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Dáil Éireann díospóireacht -
Tuesday, 8 Feb 2005

Vol. 597 No. 2

Adjournment Debate.

Hospital Procedures.

I welcome the opportunity to debate the ongoing difficulties, suffering and trauma experienced by more than 100 women arising from their maltreatment at Our Lady of Lourdes Hospital, Drogheda. Recently, I was invited to a meeting in Drogheda by a group called Patient Focus in Drogheda which wanted assistance in having its members experience at the hands of a consultant obstetrician and gynaecologist in Our Lady of Lourdes Hospital dealt with. The President of the Medical Council acknowledged in a report that women, babies and families were damaged in the hospital. This was very strong talk from the President of the Medical Council. I will quote an extract from a report on the fitness to practice of the consultant. It reads as follows:

The Report makes difficult and distressing reading. It tells the story of a tragedy which has very seriously injured you and other women. [This relates to ten chosen women from the fitness to practice committee investigating Mr. Neary]. The fact that you and other women could come to such harm at the hands of a member of my profession is something which I and other members of the Medical Council find unacceptable. The apology which I extend to you for that hurt cannot turn back the clock but may help a little in dealing with its consequences.

This is an apology which goes some way towards alleviating the suffering of these women. These people, who want to meet the Minister for Health and Children, have been ignored. They have sought a meeting for six years and it would help to bring some form of closure to their position. Approximately 130 women are living with the consequences of this butchery, which is the only way I can describe it. To add insult to injury, in most cases these women may have gone into hospital to have a small cyst removed, or to have a minor operation, and they were told afterwards that they were exceptionally lucky to be alive, it was a miracle they were still here and this consultant had just saved their lives. These women believed this. Later on, they met others who were also told they were lucky. Wombs were removed from women or girls as young as 19 years of age. Ovaries were removed from these women, which is a tragedy. They feel that every possible obstacle is being put in their way of having their complaints addressed.

Of the 130 claims lodged, upwards of 45 have been settled, but 39 files have gone missing. We will never know whether they were burned, but we know they are missing and there is no record of them. One must presume that something is being hidden. There are a number of incomplete files, files badly written up and sections missing from files. This is almost sufficient for a further inquiry.

What happened in Drogheda should send a message to the rest of the country. It was a student nurse who raised the alarm that something was wrong. Many professionals should have picked up on what was happening. We must ask whether sufficient safeguards are in place in this regard. Perhaps there should be comparators with different hospitals or at different monthly meetings in terms of whether something has gone beyond the bounds of what is normal. One would expect to experience just one such case in a lifetime, or one every ten years, yet a multiple of cases were involved in Drogheda.

The demands of the Patient Focus group are not very high. The group wants a firm commitment from the Government that a redress board will be established. There is a report by Judge Maureen Harding Clark and it is believed that these people can work together. There is a precedent for setting up such a board. A redress board was set up following the Stardust disaster. It would help to bring closure to what happened in Drogheda. Some of these people are unfit to go into an open court to plead their case.

I am pleased to have an opportunity to respond on behalf of the Tánaiste to the issues raised by Deputy Connolly and to advise the House of the background and current position in regard to these matters.

In 1998, employees of Our Lady of Lourdes Hospital, Drogheda, alleged to the North Eastern Health Board's legal adviser that Dr. Michael Neary had been performing an abnormally high rate of caesarean hysterectomies at the hospital. The board invited the Institute of Obstetricians and Gynaecologists to nominate an expert group to investigate the complaints against Dr. Neary. The group reported in 1999 as follows: first, Dr. Neary's practice had a high incidence of both caesarean section births and peripartum caesarean hysterectomy, namely, removal of the uterus following delivery of a baby, and, second, in regard to the patients who had a peripartum caesarean hysterectomy, Dr. Neary's clinical practice was unacceptable in 46.2% of cases, doubtful in 12.8% of cases and acceptable in 41% of cases.

The North Eastern Health Board referred the report to the Medical Council. The council also received 37 other complaints concerning Dr. Neary's professional conduct. The council's fitness to practice committee decided that 21 of these complaints warranted holding an inquiry under the Medical Practitioners Act 1978. On the application of the Medical Council in February, 1999, the High Court granted an order suspending Dr. Neary from the Medical Register. That order remained in place for the duration of the inquiry.

