Nithe i dtosach suíonna - Commencement Matters

Health Services

I thank the Minister of State, Deputy Feighan, and welcome him back to the Seanad. This issue relates to the Scoliosis Advocacy Network. I am not sure if the Minister of State has been briefed on this issue, but its representative appeared last week on "Today with Claire Byrne" on RTÉ. One of the reasons I am following up on this is that the Scoliosis Advocacy Network has been in touch with me, as it has been in touch with many other Members. The network's concern is what it describes as children languishing on waiting lists to have their medical needs and surgery addressed.

On "Today with Claire Byrne", the cofounder of the Scoliosis Advocacy Network, Ms Clare Cahill, said there had been no engagement with the Minister for Health, Deputy Stephen Donnelly, despite repeated requests. That surprised me. I have a lot of time for the Minister; he is most engaging. Any time I have had any reason to deal with him on any matter he has been prompt and responsive. That is on the record and I have checked it again. This story was covered on RTÉ radio. I checked again this morning just to be sure. The network has said it is a concern and I would like some clarification on that assertion.

The network has cited the last-minute cancellation of surgery, as well as the experience that some children have had of surgery being cancelled; many of them have had it cancelled three times. That is clearly unacceptable. We know that the Ombudsman for Children has highlighted access to scoliosis care for children and has spoken about it as being a fundamental children's right. I agree with him.

The HSE promised it would buy surgeries and provide health services through the private health system, in a similar manner to the National Treatment Purchase Fund, NTPF. I now understand this is not available for those with very complex needs, and I can understand that. That is fair and reasonable.

Two issues stood out in RTÉ's coverage of this issue. The Taoiseach has said that the delays in treatment are not because of the lack of resources, but rather are the result of a systemic failure. He said he has spoken to the Minister for Health about these matters. The Minister for Enterprise, Trade and Employment, Deputy Leo Varadkar, said the Government severely regrets that children and their families are experiencing long waiting times for scoliosis treatment and that he is seriously concerned about it. I think that is fair comment.

I had hoped to ask the Minister for Health about this. There are now 172 children waiting for scoliosis treatment, many of whom are, as their parents have described, in agony. They have specific needs and the longer interventions are delayed, the more impact there will be on them. It is a scandal. Health is an important issue. It is something that has to be addressed, in particular where children are concerned.

I am not sure if the Minister of State is in a position to answer my question, but I intended to ask the Minister for Health to explain why there is such a delay in surgery and what the systemic failure is that the Taoiseach is on the record as saying exists regarding scoliosis treatment. In a nutshell, I want the Minister of State, if he can, to set out a timeline for how these children will be treated and, more importantly, an absolute commitment that the Minister and Department of Health will engage in a meaningful way with the Scoliosis Advocacy Network.

I thank the Senator for raising this very important issue. On behalf of the Minister, Deputy Donnelly, I welcome the opportunity to address the House.

I sincerely regret that children can experience a long waiting time for scoliosis treatment and I remain conscious of the burden this places on them and their families.

The priority of the Minister for Health and the Government is to improve waiting times for all patients accessing hospital treatment, and reducing paediatric waiting lists for orthopaedic procedures remains a priority within that. The Department, the HSE and the National Treatment Purchase Fund, NTPF, are working on a multi-annual waiting list plan to address waiting lists and bring them in line with Sláintecare targets over the coming years. This process will be overseen by a ministerial task force, chaired by the Secretary General of the Department and including representatives from the HSE and the National Treatment Purchase Fund. It will take the learnings from the achievements of the vaccine task force to inform the plan.

To support the work of the task force, an additional €250 million is being provided in budget 2022 to improve access to care across the health system. It is recognised that waiting times for scheduled appointments and procedures have been impacted in the past 19 months as a direct result of the Covid-19 pandemic and, more recently, as a result of the ransomware attack. The cyberattack in May 2021 in particular caused significant disruption to the orthopaedic service and all services across the Children's Health Ireland, CHI, hospital group. Without access to a patient's full history and previous diagnostic investigations, it was not considered safe to proceed without all electronic support systems in place. This impacted patients with complex needs in particular and restricted the patient cohort that could safely proceed without surgery during this time. Most systems are now back up and running across CHI sites, but backloading of information is ongoing, and this continues to have an impact on waiting lists and the numbers of surgeries completed.

