Commencement Matters

Dublin-Monaghan Bombings

I would like to welcome the Tánaiste and Minister for Foreign Affairs and Trade to the Chamber. Senator Gallagher has four minutes to outline his case.

Go raibh maith agat a Chathaoirligh. Ar dtús a Aire, ba mhaith liom fáilte mhór a chur romhat go dtí an Teach seo inniu. Ba mhaith liom buíochas a ghabháil leat fosta chun a bheith anseo inniu chun labhairt faoin ábhar iontach tábhachtach seo. The Minister is very welcome to the House. I appreciate that this is a particularly busy time for him and his presence this morning is to be appreciated by all. I acknowledge the fact the Minister made an effort to come here to address this very important issue.

As the Minister is aware, tomorrow 17 May marks the 44th anniversary of the Dublin-Monaghan bombings. Some 33 people in Monaghan and Dublin lost their lives on that day and it turned out to be the worst loss of life of the entire period of the Troubles. I take this opportunity to request of the Minister a renewed effort on his part and, indeed, on the part of the Government so that the files in relation to this particular issue are released by the British Government in order that the people of Dublin and, indeed, Monaghan can have final closure on this issue.

It is difficult to imagine that 44 years on we are no wiser as to who was responsible, what happened or what group was responsible for this atrocity in which 33 people lost their lives - seven from County Monaghan and 26 from Dublin. We can only imagine the pain the families continue to endure over this period of time and that pain is compounded by the absence of more than four decades of the truth of what actually happened on that day. People have campaigned for many years. Justice for the Forgotten deserves credit for its continued renewed efforts over many years to try to find justice and the truth of what happened. Every year on the anniversary of this event, all Members of both Houses renew our determination to try to find some comfort for those who have suffered. As the anniversary approaches tomorrow, our thoughts and our prayers are with the victims and their families at this difficult time of commemoration.

I am sure it is difficult for the families to appreciate that no one has been charged, much less convicted for that day of carnage and the truth of what actually happened remains a mystery. Indeed, the families' quest for truth and justice has been painfully slow, blocked in every direction and largely ignored. The British Government must make those documents available. There must be some international agreement that it is breaching by not so doing. The British Government has said that it would set up an inquiry into what happened but we still await the outcome of that.

I call on the Minister in his new role and his new portfolio to reinvigorate our efforts and the efforts of the Government on behalf of the people of this country, especially the people of Monaghan and Dublin, to request the British Government to release the papers so that the families can finally bring closure to this and so that they can put the memories of their loved ones to rest and finally realise who or what was behind that atrocity on that fateful day.

I thank the Senator for raising this issue and I am very aware that in the week of the 44th anniversary of the Dublin-Monaghan bombings that this is hugely sensitive time for the families concerned. That tragic incident saw the biggest loss of life in any single day during the Troubles, as pointed out by the Senator. It is important to acknowledge politicians across the Oireachtas who work on a cross-party basis with the Government on this issue, in support of the tireless efforts of Justice for the Forgotten which is playing such an important role, in terms of trying to move this process forward.

The Government will be represented at the wreath-laying ceremony tomorrow to mark the anniversary of these tragic events by my colleague, the Minister for Justice and Equality, Deputy Charles Flanagan. I will be taking Leader's Questions which is why I cannot unfortunately be there myself.

The Programme for a Partnership Government highlights the priority that the Government attaches to the implementation of the all-party Dáil motions relating to the Dublin-Monaghan bombings. I recently met with Justice for the Forgotten to hear its views and update it on the Government’s continuing engagement on legacy issues, including with the British Government, and on the Dáil motions.

The all-party motion on the 1974 Dublin-Monaghan bombings that was adopted by the Dáil on 25 May 2016 has, like those adopted in 2008 and 2011, been conveyed to the British Government. These motions call on the British Government to allow access to an independent, international judicial figure to all original documents relating to the Dublin and Monaghan bombings, as well as the Dublin bombings of 1972 and 1973, the bombing of Kay’s Tavern in Dundalk and the murder of Mr. Seamus Ludlow.

