Dáil Éireann díospóireacht -
Tuesday, 6 May 2014

Vol. 840 No. 1

Topical Issue Debate

Water Services Provision

Deputy Andrew Doyle

I welcome the opportunity to raise this matter. This issue concerns a problem that has occurred seasonally over the past couple of years, in particular because demand has increased capacity and the system is reaching its limit. The algae involved occurs naturally in clean, fresh water and does not pose a health risk, but it seriously affects and slows down the treatment process at the production plants. As a result, over the past ten days, we have seen a significant reduction and limiting of water supplies to north-east Wicklow in particular. People in the area become annoyed when they see restrictions on water which originates in and is treated in Wicklow, albeit under Dublin City Council up to now, but from now on the responsibility of Irish Water.

The water seems to be flowing unimpeded to Dublin city. I do not begrudge Dublin getting water, but many areas of north Wicklow which are much closer to the supply source are being cut off, in particular areas such as Kilpedder, Enniskerry, Kilmacanogue and higher areas where pressure has become a problem. A statement this afternoon from the head of communications at Irish Water states that it is not planned to interrupt supply tonight, 6 May, but a further assessment of shut-offs will be made tomorrow, Wednesday, 7 May. Nonetheless, properties at high elevations will suffer loss of water during daytime, but should receive enough water. I acknowledge this is an improvement on the situation.

I flagged this issue at a briefing we received from Irish Water some time ago and pointed out the algae problem was a problem that was likely to occur. While, there are long-term proposals to upgrade the plant to deal with the issue, we need an interim solution. This is a predictable phenomenon. We need a rapid response plan in place. We can predict weather. Therefore, we could determine and predict this problem. We know roughly when the algae bloom is about to occur and are aware of its impact. Until we have a new plant, we know what interim, remedial work is required. Unfortunately, this involves painstakingly and laboriously scraping the algae off the filter beds to keep them in production. This may be a simple manpower issue, but it is resolvable. This interim measure should be taken until such time as the significant work to upgrade the plant is completed.

I call for the Minister, in conjunction with management and officials at Irish Water and local management, to address this issue so that we do not suffer this unnecessary and avoidable problem. As I said, the algae does not cause health problems, but indirectly, the lack of water or limited water can have a health impact on families, older people and people with special needs. Last weekend, Fáilte Ireland was part sponsor of a very successful gourmet Greystones weekend. While the gourmet weekend may not have been the reason for it, the water was turned on in Greystones for the weekend. While there was a limited supply, at least it was turned on and without it, the festival would have had to be cancelled. I call on the Minister of State to take on board the concerns I have expressed here on behalf of the citizens of north Wicklow.

Minister of State at the Department of the Environment, Community and Local Government (Deputy Fergus O'Dowd)

I thank Deputy Doyle for raising this important matter in the House. However, the Department has no responsibility for, or role in, the management, maintenance or operation of water infrastructure. This is a matter for Uisce Éireann, the water services authority, which is responsible under statute for the operation, maintenance and management of water infrastructure.

Local authorities, in this case Wicklow County Council, continue to provide water services on behalf of Irish Water through service level agreements that have been put in place. The Vartry water supply is a critical element of the greater Dublin area water supply system and is the sole supply to north-east Wicklow, including Bray, Greystones, Delgany and Kilmacanogue. In recent years, the plant has been badly hampered in late spring and early summer by heavy algal growth which clogs the sand filters, reducing output severely.

From inquiries made to Uisce Éireann, I understand that water production at the Vartry water treatment works at Roundwood has reduced significantly due to the seasonal impact of algae in the source water. The algae occur naturally in clean, fresh water and do not pose a health risk, although it does slow the treatment process. In addition, local supply issues, which were unrelated to this reduction in production, impacted on customer supply.

