Nithe i dtosach suíonna - Commencement Matters

Home Care Packages

I welcome the Minister of State, Deputy Jim Daly, to the House.

I congratulate the Acting Chairman on his elevation to the position of Cathaoirleach for the day. I hope this day is reckonable for pension purposes. I welcome the Minister of State. The issue I raise today is that of the so-called in loco parentis restriction which, as he will know, applies to HSE home care. Essentially this means that when a child is receiving care from a nurse or other healthcare professional in his or her home, his or her parent is obliged to stay in the home for the duration of the visit or to nominate another adult to be present in his or her place. I understand that the restriction is applied as a matter of policy within the HSE and that, as such, it could be abolished at the stroke of a pen.

This restriction has a range of negative impacts on families. It renders the whole purpose of the home care package ineffective and it engenders an air of mistrust between parents and care providers. It is as if the HSE feels they cannot or should not be trusted to be alone with the children in question. It is also insensitive because it suggests that parents are somehow negligent if they leave their children in the care of fully trained healthcare professionals and that those professionals are not sufficiently qualified or trustworthy to have children in their care alone. Each one of these practical impacts of this rule is ridiculous. It is very distressing for people. One of these impacts is to render parents prisoners in their own homes and, in many cases, to deny them a break and an opportunity to leave their home to attend to other basic family matters such as doing the weekly shopping or getting their hair done.

Groups who represent parents and those who provide care in the home, which are groups to which we should listen very carefully because they are at the coalface, are scathing about this rule. The Jack and Jill Foundation says that it flies in the face of compassionate care. Ms Eilín Ní Mhurchú, the Jack and Jill Foundation's liaison nurse in Cork, has said:

It is only adding to the burden of care for these families, it is not helpful. The HSE seems so far removed from the daily lives of these families ... They are not showing care or compassion.

Until March 2018, the Government repeatedly gave the same prepared stock answer to this issue whenever it was raised, particularly in the Dáil. That answer had three elements. It first said that the restriction was justified because these home care arrangements provide clinical as opposed to respite support. Second, it said that parental presence might be necessary for "an acute emergency such as respiratory arrest, decannulation of a tracheostomy or status epilepticus". This medical lingo was included verbatim in replies to several parliamentary questions, which suggests it is a copy-and-paste job from the HSE. The third part of the stock answer is that when the national quality assurance process is complete the national steering group for children with complex medical conditions will review the issue. The Minister, Deputy Harris, gave the latest version of this stock answer to Deputy Ó Caoláin in the Dáil last November. I hope that the Minister of State will give more than the standard reply today.

The position taken by the HSE is a cold, formal, businesslike attitude to a situation that requires common sense and compassion on its part and on the part of the State. I note that on 27 March 2018, more than 15 months ago, it was agreed unanimously that the in loco parentis rule in home care contracts for sick children is causing unnecessary stress, worry and constraint on the parents of sick children. The Government was called on to abolish the clause immediately. As the Government accepted that motion 15 months ago, I ask the Minister of State to outline the progress that has been made on this issue since the unanimous adoption of that motion, whether the promised review has been conducted, and whether the HSE has adjusted or is about to adjust its position.

I thank Senator Mullen for raising this issue and providing me with an opportunity to update the House on recent developments. I assure the House that I am very committed to the ongoing provision of paediatric home care packages to support the discharge of children with complex needs from acute hospital services into the care of their families.

Not only do such packages benefit children and their families directly but they create capacity within hospitals to treat other children in need. We have 417 such packages in place and intend to increase the total number to 457 by the end of the year, which would represent an additional 80 packages compared to the number in 2018. To support this level of service, €28.7 million has been allocated for the provision of these packages in 2019, an increase of more than €6 million year on year.

