Commencement Matters

Medical Products

I thank the Minister of State for coming to the House at a very busy time. I appreciate the time he is giving me today for this important issue. I have been contacted by a number of my constituents regarding uro-gynaecological transvaginal mesh implants for the management of stress urinary incontinence or pelvic organ prolapse and the many and often severe complications following these procedures. My understanding was that the Chief Medical Officer was to prepare a report which was expected to make recommendations in respect of the clinical and technical issues involved. I am informed that this report had an anticipated publication time of the first two weeks in November, yet we are currently in December.

While we awaited this report, a number of significant system actions on mesh implants were advanced on foot of priority recommendations identified during the course of the preparation of that report. I am aware of this and welcome the swift action in this matter. I understand all procedures in HSE-funded hospitals involving mesh implants for the management of stress urinary incontinence, a common condition in women following childbirth or at menopause, or of pelvic organ prolapse, where a pelvic organ moves out of place, have been suspended in cases where it is clinically appropriate and safe to do so.

There was also a recommendation to ensure that in situations where expert clinical judgment was such that there was an urgency to carry out the procedure and no suitable alternative existed, surgery should have proceeded only if a delay would risk harm to the patient and should be based on multidisciplinary team decisions and fully informed consent.

I would like clarification that the suspension of these procedures has actually taken place pending publication of the report, and that no woman is enduring this procedure unless there is an identified risk associated with not carrying it out. The pause in this procedure was to remain in place pending confirmation of implementation by the HSE, working in conjunction with the Institute of Obstetricians and Gynaecologists and the Royal College of Surgeons in Ireland, of three urgent recommendations in respect of surgical training, informed consent and development of an agreed dataset of mesh procedures. The HSE has published information concerning the pause on its website for patients affected. This is no doubt due to pressure applied by the Department and must be welcomed. When this procedure was introduced in the early 2000s, clinical trials found efficacy and low complication rates for mesh implants used for incontinence. However, there soon grew to be a body of evidence indicating that efficacy was lower and complication rates higher in cases of pelvic organ prolapse. In 2012, the mesh was reclassified as high risk, and the United Kingdom has banned this procedure.

I would like to know what we in Ireland are doing for these women. Their lives were changed utterly and they have felt forgotten and left in pain. The preliminary recommendations of the report identify as urgent the provision of appropriate aftercare for women suffering from mesh complications including appropriate diagnosis facilities. Can the Minister of State clarify whether these provisions have been put in place? A learning notice concerning mesh devices in uro-gynaecological procedures was circulated on 26 June 2018 to all maternity hospitals and acute hospitals with gynaecological services to highlight the importance of appropriate patient selection. Under adequate information and consent, it was also recommended to inform service providers that a response group has been arranged to propose remedies for and address the provision of aftercare for complications.

This is also available online. I am concerned, however, that this information has not been made widely available and without discrimination to all women who may be affected. The HSE advises that all patients who have experienced complications due to mesh devices should contact their consultant's clinic in the first instance. This advice is not getting to women. Women have contacted my office and I have sent them to their own doctors. Each hospital group was to have nominated an individual to co-ordinate a response to this group of patients. Can the Minister of State confirm if this has happened? Will there be greater awareness made of any recommendations made, and the steps being taken for aftercare and the future patients? This is such a serious issue. I have had women coming into my clinics, crying, who are in a very bad situation. I hope the Minister of State has good news for me on this. It is unacceptable.

I thank the Senator for raising this important issue. I am taking this Commencement matter on behalf of the Minister for Health, Deputy Simon Harris.

The report to the Minister from Dr. Tony Holohan, Chief Medical Officer, CMO, on the use of urogynaecological mesh in the surgical treatment of stress urinary incontinence, SUI, and pelvic organ prolapse, POP, in women was published on the Department of Health website on 21 November 2018. Synthetic mesh devices have been widely used in the surgical treatment of SUI and POP in women over the past two decades. I accept the Senator's point but controversy about the safety of mesh devices has arisen in many countries because of concerns about the frequency and severity of complications associated with their use. In responding to these questions and in recognition of the complexity of the matters arising, the Minister requested the CMO to prepare a report for him on the clinical and technical issues involved in ensuring the safe and effective provision of mesh procedures in urogynaecology and an appropriate response to women who suffer complications as a result of undergoing such procedures.