Irish Water has also confirmed today that supply to Enniskerry is now back to normal. However, in Greystones, there has been a continued loss of some local service. The cause of this loss is being investigated and Wicklow County Council, on behalf of Uisce Éireann, is working to ensure that all customers have a supply of water from the public mains for a period within the 24-hour day. Continued water conservation measures over the weekend were necessary to replenish the water level.

Wicklow County Council is reviewing whether it will be necessary to continue with restrictions for the coming days to ensure the reservoir levels are recovered. Properties at a very high elevation have been suffering a loss of water during the day time, but should receive water at pressures sufficient to fill storage tanks during night time. The council is continuing to investigate improvements and is organising an alternative water supply via water tankers. Uisce Éireann has confirmed that water to the two main centres of population are close to normal and will further improve during this week. Customer information has been posted on the Wicklow County Council and Uisce Éireann websites and customers have been offered a range of communication channels for more information, including phone, post, web and twitter. The Irish Water customer contact centre receives regular updates on the situation so customers receive current information. This service provides details of the locations at which water is being provided from tankers.

Irish Water recognises that the whole Vartry system is in need of major upgrading and has commenced a study to determine the scope, cost, timeframe and planning for the works required. Uisce Éireann is looking at options for interim plans of a temporary nature which might be put in place in the short term.

Since 1 January, Irish Water has had responsibility for the delivery of water services capital infrastructure and is preparing a capital investment fund for the period 2014 to 2016. The additional funding of €200 million approved by the Cabinet this morning for the period 2015 to 2016 will assist in enabling Irish Water to accelerate additional capital projects. While I understand the distress being expressed by consumers at the lack of a continuous supply of water in their areas, Uisce Éireann and the local authorities are doing everything possible to alleviate the problems and restore an adequate and safe supply at the earliest possible opportunity.

Deputy Andrew Doyle

I thank the Minister of State for his response and acknowledge the efforts being made by Wicklow County Council to address this problem. The Minister of State has referred to local supply issues that are unrelated to the reduction in production but which have impacted negatively on the consumer. That is a contention of Irish Water and one with which the county council would likely disagree. As I understand it, the problem is to do with the pumping system which, if it is interfered with, causes more problems than it solves, including air locks. As the Minister of State noted, Irish Water is considering the provision of interim, temporary plants in the short term. That needs to happen without delay and I ask the Minister of State to communicate very strongly its urgency to the chief executive officer of Irish Water.

I sent an e-mail to Irish Water more than one week ago using the Oireachtas Members' e-mail facility and have yet to receive a response. I wrote to the CEO on Thursday expressing my disappointment at the lack of a response against a background where we had received strong reassurance there would be no such issue. I do not like having to raise the matter here, but I am obliged to do so. It is not acceptable that a query submitted on behalf of a considerable number of people, all of whom will be expected to pay their water charges, should be ignored in this way. I have no problem with the introduction of water charges, but people cannot be expected to pay for water when there is no supply. We need to address this issue now; it is not something that can be left on the long finger. While significant funds will be coming on stream for capital development, an interim measure is necessary to ensure the problem does not recur. As I said, it is a predictable and foreseeable issue and a plan of action must be in place to address it.

Deputy Fergus O'Dowd

I am shocked that Irish Water has not responded to the Deputy's e-mail of more than one week ago. That is not good enough and I will ask it to investigate the issue urgently. Everybody is entitled to a response to his or her queries, whether he or she is a Member of the Oireachtas through the 1890 278278 telephone number or the e-mail facility or an ordinary member of the public. One of the key objectives is that Irish Water should be able to respond to issues as they arise and ensure communications are properly and effectively managed. The Deputy's experience is not acceptable and I will ask Uisce Éireann to get back to him immediately on the matter.

Acting Chairman (Deputy Marcella Corcoran Kennedy)

The second Topical Issue matter is in the name of Deputy John Lyons who I understand is seeking a deferral.

Deputy John Lyons

Yes. I am requesting that the matter be deferred to an alternative date when the Minister for Social Protection, Deputy Joan Burton, is available to take it. I understand it has provisionally been tabled for Thursday.