Turning to the Senator’s point about the in loco parentis provision, it is important to note that, first and foremost, paediatric home care packages are a clinical, not a respite care, support. While providing nursing care for the child with complex healthcare needs in the home, nursing staff cannot assume sole responsibility for a child where parents may not be available. A designated and competent person appointed by the parent is, therefore, required to be available to act in loco parentis. This requirement ensures a second person will be present in the event that there is an acute emergency such as respiratory arrest, decannulation of a tracheostomy or status epilepticus. Nonetheless, I am very aware that providing respite care can be an issue for parents of children with complex medical needs.

I am aware of the concerns raised in this House and elsewhere about the operation of the in loco parentis provision. I am, therefore, pleased to be able to advise the House that the HSE recently completed a national quality assurance initiative process for paediatric home care packages, PHCP, which, among other things, examined the question of respite care. As part of this process, new guidelines for children with complex healthcare needs, carer's break approval and risk minimisation have been developed. The new guidelines are intended to address concerns about the issue of in loco parentis provision by providing for a carer’s break under certain criteria. This should introduce greater flexibility in the operation of individual PHCPs and has the potential to provide additional support for parents and families as part of an integrated approach to the delivery of care. It is important to stress that the guidelines have been developed following extensive collaboration with the Royal College of Nursing in the United Kingdom, the school of nursing in Trinity College Dublin and, crucially, the parents of children availing of the service. The HSE continues to work towards publishing the guidelines in the third quarter of the year as part of a suite of documents on the care of children with complex medical needs. In the meantime, I understand detailed briefings are scheduled for operational staff and that an implementation plan will be agreed with each community healthcare organisation throughout the country.

I thank the Minister of State for his reply. It looks as if and sounds like progress is being made. I will examine the reply with care, although I do note the stock answer reappeared. My concern is the restriction stems from a bureaucratic or status mindset that insists on a distinction being made between clinical support and normal home care support, as we understand it. The fact that it is deemed to be desirable that there be such clinical support in the home shows an excessive distinction between clinical support and normal home care support is inappropriate and possibly unethical. Part of the clinical support component is the human dimension. Care of the person is or should be incorporated in clinical support. It does not necessarily require advanced training, but it is, nonetheless, a necessary part of clinical support. If we reflect on recent controversies about Holles Street hospital and the way it treated one couple who had lost a child, we really get the sense that sometimes those delivering clinical support are overly separated from the necessary human dimension of the care they are providing. The in loco parentis provision sends a bad message which perhaps stems from an excessive desire to separate what is a clinical support responsibility from a home care support responsibility. One should be integrated into the other. I hope the new guidelines will make this point clearly and allow for something real and tangible in what the Minister of State described as the carer's break in order that carers will be able to take a break in such circumstances.

As I outlined to the House, paediatric home care packages are clinical care nursing packages designed for children with complex medical conditions who have significant healthcare needs and are not intended as respite care support. The nursing staff cannot assume responsibility for a child where the parents may not be available. A designated and competent person is required to be available to act in loco parentis in the event that there is a medical emergency. Nonetheless, the HSE and the Government are cognisant of the concerns raised about the matter. Of course, we wish to provide as much support as possible for children and their families. The national quality assurance initiative process for paediatric home care packages commenced in 2017 and recently completed. As part of the process, a suite of documents have been developed that set out standardised protocols and care plans. As I said, they are expected to be published in the third quarter of the year. The documentation includes the development of new guidelines for dealing with children with complex healthcare needs, carer's break approval and risk minimisation. The guidelines reflect the outcome of extensive consultations with clinical experts and parents. I hope the House will join me in welcoming the implementation of the new procedures which will enhance the quality of care provided and improve the supports for parents in caring for their children with complex healthcare needs.

Services for People with Disabilities

I welcome the Minister of State back to the Chamber and thank him for taking time out of his schedule to be here.