Preparation of the report has involved consultation and engagement with national and international bodies. The report has been informed by reviews of international reports and safety reviews of mesh surgeries that have been published in recent years. The report has also been informed by the personal experiences of women who have suffered complications following mesh surgery. The Minister acknowledges the bravery, commitment and dignity shown by the women he met and by those women who have written to him concerning this issue, in sharing their harrowing and deeply personal experiences.

The report identifies that for many women, surgical procedures using synthetic mesh devices have provided a more effective and less invasive form of treatment than traditional SUI and POP procedures. Mesh devices, however, are associated with significant and severe complications in a minority of women. These are of concern given the difficulties of mesh implant removal. The report makes 19 recommendations, including the development of patient information and informed consent materials; surgical professional training and multidisciplinary expertise in units carrying out mesh procedures; the development of clinical guidance; the development of information systems to monitor the ongoing use of mesh devices; ensuring the reporting of mesh-related complications; and ensuring timely, appropriate and accessible care pathways for the management of women with complications.

At the CMO's request, a programme of work to advance some of the report's more important recommendations has commenced in the HSE in advance of completion of the report. The HSE was also asked by the CMO on 24 July to pause all mesh procedures where clinically safe to do so until a number of key recommendations are implemented. The HSE has a published a dedicated web page about vaginal mesh implants, including contact information for women suffering complications, which I hope is a useful resource and for which we can make the link available.

The Minister of State is aware of the seriousness of this issue. The people I have been dealing with have been trying to go England because the mesh itself cannot be taken out in full, once one has it. That is a concern. Evidently, part of the mesh can be taken out. This is a crucial issue and I ask the Minister of State to convey to the Minister for Health that this cannot happen to anybody else, in particular given the way people have been affected by this. Their whole lives have changed. This is an important issue. I have seen the 19 recommendations and I will return to this issue. I hope this can be sorted and that no one else will be left in the situation of some of the people I have dealt with over the last few months.

I take the Senator's point. The Minister for Health is committed to ensuring the safe and effective use of mesh implants and an appropriately and a timely response to women suffering mesh complications. Last week the Department wrote to the HSE again to request that it prepare a detailed implementation plan for the complete set of recommendations set out in the CMO's report, working in conjunction with other stakeholders. On another level, the Minister intends to meet with the Mesh Survivors Ireland group in the coming weeks to discuss the report. I will certainly convey the Senator's genuine concerns to the Minister, Deputy Harris.

School Accommodation

Gabhaim buíochas leis an gCathaoirleach agus leis an Aire féin as a bheith anseo go pearsanta chun an t-ábhar seo a phlé liom. An tseachtain seo caite bhí mé istigh i nGaelscoil Cholmcille. Bhíodar ag ceiliúradh Bliain na Gaeilge agus bhí mé an-tógtha leis an méid a bhí ar siúl ann, idir cheol, drámaíocht agus amhránaíocht. Gach uair a bhím i láthair sa scoil ar Bhóthar Oscar Traynor cuireann an fhoireann ar fad ina luí orm go bhfuil sé thar am dóibh foirgneamh buan a bheith acu. Tá siad ag feitheamh anois níos mó ná 20 bliain. Cé go raibh an méid sin amhránaíochta agus drámaíochta agus ceol ar siúl ag na páistí, bhí sé soiléir do gach duine go raibh na háiseanna agus an halla atá acu i bhfad ró-bheag don scoil sin. Tá an scoil ag iarraidh fáis agus dul i méid agus tá an-chuid daoine ag iarraidh a bheith ag freastal ar an scoil ach tá an scoil ag fanacht níos mó ná 20 bliain ar fhoirgneamh nua.

Gaelscoil Cholmcille is doing fantastic work. It is a very popular local primary school. Last week I visited the school again and it was impressed upon me once more the fact it is waiting more than 20 years for a permanent building. There is a site next door which Dublin City Council has plans to develop. The long-term solution is right there facing the school. The school is adamant that a process be put in place and that it would have a chance to maximise its potential as a primary school.