Acting Chairman (Deputy Marcella Corcoran Kennedy)

Is it agreed that the Deputy's Topical Issue matter be deferred? Agreed. We will proceed with the third matter in the name of Deputy Billy Kelleher.

Medical Card Eligibility

Deputy Billy Kelleher

I welcome the Minister for Health, Deputy James Reilly. What is happening in the provision of discretionary medical cards is simply deplorable and something must be done to alleviate the burden being imposed on families. Those affected include individuals who are very ill, some of whom are terminally ill, and many facing huge challenges and difficulties in their everyday lives. The Government, however, continues to insist there has been no change in policy. If there has been no change in policy, there certainly has been a change in practice. The numbers speak for themselves when it comes to the culling of discretionary medical cards, with a reduction of more than 30,000 since 2009.

To any fair-minded person, the idea that the probity exercise of €113 million announced in the budget would not in some way impact on people is beyond belief. At this stage, if we could get the Government to accept that the policy or practice it is pursuing is having a detrimental impact, we would at least have achieved something. The issues that arise day in and day out in constituency clinics throughout the country and which have been repeatedly raised in the House in the past two years by Members of all parties and none must surely resonate with the Minister. There has to be a reversal of policy in this regard.

The Government has chosen to prioritise the provision of free GP care for all children aged five years and under. I have said time and again in the House that the easy, populist choice for me would be to endorse that proposal without criticism. The difficultly, however, is that the resources which will be applied to fund free GP care for the under sixes are being taken from children and older people facing the gravest challenges on a daily basis. For many of them, it is a challenge just to get through one day. Universal provision of free GP care is a noble idea; the problem arises when there are scarce resources. By my analysis and that of many commentators, this proposal is being funded by depriving those who need a medical card simply to get by on a daily basis.

We on this side of the House have consistently maintained that there must be a prioritisation of need in this matter. The Minister has spoken about being a proud citizen of this republic. Any genuine republic should be judged on how it treats those in most need of the state's support. It is not in the vein of true republicanism to ask a very sick seven year old, a very frail 90 year old, a person with motor neuron disease or a child with Down's syndrome to fund general practice cards for healthy children of five years and under, some of whom are from affluent backgrounds. That is simply wrong. I urge the Minister to reverse the cull of discretionary medical cards which is in nobody's interests, least of all those who need them most.

Minister for Health (Deputy James Reilly)

I thank the Deputy for raising this issue. To clarify, an additional €37 million in funding was made available in the budget for the specific purpose of providing free GP care for children aged six years and under. We are not taking money from anybody else to fund the initiative.

Under the Health Act 1970, persons who are unable, without undue hardship, to arrange GP services for themselves and their families can qualify for a medical card, having regard to their overall financial situation and reasonable expenditure. The Health Service Executive can only award medical cards in accordance with the Health Act and, therefore, must assess the overall financial situation of the applicant and his or her spouse or partner. The HSE gives effect to this legislation through its medical card national assessment guidelines. "Undue hardship" is ascertained through an assessment of financial means.

It is not legally possible to award a medical card by virtue of an illness or a disease. However, where an applicant or a member of his or her family has an illness or disease, medical costs and necessary expenses arising from that condition are taken into account in the assessment process for a medical card. Thus, people whose means are above the income limits but who face genuine hardship in providing GP care for themselves and their dependants may qualify for a medical card.

Recent media reports have referred to the reduction in the number of discretionary medical cards. I reiterate that there is no policy to abolish the awarding of medical cards on discretionary grounds or target any patient group.

The medical card scheme continues to operate in such a way that those who suffer undue financial hardship as a result of a disease or an illness are awarded medical cards. Last year I insisted on a medical team being put in place to review the position on discretionary medical cards in order that people's medical conditions would be taken into account in the context of the financial hardship to which they gave rise. While the number who hold medical cards on discretionary grounds has fallen in recent years, many individuals who previously were marginally over the normal qualifying guidelines have been granted medical cards. Only a small proportion of people with discretionary medical cards have been found to be ineligible for medical cards. While the number in this regard may be small, I in no way underestimate the difficulties caused for those who are considered ineligible.

