I propose to take Questions Nos. 591, 639, 641, 649, 659 to 661, inclusive, and 721 together.
In July this year the Government announced a comprehensive response to the long standing and sensitive issue of surgical symphysiotomy. The key response is the establishment of an ex-gratia payment scheme, which will cost around €34 million. In addition, there is a commitment to the continued provision of medical services, including medical cards for the women. The details of the Symphysiotomy Payment Scheme are currently being finalised and I expect the Scheme to be launched in the very near future.
The decision by Government to implement the Scheme followed Government's examination of a report carried out by Professor Oonagh Walsh, on Practice of Symphysiotomy in Ireland, between 1944 and 1984; and
an Independent Review of Issues relating to Symphysiotomy by Judge Yvonne Murphy which advised Government, inter alia, on the relative liabilities of insurers, indemnifiers and/or other parties in relation to symphysiotomy and on the merits and costs of proceeding with a payment scheme relative to allowing the court process to proceed.
Judge Murphy outlined the case for a scheme in her report and her recommendations on levels of awards were accepted by Government. Subsequently, I asked Judge Murphy to draw up a detailed draft scheme. I have consulted through the summer with the Judge and have also been speaking to relevant parties about the proposed scheme. Judge Murphy submitted her more detailed proposal to me on 11 September 2014, setting out how the scheme should operate. In this context I met the support groups representing women who have undergone symphysiotomy on 19 September 2014. I wanted to hear from the support groups how they hope the scheme will operate, and to confirm to them that the scheme will be established as quickly as possible. Two of the groups (Patient Focus and Survivors of Symphysiotomy Limited) have welcomed the establishment of the scheme. The third group (Survivors of Symphysiotomy) has advised women to reject the scheme. The views of all three groups have been taken into account in devising the scheme and I hope that when the women see the details of the scheme and the efforts made to ensure it is person-centred, simple and non-adversarial many of them will opt to join the scheme.
Key aspects of the scheme include:
- Women who had a surgical symphysiotomy in the State between the years 1940 and 1990 may apply in accordance with, and subject to the terms of the scheme.
- The scheme will be run by an independent Assessor. If women have questions on any aspect of the scheme, the Assessor or secretariat, will be available to assist.
- The scheme will be simple, straightforward and non-adversarial. It will allow women to have legal and other advice available to them in preparing to submit an application. It will result in awards of between €50,000 and €150,000 for the women.
- Women who have had a surgical symphysiotomy and have medical evidence to prove it may accept an award of €50,000 without further assessment. If no medical records are available a medical assessment will be carried out.
- For those who wish to apply for higher awards (€100,000 or €150,000) a medical assessment may be necessary if up to date medical records are not available, or if the Assessor decides this is needed for final determination of the award.
- Women will not waive their rights to take their cases to court as a pre-condition to participating in the scheme. Women may opt out at any stage in application and assessment process, up to the time of accepting their awards.
However, on accepting the offer of the award under the scheme, women will have to agree to discontinue their legal proceedings against any party arising out of their symphysiotomy.
While I am aware of the comments made by the UN Human Rights Committee, the Government believes that the establishment of this scheme is a fair and appropriate response. In agreeing to the ex-gratia scheme, the Government has demonstrated its commitment to trying to bring a resolution for the women concerned. The Government has acknowledged the pain and suffering which the procedure caused to many of the women and is aware also of the uphill battle many of them will face in the courts with uncertainty about the outcome of that process.
Regarding the numbers of symphysiotomies carried out in the State, Professor Oonagh Walsh, whose report has informed Government about the issue, estimated that around 1,500 symphysiotomies were carried out in hospitals in Ireland in the period between 1944 and 1992. She noted that it was a rare intervention in comparison with Caesarean section, with a rate of approximately 0.05% of total deliveries, or a symphysiotomy rate of 60 per 100,000 births.