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Seanad Éireann debate -
Tuesday, 22 Feb 2022

Vol. 283 No. 1

Nithe i dtosach suíonna - Commencement Matters

Nursing Education

I welcome the Minister of State. I cannot believe that I am once again here talking about paying student nurses and midwives. I ask the Minister of State to take my pleading back to the Minister for Health to sort out the pandemic payment for student nurses and midwives. It is unbelievable that this is still going on. A year ago, I introduced a piece of legislation that would allow student nurses and midwives to be paid. The Government, cynically, did not oppose the Bill. In fact, it let it proceed to Second Stage and be sent off into the ether rather than face a bad headline of once again simply refusing to acknowledge it or to commit to paying student nurses and midwives. Whatever about the argument that student nurses and midwives are not working and, accordingly, whether they should therefore be paid, that is a little bit beyond the scope of what I am here to speak about today.

I ask the Minister of State why student nurses and midwives have still not been paid the promised pandemic payment. I have spoken to a number of student nurses and midwives around the country, and they want the Government to put its money where its mouth is and instead of clapping for them, to pay them the promised pandemic payment. Students were deployed to fight this virus and while the Government did pay them the rate during the first wave, they ended up working during the much more aggressive second and third waves free of charge. Student nurses and midwives took on the same workload as nurses while still balancing learning the skills required as part of their college training placement.

I will not lie. After two years of this pandemic, with all that we asked of student nurses and midwives and all that they did on the Covid-19 front line, I was almost apoplectic when I learned that the reason their payment, for which they have been fighting tooth and nail, was not yet paid was because a memorandum had not yet been written. It is a very hard pill for student nurses and midwives to swallow that they are not getting a payment they had been promised from September, one I was told had been approved by the Cabinet before Christmas, although it is now February, nearly March, because a memorandum has not been written. That is beyond unseemly. It is extremely frustrating for student nurses and midwives.

It is unbelievable that we have left struggling student nurses and midwives, and have not paid them this meagre contribution given that they held the hands of dying patients at the height of the pandemic when their family could not be there for them. They cared for elderly patients on wards and played a crucial role in keeping the lights on and the doors open while Covid consumed the health service, all while they were students and supposed to be learning and on placement, upskilling and training to get the technical skills that are so desperately needed on their part. The pandemic payment is not a whopper. I believe it is €100 a week, which is not insignificant. It is incredible that it has not yet been paid.

I would contest that student nurses and midwives are currently working for free, but the Government has the power to change that. The Minister of State will probably tell me that the reason they have not been paid is because a memorandum has not gone out and that someone else has not done the work.

Ultimately the Minister for Health is in charge of ensuring that student nurses and midwives are being paid. That memo went to Cabinet and my understanding is that it was agreed by Cabinet. As I said, it is unbelievable that we are in this situation. It is February, nearly March, and student nurses and midwives are going to be coming to the end of their academic year very soon and they still have not been paid. Why has this happened and, most important, when is it going to be rectified?

I thank the Senator for raising this very important issue. It is not the first time she has taken to her feet to raise this. A key Government priority is to protect the education of all students, including student nurses and midwives. Clinical placements account for 50% of the overall education programme requirements for student nurses and midwives and supporting students to undertake clinical placement remains a key priority for the Government. In early 2021 the Minister, Deputy Donnelly, directed a longer term review of matters relating to student nurses and midwives to be undertaken. He appointed Mr. Seán McHugh to carry out this important work. In November 2021 following consideration of the recommendations within the McHugh report, Government approved the Minister's interim proposals to provide significant additional supports, worth €12 million, to student nurses and midwives while attending their clinical placements.

For supernumerary students these proposals extended the pandemic placement grant, PPG, of €100 per week to all eligible nursing and midwifery students on placement for this academic year backdated to September 2021. In addition, the McHugh report sets out recommendations to enhance the current travel and subsistence scheme for students in attending their supernumerary clinical placements. The Minister will consider these further so that a permanent enhanced scheme can be developed that will provide a targeted and more equitable approach to supporting students in undertaking supernumerary clinical placements, to be in place from September 2022.

In the meantime the Minister has doubled the weekly cap on vouched accommodation allowance to €100 per week of placement for supernumerary students needing overnight accommodation away from their normal place of residence in order to attend some of their clinical placements, which is also backdated to September 2021.