The Government is committed to actively pursuing the implementation of these all-party motions, and has consistently raised the issue with the British Government. I am actively engaged with the British Government on an ongoing basis on this issue, as are officials from my Department. I raised the issue again in person with the Secretary of State for Northern Ireland, Karen Bradley, last month and my officials were in touch with their British counterparts as recently as last week. I have consistently underlined to the British Government that the Dáil motions represent the consensus political view in Ireland that an independent, international judicial review of all the relevant documents is required to establish the full facts of the Dublin-Monaghan atrocities.

I have consistently underlined to the British Government that the Dáil motions represent the consensus political view in Ireland and that an independent international judicial review of all of the relevant documents is required to establish the full facts of the Dublin-Monaghan atrocities. I have also made it clear that the absence of a response from the British Government is of deep concern to the Government and both Houses of Oireachtas. I have emphasised the urgent need for such a response. I will draw the attention of the Secretary of State to this debate in the Seanad and the many questions which have been raised in the Dáil to illustrate this point. I wish to reassure the House that the Government will continue to engage with the British Government on the request on the Dublin-Monaghan bombings and pursue all possible avenues that could achieve progress to that end.

I thank the Minister for his response. I do not for a minute doubt his sincerity in respect of this particular issue. I have some brief questions. Why, after all these years, has the British Government refused to hand over the files that would provide some clarity on this issue? In the Minister's opinion, what is the reason behind that? Can we apply any new pressure, internationally or otherwise, to force the British Government to release the files? I am sure the Minister will agree that 44 years is a long time to be waiting on justice. Every avenue which can be explored should be explored.

The honest answer is that I do not know why the requests that have come from the Government on the back of all-party Dáil motions have not been responded to in a more satisfactory way. There is now an opportunity to address the issue. The British Government is moving ahead with a legacy consultation process in Northern Ireland, dealing with very sensitive and difficult cases. That is a process which, it is to be hoped, can lead to truth and reconciliation for many families, unionist and nationalist. I hope that can create a context whereby we will see a more proactive and helpful response to the requests we are making regarding the Dublin-Monaghan bombings. We will continue to raise this issue and I can assure the Senator that Karen Bradley, my counterpart in Northern Ireland, is very aware of the concern of the Irish Government in respect of the Dublin-Monaghan bombings.

Medicinal Products Regulation

I welcome the Minister of State to the House and appreciate his taking the time to deal with this matter. As he is aware, I am a member of the Joint Committee on Health. We produced a report on orphan drugs, in particular trying to fast-track the process and bring more certainty at an earlier stage. I understand that the assessment process for many drugs here takes, on average, 23 months before a decision is made on moving forward to the next stage in the process. The people who are doing research and development in this area spend a lot of time and money trying to bring forward products which can be of benefit to people. Likewise, the number of people who would benefit from such drugs is quite small but it is very important to them. Over the past two or three years, a number of ongoing battles about whether a drug would receive approval have taken place in the public domain. The report sets out quite clear proposals about expediting and improving the process. The Minister of State should outline the work done by the Department and HSE to improve the processing of applications.

I thank Senator Colm Burke for raising this issues in the Seanad. Medicines play a vital role in improving the overall health of Irish patients. Securing access to new and innovative medicines in a timely manner is a key objective of the Irish health service. The challenge is to deliver on this objective in an affordable and sustainable way.

As of 11 May 2018, there are 120 orphan drugs in Europe. Of these, 12 have been refused by the European Medicines Agency, four have been withdrawn and 104 have had approvals. It is expected that the trend will be towards more applications for orphan drugs in the years ahead. That is why it is essential that Ireland has a scientific, robust and evidence-based assessment process in place. This ensures that decisions on the reimbursement of medicines are made on an objective and scientific basis, recognising the health needs of the population and other factors.

The Health (Pricing and Supply of Medical Goods) Act 2013 provides the legal framework in Ireland for such a process. This Act gives full statutory powers to the HSE to assess and make decisions on the reimbursement of medicines, taking account of expert opinion as appropriate. The HSE follows the process set out in the Act for the assessment of all drugs, including orphan drugs. While orphan drugs are assessed in the same way as other drugs, the HSE is mindful of the differences and challenges in terms of patient numbers.