Despite the impact of the pandemic and the cyberattack, Children's Health Ireland advises that as of the end of September 2021, 266 spinal surgeries had been carried out, which is an increase of 41 compared with the same period last year. CHI has remained committed to increasing activity levels and examining innovative measures to improve access to all specialties. For example, additional theatre sessions are being held in Cappagh National Orthopaedic Hospital for non-complex, age-appropriate orthopaedic patients. CHI also continues to develop the advanced clinical triage model in Citywest. Active clinical triage is a system which has been adapted for use within the paediatric orthopaedic unit at CHI Crumlin. Its purpose is to reduce the overall orthopaedic outpatient waiting list, starting with the longest waiting clinically appropriate referrals.

A new orthopaedic consultant with a specialist interest in neuromuscular conditions started in Temple Street in September, which should also enable the use of additional theatre capacity and support additional capacity as part of the Cappagh kids programme. Officials in the Department of Health remain in regular contact with CHI regarding scoliosis services, and CHI has advised that all patients with a diagnosis of scoliosis require a preoperative work-up prior to spinal surgery, including multiple diagnostic investigations and a review by a multidisciplinary team. The plan of care, which is implemented for each patient, is tailored to best meet a patient's clinical requirements. It is the responsibility of the treating consultant to prioritise patients clinically on the waiting list for surgery.

I am very disappointed. I do not know who prepared the Minister of State's response. This matter was specifically about scoliosis. This was not about the National Treatment Purchase Fund or waiting lists generally. This was a very focused Commencement matter about 170 children with scoliosis. It was as a result of an episode of "Today with Claire Byrne" on RTÉ last week and correspondence that had been sent to the Taoiseach, the Tánaiste, the Minister for Health and the leader of the Labour Party, Deputy Kelly. There is no comfort in the Minister of State's reply. What do I say when I pick up the phone in ten minutes' time to speak to the Scoliosis Advocacy Network, whose members asked me to make a case for them here today?

The reply does not talk about the systemic failure the Taoiseach spoke about and is on the record as having spoken about. It does not talk about the severe regrets expressed by the Tánaiste or children's experiences of long waiting lists or the need to remain conscious of the burdens that are placed on the families concerned. None of that is addressed in the Minister of State's response.

I respect the Minister of State. He has a task to do and he is delivering the substance of this message on behalf of the Department but I ask him to go back to it and say this is urgent. It relates specifically to the 172 children who want to know when they are having their treatment. They do not want to hear, for the fourth time, that their treatment has been deferred. I thank the Minister of State for giving the Department’s response but I respectfully ask him to go back to the Department and say he is not happy with it. It is not comprehensive and it does not give comfort to the children and families involved.

Again, I thank to Senator for raising this issue. I am acutely aware of the distress and inconvenience caused to patients and their families when urgent care is delayed. Improving waiting times for hospital appointments and procedures is a priority. I will relay the Senator’s concerns and annoyance to the Minister and the Department.

It is recognised that waiting times for all scheduled appointments and procedures have been impacted in the past 19 months as a direct result of Covid-19. There have been some positive aspects but the needs of the 172 young children need to be addressed as quickly as possible. I hope my officials in the Department will work closely with Children’s Health Ireland and the wider HSE to try to improve access to this treatment.

The Senator asked for a commitment to a timeline. I cannot give him one. However, I thank him for raising this difficult and important issue. I will relay his views to the Department and try to get him a response as quickly as possible.

Departmental Funding

I thank the Minister of State, as always. I really appreciate his great commitment to us in the Seanad.

I really welcomed the announcement in the budget of an additional €6 million for the Minister of State’s Department. I have submitted this matter because we really need to understand how much of the funding is being apportioned to the drugs and alcohol tasks forces under the drugs strategy. The Minister of State is no doubt aware of the views of the chairs of the drugs and alcohol task forces around Dublin. I am privileged to be the chair of the Dublin 12 drugs and alcohol task force. For much of my contribution, I will use its words. The drugs initiative budget was cut every year between 2008 and 2014, resulting in an overall cut of 35% to key services responding to the drug problem on the ground. There has been little or no attempt to restore the pre-recession budgets and no increase in the allocation between 2014 and 2018. In 2019, there was an additional €20,000 per drugs task force but half of that was clawed back in 2020. In 2021, a need for an increase in drugs and alcohol task force budgets was anticipated. There has been a failure year on year, which is frustrating and demoralising for those working on the ground. The drugs problem has become more widespread. It is complex and deep rooted. Each community has its own problems to deal with and its own needs to be met. Therefore, communities need discretion to model their actions and respond at local level.