I want to talk about the Drumconrath healthcare facility in County Meath. Caridas House was part of the facility which was operated by the HSE. It was a residential care centre for people with disabilities. Its recent closure affords the HSE an opportunity to expand services further at the location. The facility has two or three GPs who are working full-time and provide an excellent service not only for the people of Drumconrath but also the people of north Meath generally and as far away as Carrickmacross, County Monaghan and Kingscourt, County Cavan. I am thinking about additional clinics being made available for people living in the area. For example, a public health nurse could be located there a few days a week or a social worker could be included, with mental health and physiotherapy services, among many others. I hope the HSE will take on the task of exploring what services could be put in place for the benefit of the people living in Drumconrath, north Meath and as far away as Kingscourt, County Cavan and Carrickmacross, County Monaghan. I look forward to hearing the response of the Minister of State. This is about providing additional health services for the people living in these areas.

I thank the Senator for raising this issue and giving me the opportunity to respond on it.

The Government’s ongoing priority is the safeguarding of vulnerable persons in the care of the health service. We are committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives.

Significant resources have been invested by the health sector in disability services in recent years. This year alone, the Health Service Executive, HSE, has allocated €1.9 billion for its disability services programme. As part of its ongoing service provision, the HSE will provide more than 8,500 residential places this year for families in need throughout the country. In fact, residential services make up the largest part of the disability budget.

Residential placements for adults with disabilities are considered following detailed clinical assessments made by HSE services. Access to places for those with the most complex needs are allocated on a priority basis and appropriate availability of services. Regarding the centre mentioned by the Senator, I am advised by the HSE that Caridas House is a small bungalow situated on the grounds of the health centre in Drumconrath, County Meath. In 2018 the HSE decided to review continued service provision in Caridas House based on the service experiencing challenges in meeting the needs of families and service users. I understand the rural location, small house size, perceived poor access to community activities and a lack of public transport were key factors in that regard. The decision was based on the premise that moving the residents to an alternative community residential home operated by the HSE's disability services would ensure they would maintain or improve the quality of their lives and, furthermore, that they would continue to be supported by staff known to them.

During 2018 and into this year, numerous meetings were organised by the HSE with the families of the two individuals who were resident in Caridas House to discuss the future plans for the facility and its residents.

I understand that just one client remains as a resident of the facility, and in fact the person concerned is moving to an appropriate community residential home with immediate effect. It is still the case that international evidence demonstrates that the outcomes for individuals are always better in the community, and Government policy is for people with disabilities to be supported to achieve their full potential so that, where possible, they can live ordinary lives, in ordinary places, doing ordinary things.

Future plans for the building are a matter for the HSE. My understanding is that the building, when vacated, will need to be assessed by the HSE as to its suitability for any further use.

Before I call the Senator, I want to welcome to Seanad Éireann all our visitors from the Holy Trinity National School in Leopardstown. I am sure that the Minister and Senator Gallagher will join me in that welcome and in hoping that they have a nice day here today.

I too extend a warm welcome to our visitors and hope they have a very enjoyable day.

I thank the Minister of State for his comprehensive response. We realise that things have moved on with the care facility; it has closed down and people accept that. The two most important lines come at the end of the statement and are about future plans. That is what I want to talk about this morning. There is potential for the HSE to bring additional services to that community, and I would like the Minister to stress to the HSE the importance of bringing additional GP-led services to the facility in Drumcondra for the benefit of the entire area.

I thank the Senator for highlighting the importance of the availability of a resource such as this to the HSE, and ensuring that focus is kept not just on the ending of one service but the beginning of a new one. These facilities have cost a lot of money, and communities have invested a lot through fundraising. It is important that they are maintained into the future as part of the service delivery. I will echo the Senator's sentiments to the HSE that we would like a plan for this facility to be put in place as soon as is practicable and possible.

Senator Mac Lochlainn was supposed to be present to ask the Minister for Agriculture, Food and the Marine, Deputy Creed, about the dispute relating to fishing rights and Rockall. As neither of them is present, we will move on to Senator Burke.