The Medical Council reported in July 2003 and decided that Dr. Neary's name should be erased from the Medical Register after finding him guilty of professional misconduct in regard to the unnecessary removal of wombs from 12 patients between 1986 and 1996. The Government decided that a further inquiry was necessary into the matters raised by the Medical Council. Judge Maureen Harding Clark, a judge of the International Criminal Court, was appointed to chair the inquiry. The principal purpose of the inquiry, which is non-statutory, is to establish why so many peripartum hysterectomies were performed at Our Lady of Lourdes Hospital over such a long period, and to ensure that all necessary measures are put in place to prevent any recurrence of this within the hospital system. Specifically, the inquiry is examining the rate of peripartum hysterectomy at Drogheda, and how this rate compares with the rate in other maternity units of similar status. It is seeking to establish whether the practice was commented on or acted upon by consultant or other medical and nursing staff, or by management of the hospital. It is seeking to ascertain the system of recording at the hospital, whether such records still exist and, if not, what has become of them. It is seeking to establish whether this review and consultation took place within the unit and whether periodical clinical reports were prepared. It is also examining the practices and protocols currently in place at the hospital with a view to advising on whether additional protocols and systems of control should now be put in place.

It is understood that the inquiry is making good progress and has received a significant level of co-operation to date in its work. Subject to legal advice, it is the intention of the Tánaiste to publish the report of the inquiry when it comes to hand.

Patient Focus is an advocacy group that represents some 130 women who were patients at the obstetrics-gynaecology unit at Our Lady of Lourdes Hospital. It is understood the group has been co-operating with the inquiry.

The Tánaiste has received proposals from Patient Focus requesting the establishment of a redress board and intends to meet the group shortly to discuss its request. Following that meeting, the Tánaiste will discuss the matter in consultation with her Government colleagues.

Cancer Screening Programme.

This matter concerns the extension of BreastCheck to the rest of the country and not only to the Dublin area. I thank the Minister of State for taking this matter but it is time the senior Minister started to take these issues more seriously.

A newspaper article stated:

The BreastCheck screening programme is being extended to three more counties, the Minister for Health, Mr. Martin, has announced.

The service, aimed at women aged between 50 and 64, has up to this only been available in the Eastern Regional Health Authority . . . and Midland Health Board areas. It will now be extended to Carlow, Wexford and Kilkenny [and the south].

That statement appeared in a newspaper article of 11 February 2003 and it is now 9 February 2005. However, we should not be surprised about the failure of the Department of Health and Children and the former Minister to meet that commitment. Despite the fact that the current Minister for Health and Children has been in office for a considerable period, the fact the promises made by the previous Minister, Deputy Martin, are unfulfilled is scandalous. BreastCheck must be made available to women all over the country. Anything less puts women's lives at risk.

The previous Minister, Deputy Martin, announced the rollout of BreastCheck to the Cork area in 2002 prior to the last general election. As soon as the election was called work on this stopped. Premises for the facilities had been purchased at the South Infirmary-Victoria Hospital and it was intended that three mobile units would operate from that unit in the general Munster area. It appears that the site brief, which includes the BreastCheck unit, was only completed in April 2004, some two years after it was originally announced. From April 2004, it would take a further 18 months for contracts to be signed. This is yet another unacceptable delay. This delay means that some women will not receive the treatment to which they are entitled. That is a straightforward fact. If there is not early diagnosis of such cancer, women will not get the treatment they need. Given the statistics that 600 women die every year from breast cancer, any further delays are unacceptable.

I hope the current Minister is not deliberately delaying the availability of this service so that she can once again announce it in the run-up to the next general election. It appears from the executive officer of the South Infirmary-Victoria Hospital, where the unit is to be based, that according to the Department of Finance the moneys for the BreastCheck unit will not be available until 2008. People will no longer by fooled by such promises.

All the evidence suggests that the BreastCheck programme is a tremendous success. There has been a 73% uptake rate among women invited for screening, which exceeds the target uptake to June 2000. The programme has exceeded its target for the diagnosing of cancer. In other words, BreastCheck works.

A recent report from Northern Ireland states that after ten years the evidence is clear that BreastCheck works and early diagnosis is vital in the fight against this disease which affects women. Most of these research pieces take approximately 30 years to be published, but it took only ten years to publish this one. Those involved in it were so convinced of the validity of the research that they published it.

Another newspaper article stated:

If ever there was a damning comment on how Ireland measures it medical priorities it is that we are spending more on eradicating disease in the farmyards than on breast cancer.

This fact emerged at an Oireachtas committee where BreastCheck, the cancer screening unit, said it needs €21 million to roll out its service nationwide.

It is a sign of the times, however, that badly needed funding has dried up, while this year €217 million will be spent on eradicating disease in farm animals.

As a result of the cutbacks, a nationwide expansion of the vital breast check service will not be achieved for years.

So, despite the Government's solemn commitment to underwrite this crucial service, tens of thousands of women are left facing a cancer risk. This means a service which saved the lives of many women is not yet available in Connacht or Munster.

What does that say about the priorities of a system that puts the eradication of animal disease before detection of cancer in women?

That newspaper article was from 14 February 2003. If the new Minister Health and Children has any clout or intends, unlike her predecessor, to make any fist of the Department, I advise her that the women of Munster can wait no longer for the provision of this service and they definitely cannot wait until 2008.