In regard to internship students on rostered placement, work is ongoing to progress other recommendations within the McHugh report, including increasing the salary of intern students to 80% of the staff nurse salary. In the meantime we are providing student nurses and midwives on paid internship placement with additional support of €50 per week of placement, amounting to €1,800 in total. This is for the duration of their internship and is with effect from January 2022, the same date as paid internships for the current academic year began.

To go to the nub of the Senator's question, on 22 January 2022 the Department issued sanction to the HSE regarding these additional supports and requested that payment be prioritised. Yesterday the Department was informed by the HSE that it is finalising a memo to be issued to services to provide for payment. As part of this process the draft communication has been shared with representative groups. After the memo is finalised and issued, the HSE has confirmed payment will follow the normal lead in time for routine payment cycles which I believe is fortnightly. The Department has once again emphasised to the HSE the importance of expediting these payments.

In conclusion the Department has also commenced its work on the recommendations from the McHugh report that are applicable to the next academic year, and in this regard the Minister intends to bring a detailed proposal to Government in due course.

I thank the Minister of State for her reply. We understood the memo had very recently gone out. The review is extremely welcome and I urge the Minister to enact these recommendations with haste. It is all well and good that this is going to be sorted out soon. I note there is no set date yet. It is still somewhat in the hopefully not-too-distant future, which will bring student nurses and midwives some comfort but it will not help them backdate anything. Backdated payments are all well and good if you can afford to have a backdated payment. However, landlords are not going to take backdated rent, Vodafone will not take a backdated bill, and Tesco is not going to take a backdated payment for groceries. I am sure the Minister of State understands how deeply frustrating this is for students nurses and midwives. They go in every single day and do their absolute best and they are exhausted.

They are wrecked. The pandemic payment is a small payment and it immensely frustrating for those student nurses and midwives. My phone is literally hopping in front of me with people asking when they are getting this, on which date and what is happening. We cannot have stuff backdated all the time. I hope that this can be sorted very quickly.

To reiterate, on 26 January 2022, just under a month ago, the Department issued the sanction to the HSE regarding these additional supports and requested that payment be prioritised. Yesterday the Department was informed by the HSE that it is finalising a memo to be issued to services to provide for payment. The Department has, once again, emphasised to the HSE the importance of expediting these payments. The Senator is quite right. It is exactly as she said. They are student nurses and they have been guaranteed this payment. It needs to happen very quickly.

In conclusion, I just want to make some additional remarks. I want to inform the House that the overwhelming majority of student nurses and midwives have availed of the Covid vaccination, which has been a significant contributing factor to ensuring that clinical placements have continued with minimal disruption. I want to commend all student nurses and midwives in this regard.

Second, to ensure that appropriate oversight of support is in place for students, the clinical placement oversight group has remained in place and reports to the chief nursing officer in the Department.

I will again raise the Senator's issue. We are nearly there but nearly is not good enough. They need their back money and I do appreciate that.

Hospital Services

It is always a pleasure to have the Minister of State, Deputy Butler in the House. I am raising this matter about the adult metabolic services at the Mater hospital in Dublin. I am sure the Minister of State is aware of the importance of the work that this unit does.

However, it is, unfortunately, significantly under-resourced. There are much-needed resources required for this unit to operate at a reasonable capacity. At the moment, it is not operating to its capacity at all. It certainly is not reaching its potential and, sadly, it is not reaching the potential that it could achieve for the patients who are suffering. I am thinking particularly of the patients who are diagnosed with phenylketonuria, PKU. I am sure the Minister of State is aware of how debilitating PKU can be.

From birth, many children who are diagnosed with PKU find that their eating habits have to be completely altered. They are isolated from their peers even when they go away on school tours, trips away and so on. They have to have a special diet because of their condition. This continues into adulthood. A friend of mine has it and it is a daily struggle in terms of just putting together a diet that one would feel satisfied with and one would feel they are fulfilling the best they can in life. That is a huge strain on people. It is a huge strain on people’s mental and physical health.

We have, as a society, a responsibility to do all that we can to support these people who are a small minority of our population. Yet, Ireland has double the European average of people who suffer from PKU. Many medicines are being trialled but, unfortunately, they are not being trialled on adults because the resources are not there and the expertise is not in place at the Mater to do so. I am thinking, particularly, of a drug called Kuvan. Perhaps the Minister of State is aware of this drug. It is a new drug and it is believed it can revolutionise the lives of people who have PKU. However, it is no good to people in Ireland who are suffering from PKU because the drug is not being trialled at the Mater hospital.