Local Authority Boundaries

I thank the Minister of State for coming to deal with the matter of the extension of a city boundary in Cork, in which he was very involved. There is a lack of clarity regarding the jurisdiction of the city sheriff and the coroner for the area. I spoke to the coroner last week, who advises me that his jurisdiction remains along the lines of the old city boundary. I understand that there is also a lack of clarity regarding the jurisdiction of the city sheriff. This is an important issue for him in relation to a number of matters, such as court judgments and their implementation. Is he now confined to the old city boundary, or does his jurisdiction extend to the new city boundary? The Minister of State will be aware that an additional 85,000 people have come in from the county to the city; it now takes in Ballincollig, Glanmire, Blarney and Tower. I have brought forward this Commencement matter because I am looking for clarification.

I am replying on behalf of the Minister for Justice and Equality, Deputy Flanagan, who cannot be in the House today. I thank the Senator for raising two issues of jurisdiction concerning sheriffs and coroners following the recent alteration in the boundary between Cork city and county. The question arising is whether this boundary change affects the respective bailiwicks of the city or county sheriffs, or the relevant coroners' jurisdictions under the provisions of the Local Government Act 2019. The Minister for Justice and Equality is responsible under section 12 of the Court Officers Act 1945 for the appointment of sheriffs. They are appointed to a particular bailiwick, or jurisdiction, which are generally understood to comprise the counties of the State and, in the cases of Dublin and Cork, county boroughs.

Section 2 of the Local Government Act 2001 is relevant. It defines "administrative area" as "an area standing established under section 10 for the purposes of local government and which is — (a) a county in the case of a county council, (b) a city in the case of a city council, (c) a city and county in the case of a city and county council". The administrative areas were established "for the purposes of local government" and for no other purposes.

On sheriffs, the Department of Justice and Equality consulted the Revenue Commissioners, who advised that "administrative area" is a defined term for the purpose of local government. It is clear, therefore, that the transfer of areas in Cork is not intended to have effect for any purposes other than local government purposes, thus the boundary adjustment has no effect on the bailiwick of the Cork city and county sheriffs insofar as either revenue or court matters are concerned.

The Senator also raised the issue of possible changes in the coronial districts in the context of the boundary change. He may be aware that changes to these districts are governed by the Coroners Act 1962, in particular section 6(3) of that Act. This provides that changes to adjoining coronial boundaries are a matter for the Minister for Justice and Equality to determine following consultation with the Minister for Housing, Planning and Local Government. It also requires the consent of the coroners for the districts. No alteration to the boundaries of the relevant coronial districts in Cork were, or are, proposed.

This causes a legal difficulty. The county sheriff is appointed as the sheriff for Cork county, but this reply indicates that the county sheriff now also has jurisdiction in parts of the city. Does the law allow that, given that it is now a totally different boundary? The State may be open to legal challenge if a person appointed as the county sheriff for Cork now has jurisdiction for part of the city. I raise this question in that context. It needs to be clarified from a legal point of view, because it will not be too long before someone living in what is now the city, and which was part of the county, will challenge the jurisdiction of the county sheriff.

I accept what the Minister of State said about the coroner, but it is unusual for someone to be the city coroner, with another coroner for the county who also covers part of the city. Those job description problems need to be looked at and clarified, but it is the legal issue that I am concerned about.

I have not yet had a chance to talk directly to the Minister for Justice and Equality about this, but I understand the issues that the Senator raises. It would be desirable in the long run to bring the multiple boundaries in line with one another, and I will certainly talk to the Minister about that. As the Minister for Justice and Equality outlined in his response, which I have just delivered, there is currently no consideration of that, but I will ask him whether, in the light of the fact that he has much legislation going through both Houses of the Oireachtas, there is a mechanism for bringing into line the boundaries for sheriffs and coroners.

The legal issue is what I am concerned about and that someone may make a challenge. The Department should get written clarification from its own point of view.

I cannot answer that.

Rockall Island Ownership

I apologise to the Minister. We skipped him earlier as Senator Mac Lochlainn was slightly delayed.