I know the Minister will share with me his vision that every child will attend a school with a permanent building and can look to the future with a level of confidence. The confidence within the school has been ebbing away over the last number of years. When there are announcements of new schools being developed and recognised - nobody has an issue with this - this school seems to be on the end of the list when it comes to achieving what it wants to achieve.

I am interested in hearing the Minister's reply. While he is new to his post, the Irish language is of particular importance to him and he wants to do what is best for everyone. On behalf of the parents, staff and board of management of Gaelscoil Cholmcille, I note that a positive response would be greatly appreciated.

Gabhaim buíochas leis an Seanadóir as ucht an t-ábhar tábhachtach seo a ardú inniu. Is léir ón teachtaireacht inniu ón Seanadóir go bhfuil fuinneamh dearfach ag dul ar aghaidh sa scoil. Tá sé ceart go bhfuil sé tiománta agam an teanga a bheith ag bailiú nirt amach anseo fosta agus gabhaim mo aitheantas chuig an ceannaireacht thíos sna scoileanna fá choinne an tiomántas ar son na teanga. Mar atá a fhios ag an Seanadóir, tá Gaelscoil Cholmcille ag obair faoin ethos Catholic agus ag obair faoin fhoras patrúnacha agus tá suas le 277 duine óige sna mbunscoileanna ag foghlaim trí mheán na Gaeilge. Tá daoine obair sna scoileanna fosta agus tá 11 cloigeann duine ag obair agus 2.5 duine ag obair i dtacaíocht speisialta.

In 2008, my Department provided a two-storey, semi-permanent school building consisting of 12 classrooms and ancillary accommodation for Gaelscoil Cholmcille. As this building has a life span of 25 to 30 years, my Department has no plans to replace it in the foreseeable future. However, I take on board what the Senator stated in the context of parents seeking a period of certainty. I understand that in March 2018 the school submitted an application under my Department's additional school accommodation scheme seeking the provision of additional temporary accommodation to provide for a further mainstream teaching post being appointed for 2018. Having engaged with the school to seek clarification on aspects of the application, my Department finalised the assessment of the application in September. I am pleased to confirm that my Department granted approval for the provision of two permanent mainstream classrooms with en suite toilets and a separate assisted user's toilet to address the deficit of accommodation in the Gaelscoil. The project was devolved for delivery to the Gaelscoil authority. This means that it is now a matter for the Gaelscoil authority to appoint a consultant and advance the project through the design and construction phases. Gabhaim buíochas arís leis an Seanadóir as ucht an t-ábhar tábhachtach seo a ardú inniu.

Ba mhaith liom buíochas a ghabháil leis an Aire. Unfortunately, I find the answer disappointing. The Minister can appreciate how disappointing it is from the school's point of view, having waited so long for a permanent building only to get an indication from the Department that it does not foresee an opportunity to replace the building because it is a two-storey semi-permanent structure with a lifespan of 25 to 30 years. I accept what the Minister says about the two permanent classrooms but I note that there is a site beside the school which is to be developed by Dublin City Council. It is a major development with potential for 500 housing units. There is a perfect opportunity here for the Department to engage with Dublin City Council regarding the site in order to find a permanent answer for the needs of this school. I implore the Minister. To say that a temporary building has a 25 to 30-year lifespan, considering that it is already ten years old, does not provide much succour to the people who care about the school. I ask that the Department engages with Dublin City Council to find a long-term solution for this much-loved and needed school in this community. I ask the Minister to engage more imaginatively to find a permanent solution. This school and its current and future pupils deserve no less.

Chuala mé an teachtaireacht inniu. I hear the message. I place this in the context of the pressure the Department has been under over many decades.

Even going back to the late 1970s and the 1980s, many flat-roofed schools were built and they are still fit for purpose and being used today. The Department is looking at a type of retrofit project that will address environmental and sustainability issues for schools built before 2008. The accommodation in question was built prior to 2008 and I understand that parents and the community want a more permanent solution.