Kuvan is just one drug. I believe there is much research internationally being done on PKU. There are many drugs at pretrial and trial stage in other countries. However, we are a long way down the line from ever being able to trial those drugs in this country.

PKU sufferers are citizens of this country as well. They pay their taxes the same as the rest of us.

They are citizens and they have the same right to access to proper, decent healthcare and the potential to have access to new medicines that can and would transform their lives. We have spent a great deal of money on health over the past number of years for the good reason that we were in a pandemic. The spend on health in this country has increased year-on-year dating back over the past ten years. The health budget is €24 billion. When €24 billion is being spent on health, all citizens should have a reasonable expectation that they are going to benefit from it. This unit in the Mater hospital needs investment. It needs to be tooled up and resourced so that people who are suffering from PKU will have the same access as their European counterparts to ground-breaking medicines that will change their lives.

I thank the Senator for the opportunity to address the House on this important matter, which I am taking on behalf of Minister for Health, Deputy Stephen Donnelly.

As the Senator will be aware, the Mater Misericordiae University Hospital is the designated site for the National Centre for Inherited Metabolic Disorders for adults. This centre provides assessment and treatment to adults with inherited metabolic disorders. It is also responsible for the diagnosis and management of these patients. Inherited metabolic disorders include a diverse group of rare conditions that can result in significant morbidity and mortality. Presentation may occur at any age. With advances in healthcare delivery and new therapeutic interventions an increasing number of affected children whose lifespan previously would have been severely curtailed are now reaching adulthood.

The adult metabolic service in the Mater hospital provides multidisciplinary care for patients with metabolic disorders. These disorders include phenylketonuria, PKU, which the Senator has spoken about, galactosemia and lysosomal disease. This important service helps patients to manage their conditions with optimal diets that match their metabolic needs. The HSE has informed me that current staffing in this important service at the Mater hospital is 12.5 whole-time equivalents. This team includes consultants, non-consultant hospital doctors, nursing staff, dieticians, a medical social worker, a psychologist and administration staff. Currently, approximately 900 adult patients attend the metabolic service at the Mater hospital. It is anticipated that will increase by at least 100 additional patients per annum over the next five years. These additional patients will include transition patients from the paediatric services located in Children's Health Ireland, CHI, at Temple Street. In addition to the above, the centre tests patients' responses to therapies for PKU treatment.

Since August 2019, newborns diagnosed with PKU have been tested in CHI at Temple Street and treated, when responsive, with Kuvan. There are also a number of patients with known dietary requirements who have been trialled on this medication. Once a child is placed on Kuvan, this treatment is expected to be lifelong. To date, access to Kuvan has not been available for PKU adults attending the centre at the Mater hospital, other than for three patients who received ongoing approval following an earlier phase 3 clinical trial extension.

I have some good news for the Senator. I have been informed that the HSE and the Mater hospital have now agreed appropriate funding levels for 15.6 whole-time equivalent staff and the Mater hospital is commencing this recruitment process. With this resource in place, the centre at the Mater hospital will begin to expand the service to meet current and future requirements. This resource will also support provision of Kuvan trialling and monitoring for appropriate patients with PKU. I am assured that the HSE and the Ireland East Hospital Group remain committed to the progressive development of metabolic services at the Mater hospital and to improving this service for patients of the Ireland east region.

I thank the Minister of State for the comprehensive update. It is very positive news. I sincerely hope that the recruitment of the additional three or four whole-time equivalents happens and that it does not fall into the HSE ambitious plans for recruitment that does not happen.

This is specialised and critical and I imagine it will have to be an international recruitment process. The reason people want adults to avail of Kuvan, in particular, relates to the fact they have seen its success with children and the difference it makes. The adults the Minister of State mentioned who are continuing to use it in their lives following the trial have benefited from it.

Given there are clear benefits and the results speak for themselves, it is essential that this happens. I sincerely hope the recruitment will happen in 2022, with Kuvan rolled out this year also. The Minister of State might stress to the HSE, perhaps even in writing to the chief executive, the need to put this on the priority recruitment radar, even above and beyond other recruitment, in order that it will be made a top priority of the HSE.