We have a commitment in the programme for Government. It states:

The Drug and Alcohol Task Forces play a key role in implementing this strategy and increasing access at local level to harm reduction initiatives. We will examine how we can continue to support it in identifying local need in communities, and support targeted initiatives addressing drug and alcohol misuse.

To date, there has not been great progress in supporting the increase in the demand for those services, although I acknowledge the Minister of State’s absolute commitment and support. I acknowledge also that he recently met representatives of each of the drugs task forces and set out the six strategic areas on which he is going to work with them. However, the matter highlighted in the budget submission of the drugs and alcohol task forces is that, although there is inflation, the budget has not matched it.

There is an increase in demand, the tsunami expected after Covid. We need an increase. There is an increase in the number of people with a dual diagnosis to which we need to be able to respond.

There is no discretion for design and delivery in the scope of the funding available to services. We need to build back better. The pandemic response needs to be phased, targeted and very community focused and community-based because the culture and context is unique to each task force. I see this even with our task force and the individual areas within Dublin 12. I would welcome the Minister of State's comments on how much of this budget is being allocated to task forces. It would be great to see a major amount because it is more than needed, to say the very least.

I again thank the Senator for raising this issue. I welcome the opportunity to update the House on the funding allocated in budget 2022. I echo her contribution regarding the work the task forces do. I will put on the record my great admiration and thanks for the great work the volunteers and people in the task forces have done.

I am providing €6 million in new funding for new measures to support the implementation of the national drugs strategy. This funding will strengthen the health-led approach to drugs and alcohol use and will deliver on new strategic priorities for 2021 to 2025 under the national drugs strategy, including commitments in the programme for Government, which the Senator referenced. I am happy to inform the Seanad that I am providing €500,000 to increase access to, and provision of, community-based drug and alcohol services in budget 2022. The funding will have a specific focus on services for women, ethnic minorities and LGBTI+. It will address the barriers women and minority groups can face in accessing drug and alcohol services.

The lived experience of people who use drugs will be central to the design and delivery of the new services. The new services will be developed in conjunction with the national network of drug and alcohol task forces. The Department of Health has published a fact sheet on the allocation of the €6 million funding, which is available online and is being circulated to all stakeholders, including drug and alcohol task forces and the community and voluntary sector.

The Senator will be interested in the other measures I am supporting in budget 2022. These include €1.7 million to increase the availability of HSE drug and alcohol services on a nationwide basis for people with alcohol addiction, people under 18, families affected by drugs and rehabilitation and recovery programmes; €700,000 to reduce the impact of parental drug and alcohol use on children and young people in line with the joint HSE-Tusla Hidden Harm strategic statement and practices guide; €300,000 for harm reduction responses to address high-risk drug use, such as crack cocaine and stimulant drugs in local communities and the night-time economy, and to extend the Naloxone demonstration project to prevent drug overdose deaths; and €700,000 to provide health screening and brief intervention for people who use drugs known as SAOR. This service will be a core component of the health diversion programme for people found in possession of drugs for personal use, so they are treated with compassion and have the opportunity to avoid a criminal conviction. There will also be €300,000 to expand health supports for people who are homeless and have complex health and addiction needs. This includes an additional 260 tenancies under Housing First and an enhanced health service for up to 4,000 single homeless people in Dublin.

I envisage a key role for community and voluntary organisations, including the network of drug and alcohol task forces, in delivering these new measures I announced in budget 2022. Additional resources will be directed towards interventions that lead to reductions in problem drug and alcohol use and achieve an improvement in public health outcomes. Measuring the effectiveness of these additional services will, therefore, be an important objective of public policy.

I thank the Senator for raising the issue of dual diagnosis, which is one that we must work on in all sectors across all Departments.

I am keen to work with all stakeholders on ensuring that we can tackle it a bit more robustly than has been the case in recent years.