I thank Deputy Lynch for raising this matter. I take this opportunity to set out the current position on the BreastCheck programme and, in particular, on the extension of it to the remaining counties.

The national breast screening programme commenced in the eastern and midland regions in February 2000. Screening is offered free of charge to women in the 50 to 64 age group in these regions. Last year the programme was extended to cover counties Carlow, Kilkenny and Wexford. The expansion to the south eastern counties will result in an additional 18,000 women being invited for screening.

Since February 2000, cumulative revenue funding of approximately €60 million and €12 million capital funding has been allocated to support the programme. Up to September last year, 167,000 women had been invited for screening and approximately 120,000 women have availed of the service. It is estimated that the cancer detection rate is approximately 7.8 per 1,000 screened and to date over 1,000 cancers have been detected.

The national rollout of the BreastCheck programme to remaining counties is a major priority in the development of cancer services. The expansion of this service will ensure that all women in the relevant age group throughout the country have access to breast screening and follow-up treatment where required. A capital investment of €21 million has been approved to construct and equip two static clinical units, one at South Infirmary-Victoria Hospital, Cork and the other at University College Hospital, Galway. This investment will also ensure that mobile units are available to screen all women in the relevant age group throughout the country.

Detailed planning for the static units is progressing as a matter of priority. A project team was established to develop briefs for the capital infrastructure required for the two new units. The design briefs for both sites were completed in January 2005. The next stage is to appoint a design team to complete the detailed design of the two units. Given the scale of the investment involved, EU tendering procedures will apply.

It is intended that the facilities at Cork and Galway will be progressed simultaneously under the capital investment framework, 2005 to 2009. Capital funding in both cases has already been identified under the framework. The HSE, in conjunction with the Department, is examining the health capital investment framework with a view to initiating as quickly as possible new capital commitments for this and subsequent years.

The majority of women diagnosed with breast disease are treated outside the BreastCheck programme. The report on the development of services for symptomatic breast disease, which was published in 2000, found that the necessary care could best be provided by the establishment of specialist breast units. The report recommended the development of 13 such units, strategically placed throughout the country, each treating sufficiently large number of patients to maintain expertise and to promote best practice. Six of the units recommended in the report are now fully operational and the remainder are at advanced stages of development.

Since 2000, more than €60 million has been made available for the development of symptomatic breast disease services throughout the country. As regards the Health Service Executive southern area, there has been a cumulative additional investment of €76 million for the development of appropriate treatment and care services for people with cancer, including breast cancer, since 1997. This funding has provided for the approval of an additional 11 consultants in key areas of cancer care. These include two surgeons with special interest in breast disease. The funding has also provided for the appointment of 27 cancer care nurse specialists across the southern area.

The Tánaiste is committed to the national expansion of BreastCheck, the national breast screening programme. The design, construction and commissioning of projects of this nature generally take approximately two and a half years. It is anticipated that the advertisement for the appointment of a design team will be placed in the EU journal in the coming weeks and I am confident that the target date for the expansion of BreastCheck nationally, of mid-2007, will be met.

Job Losses.

Last Friday week, Minch Malt Limited, which is owned by Greencore, announced its decision to close its malting plant in Banagher and its branches in Tullamore and Borrisokane. This will result in the loss of 19 jobs in Banagher and nine full-time staff in its agri-trading branches in Banagher, Tullamore and Borrisokane, a huge blow to the staff, particularly in an area where there are few prospects for alternative employment. We have effectively witnessed this company closing its doors in the midlands in the past nine years — it has closed operations in Roscrea, Birr, Tullamore, Banagher, Borrisokane, Edenderry, Mullingar, Trim, Portlaoise and Rathangan.

This company has not only turned its back on the staff but on 350 specialist malting barley growers in the midlands. These growers supply between 40,000 and 45,000 tonnes of malting barley to Banagher each year, producing 30,000 tonnes of malt. The numbers with contracts to supply Banagher have dropped from 700 to 350 in only eight years. Last week in the Chamber, however, when I raised this issue with the Minister for Agriculture and Food, she said that malt and barley have nothing to do with her. I can only hope that she meant this in jest, even though it is not funny, because it has everything to do with her and her portfolio. The Minister's Department has given grants to malting plants in the past and gave €1 million to the same company's Athy plant in 2002 under the national development plan. I hope the Minister's comments were not indicative of her attitude and the Government's attitude to malting barley growers in the midlands because my constituents and I would find this totally unacceptable.

Growers made their farm plans for this year months ago. The seed will be sown from mid-February onwards — they do not have any other option in such a short time. The growers had a legitimate expectation that their contracts would be renewed this year, as happened every other year. No indication was given to them that this would not happen. In the past, as the chairman of Offaly IFA stated last week, business was based on mutual trust and understanding, out of which a deep sense of loyalty developed. Sadly, this is no longer honoured.