We know that even where medical expenses have been taken into account, there will be some who are not eligible because their net income remains in excess of the guidelines, sometimes by as much as €1,000 a week. Some of the households in question include people with ongoing medical conditions and, in that context, I have asked the HSE to consider how best we can ensure such households receive all the supports available to them from the health system, within the relevant legislative parameters. The clear intention is to ensure people's entitlements to health services will be maximised to the fullest extent possible, especially where individuals may be facing significant medical expenses. This process is ongoing and I hope it will come to a conclusion in the near future.

Deputy Billy Kelleher

My difficulty is that we have been raising this issue for over two years. In that time we have drawn a complete blank in obtaining an admission that there is a difficulty in respect of those with discretionary medical cards. Last week, however, there was some semblance of a response from the Minister when some 20 of his colleagues in Fine Gael raised this issue at a parliamentary party meeting and he acknowledged that we at least had to consider it. We must do more than this. In good times and bad, the process of governing involves establishing priorities and making choices. In that context, the Minister has, unfortunately, got caught in a bind between the commitments made in respect of free GP care and trying to fund a health service which, for many reasons, is inadequately resourced. I accept all of the responsibility my party bears in that regard and which the Minister outlines on a continual basis. In this instance, however, the difficulty has arisen on foot of a choice made by him initially. It is echoed in similar choices being made on a daily basis by the Department of Health and the HSE and under his watch. As a result of the choices to which I refer, resources are being transferred from those who need them most to persons who may not need them at all. That is clearly wrong.

As a result of a television interview on Saturday night last, people have been made aware of the case of Alex Coyle. There are hundreds of similar cases. Organisations which represent and advocate on behalf of people with profound intellectual and physical disabilities and life-limiting illnesses have stated it is inherently more difficult for people to retain discretionary medical cards or access full medical cards than it was some years ago. Regardless of whether the Minister likes it, there has been a change in practice. I urge him to amend this by introducing a policy initiative in order to ensure vulnerable people will be protected.

Deputy James Reilly

During 2013 the HSE issued 644,858 review notices. As of 27 February 2014, assessments of eligibility had been concluded of 482,000 medical card holders and continuing eligibility was confirmed in respect of 465,000, or 96.4%, of these individuals. Some 17,258 medical cards, or 3.6%, were not renewed because the eligibility criteria, that is, the income thresholds, were not met. In a further 52,000 cases medical cards were not renewed because the card holders did not respond in the review process. On the date in question, assessments of eligibility were ongoing in respect of 102,000 medical cards and in 6,736 cases the card holders were deceased. I could supply the Deputy with much more information, but I will not do so at this time.

There must be probity within the system as a result of the continually changing dynamic. From discussing the matter with the primary care reimbursement office, PCRS, I am aware that the vast majority are not written to at all, except to be informed that they will be keeping their medical cards. This is because we know, on foot of the information in our possession, that they are entitled to them. Another large group are only required to tick a box to indicate that their circumstances have not changed. We are required to examine a small percentage of cases in order to ensure those involved are still entitled to medical cards. As Minister for Health, my role is to ensure the system retains the compassion it is supposed to possess in the first instance. I am also obliged to ensure there is more focus on ensuring people have access to the support and care they require as opposed to medical cards. The HSE is seeking to find the best way to achieve that to which I refer in order to ensure families will receive the support they need.