The HSE strives to reach a decision in as timely a manner as possible and within 180 days. However, because of the significant moneys involved, the HSE must ensure that the best price is achieved, as these commitments are often multi-million euro investments on an ongoing basis. Successful price negotiations also allow for further drugs to be approved within the finite budget available.

A study published in December 2017 in the European Journal of Clinical Pharmacology concluded that the majority of European countries do not have a separate reimbursement system for orphan drugs. The Department of Health has received the report on evaluating orphan drugs from the Joint Committee on Health. The Department is examining the committee’s report and its recommendations. The report raises some significant policy issues which require careful consideration.

The Minister and the Department are very aware of the human side of this entire process. A medicinal products review committee has been established as part of the recommendations advocated by the national rare disease plan. This committee will look at the possibility of devising managed access programmes for patients, including orphan drugs, and will consider the need for different assessment criteria to apply in the case of drugs for rare diseases. The Government is committed in the programme for partnership to look at opportunities for leveraging purchasing power. That is why, over the past two years, my Department has been engaging with other European countries in an effort to identify solutions to medicines pricing, sustainability and supply.

Ireland is participating in several voluntary EU forums, including round-table meetings with EU health Ministers and the pharmaceutical industry, high level pharmaceutical policy meetings, the BeNeLuxA collaboration and the Valletta technical committee. These platforms are currently exploring possible areas for co-operation including information sharing, horizon scanning and possible price negotiations and joint procurement.

Ensuring timely and sustainable access to new medicines, especially orphan medicines, is a key priority of the Minister. The Department and the HSE are actively working towards this goal. However, any innovative approaches that may be tabled must be compatible with the statutory provisions which are in place and must also recognise the fundamental pricing issues in the context of finite Exchequer resources.

The European Medicines Agency approves drugs and we then seem to go through a process which takes over two years. That is causing a lot of frustration for people who could benefit if the drugs were available, as well as those carrying out research and development. That is why the report sets out clear recommendations. I ask that the Minister of State and the Department examine the report's recommendations and see which ones could be implemented at an early stage. They could then examine the other issues. It is important that we bring about some change in this area.

I thank the Senator and accept the challenge put forward by him. We have to ensure approval is timely, appropriate, represents value for money and that we are proactive as opposed to reactive. I will gladly take on board the request of the Senator to review the recommendations and see whether we can expedite any processes within the overall process.

Children and Family Services Provision

I welcome the Minister of State. This is the fifth occasion on which I have raised this issue. I have raised it three times on the Order of Business and this is the second Commencement matter I have tabled in respect of it. More than six months have passed since I raised it by way of a Commencement matter. At that point, it had already been two and a half years since enactment of the Children and Family Relationships Act 2015. It is now three years since the legislation was passed but families, particularly LGBTQI couples who conceive through assisted human reproduction methods, still do not have equal family status because the Government has not commenced Parts 2 and 3 of the Act. Why is this taking so long? The impact of this Government inaction includes preventing a family from applying for an Irish passport and citizenship for their child, preventing the child from accessing his or her parents' estate if they die and preventing a parent from making emergency health decisions on behalf of a child where the legal parent is unable to do so.

During the debate on the Commencement matter I tabled in December 2017, the Minister of State, Deputy Catherine Byrne, said, "If possible, it will be implemented by the end of January and if not, then the beginning of February." This followed repeated missed deadlines on the part of the Department. These deadlines were late 2016, early 2017, mid-2017 and late 2017. Following parliamentary questions or questions on promised legislation in the Dáil on the topic, the Department's responses have omitted a deadline and simply state that a small number of technical issues are holding matters up and that Parts 2 and 3 will be commenced as soon as possible. The most recent responses have the added element of requiring advice from the Attorney General. It has taken the Department over two years just to figure this out. Surely these technical issues would have been resolved by now had they have been given priority over the past three years. We need an open and honest explanation of the delay and a truthful deadline as to when families can expect certainty on this issue.

The Leader, Senator Buttimer, sought a meeting last month involving me, departmental officials and the families affected but the Department rejected his request. All I wish is for departmental officials to meet the families affected and explain why they have delayed the commencement of these people's rights and left them vulnerable. As matters stand, the families are being stonewalled.

