Deputy Shatter said he would take the matter on board. We clearly need to see action to ensure that issues such as adult pornography, which should only be available for adults, are filtered so that they can be controlled. There has been criticism of filters and any tech savvy child can get around them, but it is not a defence to throw our hands up in the air. We want to try to avoid the situation where a child casually scanning different Internet sites comes across this material accidentally. We also need to educate parents who are not aware of it. They are not tech savvy like their children, unless they have high levels of skill themselves. They can be completely unaware of what their children are being exposed to.

The UK Prime Minister, in consultation with Internet service providers, is proposing a filter that would block this material permanently and if adults want to access such material, they can request that the filtering mechanism be turned off. That sounds like a very reasonable and sensible approach. He is also proposing that public WiFi be family friendly and that logos can claim that the WiFi in a particular area is family friendly.

We need to move on this issue. The growth of pornography on the Internet is continuing. It is racing ahead of all of us. Like anything, when we put something in place, we have to jump higher again. We need to engage with the service providers and ensure that they live up to their huge responsibility in this area. Ultimately, people look to the Government and legislators to raise awareness and to discuss how we can implement protection measures for our vulnerable children.

Deputy Alex White

I thank the Senator for raising this issue.

We all accept that the web is one of the great innovations of our age. It has already brought huge benefits and has the potential to expand our knowledge in ways we could not have imagined only a few decades ago. Sadly, new innovations do not come with a guarantee against misuse. There are two distinct aspects of the Internet's evolution that concern us today and that arise from Senator Clune's contribution, the first being the fact that the web has long been used for the distribution of legal - if restricted - pornographic materials, and the second being around the entirely unacceptable practice of the web's use to circulate images of child abuse.

This latter issue has been the subject of a sustained and very substantial effort on the part of states all over the world, and with some success. For example, the Minister for Justice, Equality and Defence, Deputy Shatter, had the opportunity recently during the Irish Presidency of the EU to raise the need for enhanced international co-operation in tackling the dissemination of child pornography. The EU and the USA have initiated a global alliance against child sexual abuse online and I gather that this initiative is expected to develop quickly in the coming years. Moreover, discussions on the establishment of a structured arrangement for the blocking of access to websites containing child pornography are at an advanced stage.

The arrangement that is being discussed will entail close collaboration between the Garda and Internet service providers, ISPs. It will be based on a written agreement and procedures between the gardaí and individual ISPs. Under the proposed arrangement the gardaí will identify sites and, when satisfied that the material is child pornography and therefore illegal, they will notify the ISP of the sites in question. The ISP will then act in accordance with the agreed arrangements to block access to the site or sites. The Garda will have the benefit of its links with other police forces and the international policing organisations such as Interpol and Europol in seeking out and identifying sites. The arrangements about which I have spoken are in line with the provisions of EU Directive 2011/93 on combating the sexual abuse and sexual exploitation of children and child pornography, in particular Article 25 of that directive. Article 25 provides for measures against websites containing or disseminating child pornography. The first part of the article deals with the removal of web pages containing such material. In Ireland the hotline.ie service already provides for the removal of illegal material. It has performed very well and has had some notable successes in fighting this scourge. The second part of Article 25 is concerned with blocking access to sites containing or disseminating child pornography. The arrangements under discussion between the gardaí and the ISPs would provide us with a mechanism that fulfils the second part of Article 25.

I want to return to an aspect of the debate on blocking or restricting access to sites that causes genuine concern to many people. There are concerns about State censorship and interference with freedom of speech if official agencies are given powers to effect these measures. These are genuine and legitimate concerns. Some see any step in this direction as a beginning, the thin end of the wedge. Where the material involves children, however, different factors apply. We must recall that, not only are they forced to participate but, by virtue of their age alone, they do not have the capacity to consent to taking part. They have no freedom to exercise free choice and because of their age, they are unable to exercise that free choice. Therefore, while protecting the general principle of free expression, we must ensure that we also protect the very basic integrity of the children involved. In my view, the safeguarding of children must be the first priority.

The British Prime Minister's remarks on what is termed "filtering" focus the debate on a slightly different matter, however, the question of controlling access by children to material that is pornographic in nature. My colleague, the Minister for Communications, Energy and Natural Resources, Deputy Pat Rabbitte, spoke about the UK plans on radio this morning. He told "Morning Ireland" he was prepared to take a look at the proposals from the UK Government and I agree that we should examine these with some urgency. The extent of the effects of widely available pornography on the development of young people is not yet fully understood, and it is entirely understandable that parents would seek means to address this. Both the Department of Education and Skills and the Department of Justice, Equality and Defence have long had programmes in place to support children, young people and parents in engaging and dealing with the online world. After all, the worldwide web is of profound benefit in expanding our knowledge of the world, and central to the future careers of many of our young people - the last thing we want is fear of what it might hold. There is also a wide range of available tools that can be used to set content restrictions on devices. The route taken by the UK Government, however, asking Internet service providers to set a "default on" block is something new. It is unlikely to be without its problems in implementation but it may well be worth considering.