The Senator is absolutely correct. As he will have heard in my earlier response, it is anticipated the number of patients presenting will increase by at least 100 per annum over the next five years, so we have to build capacity. There are currently 12.5 whole-time equivalents in the adult metabolic service at the Mater hospital and that figure will increase to 15.6, or an additional three posts. That is welcome and recruitment should be commenced as a matter of priority.

The recruitment of the additional staff agreed between the hospital and the HSE will enable the service to expand to meet future requirements, including the provision of Kuvan trialling and monitoring for appropriate patients with PKU. As I said earlier, children who are put on the drug remain on it, but it is not as accessible for some adults. I will certainly convey the Senator's concerns to the Minister for Health and I thank him for raising the issue.

Health Services

I thank the Minister of State for appearing before the House to discuss this important topic. I seek an update on the progress of the roll-out of the programme on women's health announced in budget 2022. Budget 2022 included a number of announcements relating to women's health, one of which involved the provision of free contraceptives for 18 to 25-year-olds. It is my understanding this is due to happen from August. A survey carried out by Plan International Ireland has found that many females have decided they are going to avail of the offer. Will it begin in August? Will someone who is almost 26 years old be cut off when they turn 26 or can they continue for a year or two?

A total of €10 million of the funding will be used to address period poverty. One survey has found that many females aged between 12 and 19 have found the cost of sanitary products to be very difficult. Some public buildings have started to provide free sanitary products, as have some local authorities. Similarly, in Scotland and New Zealand, free period products are offered to all those who need them. Who will be in charge of the programme in Ireland and will we be able to match what is being done in Scotland and New Zealand, for example? What will be the nature of the roll-out in schools, universities and colleges?

There was also an announcement relating to the funding of four menopause clinics, a really important area. The first one has opened, in Dublin. Will the other three be spread out among the regions or will they all be Dublin based?

For example, will there be one in Munster and another in Connacht? It is important that there be a regional spread.

Will the Minister of State update the House on the gynaecological model of care? It ties in with the menopause clinics and is part of the maternity strategy.

Significant emphasis was placed on endometriosis. Will the Minister of State provide an update in that regard? I look forward to hearing from her.

I thank the Senator for the opportunity to speak to the House on the important topic of building a more positive outlook for women's health. That this Oireachtas has finally placed such an emphasis on women's health is a positive outcome. It is great to hear the different voices in both Houses all supporting one another.

My Department is committed to improving women's health. Since the establishment of the women's health task force in 2019, we have engaged with women all over Ireland. We have listened to what they want from their health service and we have taken a number of positive steps to improve women's experiences of healthcare and health outcomes. We are building supports for tackling period poverty. The Government has supported the Free Provision of Period Products Bill 2021, taking into account the recommendations of the period poverty in Ireland discussion paper. A cross-governmental period poverty implementation group is co-ordinating the development of interventions recommended in the programme for Government, the discussion paper and the Bill. More than €700,000 has been allocated to my Department in 2022 for initial period poverty measures. I hope to have more detail on the Senator's question about schools and universities soon. I would be happy to return to the House and update it on the matter. We are currently working on HSE-led initiatives for members of the Traveller and Roma communities in the south east as well as projects in collaboration with local authorities, for which the majority have already submitted expressions of interest. We are reaching out to the voluntary sector, including food banks, to support as many people as possible.

Following up on the programme for Government commitment, we are preparing to introduce free contraception for women, starting with 17-to-25-year-olds. Funding of €9 million has been allocated for 2022. The scheme will provide the cost of prescription contraception, two GP consultations per year and fitting, removal and check-ups for long-acting reversible contraceptives; and additional training and certification for medical professionals to fit and remove long-acting reversible contraceptives. Contraceptive options will include contraceptive injections, implants, coils, the patch and ring, and various forms of oral contraceptive pill, including emergency contraception. As such, it will not be limited to oral contraceptives only. Expanding the scheme to further age cohorts can be considered once we have had a chance to monitor and evaluate the 17-to-25-year-old scheme and ensure that it is working smoothly.