Symphysiotomy Payment Scheme

Deputy Clare Daly

I was prompted to raise this matter once more by reports in the Sunday newspapers which indicated that the Coombe hospital did not have full insurance prior to 1961 and which highlighted the prospect that it would be obliged to bear the cost of claims related to the 14 symphysiotomies carried out in it between 1950 and 1967. Frenzied calls were then made in respect of bankruptcy by some of the patient associations. These calls were not repeated by the Minister or the survivors of symphysiotomy. The claims of bankruptcy have clearly been exaggerated, but the real issue relates to how we might obtain justice for those women who were so cruelly butchered in their prime. I am somewhat concerned about both the origin and timing of the story. It emerged against the background that, relatively soon, the Minister who is examining the Murphy report would be making an announcement on how he proposed to deal with this issue. I again record the determination of the survivors that they will not be corralled into any sort of redress scheme. I do not know whether the story relating to the Coombe - one of the hospitals in which only a small number of symphysiotomies were carried out - has been put out in order to create a climate against the women taking the type of legal action I believe they are entitled to pursue.

It is clear that the damage visited on the women to whom I refer cannot be undone. Some were obliged to undergo 25 operations following the initial procedure and left immobilised while in the prime of their lives. In many instances, children were robbed of their mothers, while husbands were robbed of their wives. The women in question were obliged to suffer incontinence and chronic pain for decades. In some ways, this is not a health issue at all; it should be treated as one of justice. One of the important points to make is that the survivors have made it clear time and again that they view it as one of personal injury caused by gross medical negligence. They need this to be acknowledged before there can be any closure in this matter. The judgment handed down in January by the European Court of Human Rights in the O'Keeffe case vindicated the position of the survivors of symphysiotomy, namely, that redress schemes are not adequate in addressing the needs of the victims of human rights abuses. It is clear that the women to whom I refer are the victims of such abuses.

The women in question have stated any scheme based on the Magdalen laundry model would be unacceptable because wrongdoing would not be admitted and due to the fact the levels of restitution would fail to reflect the damage done to them. References to payments in excess of €50,000 being made on a phased basis appear to be a cynical ploy aimed at ensuring the women who are elderly will die before they receive full compensation. If a Magdalen laundry model were adopted, there would also be no right of appeal and the right of the women concerned to independent legal representation would be denied. Some members of the Survivors of Symphysiotomy group have indicated that such a scheme would be one of the worst imaginable and that they are not interested in pursuing it. The group offered to meet the Minister over one year ago in order to discuss their proposals with regard to what they believed would constitute an adequate and acceptable settlement. Such a settlement could facilitate the provision of more appropriate restitution along the lines of what the courts were offering but with a haircut to reflect both the austere economic times in which we are living and the fact that legal actions would not be taken.

However, they also require an individualised assessment and independent medical and legal supports such that the compensation paid would reflect the range of injuries inflicted on them. I call on the Minister to reconsider that position and to agree to meet the survivors of symphysiotomy to negotiate a settlement. If the Minister imposes a settlement it will only result in their going to the Irish and European courts to seek justice.

Deputy James Reilly

First, I wish to put on the record of the House that I have met the survivors of symphysiotomy on several occasions during the period to which the Deputy refers. Second, no one is coercing anyone into anything. To effectively and comprehensively provide indemnity to hospitals and their patients in the event of a medical mishap, the State introduced the clinical indemnity scheme in 2002. The scheme is managed by the State Claims Agency and provides a robust system for managing eligible claims that arise nationally from that date.

Indemnity in respect of claims made relating to incidents occurring prior to the introduction of the clinical indemnity scheme in 2002 is a matter for the individual hospitals concerned and their insurers. The Government at the time decided that the clinical indemnity scheme should not apply retrospectively given that individual hospitals and doctors would have purchased indemnity from insurers on a commercial basis and insurers have an obligation to fully provide the cover which had been purchased. It is important to remind ourselves of that fact. Insurers have an obligation in this regard.

The master of the Coombe Women & Infants University Hospital informed the Secretary General of my Department in April last year that the hospital had issues relating to insurance cover prior to 1961. Since this matter has arisen in the context of legal proceedings the Department cannot comment on indemnity obtained by either the hospital or the medical practitioners involved in respect of any individual claims. Indemnity is a complex technical issue and a range of indemnity and insurance arrangements are in place for hospitals from before the establishment of the State's clinical indemnity scheme. My Department together with the State Claims Agency will continue to monitor the position in respect of historical claims against the Coombe hospital.