This House debated the Sea-Fisheries (Amendment) Bill earlier this year. The central premise of the Government's argument was that it was important to permit UK-registered vessels to have access to Irish fisheries right to the shoreline and to reinstate the principle of voisinage agreements ahead of Brexit, to build good relations with the British Government. In recent weeks, the Scottish Government has stated that Scotland will board Irish vessels and take them back to Scottish ports, and will take the owners to court, if needs be, to defend what they call their 12-mile limit around Rockall.

At the time we wondered. This is not typical behaviour of the SNP Government, led by Nicola Sturgeon. Normally, it is a prudent Government. However, now, several issues have emerged. The 2013 bilateral agreement, which was signed by the then Tánaiste, Deputy Eamon Gilmore, at a time when the current Taoiseach and Tánaiste were in government, with the latter having responsibility for the marine, recognises not only the exclusive British economic zone around Rockall but also significant waters around it. They have drawn a marine boundary and signed a bilateral agreement. That agreement was never laid before these Houses. It has never been open to the scrutiny of these Houses. No fisheries organisations were consulted about the agreement. I seek legal clarification, therefore, from the Minister as to the status of that agreement, how it impacts on the Scottish or British claim to Rockall and the fisheries around it, and, perhaps, oil and gas reserves. What is the status of that agreement and why was it signed?

Second, why did the Minister fail to make it clear to the Oireachtas Members he briefed, having spoken to both Houses, at the time that he sought to reinstate that arrangement under the Sea-Fisheries (Amendment) Bill? Why did he not make clear that at that time the Scottish Government was corresponding with him and threatening to board Irish vessels, asserting its authority over the 15-mile limit? Why did he not think it necessary to make Members aware of that at the time? Does he think that would have impacted on the decision made by these Houses? The fisheries organisations are very angry. Some say they acted in good faith when they were briefed by the Minister to support the legislation, which they did reluctantly, but now they have learned of the correspondence with the Scottish Government to the effect that Britain was reasserting its rights and trying to keep Irish vessels out of its waters, and that far from Ireland not standing up for its interests, we would give them more. It is extraordinary. We need answers.

The Tánaiste received a formal letter of notice from the Scottish Cabinet Secretary for External Affairs, Fiona Hyslop, MSP, on 31 May, stating that Scotland would deploy vessels in the Rockall area to take "enforcement action" against Irish vessels found fishing within 12 miles of Rockall.

Ireland's position is that there is no basis for excluding Irish fishing vessels from the waters around Rockall as they are legitimately pursuing EU fishing opportunities and have done so unhindered for decades. We do not accept that there is any justification for enforcement action against Irish vessels fishing legitimately in these waters. The United Kingdom claims sovereignty over Rockall and a 12-mile territorial sea around it. The United Kingdom first made its claim of sovereignty in 1955 and sought to incorporate it as part of the UK in its domestic law by virtue of the Island of Rockall Act 1972.

The Irish Government has never sought to claim sovereignty over Rockall. Its position has been, and remains, that it does not accept the UK’s claim to sovereignty over Rockall, which it regards as forming part of the UK's exclusive economic zone and, accordingly, part of European Union waters under the Common Fisheries Policy, to which the principle of equal access for the vessels of all EU member states applies. Irish vessels have operated unhindered in the Rockall zone for many decades fishing haddock, squid and other species.

I met as soon as possible representatives of the Irish fishing sector to inform them of the letter from the Scottish authorities, but also confirmed that Ireland’s position on Rockall had not changed. The industry representatives explained that Ireland's main fisheries in the Rockall area are for haddock and squid and both fisheries are of substantial economic importance to our fishing fleet based in Greencastle, Killybegs, Castletownbere and other ports. The industry was appreciative of that engagement, but was also concerned at the possibility that unjustified enforcement action might be taken against them. The issue was not raised by me during the debates on the Sea-Fisheries (Amendment) Bill earlier this year as it was not relevant to that debate and, even had it been, I do not believe that the position of Scotland on Rockall would have, or should have, influenced in any way our determination to re-establish the long-standing entitlements of Northern Irish fishermen under the voisinage arrangement. This was the right thing to do in the interests of all the peoples on this island.

