Vol. 886 No. 4
1. Deputy Billy Kelleher asked the Minister for Health if he will provide an update on the implementation of the commitments in the programme for Government on universal health insurance; his views that both parties in government remain committed to the goal of universal health insurance, based on multiple insurers; and if he will make a statement on the matter. [27791/15]
Will the Minister for Health provide an update on the implementation of the commitments in the programme for Government on universal health insurance and his views on whether both parties in government remain committed to the goal of universal health insurance based on multiple insurers as opposed to universal health care? I would appreciate it if a bit of honesty could be brought to the debate on this issue. We now have conflicting views and reports from various Ministers, the Taoiseach and the Tánaiste and there seems to be continual change of emphasis in the language from the Minister around universal health care as opposed to universal health insurance.
The Government is committed to a major programme of reform for the health service, the aim of which is to deliver a single-tier health service where access is based on need and not income. The White Paper on universal health insurance was published on 2 April 2014. Following its publication, a major costing exercise involving the Department of Health, the ESRI and others was initiated to examine the cost implications of a change to a multi-payer, universal health insurance, UHI, model, as proposed in the White Paper. Draft results from the initial phase of the costing exercise were presented to me at the end of May. These draft results are now informing deliberations on next steps, including the necessity for further research and cost modelling.
Ultimately, the UHI costing exercise is a major research project with a number of phases. The next phases in the costing exercise are likely to include deeper analysis of the key issue of unmet need and a more detailed comparative analysis of the relative costs and benefits of alternative funding models.
This will inform Government discussions on the best long-term approach to achieving universal health care. It is important that universal access does not result in shared but longer waiting lists for all, but instead results in more health care needs being met in a timely manner. For this reason additional analysis of unmet need and capacity is important as we implement changes on a phased basis.
Finally, I have already indicated that it will not be possible to introduce a full universal health insurance system by 2019, as envisaged in the White Paper. However, I emphasise my commitment to universal health care and to implementing key health reforms, as set out in the programme for Government and the White Paper. In particular, I have pushed ahead with critical building blocks for universal health care, including the phased extension of universal general practitioner care without fees, improved management of chronic disease in the community, implementation of financial reforms, including activity-based funding, and the establishment of the hospital groups. We have recently seen significant progress in the extension of GP care without fees to children under six years of age and we are also seeing the phased expansion of free GP care to all those aged 70 years and above from August. The introduction of universal GP access for the youngest and oldest in our society is an important step on the path to universal health care.
That is an extraordinary reply. We are back to the same old view that has been expressed by the Minister in recent times in respect of universal health care. I remind the Minister that the programme for Government states:
This Government will introduce Universal Health Insurance with equal access to care for all...A system of Universal Health Insurance (UHI) will be introduced by 2016, with the legislative and organisational groundwork for the system complete with this Government's term of office.
The idea that the Government is now saying that no due diligence was done on how it would implement universal health insurance in advance of the last election and in advance of putting it into the programme for Government is extraordinary. It is the case that the Government is making this up as it goes along. It is evident that the Minister is fundamentally opposed to universal health insurance. The Taoiseach is attaching himself to it with pretence. He comes into the House and effectively says he is committed to it, although the Minister has abandoned the idea of bringing in universal health insurance.
Many Members subscribe to the idea of universal health care, but the question of how we fund our health services is the critical issue. We are not talking about opposing some concept of universal health care, but universal health insurance is the Government's stated way of funding universal health care and the Government seems to have abandoned it. We need honesty and straight, upfront views on what the Government is going to do with regard to universal health insurance.
I appeal to Deputies to stick to the time limit. What happens is that when we get to Other Questions for ordinary backbenchers, there is not enough time to answer them because we are taking up too much time on Priority Questions.
There is none here.
There is no such thing as ordinary backbenchers.
They will not come to the Chamber until we get to Other Questions.
I know there is a good deal of debate and comment around terminology. Universal health care is a group term meaning access to health care on an equal basis, based on need rather than ability to pay. There are many ways of bringing that about. Universal health insurance is one of those. We can have a multi-payer or a single payer system, a social insurance-based system, a tax-based system or an out-of-pocket system. These are all different ways of funding it.
Another element in the programme for Government is the extension of GP care without fees. That is not being done through insurance and it was never envisaged that it would be done through insurance. We spent a considerable period in negotiations with the Irish Medical Organisation on that contract on the basis that it would be based on a tax-funded system. There is a separate part in the programme for Government on that aspect.
Obviously, a considerable amount of work has had to be done in the meantime. The costings indicate that universal health insurance would be very expensive and that the premiums would be very high. Maybe they need to be high, because any universal health care system worth having is one that delivers timely health care. We could have universal health care tomorrow and simply put everyone on a waiting list, but I am unsure whether that would be very attractive.
Unfortunately, it is a case of what a tangled web we weave when first we start to deceive. There is no doubt those in government are forgetting what they have said with regard to the health policy and how it is to be funded. When announcing the White Paper on 2 April 2014, the Taoiseach stated that "Those with existing health insurance will now for the first time have primary care services included." It would have been fine if he announced that on 1 April because it is a fool's document and the Government is trying to make a fool of everyone in this House and those on the street as well.
The Minister has a fundamental opposition to universal health insurance. The Taoiseach comes to the House on a regular basis and pretends that it is a central plank of Government policy while his Minister is undermining it.
A question, please.
Will the Minister once and for all tell us clearly whether he is committed to universal health insurance as opposed to universal health care? We all subscribe to the principle of universal health care. The key issue is how we fund it. Is the Minister committed to universal health insurance, as proscribed in the programme for Government?