In the context of options involving alternative sites - and the Senator has come forward with options - one thing I have to say about the officials, who I have only got to know in recent weeks, is that they are very flexible and adapt to new suggestions and ideas. Obviously, I am trying to get a figure for the budget that has been spent in the areas of Wicklow, Kildare, Meath and Dublin in the past ten years, given there has been phenomenal growth in population and we must add that to the pressures and constraints on new buildings. I understand that when parents hear of other announcements of new schools, they obviously ask what is the situation regarding this school. We have a ten-year capital plan and the Project Ireland 2040 plan, which points to the space we will be in by 2040. I know parents and others in the community are not living in a space where they believe this is to be realised by 2040, but that we start working in that capital space in terms of how we get there over that period.

Cloisim an teachtaireacht ón Seanadóir. Ba mhaith liom mo aitheantas a ghabháil leis fá choinne seans a thabhairt dom labhairt ar Ghaelscoil Cholmcille - ainm deas agus ceangal le mo chontae féin, Tír Chonaill. Nuair a bhíonn tograí scoile ar intinn ag Seanadóirí, bíonn mo chluasa foscailte. Beidh mé ag labhairt le mo chomhghleacaithe chun níos mó sonraí a fháil i dtaobh stádas an togra atáthar ag iarraidh a bhaint amach ó bhí 2008 ann, agus i dtaobh an plean nó an bealach a bheidh de dhíth go dtí go mbeidh foirgneamh níos fearr ag an scoil sa todhchaí.

Special Educational Needs Staff

I welcome the Minister and thank him for coming before the House to deal with this issue. I know a number of special needs assistants who have gone back to further education who have advised me that departmental circular letter 22/2012 prevents them from taking on any employment. The circular states:

7.1 The taking up of regular paid employment of any kind elsewhere in the State while on career break would be contrary to the objectives of the scheme and shall lead to refusal of an application or withdrawal of approval already given.

7.2 A special needs assistant on a career break is precluded from taking up an appointment in any capacity in any school within the state.

This circular came into force in 2012 when jobs were scarce. I fully appreciate why these were the criteria set down in respect of special needs assistants who took career breaks. The people who contacted me are those who have gone back to further education. They are paying full college fees because they are mature students and they are technically precluded from taking on any type of employment while on career break.

It is time to review circular 22/2012, taking into account that some schools are finding it difficult to get replacements, for example, where a special needs assistant goes out sick, and this is particularly the case in areas outside Dublin. I ask the Minister to review this matter.

I am talking specifically about people going back to further education and they should not be penalised in this way that prevents them from taking on employment. I ask for the matter to be reviewed.

I thank the Senator for the opportunity to address the matter regarding the career break scheme for special needs assistants. In accordance with the Education Act, the terms and conditions of employment of special needs assistants employed in approved posts funded by moneys provided by the Oireachtas are determined by the Minister for Education and Skills, with the concurrence of the Minister for Public Expenditure and Reform.

Special needs assistants are recruited specifically to assist in the care of pupils with disabilities who have additional and significant care needs in an educational context. They may be appointed to a special school or a mainstream school to assist school authorities in making suitable provision for a pupil or pupils with special care needs. The first priority is that the care needs of the pupils are met on an ongoing basis during the school year. In June 2012, my Department, in conjunction with the school management bodies and the relevant trade unions, agreed a career break scheme for special needs assistants in recognised primary and post-primary schools, the provisions of which are contained in Circular 22/2012, which is available on my Department's website.

Paragraph 1.2 of the circular states:

The main objectives of this scheme below, which are not exhaustive, is for employers, wherever possible to facilitate applicants in the areas of:

- Personal Development

- Education (including teacher training)

- Public Representation

- Childcare/Dependent care

- Self-employment

The career break scheme therefore is applicable to special needs assistants who wish to pursue courses such as teacher training where participants are required to spend significant periods of time on school observation or teaching practice during the school year. The taking up of regular paid employment while on career break would be contrary to the objectives of the career break scheme and such applications shall be refused by the employer.

Paragraph 4.2 of the circular states, "A career break shall be a period of not less than one school year and may be extended on an annual basis provided the total period of the career break does not exceed five years at any one time.". Thus the priority of my Department is to ensure that the continuity of care and the welfare needs of pupils take precedence over all other considerations in the granting and duration of career breaks. I thank Senator Burke for affording me the opportunity to respond to the House on this matter.