We have built with Scotland a strong and positive relationship to our mutual benefit over many years. I hope that we can use that close relationship to find a way to resolve these matters and to remove the unacceptable threat of enforcement action against Irish vessels.

Dialogue is continuing between the Irish and Scottish Governments and there have been close contacts at official level which are ongoing. It has been agreed that a process of intensified engagement will take place, led by senior officials from both administrations. We are hopeful that on this basis the latest difficulties can be de-escalated.

I refer to Article 10.4 of the Constitution. It is clear regarding the responsibility of the Minister and the Government to ensure that any alienation of minerals or waters is brought before these Houses, so that the Houses of the people have their say on the matter. Despite what the Minister has just told the House, in 2013, the agreement I have before me was put before Westminster. Our Government co-signed this bilateral agreement, which recognises the exclusive economic zone of the United Kingdom including Rockall and vast waters around it. This was from 2013 when the current Taoiseach and the Tánaiste were members of Cabinet, but the agreement was never laid before these Houses.

That was in contravention of Article 10.4 of the Constitution. I ask that the Minister bring that agreement for debate or ratification before these Houses at the earliest opportunity. I believe this agreement is void until he does so.

The words are there on paper. I listened to the words of the Minister and the Tánaiste, Deputy Coveney, and initially I thought they were strong words. I though he was defending Ireland's interests and was puzzled as to why the Scottish Government was behaving in this way but it turns out that we gave them the grounds to do so in 2013. I find it extraordinary that we agreed the Sea-Fisheries (Amendment) Bill, which I accept went through these Houses democratically, but the Minister did not put the correspondence from the Scottish Government before us. They were telling us they wanted us out of what I regard as waters in which Irish vessels have the right to fish. I am not so brazen as to claim faraway territories but we must insist always on the right to fishing resources or all other resources around Rockall as shared resources.

Iceland is contesting this bilateral agreement to the UN. It has a different perspective. Why are we not uniting with Iceland? Why are we not uniting with Denmark to ensure it is a shared space? My fear is that after Brexit, when EU fisheries policy no longer applies to the UK, we will have a serious problem on our hands. I ask the Minister to reflect on all of this and to realise that the 2013 agreement needs to be brought back before the Oireachtas as soon as possible for debate and democratic ratification or rejection by these Houses. I hope it will be rejected. I will strongly advocate its rejection. The Minister needs to explain further why this was not on the table when we were dealing with the Sea-Fisheries (Amendment) Bill.

I have given the Senator some extra time because I appreciate that this is a very sensitive matter, particularly for his local area.

It is worth bearing a number of points in mind. The UK claims sovereignty on Rockall. We do not recognise that sovereignty. We have not claimed sovereignty on Rockall. Under the UN Convention on the Law of the Sea, a claim on sovereignty is unable to establish an exclusive 12-mile zone around an uninhabitable island. We believe our fishermen are pursuing a legitimate opportunity to fish in that region for quotas that have been allocated to them under EU Common Fisheries Policy legislation. The Senator seems to be conflating the issue of sovereignty around Rockall with the entirely different issue of the exclusive economic zone. Rockall rests within the UK's exclusive economic zone. That issue has been negotiated. In fact, when the final draft of the exclusive economic zone agreement mentioned by the Senator was concluded, following protracted negotiations, it was much more favourable than what had originally been proposed. I think there is a degree of misinformation and conflation of issues here. The issue of the accepted definition of the boundary between our exclusive economic zone and the UK's exclusive economic zone is entirely different from the matter of an exclusion zone being in place around Rockall on the basis of sovereignty. The bottom line here is in respect of sovereignty. We do not recognise UK sovereignty. We believe we have been fishing there legitimately and continue to fish there legitimately. On the question of voisinage, there is no issue connecting these two matters. The voisinage legislation was about reinstating the right of Northern Ireland boats to fish in our inshore waters, which they had previously enjoyed. When that legislation was being considered, we enjoyed the right to fish in their inshore waters.

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