Since coming into office I have endeavoured to satisfactorily facilitate closure for approximately 250 women affected by symphysiotomy. On 26 November 2013 the Government approved the appointment of the retired Circuit Court judge, Yvonne Murphy, to assist in setting out a possible course of action in respect of women who have undergone surgical symphysiotomies. Judge Murphy commenced a review of the issues relating to symphysiotomy in December and submitted a report to me in mid-March. I am examining the report and its recommendations and I intend to bring a memorandum to Government in the coming weeks in order that a decision can be taken as early as possible with regard to the next steps. Any proposals brought to Government will take into account the findings of the independent research report, Symphysiotomy in Ireland, 1944 – 1984, commissioned by the Department, otherwise known the Walsh report, along with any other relevant information. It is also intended that the Walsh report would be published once the Government has decided on its response to this complex and sensitive issue.

Deputy Clare Daly

I hope I can take the Minister's extra minute. The Survivors of Symphysiotomy group specifically requested that the Minister meet them to discuss their proposals for a settlement of survivors' actions. This is the meeting to which I am referring. Their needs include that the wrong be acknowledged and that restitution be in line with what has been awarded by the courts. In the Kearney v. McQuillan case Mrs. Kearney was awarded over €300,000. That was probably a mid-range case rather than one of the more severe cases. In other cases, figures of approximately €600,000 have been mentioned. The group are prepared to negotiate a haircut on those amounts but the key stumbling block is that there is no acknowledgement of wrongdoing. The Minister referred to the Walsh report, but that report was much criticised for the very reason that basically it stated that the practice of symphysiotomy was medically acceptable at that time, although it actually was not, and because there was no admission of wrongdoing. There is a belief that much of this is framed to protect the Institute of Obstetricians and Gynaecologists and the interests of certain members of that organisation. Furthermore, if hospitals are insured then individual medical practitioners are also so insured, and presumably their personal insurance could be called to account to pay for some of these debts and for the horrendous cruelty and damage inflicted on these women.

A repeat of the arguments that have been rejected by the overwhelming bulk of the survivors simply means we are going around in circles on this issue, and as a result I do not believe we will have a solution. Since he has said that he has met the group several times - I know he has - I call on the Minister to take up their invitation from one year ago to sit down and discuss precisely what they are seeking in respect of the legal actions. I fear that if this does not happen we will be dealing with European court cases, going to the United Nations committees and so on. Meanwhile, the women concerned are getting older and some of them have tragically died in the intervening years.

Deputy James Reilly

I accept that the Deputy has the interests of the women at heart, as do I. The reality is that many of the women in these cases do not know the doctor concerned, cannot remember the name of the doctor or cannot find notes. The possibility of their succeeding in court is next to nil. Deputy Daly referred to a court case involving a lady who has been very public about her experiences, but it took her 11 years to get a settlement. How many more women will pass away in that period? I am trying to bring closure to this in the quickest way possible for all the women concerned. I realise that for many of them what is suggested, regardless of what it is, will not be a suitable substitute for going to the courts. The case Deputy Daly highlighted was a clear wrong. It was symphysiotomy on the way out, as it is alluded to - in other words, symphysiotomy after the baby had been born - which is utterly inexplicable.

I know the suffering that these women have had and I have heard their harrowing stories. I want to address their suffering by achieving closure of this as quickly as possible. I know I cannot undo the pain they have endured. That pain is physical, psychological and societal in many respects because it limited their ability to socialise. Having said that, I have no wish to pre-empt what the Government might say. We have a report. I wish to take advice from the Government. A memorandum is going to Government shortly. I believe this is the quickest way to expedite the matter for all the ladies concerned. No one is suggesting for one moment that people who wish to go to court would be prevented from so doing.