The circumstances have changed since this regulation was introduced. The point being made to me by these special needs assistants is that they are trying to further their career. They have gone back to full-time education and are not in receipt of any income. Under regulations, they are prevented from getting any kind of income, and this policy should be reviewed. I fully accept the Minister's comments about facilitating special needs assistants who wish to pursue courses such as teacher training where participants are required to spend significant periods under school observation. They are prepared for that but the Minister knows the cost of rent and day-to-day living. It is not physically possible for them to take time out of a full-time job, go back to college where they pay fees, all the while being prevented under regulations from taking on any type of employment. I ask that the matter be carefully examined.

The Senator is being quite reasonable in his representation today. He has spoken to a cohort of people doing tremendous work and who are very much part of the school "infrastructure", for want of a better word. It may not be a good word but it signifies the value that students, teachers and principals place on the role of special needs assistants so integral as they are to the running of a school. They are very much part of the ecosystem. We are looking at reviewing the role of the SNAs and this will provide an opportunity to feed in the sentiments and observations made by the Senator today. Maybe this matter can be considered in that context.

I refer again to the contribution of SNAs. There will be an increase next year and upwards of almost 16,000 SNAs will be employed; we announced another 900 in the recent budget. This demonstrates the value of and demand for those SNAs. In 2011 there were approximately 455 special classes but that number has increased this year to almost 1,500.

That is the position in terms of the demand. Obviously, it also reflects the growing choices parents have as to whether they want their children to go to a special school or to special classes within mainstream schools, be they ASD units or other forms of provision.

The most important point with regard to SNAs is the role they play. They provide one-to-one help and support but they also play an all-inclusive, all-school role. They play a fundamental role in education. I acknowledge the work they have done and continue to do and obviously they will have a future role in our education system. That is why we are going to carry out a comprehensive review of SNAs. I will keep the Senator and this House posted on developments.

Closed-Circuit Television Systems Provision

I thank the Minister for Justice and Equality, Deputy Flanagan, for taking time from his schedule to be here. I wish to discuss closed-circuit television, CCTV, schemes and the delays being experienced in that regard. The Minister will agree that CCTV is an invaluable tool in the context of deterring people from engaging in crime or public disorder. In addition, CCTV can greatly assist the Garda in respect of public order issues or crimes during the investigation process and for the purpose of identifying those involved. Most importantly, CCTV gives comfort and security to communities throughout the country where there is a CCTV scheme in operation.

Last week, there was an incident in Monaghan town in which a young man was viciously assaulted late in the evening. Unfortunately, incidents of this nature are occurring too often. People are exhausted. They are sick and tired of public order offences and public disorder in the streets. The benefit of a properly running CCTV scheme cannot be underestimated with regard to such activity. Garda numbers are not what we would wish them to be and in situations where gardaí are not on the streets, the part CCTV can play is immeasurable. While CCTV will not replace the gardaí, it is important that we have CCTV schemes in operation.

With that in mind it is disappointing that delays are being experienced with schemes that should have been up and running long ago. There is a responsibility on the Government to ensure the schemes are implemented without delay. I understand that part of the problem relates to a general data protection regulation, GDPR, issue and who the data controller is.

There is an ongoing dispute or impasse between the City and County Managers Association, CCMA, and the Department regarding the role of data controller. Meanwhile, as this impasse continues, assaults and other serious crimes are happening on a daily basis in many towns throughout the country. I heard recently that CCTV cameras were installed in Littleton, County Tipperary, more than 12 months ago but are not yet up and running. I am sure the Minister will agree that this is simply not good enough. Surely when it comes to matters of policing, responsibility lies with An Garda Síochána and not with the local authorities. I am hoping that the Minister will be able to shed some light on this issue in order that CCTV schemes that are at an impasse at the moment can progress and people will have the added security of knowing that the schemes are operational in their towns.

I thank the Senator for raising this important issue. I hear about CCTV schemes from many groups all over the country and in my capacity as a rural Deputy, I am fully aware of the desire for CCTV in local areas. I appreciate the sense of security that CCTV brings to many communities. In responding to community demand, the Government has made significant funding available to assist groups who wish to establish community CCTV in their areas. The grant aid scheme administered by my Department is intended to run for three years, with the sum of €1 million available each year.