I acknowledge the Minister of State’s personal commitment from the moment he took on this responsibility. He has shown an extraordinary commitment and openness in the context of listening to the sector. I welcome the breakdown of the funding allocated. I will be delighted to share that information with the chairs and co-ordinators of the drug and alcohol task forces when I go back to my office. The health model is problematic, though, when we are dealing with such a complex basket of needs. What is required is an interdepartmental and interagency response. I hope that we will get an opportunity in the context of the strategic review to highlight this aspect with the Minister of State. We need discretion in this area and the budget provision must have some sort of discretionary element.

Following agreement on the strategic priorities for the national drugs strategy for the period 2021-25, I recently met with the drug and alcohol task forces, as the Senator said, to outline the additional funding I am providing to deliver on these strategic priorities. This includes €1 million in funding for the development of a programme of community-based drug and alcohol services. The programme will adopt a population-based approach to the provision of drug and alcohol services in line with the Sláintecare model. An allocation of funding will be provided to each community healthcare organisation, and there will be engagement with the drug and alcohol task forces to identify service priorities for their regions. That development has been welcomed by the task forces. I will also be announcing shortly a prevention and education programme on alcohol and drugs use among children and young people. The drug and alcohol task forces will have an opportunity to develop proposals for funding under this programme. Together with the measures announced in budget 2022, this additional funding will strengthen the health-led approach to drugs and alcohol use and deliver on the strategic priorities for the period 2021 to 2025 under the national drugs strategy, as well as on the commitments in the programme for Government.

Freedom of Speech

It is always good to see the Minister of State. I thank him for coming into the House. I raise the issue of the continuing incarceration of Julian Assange and ask for urgent action from the Irish Government on this issue and for it to speak out about it. Since 9/11 and the subsequent, and misnamed, war on terror, respect for international law by the US, NATO and other allied countries has virtually collapsed. That has led to the most horrific war crimes and abuses being committed. Sadly, Ireland is implicated in this situation because of our facilitation of the US military at Shannon Airport.

Mr. Assange has spent ten years incarcerated, first in the Ecuadorian Embassy in London and then in solitary confinement for the past two years in Belmarsh Prison in the UK. Although a British court refused to extradite Mr. Assange due to fears that he would not survive the US penal system, that decision is now being challenged by the US Government. If the appeal succeeds, then Mr. Assange will face a sentence of 175 years in prison. He will likely spend that time in extreme isolation. This is clearly a politically motivated case, taken simply because Mr. Assange exposed US military and other war crimes, human rights abuses and corruption in the US-led wars in Afghanistan and Iraq.

The documents released by WikiLeaks were published widely by mainstream media outlets such as The Guardian, The New York Times, Der Spiegel, Le Monde and many others. First came revelations of the breaches of international law at Guantanamo Bay and then the collateral murder video, which recorded US pilots in an Apache helicopter gleefully slaughtering 18 innocent Iraqi civilians. In co-ordination with international media organisations, Mr. Assange followed those revelations with the Afghan war diaries and the Iraq war diaries, which exposed major war crimes committed by US forces and their allies.

Mr. Assange is, in effect, a political prisoner. His continued incarceration and threatened extradition to the US, therefore, is not just a threat to him personally but to all journalists, editors and publishers and the cause of investigative journalism, press freedom and freedom of speech generally. It is ironic that western countries, which claim to be defenders of freedom, are acting in this way.

In fairness to the Government, in recent times the Minister for Foreign Affairs has been very outspoken on both the failures of international policies and the very clear abuse of power shown by nations, in particular in respect of journalists and political opponents. Recently the Minister condemned the incarceration of Alexei Navalny in Russia. He also spoke out about the Ryanair flight that was in effect hijacked over Belarus to detain Roman Protasevich, a journalist who was outspoken against the Belarusian Government. Even more recently the Minister outlined his views on the catastrophic failures in US foreign policies in Afghanistan. It was those failures of American policymakers that Julian Assange helped to highlight and let the world know about. He is an outstanding journalist and a credit to the work he has done. He should be treated as such and should not be held in captivity any more. He should be released immediately. Ireland now has a very strong voice in our position on the UN Security Council. It is time we used that for the common good and spoke up for Julian Assange.

