Dáil Éireann díospóireacht -
Tuesday, 24 Jun 2014

Vol. 845 No. 1

Leaders' Questions

Deputy Micheál Martin

Yesterday there was an announcement that the HSE's review of maternity services in the west/north west hospitals group was being shelved and would be subsumed into the national maternity services review. The report into the group's maternity services was near finalisation and it was exposed recently as containing alarming recommendations for the downgrading and potential closure of maternity services across the region.

There was no public consultation on the report and public procurement rules were circumvented. Owing to the good work of Senator Marc MacSharry and others, the issue was disclosed and exposed and it contained revelations about proposals concerning maternity services at Portiuncula, about which there are very grave concerns.

Services in the north west will be included in the national examination of maternity services. There are approximately 19 public maternity units in Ireland. What is the agenda for the strategy and the review? Will the Government publish the terms of reference and ensure there will be public consultation? Will the Taoiseach confirm that the agenda is not to reduce the number of maternity units to 14, 12, ten or fewer? People consider such a reduction is within the remit of the maternity services strategy. There are key issues regarding the recruitment of obstetricians and midwives. The Government's policy on obstetricians has backfired and we are short of obstetricians throughout the country. There is a need to end the anxiety in places such as south Tipperary, Portlaoise, Portiuncula, Castlebar and Sligo. If the trend is to locate maternity services in acute tertiary centres, where does that leave existing maternity hospitals? It is important that the Taoiseach indicate to the House the terms of reference.

The Taoiseach

The national examination of maternity services arose from a number of high profile, tragic cases. The Minister was in order in saying we needed to see the highest standards applied in maternity units throughout the country in order to maintain Ireland's reputation as one of the safest countries in the world in which to give birth. For that reason, it is very important that mothers-to-be understand medical care, facilities and safety are of the highest order. Before the recent elections, one would have assumed, according to what I was hearing, that we planned to close maternity services in Letterkenny, Sligo, Mayo and at Portiuncula, leaving the entire west and north west with one centre for the provision of maternity services, Galway hospital.

Deputy Mattie McGrath

Was the Taoiseach listening?

The Taoiseach

Obviously, this is not the case. It is in order that there be a national examination of standards in maternity units. There should be public consultation and the terms of reference should be published and they will be. Our intention is to raise standards to the highest quality in order that those giving birth will be comfortable in the knowledge that whatever maternity unit they are in is of the highest standard and integrity. That is the policy and intention.

Deputy Micheál Martin

In February the Minister for Health, Deputy James Reilly, announced the national maternity care strategy, but we have still not seen the terms of reference. At this stage, we are entitled to see them because this is a very important issue. Some people working in maternity services argue that they need immediate intervention by the Government to upgrade staffing levels to provide an obstetrician-led service, more midwives and better conditions. Not long ago, leading practitioners in the field of obstetrics said our maternity hospitals were not safe and did not have safe staffing levels and that those responsible for delivering a safe service were at the end of their tether because of the difficulty in recruiting obstetricians. There are clear issues regarding terms and conditions which have resulted in shortages and great difficulty in recruiting obstetricians and midwives. We need to see the terms of reference and I ask the Taoiseach to come back to me on their publication. Although the strategy which began in February is meant to be complete by October, we have not seen the terms of reference. The Taoiseach has shoved the west and north west into the process because it was too hot a potato for him to deal with.

The Taoiseach

It is important that the terms of reference be published and they will be. Although people with experience in child health said it would be very dangerous in maternity units during the changeover when staff were taking early retirement from the service, nothing of the kind happened. It is everybody's interests that there be an examination of the standards that apply and that where they are inadequate, they be raised, by whatever means necessary. It is very important, as the Deputy can understand, that women and families be comfortable in the knowledge that they are going to one of the safest places on the planet in which to give birth. It is right and proper, following a number of high profile and tragic cases, that there be an analysis and examination of the standards, efficiencies, staffing and criteria that apply in order that we can keep and be seen to keep Ireland's reputation as one of the safest places in the world in which to give birth.

Deputy Gerry Adams

Some nine mental health consultants in Carlow, Kilkenny and south Tipperary have withdrawn their confidence in the HSE's management of the service. As was revealed on RTE's "This Week" programme, these doctors, in a letter to the Minister of State, Deputy Kathleen Lynch, cited nine suicides by service users between August 2011 and January 2013. They included three suicides by in-patients by the same means, four suicides in home settings and one in a crisis house. The Taoiseach will agree that this is dramatic, disturbing and a very serious development. The doctors in question raised their concerns with the HSE in November 2012 and on a number of subsequent occasions. In their letter to the Minister of State one year ago they repeatedly questioned the safety of governance in the service, saying they felt devalued and ignored in attempting to raise concerns. They called on the Minister of State to intervene to ensure the proper investigation of incidents and that review findings would be properly communicated and appropriate reforms implemented. They were told their concerns had been addressed, but they said they were not informed of the outcomes of reviews of serious incidents. Is the Taoiseach concerned about the number of deaths by suicide of mental health service users in this area? Has he discussed it with the Minister or the Minister of State? What does the Government intend to do about this very disturbing revelation?