The Senator will appreciate that there are a number of legal requirements in setting up of CCTV systems. Such systems are installed for the purpose of crime prevention and as aids to policing in areas to which the public routinely have access such as town centres. CCTV systems fall into two distinct but complementary categories, namely Garda CCTV systems and community-based CCTV systems. Neither type of system can be set up without an appropriate authorisation by the Garda Commissioner under section 38 of the Garda Síochána Act 2005. There are further requirements for community CCTV, which is governed by section 38(3)(c) of the Garda Síochána Act 2005 and the Garda Síochána CCTV order of 2006. The legal framework requires that any proposed community CCTV scheme must, in the first instance, be approved by the local joint policing committee, JPC, have the authorisation of the Garda Commissioner, often on foot of a recommendation from the local Garda crime prevention officer and must have the prior support of the relevant local authority. In this regard, it must be noted that the local authority must act as data controller. I must emphasise that this is the legal basis for all community CCTV schemes, regardless of whether grant funding is sought from my Department to assist in their setting up.

In accordance with this legal framework, the large majority of local authorities have previously undertaken to act as data controllers in the context of specific community CCTV schemes. This has been the case either in the course of the current grant aid scheme administered by my Department, during previous grant aid schemes operated by Pobal on behalf of my Department or in connection with schemes funded independently by local authorities. I understand from my Department's engagement with the Local Government Management Agency, LGMA, that the total number of local authorities that have undertaken the role of data controller for these purposes amounts to 28 out of a total of 31 local authorities nationwide. I am also pleased to inform the Senator that the Data Protection Commission, DPC, issued guidance on data protection and community CCTV on 29 November. The guidance, which is available on the DPC website, confirms that there is a legal basis for community-based CCTV and that the general data protection regulation, GDPR, does not introduce any new barriers in that regard. In particular, the DPC confirms that data protection legislation does not stand in the way of the roll-out of community-based CCTV schemes that have been authorised by the Garda Commissioner.

It also states that once the local authority in the administrative area concerned is willing to take on and deliver on its responsibilities as the data controller for the schemes concerned, there is no legal impediment under data protection legislation to the scheme commencing.

The guidance covers a number of other issues also. For example, it confirms that local authorities are not required, as a result of their role as data controller, to monitor CCTV live feeds on a continuous basis. I am confident that this and other clarifications in the note will be of significant assistance to local authorities in terms of how they carry out their role under law in relation to community CCTV.

The Office of the Data Protection Commissioner is also currently conducting an audit of issues, including the practice, operation and governance of CCTV. Again, I expect the more detailed findings of that process to be of assistance to all concerned and, in particular, to local authorities. The Senator may also wish to be aware that my Department is also engaging on an ongoing basis with the Local Government Management Agency and the County and City Management Association, CCMA, to clarify any queries that might arise.

A Programme for a Partnership Government commits to supporting investment in CCTV systems and, as I have said, my Department is administering a grant aid scheme to assist groups in the establishment of community based CCTV systems in their local areas. Eligible groups can apply for grant aid of up to 60% of the total capital cost of the proposed system, up to a maximum total of €40,000. To date, there have been 27 applications to the scheme, of which 20 have been approved for grant aid, totalling more than €500,000. A further four applications to the scheme are currently being assessed and considered. The remaining three applications have been returned to the applicants concerned to enable them to supply the information necessary to qualify for grant aid.

I assure the Senator that all interested groups, in both rural and urban areas, can take advantage of the availability of this grant aid scheme. If the Senator is aware of community groups wishing to avail of the scheme, full details of the grant aid package are available to download from my Department's website www.justice.ie and support and guidance is available to help interested groups to apply for this funding through a dedicated email address, which is communitycctv@justice.ie.

I thank the Minister for his comprehensive response on the important issue of CCTV that I have raised. I have spoken to a number of local authorities and as far as they are concerned, this impasse continues to exist so I am a bit confused in that regard. Can the Minister confirm that the difficulties the CCMA were having are now resolved? Another issue that came up for smaller local authorities, in particular, was the cost incurred by them in administering such a CCTV scheme.

I am confident the guidance issued recently by the Office of the Data Protection Commissioner regarding data protection will be helpful to all those concerned and I put on the record my thanks to those local authorities which have already supported their communities in setting up such schemes. I assure them that my officials are doing all they can to further streamline and simplify the process.