To conclude, I want to assure the Senator and the House of my own and the Government's strong commitment to the safety of children, online and offline, and that we will continue to consider any additional steps that can be taken in cases where children are put at risk.

Senator Deirdre Clune

I thank the Minister of State for his reply and I note the comments of the Minister for Communications, Energy and Natural Resources, Deputy Rabbitte, that he believes it is probably worthwhile looking at the issue of pornography and children's access to it, not necessarily child pornography but pornography in general that is legal but access to which should be restricted.

The Minister of State said that the extent of the effects of widely available pornography on the development of young people is not yet fully understood. Anything I have read shows that it has a distorting effect on children. I am sure it is not desirable. I hope that the Minister for Communications, Energy and Natural Resources will engage with this matter and do his utmost to ensure that the Internet service providers also engage and that we do have filtering mechanisms in place. I am not saying they will be the solution to everything and I know there will be mechanisms found to get around them but not necessarily by all children. Protection of vulnerable children should be our highest priority.

Appointment of Ombudsman

Senator Paul Bradford

My statement is more a question than a rambling discourse. I am interested in knowing what procedure will be used to fill the vacancy at the very important Office of the Ombudsman and Information Commissioner once the incumbent, Ms Emily O'Reilly, takes up her job in Europe. I want to put on record my admiration for the work she has done. It is an enormous tribute to her abilities and reputation that she succeeded in being elected to the position of European Ombudsman and I wish her every success in that role. If she brings to it the qualities that she brought to her domestic position every citizen of Europe will benefit.

We are lucky that since the Irish Government in the early 1980s put in place the Office of the Ombudsman - if I recall correctly the first holder of the position was Michael Mills - we have been very well served and countless thousands of citizens, sometimes in a very quiet way, have benefited from the investigations put in place time after time by the Ombudsman. It is fair to say that sometimes the Office of the Ombudsman and Information Commissioner seems just like another Department but all of us as politicians would have used the office and it is very reassuring to hear from people that, not only do they always get very detailed correspondence from the office, but occasionally they get a telephone call from a very senior official of that office and sometimes from the Ombudsman him or herself. It is a great interaction between an office of State and the citizen which is very reassuring.

In conclusion, I wish Ms O'Reilly well in her new and very significant posting but I want to know what process or procedure or application must be entered into to replace her. I recall that previously the appointment was made on the recommendation of the Minister for Finance to the Government. Are there now public appointments or is there a panel or some sort of application form on the back of one's local newspaper? The Minister of State might advise me on this. We look forward to matters progressing and the next person, man or woman, doing the same effective job on behalf of every citizen of the State as Ms O'Reilly and her predecessors did.

Deputy Alex White

I thank Senator Bradford for raising this matter. As he and the House are aware, Ms Emily O'Reilly has offered her resignation from the Office of Ombudsman and Information Commissioner with effect from 29 September 2013. I would like to take this opportunity to join Senator Bradford in congratulating her on her election by the European Parliament as European Ombudsman and to wish her every success in her new role. I think we can all agree that Ms O'Reilly has made a significant contribution over the past 10 years as Ombudsman and Information Commissioner. I join Senator Bradford in acknowledging this before the House and thank her for all her work and dedication. I agree with Senator Bradford's remarks and would like personally to congratulate Ms O'Reilly and wish her well as somebody whom I knew for many years in our respective previous careers. I wish her every success in her new role.

I agree entirely with what Senator Bradford said about the broader question of the importance, efficiency and professionalism of the Office of the Ombudsman and Information Commissioner. Some of us in Government have been at the receiving end of decisions made by that independent office.

As Ministers, we may not have liked them, but, of course, we accept them and fully acknowledge that the Ombudsman and Information Commissioner has acted entirely professionally and properly and in the public interest throughout her tenure in this role, just as her predecessors did.

The remit and powers of the Ombudsman were recently expanded following the passage of the Ombudsman (Amendment) Act 2012. The Ombudsman's remit now covers all Departments, local authorities, the HSE, and circa 180 additional public bodies recently added to the remit. This is a positive development which will empower citizens in their interactions with public bodies and help to further improve standards of public administration. The role of the Ombudsman is not simply to examine individual complaints but also to ensure a better quality service for customers or clients of public bodies by improving the system of public administration.

The process to be followed in the appointment of a new Ombudsman is set out in the Ombudsman Act 1980, as amended. The appointment is made by the President following nomination by resolution of each House of the Oireachtas. Since the Freedom of Information Act 1997 came into force, the Ombudsman has also held the office of Information Commissioner. Appointment to the post is by a similar process to that for the Ombudsman. The Ombudsman also serves as Commissioner for Environmental Information and is an ex officio member of the SIPOC, the CPSA, the Referendum Commission and the Constituency Commission.

The 2012 legislation now provides that the appointment may be preceded by consideration by a committee of the Houses of the Oireachtas as may be designated by the relevant Minister. It is the intention of the Minister for Public Expenditure and Reform that once a nominee has been approved by the Government, a referral will be made to the Public Services Oversight and Petitions Committee.