I ask the Minister of State to give an in-depth explanation as to why the Department has taken three years to provide crucial rights to LGBTQI families and give a definite timeline as to when they can expect these rights to be conferred.

I thank the Senator for raising this issue. The Children and Family Relationships Act 2015 reforms and updates family law to address the needs of children living in diverse family types. As he is aware, commencement of the Act is the responsibility of a number of Departments, including the Departments of Justice and Equality, Employment Affairs and Social Protection and Children and Youth Affairs. The responsibility of my Department relates solely to the commencement of Parts 2 and 3 and associated regulations. As well as making regulations in respect of donor-assisted human reproduction procedures, Parts 2 and 3 make provision for children conceived through the assistance of a donor. This includes mandating for non-anonymous donation and the establishment of a national donor-conceived person register to enable children to access information on their donor and genetically related siblings when they come of age, should they so wish.

These provisions were specifically included in the Act to underpin the rights of the child under Article 42A of the Constitution and Ireland’s commitment to the UN Convention on the Rights of the Child, including the right to have information on genetic heritage. Detailed regulation of these provisions will ensure that the information on any child born of donor conception will be recorded securely, in compliance with existing and forthcoming data protection legislation, and in a manner which can be accessed by that child when he or she is of age. Parts 2 and 3 also provide legal clarity on parental rights and responsibilities.

Officials in my Department have prepared draft regulations to facilitate the commencement of Parts 2 and 3 of the Children and Family Relationships Act 2015. However, in the course of that work, they have identified a small number of drafting issues with the Act. The implications of these issues are being explored by my officials and the Office of the Attorney General. As discussions in this regard are ongoing, I do not wish to pre-empt the outcome by citing specific details. If it transpires that amendment is required through primary legislation, I will seek to do so as a matter of priority in order to lay the regulations before the Houses of the Oireachtas to commence Parts 2 and 3 as soon as possible thereafter.

My Department is preparing guidance documentation that will accompany the regulations, when commenced. This is to ensure that intending donors and parents are properly advised, that the relevant consents are clearly and uniformly recorded and that the obligations of clinics, donors and intending parents to provide information to the national donor-conceived person register are clear.

I am acutely aware of the urgency surrounding the commencement of Parts 2 and 3 of the Act. I am also aware of how eagerly the Act's provisions are awaited. I will be happy to arrange a briefing on the substantive issues for all of my Oireachtas colleagues with an active interest in the matter when the discussions to which I refer have concluded.

I thank the Minister of State. I welcome the fact that he has committed to prepare legislation - should that be needed - and bring it through the Houses as soon as possible. I also welcome the opportunity for a briefing for Oireachtas Members. However, it is not good enough for those parents whose families have been left vulnerable for the Department to repeat that discussions are ongoing with the Office of the Attorney General. I do not wish to pre-empt the outcome. We have had three years to work out the technical issues and we have failed to provide legal certainty for families. At this point, at a minimum, an apology should be given.

I thank the Senator for his continued co-operation and endeavours to keep a focus on this matter and to make progress. I appreciate that it is very frustrating. For all of us, legislation is tough and challenging, particularly when there are drafting, technical and legal issues that involve a whole host of areas. I appreciate that this matter has been ongoing for a number of years. I welcome the focus and the time the Senator has put into ensuring its progress. Hopefully, we will continue that progress with the Senator's assistance.

Hospital Accommodation Provision

I thank the Minister of State for attending. Like many hospitals throughout the country, Sligo University Hospital faces many ongoing challenges, including cost pressures, recruitment issues, inpatient and day-case waiting lists, OPD waiting times and increased trolley pressures. Among the biggest challenges is that relating to bed capacity and Sligo University Hospital is no different from many other hospitals in seeking additional beds. Unfortunately, Sligo University Hospital’s capacity has reduced by 13% over the past ten years . Put simply, it needs more beds. The situation has been aggravated by the hospital losing 42 inpatient beds since 2004 and the increase in trolley pressures has presented a clear-cut case for additional bed capacity. This capacity challenge is set to become greater because Ireland has an ageing population. In that context, it is estimated that there will be a 40% increase in the number of people aged 65 and over in the next ten years.