Mr. Assange has suffered enough simply because he exposed through his journalism extensive government deceit, corruption, war crimes, state-sponsored killings, extraordinary rendition, military cover-ups of unlawful killings and, ultimately, the true wholesale horror of the disastrous, futile wars led by the US and British Governments. It is time for us to speak out. We cannot pick and choose which human rights issues we wish to speak out about. If we believe in freedom of speech, it must apply to Julian Assange as well as others.

I thank Senator Gavan for raising this matter, which has been the subject of much media comment in recent years. My colleague, the Minister for Foreign Affairs and Minister for Defence, Deputy Coveney, has informed me that officials of his Department are following the case of Mr. Julian Assange. Mr. Assange, an Australian citizen and the public face of the Wikileaks website, was arrested by British police in London in April 2019 after he left the Embassy of the Republic of Ecuador because the asylum that had been granted to him by Ecuador about seven years previously was withdrawn. He was initially jailed in May 2019 at Belmarsh Prison, London, for a breach of bail conditions. In September 2019 his remand status was changed from a serving prisoner to a person facing extradition. Mr. Assange is currently detained in the UK on an extradition request from the United States. In September 2020 he appeared before the Central Criminal Court of England and Wales for an extradition hearing. He faced a United States federal grand jury indictment. According to a US Department of Justice release of 24 June 2020, this indictment included charges of conspiracy to obtain and disclose national defence information, conspiracy to commit computer intrusions, seven counts of obtaining national defence information and nine counts of disclosure of national defence information.

On 4 January 2021, at Westminster Magistrates Court, the request of the United States for Mr. Assange's extradition was refused. The full text of this ruling can be found on the website of the Judiciary of England and Wales. I understand from press reports that the United States Government lodged an appeal against this ruling on 15 January 2021 and was given more time to submit detailed grounds for its appeal. Recent media coverage indicates that in August the UK High Court handed down a judgment that will allow the US Government to expand the grounds for this appeal. According to the press reports, Mr. Assange appeared at the hearing via video link from Belmarsh Prison.

The Minister considers this to be a legal matter within the jurisdiction of the United Kingdom that appears to be subject to ongoing legal proceedings. The question of the next steps for Mr. Assange rests with the UK judicial authorities. As legal proceedings are under way on this matter in another jurisdiction, the Minister does not intend to comment on this case.

It is so disappointing. We have a seat on the UN Security Council yet the Minister of State says the Government will not comment on perhaps the biggest human rights case facing the western world. What a contrast with the situation in Belarus. That is a situation involving a legal case.

That is a legal matter and the Government has no problem commenting on it. It has no problem commenting on legal proceedings in Russia but it will not offer a word of condemnation or stand for human rights when it comes to a man who has done more to expose war crimes than any other individual in my lifetime. The Minister of State is here to say there is nothing to see here and he will not comment.

Where are the values of this Government? How can this be acceptable in the face of the horrendous plight of Mr. Julian Assange? We all know why this is happening. The US wants to send a message to the world that if anybody tells the world what it does, this is the treatment that will be meted out. This is the punishment that will be received. We can see that happening to Julian but the Minister of State is here saying he has no comment. It is appalling.

I thank the Senator and have taken note of his remarks on the matter, specifically those on our seat at the United Nations Security Council and what is, effectively, a difference of opinion on matters related to Belarus and Russia. I will bring them back to the Minister. This is a legal matter within the jurisdiction of the United Kingdom and it appears to be the subject of ongoing legal proceedings, as I have already explained. The next steps in what happens to Mr. Assange rest with the UK judicial authorities. Again, as legal proceedings are under way with this matter in another jurisdiction, it is very difficult for us to comment on it. I will bring the Senator's views and concerns back to the Minister and I hope we can get a reply from the Department.

Water Services

I welcome the Minister of State, Deputy Malcolm Noonan. The next matter is from Senator Fiona O'Loughlin and relates to the water supply issues at the Ballymore Eustace plan in the great County Kildare. She is welcome.

It is absolutely the great county of Kildare. I am glad the Acting Chairman said that. I welcome the Minister of State, and I hope he will take on board the comments and points I will make. I certainly welcome any answers he has.

"Water is the lifeblood of our bodies, our economy, our nation and our well-being." That is a quote from Mr. Stephen Johnson, a former head of the American Environmental Protection Agency, and it rings completely true to us. I know the Minister of State is familiar with Kildare, where Ballymore Eustace has Ireland's largest water treatment plant, serving a population of almost 1 million people. It is located in County Kildare, although it is looked after by Dublin City Council. I am raising the really important question of water quality and the management of our water treatment plants.