The Ombudsman is a senior public official charged with monitoring the public administration through the examination and investigation of complaints from members of the public who believe they have been adversely affected by the administrative actions of a public body. The person appointed will be capable of leading a high profile institution through a period of expansion and change. A broad understanding and knowledge of Irish public administration, including the political and legal systems and the governance of public bodies, is essential. He or she should also demonstrate high level knowledge of current affairs and an understanding of the role of the institution of the Ombudsman within the public administration system, both in Ireland and internationally. The person appointed should also be recognised, either publicly or within his or her own professional area, as an individual of proven integrity and independence. He or she will have significant and high level professional achievements and be capable of presenting as the public face of the Office of the Ombudsman and Information Commissioner with credibility and authority. Good media or public speaking skills would be an advantage.

The practice in the past under previous Administrations was for the relevant Minister to ask the Government to note the name of the proposed nominee for the position prior to the resolutions placed before both Houses of the Oireachtas. The Minister for Public Expenditure and Reform is of the view that a more open approach should be adopted to the nomination process and he will be inviting expressions of interest in the appointment by public advertisement. This will widen the pool of possible candidates from which a nominee can be selected. Next week an advertisement will be published in the newspapers and on the Department's website seeking such expressions of interest. It is likely that the Government will approve a nominee in early September and the Minister will then consult the leaders of the Opposition parties prior to the resolutions been taken before the Houses of the Oireachtas.

Copyright Infringement

Senator Kathryn Reilly

Senator Deirdre Clune has also raised this matter. I am not a fan or an advocate of censorship because I believe a more free and open world will benefit everyone. I raise this matter because of the recent ruling by the High Court which ordered UPC to block the website thepiratebay. This was done at the whim of big business and could be the beginning of a slippery slope. We do not want to find ourselves in the same position as the Chinese in terms of the so-called great firewall of China where the content available to citizens is highly filtered. I acknowledge, however, that that is an extreme case. In Finland Internet censorship began with the very noble premise of blocking child pornography, but very quickly other websites which contained no morally questionable content were being blocked. Even worse, there is no procedure available for website owners to have their websites unblocked. If we are to go down this road of censorship, an independent body should be established to review reported websites on a case-by-case basis.

It goes without saying blocking websites should be a last resort and done in the interests of people, not big business. For example, if a website is found to be hosting copyright material, all other measures such as the US Digital Millennium Copyright Act take-down notice should be exhausted. It is possible that the people running a website have no idea that such content or material is on it, as may be the case with a public forum. It makes no sense to block the entire website owing to the actions of a couple of bad actors, particularly when less extreme actions can be taken first. It should be a transparent process and website owners should be able to appeal to have the block removed if the process is found to be in breach. It must be ensured only illegal content is blocked, not just ideas or opinions which are controversial. It should not be the case that secret lists are compiled, with few or no review procedures, and that websites not in breach of any legislation are filtered from the Internet.

I await the Minister of State's and the Department's response.

Deputy Alex White

I thank the Senator for raising this important matter. I assure her and the House that Ireland subscribes fully to the freedoms, opportunities and the access to information that the Internet provides. A broad and robust set of measures is in place to preserve these freedoms, including the profound protections given to freedom of speech in both the European Convention on Human Rights and the Constitution. These can only be breached in very particular circumstances and legally precise and transparent ways. As such, the measures that allow the State to interfere with the free flow of information over the Internet are precisely defined and can only be used in certain circumstances.

On the specific issue of copyright, it is the case that the holders of copyright are entitled, by virtue of the protections enjoyed under copyright law, to control the use of these works such as in the case of the right to make copies of the work, to broadcast the work or to disseminate the work on-line. Copyright law provides for remedies to be taken where copyright infringement is alleged, that is, where acts such as those just outlined take place without the consent of the copyright holder or without any remuneration being given to the holder of the copyright in the works. Such remedies are mandated by the EU copyright directive dating from 2001. The European Union (Copyright and Related Rights) Regulations 2012 were signed into law by the Minister for Jobs, Enterprise and Innovation, Deputy Richard Bruton, on 29 February 2012. These regulations are not about censorship but rather responding to the requirements of the EU copyright directive which requires member states to provide that injunctive relief may be sought against intermediaries whose services are being used by a third party to infringe a copyright. The regulations provide legal clarity and the ability to file for injunctive relief against an intermediary such as an Internet service provider, ISP, in a case where copyright infringement is alleged. The regulations facilitated the granting of a blocking injunction in the recent High Court case concerning thepiratebay website as mentioned by the Senator.

It is important to note that the granting of injunctions is not an automatic procedure but must involve a judicial process. The High Court has drawn significant guidance in this area from case law before the European Court of Justice. This ensures any remedy provided for must be balanced against a range of competing principles in a manner that is reasonable and proportionate to all concerned, including that the fundamental rights of an ISP's customer must be respected, namely, his or her right to protection of personal data and freedom to receive or impart information.

The Seanad adjourned at 8.50 p.m. until 10.30 a.m. on Wednesday, 24 July 2013.

Seanad Éireann debate - Tuesday, 23 Jul 2013