We are all aware of the huge pressures on bed capacity in our hospitals, especially during winter months. Last January was no different, with emergency departments such as that in Sligo under enormous strain due to high demand and the increased incidence of flu mainly affecting older people. Many Senators will be aware that the recent health service capacity review identified the need for 2,600 additional acute hospital beds over the next ten years. I understand that 600 will become available nationally in the coming year. The Government is fully committed to the provision of these extra acute hospital beds under the Project Ireland 2040 framework unveiled in Sligo last February.

I also take this opportunity to appeal directly to Minister for Health to ensure that Sligo University Hospital gets its fair share of these additional beds. I hope that some of these beds - with the associated staffing - can come on stream prior to next winter. Extra beds for Sligo will also certainly help smooth the transition to the new surgical and emergency department block being developed at the hospital. Many other excellent projects being planned at the hospital, such as the development of a cardiac catheterisation laboratory service, a radiology suite, a diabetes day unit and a central sterile services department, CSSD, upgrade.

I commend the hospital on its ongoing efforts to advance these projects but increased bed capacity continues to be a key priority. There is no question but that those 2,600 hospital beds recommended in the Government's bed capacity review will make a major difference to hospitals nationwide, including in Sligo. I understand that approximately 200 beds opened last winter across some of our hospitals, and more are due to come on stream later in the year. I attended a meeting in Sligo over two weeks ago when the management team briefed local politicians on all the various matters affecting them. Sligo must be a beneficiary when it comes to the next phase in the allocation of extra beds. I look forward to the Minister of State making a provision for these beds in order that vital additional capacity can be provided for the hospital.

I thank the Senator for raising this issue today. As he will be aware, the Department of Health has undertaken a health service capacity review in line with the programme for a partnership Government commitment, the findings of which provide an evidence base for future capacity decisions. If reforms are implemented, the report concludes, as the Senator points out, that nearly 2,600 additional acute hospital beds will be required by 2031. As a first step towards implementing this recommendation, I have asked my Department to work with the Health Service Executive, HSE, to identify the location and mix of beds across the hospital system that can be opened and staffed this year and in 2019. The HSE is continuing to develop this proposal, with the aim of formulating an evidence-based plan for increasing bed capacity nationally, which will form the basis of discussions with colleagues in government on the financing of this important programme of work.

Senator Feighan has specifically asked me to speak today on proposed plans for Sligo University Hospital. I can confirm that the HSE has been working with the Saolta hospital group on the development of specific proposals for all its hospitals. Currently, this includes a proposal for a new modular build for Sligo University Hospital that would increase bed capacity at this site by up to 52 inpatient beds. The proposal in respect of Sligo University Hospital, along with all those submitted by other hospitals, is currently being assessed by the HSE in terms of its feasibility, including matters of staffing, costing, timeline and impact, with a view to bringing an overall plan to my Department for consideration and discussion with colleagues in government. Therefore, while I understand the Senator's wish to have a clear response on this matter today, I must await the outcome of the process under way.

As outlined in the capacity review, the demographic pressures being experienced by the health service are such as to demand not just additional capacity but continued emphasis on health and well-being initiatives, an improved model of care with a stronger role for enhanced community-based services and continued improvement in productivity, including in acute hospitals. The Government has approved a record level of capital investment in health at €10.9 billion over the next ten years. This will provide for a major enhancement of the capacity of our health services to meet demand. Importantly, the accelerated introduction of additional capacity for 2018 and 2019 will be matched by forthcoming reforms, including the publication of a detailed Sláintecare implementation plan and the overhaul of the current GP contract.

We all acknowledge that the challenges we face are significant and of that there is little doubt. However, it is my firm belief that all of us want to find the right solutions - patient-centred, evidence-based, results-focused and sustainable - to the challenges currently facing our health services. I know we have a long road ahead of us but 2018 will be the start of this journey of reform and strengthening of our health services.

I thank the Minister of State for his reply. The Saolta group has proposed a new modular build for Sligo University Hospital that would increase bed capacity at the site and the 52 beds are welcome. We are looking at 600 beds that are due to come on stream and I hope Sligo and the north west, which covers my area of Boyle, would get the beds required.

Sitting suspended at 11.15 a.m. and resumed at 11.30 a.m.