The Taoiseach

Everybody is concerned about the phenomenon of suicide and its tragic consequences in any family for whatever reason. The Minister of State, Deputy Kathleen Lynch, dealt very capably with the report in recent days, both in respect of her advice that she was awaiting two reports to be brought before us and the progress made since A Vision for Change was published in 2006. She has made it clear that the recommendations made in the reports from the Mental Health Commission inspectorate are taken very seriously, as they should be. Today's report highlights the progress made since A Vision for Change was published in 2006. Further work must be done and that is evident. The report states:

Although most residences are too large, overall the care and treatment of residents in 24-hour supervised residences has improved since 2005 and it appears that the major factor influencing this improvement has been the move of clinical care to rehabilitation teams and the consequent implementation of individual multidisciplinary care planning.

Since 2012 the Government has prioritised the reform of mental health services and allocated an additional €90 million and 1,100 posts, primarily to strengthen the community mental health teams for both adults and children, enhance specialist community mental health services for older people with a mental illness and those with an intellectual disability and forensic mental health services in line with A Vision for Change which everybody accepted.

The aim is to move away from the old-style psychiatric hospitals to provide care in a more flexible, community-based mental health service. Everyone agrees with that policy. The HSE's national service plan 2014 is underpinned by a detailed mental health operational plan for the year. This is an issue of which the Minister is very cognisant. Consultation took place with all of the relevant professionals.

Where suicide occurs it is a tragedy for those concerned and their immediate families and a matter of serious importance for Government. In respect of the issue of some high support hostels having more than ten beds, the HSE has committed to reviewing the arrangements that apply. For Deputy Adams's information, it is important to note that all residents in 24-hour staffed hostels receive a mental health service and are supported either by a rehabilitation team or an adult community mental health team. Clearly, we have work to do for the future, but the report today from Dr. Susan Finnerty spells out the progress which has been made.

Deputy Gerry Adams

The Taoiseach will know that 500 people take their lives by suicide in the State and 300 do so in the North while upwards of 12,000 people self harm. These are the reported cases. The nine cases I raise with the Taoiseach, however, happened while the people were in the care of the State. Concerns were raised by the clinicians who were in senior positions in the area. Contrary to the Taoiseach's reply, they say they are being ignored. The report on the services was only commissioned six months after the consultants first wrote to the Minister.

Every second week, we hear disturbing revelations about our mental health services. There were 80 admissions of children to adult in-patient psychiatric units last year. The Children's Rights Alliance says this represents a clear breach of children's rights. It is not acceptable. We read in The Irish Times today that hundreds of psychiatric patients moved out of mental hospitals in the last few decades are living in totally unsuitable conditions with limited access to health care, which is also contrary to what the Taoiseach said.

Is the Taoiseach concerned that this is a crisis that is costing lives while, once again, the mental health services are very much the Cinderella of an already decaying health service? There is a serious matter here. I would like to think the Taoiseach will take on board in his response the fact that these nine citizens took their own lives while in the care of the State and that the consultants working in the area have withdrawn confidence in the governance of the service.

The Taoiseach

I agree with the Deputy that the mental health service was the Cinderella of the entire service for a long number of years. That is why the current Government ring-fenced particular funding to deal with the mental health service and to make it part of the normal quality of health service provided. As I pointed out to the Deputy, that is why €90 million in additional funding was put in place along with 1,100 posts to staff community consultancy teams and mental health action teams where necessary.

As I said, the Minister of State, Deputy Kathleen Lynch, has pointed out that there were consultations with everybody, including the professionals, working in the service, to bring about the best response. "A Vision for Change" was a document accepted by everybody. We have made very substantial progress and will continue with it. The nine suicides are tragic and are to be regretted as is every suicide and death that occurs of that nature. Clearly, the question of children who have died in State care is another matter of concern. Obviously, we have the statistics that point to where these tragic events happened also. Nobody wants to see a death occur by suicide or for any other reason where it can possibly be prevented. When one reads the reports, one can see the progress made since 2005 and we would like to continue to build on it through the allocation of appropriate resources in the budget later this year and in the future.

As I know from the west of Ireland, the move from the big psychiatric institutions has been beneficial for the vast majority of those who use community-based services now. We want to continue that.

Deputy Maureen O'Sullivan

The year 2016 approaches and with it the commemoration of the Easter Rising. While we have many defining moments in our history, the Easter Rising is a particularly significant one. We have had a number of celebrations to date including the strike and Lock-out and Cumann na mBan, which have been very well organised and dignified. The events in store for the anniversaries of the outbreak of the First World War and the Howth gun running operation will also be well organised and dignified.

There were a number of venues used for the Easter Rising from the Royal College of Surgeons in Ireland at St. Stephen's Green to Mount Street Bridge etc. We can agree, however, that the GPO and Moore Street were absolutely vital. They are the place the Rising began and the venue that saw its end. There are great plans in place for the GPO but there are serious difficulties around Moore Street. There was a litany of errors in the past, starting with Dublin City Council right the way through. One of those errors might have seen the whole area obliterated in the late 1990s. That would also have seen the end of the significant street trading tradition in Moore Street. It was only due to the relatives who were able to campaign and bring about the preservation order in 2007 which led to the Minister being able to designate Nos. 14 to 17 Moore Street as the commemorative centre and a national monument.