This is a product that is more than a commodity. It is grown at a premium under certain conditions and specifications and that premium has now been taken away from these farmers. It was grown locally to supply a local industry which in turn supplied a national industry. Not only will the growers lose out, so will the employees in the maltings and its branches.

This is not just a matter between farmers and a private company. It has been allowed to operate a monopoly in this area. There are no options open to growers at such short notice. If this company can say to malting barley growers this year that it is not renewing contracts, how do we know it will not do the same thing to beet growers next year? Unfortunately, it was not accepted that I could include the Carlow sugar factory in this debate, and it is not an issue that can be dealt with separately.

Last week I dealt with the cynicism of the company in announcing its decision so soon after the decision on the Carlow sugar plant. Taking both decisions together, they are devastating blows to the arable farming sector in the midlands. We cannot deal with one issue and ignore the other.

Farmers supplying beet to Carlow are facing equally difficult times. They do not have the facilities to store quantities of beet they will need to store if it is to travel as far as Mallow. There has been no information on how this will take place. If the farmers must draw beet earlier in the year, there will be a greater loss of that beet and its sugar content. Beet growers' contracts usually issue in March, leaving them little time to negotiate. If the contractors deliver it will be to Mallow but they do not know what arrangements will be made for transportation costs.

There are also serious concerns about the company's intentions for the sugar processing industry in Ireland. The Minister for Agriculture and Food stated two weeks ago that it is incumbent on the Government to ensure replacement employment and support for the workers of the company. I argue that the Government owes the same duty to the growers who supply both Carlow and Minch Malt Limited. The Minister of State should outline to the House how the Minister intends to fulfil that duty. Can the Minister take action? Has she had discussions with the company in Banagher, Tullamore, Borrisokane or Carlow and what assistance she can give to growers in these circumstances? The Minister will meet beet growers at midday tomorrow, and I ask her to extend the same assistance and courtesy to the malting barley growers.

I am aware that Minch Malt Limited is to close its malting plant at Banagher, County Offaly, and its two intake points at Tullamore, County Offaly, and Borrisokane, County Tipperary, with effect from September 2005. There will be 19 job losses in total. I am concerned about the impact these job losses will have on families in the area, but the decision to close the Banagher malting plant by Greencore was a commercial decision taken by the company. The reason given for the closure is increased competition on export markets. Furthermore, the malting industry within the European Union is stagnating due to a fall in beer consumption.

Minch Malt Limited is part of the Greencore Malting Group, which was formed in 2000 following the integration of the three Greencore-owned malting companies of Pauls Malt in Britain, Minch Malt in Ireland and Belgomalt in Belgium. As a consequence of this integration, Greencore Malt is now the sixth largest malting group in the world. There is one other maltster in Ireland, namely, the Malting Company of Ireland, which is owned by Dairygold and Glanbia, at Togher in Cork.

Minch Malt Limited is Ireland's largest maltster with an annual capacity of 125,000 tonnes. It sources quality malting barley directly from 3,500 Irish farmers, under forward contracts, for its malting plants in Athy, County Kildare, and Banagher, County Offaly. The Banagher plant processes nearly 40,000 tonnes of barley from 300 farms. It is one third the size of the Athy plant, which employs 40. Athy is already at full capacity so it cannot take over the 40,000 tonnes from Banagher.

Farmers who are affected by the closure of Banagher may decide to produce barley for the feed barley market instead. It has been suggested that this will put pressure on grain storage in the midlands area next autumn. The Banagher, Tullamore and Borrisokane facilities will be offered for sale as going concerns and may be taken over by current players in the trade. My Department is carrying out an inventory of grain storage capacity in the Offaly and north Tipperary area. In the event that this inventory shows up a problem in storage capacity for the coming harvest, I will examine the possibility of making funds available to deal with the problem.

Ireland is a surplus producer of malt, with exports in the region of 50,000 tonnes. Minch Malt Limited has been exporting to markets in Russia, south-east Asia and South America. However, Russia has now become almost self-sufficient in malt. Moreover, there is a trade agreement between south-east Asia and Australia which excludes imports from Europe, and South America has always been a difficult market. Exports have been taking place from the output of both the Athy and Banagher plants. Greencore has decided to consolidate operations at the bigger plant, Athy, to solidify the domestic market and it invested €4.5million in this facility last year, increasing the storage capacity and installing new driers. This investment demonstrates the company's commitment to the sector in Ireland.

While I regret that Greencore has had to take this decision, this is a commercial decision by that company dictated by the marketplace and I have no function in this regard.

The Dáil adjourned at 9 p.m. until 10.30 a.m. on Wednesday, 9 February 2005.
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