We anticipate significant progress with the roll-out of a number of specialist menopause clinics this year. In 2021, a specialist menopause clinic was established under the governance of the National Maternity Hospital, the first publicly funded clinic of its kind. Budget 2022 provided the necessary funding to enable the roll-out of an additional three specialist menopause clinics. As to the Senator's question on whether they will all be Dublin based, she will be delighted to learn that they will not be. There will be one in Galway, one in Cork and one in Limerick. The three new menopause clinics being established in 2022 will be part of the maternity networks in the South/South West, University Limerick and Saolta hospital groups. This provides a good catchment area around the country. As I understand it, the operationalisation of the new clinics will be dependent on resourcing the necessary staff. In this regard, the HSE's national women and infants health programme has advised that the engagement with the relevant hospital groups is progressing as planned.

Across each of the issues raised under this Commencement matter - period poverty, contraception and menopause - we are committed to progressing the agenda and advancing women's health experiences and outcomes.

I thank the Minister of State for that positive response. It is great to know that the programme is on course to deliver within the timeframe.

Regarding my first question, I am still unsure as to whether the free contraception programme will start in August. I assume from the Minister of State's answer that it will.

The fact that it is to be reviewed for an older cohort once it is up and running is very welcome.

I am delighted that University Maternity Hospital Limerick has also been included in the clinics. This is very welcome news. I thank the Minister of State and the Department for their commitment to women's health. It is an area that has been forgotten for a long time so it is very welcome news.

The Minister of State also spoke about the inclusion of food banks. There are people in poverty who go to the Society of St. Vincent de Paul and such places. It is important that there is engagement with those places regarding the provision of products.

I thank the Senator very much. I agree with her; that is why the food banks were mentioned. Like she said, the likes of the Society of St. Vincent de Paul are important.

My understanding is that free contraception will commence in August as planned.

I will touch on one point that was not raised but that comes under my remit, which is perinatal mental health supports. We currently have six main hubs across the country. All 13 spoke sites now have mental health midwives in place under the model of care for specialist perinatal mental health services for women before, during and after their pregnancy. Sometimes people can have mental health difficulties and to have those 19 perinatal mental health midwives in place throughout whole country is really positive.

We have been have been actively progressing a commitment for €31 million in additional funding for women's health in budget 2022. In the coming weeks, we will launch the women's health action plan for 2022-23 setting out the actions that will realise the investment.

I thank the Senator and other women Members of both Houses for raising their voices on women's health. It is very timely and great to see. It is great to have the Minister, Deputy Donnelly, support all our calls and have our voices heard.

I thank the Minister of State. We certainly echo that. It is wonderful to see such investment in women's health.

Environmental Schemes

I just met the Minister of State outside the Chamber. It is a benefit of arriving early, which does not happen too often. I had a good conversation with him and he was very informative and helpful in providing information regarding this Commencement matter. He has probably alleviated most of my concerns or at least answered many of them.

A massive scheme was announced last week. The headlines can be misleading at times and there are different issues to be explained with regard to the grants available. I ask the Minister of State to refresh me on a few of the points we discussed outside the Chamber.

That was a very short contribution. The Senator does not mince his words.

The Minister of State has given me a personalised answer already, in fairness to him.

It is important that I put everything on the record as well having a chat.

I thank Senator Davitt very much for raising this issue and giving me a timely opportunity to give an update on the Government's support for home retrofit. The programme for Government and climate action plan set targets to reduce greenhouse gas emissions from the residential sector from 7 megatons of carbon dioxide in 2018 to between 3.5 megatons and 4.5 megatons in 2030. A comprehensive retrofit programme will be a key measure to support the achievement of this target.

We will need to retrofit the equivalent of 500,000 homes to a building energy rating of B2 and undertake the installation of 400,000 heat pumps in existing homes to replace older, less efficient heating systems by the end of 2030. This represents approximately 30% of the housing stock and is among the most ambitious retrofitting programmes in the world.

The national retrofit plan was published last November as part of the climate action plan 2021 and sets out how the Government will deliver these targets. The plan is designed to address barriers to retrofit across four key pillars.

First is driving demand and activity, second is financing and funding, third is supply chain skills and standards and fourth is governance.