We were all shocked in August to learn of the incidents that occurred at the Ballymore Eustace treatment plant, as well as the Creagh water treatment plant at Gorey. It is clear the management of these facilities failed miserably. Essentially, the management had to protect and safeguard the quality of water coming from these facilities but that did not happen. The failure of the local authorities, including Dublin City Council and Wexford County Council, to report issues with water quality to Irish Water in a timely manner led to an absolutely unacceptable delay in the Environmental Protection Agency and the Health Service Executive being notified, meaning there was no opportunity to issue a boil water notice. A prompt response could have protected the over 900,000 people dependent on this water supply from being needlessly put at risk.

We all accept a boil water notice is a major inconvenience, and I agree that they should be used sparingly and only issued when absolutely necessary. In these cases, however, a notice would have allowed people to protect themselves while the problems at water treatment plants were resolved. The failure in communication allowed consumption to continue as normal when it was known there was a problem.

I put it to the Minister of State, Deputy Noonan, that this was simply unacceptable. I find even more concerning the reports of how the specific issues were dealt with, such as the pump failure in Ballymore Eustace and the power failure at Creagh water treatment plant. Even under normal circumstances we were failing to protect our water supply. A safe and secure water supply is the very least that any of us can expect in our country. A recent audit has found that chlorine levels at the Ballymore Eustace plant were below standard even when the facility was functioning normally. This means that the water coming out of people's taps was regularly put at risk. That is absolutely unacceptable. Unfortunately, these are not isolated incidents. The entire process of how we supply water in the State needs to be reviewed. It is clear that enhanced scrutiny and oversight of the entire process is needed. Indeed, a month ago in this House I spoke about the issue whereby a number of eels were entering the water supply in the Carlow north regional water facility, which supplies water to Castledermot in south Kildare.

These are just three examples I have given to the Minister of State but I could go on all day recounting stories of issues from across my county and the country. What plans are in place to ensure a reliable and safe water supply to be provided to Irish citizens? What mitigation measures were put in place to give the general public confidence in the water coming from their taps?

I agree with the contention about the great County Kildare. I have Kildare blood in me too. It is a fantastic county.

The Minister requested that Irish Water undertake audits on the largest water treatment plants in the State serving the majority of the population. These are now complete and refresher training has been provided to the operatives at these plants. In addition, refresher training is being provided to all local authority management and engineers who are then cascading this training to all operatives and technical staff in all 800-plus water treatment plants nationwide.

I assure the Senator that we acknowledge there were clear and unacceptable failings here in terms of communication. People took ill from what happened at these plants. The Minister, Deputy Darragh O'Brien, acted swiftly with Irish Water, with the local authorities and with local government in general to ensure that incidents of this nature do not happen again

I appreciate that it has been acknowledged that there were clear communication failures in what happened with the Ballymore Eustace and Gorey supplies. We have to ensure that does not happen again. I appreciate the plants are now stable and operating normally, are producing clean and wholesome water and the refresher training has been put in place for all staff. That is very important.

The Minister of State has mentioned very significant investment of €1.57 billion next year, which is an incredible amount of money. If that is what is needed for a safe and secure supply of clean water, then it is money well spent. It is about the outcomes, however, it is not about the money spent. We must ensure we do not have these systemic failures again because, as I said at the start, the very least people can expect is access to safe, secure water.

Again, I want to give that assurance the Senator that certainly the learning experiences from this incident have been taken on board. The Minister, as I said, has acted swiftly and the Senator is correct in saying the investment of €1.57 billion is needed. That is sustained investment that is required over a period of time. The investment of €6 billion over the lifetime of the national development plan, NDP, is required because, as we have heard in this House and in the Dáil, we have had a number of incidents throughout the country where there have been discharges of raw sewage into watercourses. It is unacceptable from a human health and biodiversity point of view and these have to be addressed. That is why the Government is deeply committed now to ensuring we have a fit-for-purpose water and wastewater treatment system that is suitable for the needs and growth of the population in years to come. It is only fit and right we continue to invest, and this Government is committed to record investment in water and wastewater treatment over the next decade.

Sitting suspended at 3.17 p.m. and resumed at 3.30 p.m.