There are indications from a number of people that the developer's assessment of the site was inadequate and flawed. That has been proven by things that have been discovered since it was carried out. What is in store for the national monument is that it will be either dwarfed by a massive shopping centre or surrounded by a derelict site. Neither represents a dignified memorial to the men and women of the 1916 Rising. There are also concerns as to who will own, control and finance Nos. 14 to 17 Moore Street. The Minister for Arts, Heritage and the Gaeltacht, Deputy Jimmy Deenihan, with whom I have had this debate on many occasions, has said he has gone as far as he can on this. Regardless of who is in power in 2016, the onus and responsibility is on those in power now to ensure that the centenary celebration is dignified. As the Minister has gone as far as he can, I ask the Taoiseach to accede to the request from the relatives to meet them personally. The commemoration in 2016 requires the Taoiseach's leadership and direction at this stage.

The Taoiseach

Deputy Maureen O'Sullivan has had a particular interest in the matter for quite some time and I thank her for her contribution. We are entering a decade of centenary commemorative events which must be inclusive, sensitive and appropriate. That is why the Minister, cross-party personnel and a number of professional historians are concerned to do this in a way which is authentic, fitting and appropriate, based not only on the revolution but on the direction of the country over the next 100 years. For that reason, the Government has made available substantial funding between now and the commemorations for the military archives at McKee Barracks, the restoration of Kilmainham Courthouse, the developments internally in the GPO, access to the Bank of Ireland on College Green and the preservation of Nos. 14 to 17 Moore Street. I was down there myself on a number of occasions and it is not the kind of place in its current condition that one would wish to send people to view the location of the eventual surrender of the group from the GPO who sought safety there.

The Minister's responsibility and function is in respect of the national monument at Nos. 14 to 17 Moore Street. He has some responsibility beyond its curtilage as to where the private property developments may impinge or impact on the foundations in the immediate vicinity. Dublin City Council also has an impact in terms of planning permission conditions etc.

On different occasions I met a number of relatives of those who had fought in the GPO and been involved in 1916, but I am not sure to which group the Deputy is referring. I am happy to engage with people. This is a centenary and it is important to get it as right as possible. This is our capital city and Ireland is recognised as one of the first small countries at the beginning of last century to achieve its independence. It is appropriate for those with responsibility in government to make arrangements to ensure the event is comprehensive, sensitive, appropriate and fitting at the commencement of a new century of progress for the people socially, economically, culturally and in other ways. Perhaps the Deputy might let me know the group about which she is talking and I will be happy to meet it with the Minister in due course to see how best we can proceed.

Deputy Maureen O'Sullivan

I thank the Taoiseach. I will be in touch with his office to set up the meeting as soon as possible. When he was director of the National Museum of Ireland, Dr. Pat Wallace made these points and it was his considered view that any consent should be mindful of the national historic importance of the Moore Street area, including its laneways and buildings. This was reiterated by the National Museum of Ireland recently when it saw the Moore Street theatre of conflict as the most important historic site in modern Irish history. This is borne out by the Imperial War Museum in London, the representatives of which said, "it is the only city-based 20th century battlefield to survive in all of Europe and possibly the world" and "historically, it is beyond price." It is also borne out by a recent exchange with the Minister of State, Deputy Jan O'Sullivan, on legislation dealing with areas surrounding a place of architectural significance. We cannot leave it to a self-appointed private group to look after an area of extreme historical significance. If Deputy Enda Kenny is still Taoiseach in 2016, he will not want to be standing outside one part of the building and surrounded by a derelict site. When he meets relatives, I hope an independent review can be discussed. People are thinking about seeking a judicial review and we could end up with NAMA using State money to defend a developer. There are precedents for undertaking an independent review; we do not want Moore Street to become like Wood Quay when we lost so much of Viking Dublin.

The Taoiseach

We do not want to get lost in interminable discussions and rows between one sector and another. Work in the other areas mentioned is under way and will I hope be fully completed before 2016. When one exits the side door of the GPO, one can turn left, heading towards Moore Street. However, the gun in place at the Rotunda hospital meant that people leaving the GPO could not move towards Moore Street and The O'Rahilly was shot further up as he moved through the side buildings to 14 to 17 Moore Street. I do not have control over the planning application for anything outside the national monument, but I assume it is compatible with retaining some element of the lanes and the paths of history for those who may wish to travel the journey made by those who left the GPO and went as far as 14 to 17 Moore Street and beyond to the Rotunda hospital where the surrender took place on the footpath. I am happy to engage with people in so far as we can, but I cannot satisfy all demands. This is an issue that must be dealt with and not allowed to drag on interminably. Otherwise, 2016 and many other years will pass and the place will not have changed. We must do something about it and that involves making decisions which may not be fully acceptable to everyone. We must do the best we can in the interests of what happened. This is our capital city and part of our history. We want to build on it for new foundations for the future.