Recognising that the achievement of our climate action plan targets will require a step change in the pace and scale of delivery of Ireland’s residential retrofit programme, the Government has approved a package of supports to make it easier and more affordable for homeowners to undertake home energy upgrades to create warmer, healthier and more comfortable homes, with lower energy bills. The key measures include: first, a new national home energy upgrade scheme, providing increased grant levels of up to 50% of the cost of a typical deep retrofit to a B2 building energy rating, BER, standard. That is up from 30% to 35% of grants that were available. There are a significantly increased number of free energy upgrades for those who are at risk of energy poverty. That is up to €400 per month, from an average of €177 per month in 2021. There is a special enhanced grant rate, which is equivalent to 80% of the typical cost for attic and cavity wall insulation for all households. That is to urgently reduce energy use as part of the Government's response to current exceptionally high energy prices.

The new initiatives will be funded by the unprecedented national development plan financial allocation for residential retrofit. That is €8 billion available up to 2030. More than 60% of this funding, €5 billion, will be sourced from carbon tax revenue. A total of €267 million has been allocated for the Sustainable Energy Authority of Ireland's residential and community schemes and the solar photovoltaic scheme in 2022. This is the highest ever allocation for the schemes. The investment this year would support almost 27,000 home energy upgrades, including over 8,600 homes, to a building energy rating of B2. This is a near doubling of the number of homes delivered to B2 in 2021. In addition, €85 million funding has been provided by the Minister for Housing, Local Government and Heritage, Deputy Darragh O’Brien, for the local authority energy efficiency retrofit programme. This means that of the total Government retrofit budget of €352 million, 58%, or €203 million, will be spent on dedicated energy poverty schemes and local authority retrofits.

Regarding wood pellet burners, a marginal abatement cost curve was developed as part of the climate action plan. That was to provide a solid, analytical foundation on the most cost-effective pathway to reduce emissions in line with Ireland’s decarbonisation targets. In using Ireland’s 2018 greenhouse gas emissions projections to 2035, associated projections of economic activity and assessments across 300 business cases for technology, the analysis identifies the technologies, including fuel switches and the associated levels of adoption that are required to meet our 2030 targets in the most economical way. Our national target of 400,000 heat pumps was derived from this analysis, and Government funding and incentives are aligned with this policy objective, as opposed to other heating systems, such as wood pellet burners, which do not have national targets.

I thank the Minister of State. The rising cost of electricity is probably the biggest concern, especially with some of the retrofit innovation. Heat pumps are probably our largest concern. They are so tied to the ESB. This is particularly the case when we cannot feed power back onto the grid. We are doing so in a very minimal way at present. That is really an issue. The sooner that link with ESB is tidied up to be able to feed power back in through the grid, it will be a massive help. The cost of power when it comes to heat pumps is probably the greatest concern I have in relation to this matter. I appreciate the Minister of State’s answer. He has been very helpful.

The Senator rightly identifies that electricity has a key role to play in decarbonisation. He is right to ask about the refit tariff. This is the money that is paid to people for selling their electricity back to the grid. That process is in train as fast as it can be done. It will be ready within a small number of months.

Regarding the deep retrofits, our analysis says that approximately 50% of homes need their attic insulation redone and that they would get a great return on investment by doing that. Attic and cavity wall insulation are the two most cost-effective measures. For somebody who spends €500 on getting their cavity walls and their attic insulated, the Government will pay €2,500 on top of that €500. That means that they will make back about €300 a year. It means that their return on investment of €500 down will be made within less than two years. It is a very good way to save money on electricity bills. It is worth more per year than the €200 that we are putting in people's accounts on one-off basis. They will get €300 every year thereafter. We are very keen that as many people as possible take that up.

It is a very affordable scheme for people who are not on welfare but are on low pay.

The Minister of State pointed out something to me outside the Chamber that I had not realised from listening to the media which is that this can be done bit by bit. That can be done without doing other parts of the retrofit. That is very good.

Yes. When the one-stop-shops are in place it will bring a lot of clarity. I have suggested that post offices in our communities would be very much involved both in helping with finance and in doing some of the one-stop-shop business as well.

An Post has offered a one-stop-shop service. Electric Ireland is also doing so. Its service is called Electric Ireland Superhomes. The credit unions will also offer one. They are three trustworthy bodies across Ireland and I expect to see others.

Cuireadh an Seanad ar fionraí ar 3.16 p.m. agus cuireadh tús leis arís ar 3.34 p.m.
Sitting suspended at 3.16 p.m. and resumed at 3.34 p.m.