When it comes to whether it covers GP care, it depends entirely on what policy people have. Many people have a policy already that covers GP care, but most people do not and chose not to take that out. Where we differ is that I do not believe the most fundamental question is how the money is collected and funded.
Is the Minister referring to where we differ or where he and the Taoiseach differ?
The fundamental question is whether the health services are adequately funded. No matter what the system, if the funding and staffing levels are inadequate, then it will not be a good health service. The second thing is to ensure that money is spent well. This comes from activity-based funding. We are very much pushing ahead with activity-based funding to ensure that money follows the patient and that hospitals are paid for what they do. Research has been done by the ESRI and I look forward to publishing it as soon as possible. The research indicates different sets of costings. We could apply universal health insurance only to hospitals, to hospitals plus primary care or to hospitals plus primary care plus drugs and social care.
The commitment is to primary care.
All those things need to be determined. We also have to get other things right first; things which have not been got right.
2. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he is aware of the significant level of discontent, and, in some cases, outright dejection being felt and expressed by victims of the barbaric practice of symphysiotomy, at the unsympathetic and adversarial conduct of the Government-initiated payment scheme established for the ever-decreasing number of aged survivors; if he will undertake to address the serious shortcomings in its out-working, including the disbelieving disposition of its principal, and the confrontational and interrogational operation of the process; the qualifications of the various medical experts employed by the scheme; if he is satisfied that they are sufficiently qualified to make judgments on the particular cases presenting; and if he will make a statement on the matter. [27899/15]
I seek to draw the Minister's attention to the expressed dissatisfaction of victims of symphysiotomy who have contacted me regarding the conduct of the State's scheme of payment to survivors of this barbaric procedure. I appeal for the Minister's intervention, even at this late stage, to ensure a more compassionate and humane approach is adhered to from this point forward.
The surgical symphysiotomy payment scheme commenced on 10 November 2014. It was estimated that 350 women would apply to the scheme, but in fact 577 applications have been accepted. The applications are being assessed by former High Court judge Ms Justice Maureen Harding Clark.
Contrary to the Deputy's assertion, the scheme has brought about an end to years of uncertainty and costs for women who have undergone surgical symphysiotomy. The scheme was designed to be simple, straightforward and non-adversarial and it aims to minimise the stress for all women concerned. The scheme was designed following meetings with all three support groups, two of which have welcomed its establishment. It was set up to give women who do not wish to pursue their cases through the courts an alternative option in which payments are made to women who have had a surgical symphysiotomy, whether or not negligence is proven.
The scheme is voluntary and women did not waive their rights to take their cases to court as a precondition of participation in the scheme. Women may opt out of the scheme at any stage in the process, up to the time of accepting their award. It is only on accepting the offer of an award that they must agree to discontinue legal proceedings against any party arising out of a symphysiotomy or pubiotomy.
Ms Justice Clark has informed my officials that as of 3 July 2015, 235 offers have been made to women. In some cases, however, the applicants or their legal advisers have not yet provided the necessary documentation and information in support of their applications. Ms Justice Clark has indicated that she will write to each of these applicants to request that all outstanding documentation and information that the applicant may wish to rely on in the assessment of their application is furnished to the scheme. The judge will specify a time limit in which information must be furnished and after this time has expired, the applications will proceed to assessment on the basis of the documentation and information furnished. Given the legal and other costs involved and the frailty of some of the women, the judge wishes to ensure that the scheme does not continue for longer than is necessary.
Ms Justice Clark has commissioned medical experts in the areas of obstetrics and gynaecology, radiology and orthopaedic surgery to assist her in assessing applications where there is an absence of available evidence either that the procedure was undertaken or of its consequences on the health of the woman. The three consultants concerned are eminently qualified in their respective fields to do this work.
The Government has given careful and detailed consideration to this complex and sensitive matter. It believes that the provision of the scheme, together with the ongoing provision of medical services by the HSE, including medical cards, represents a comprehensive response to this issue that should help bring resolution for the women - many of whom are elderly - and their families.
Individual claimants, survivors to this day of a barbaric procedure performed on them without their consent or understanding, before, during and, in some cases, after childbirth have been speaking out regarding their personal experience and the experience of other women known to them who have presented before the Government's payment scheme to these victims and have, in their own words, had their lifelong pain compounded by the experience.
These women spoke of a process that is challenging and, despite the Minister's claims, adversarial. It appears to lack compassion or understanding and for some it has been demeaning. The former judge, Ms Clarke, who is the sole overseer of the process, has described women subjected to symphysiotomy as making a full recovery over a relatively short period of time and with no continuing ill effects. Neither of these claims stands up to Irish or international scrutiny. In some cases she has looked for a pathological gap in the pelvis in a belief this would represent objective evidence of injury even though the High Court accepted in a recent case there is not necessarily a link between such a gap and the pelvic pain that is a reality for many of these women.
I ask the Minister what steps he will take to address the inappropriate disposition of Ms Clarke in the carrying out of her role and to ensure that all women victims presenting before her are treated to true compassion and respect rather than made to face a process that is nakedly operated to keep payments to the lowest possible level, which in some cases is nothing.
The scheme was established in this manner so that it would not be adversarial. One alternative was to require people to go through the courts and make their case on the witness stand, with the possibility of being subjected to cross-examination and significant financial losses if the case is unsuccessful. The Deputy will be aware that judgments in a number of recent cases have found against the women concerned. The other alternative was a form of tribunal which would adopt a similarly adversarial approach. The chosen scheme is the least adversarial system that could be established. It is not unreasonable to require the 577 people who have made applications to produce evidence that they underwent surgical symphysiotomy. Of the 235 offers made, 222 have been accepted.
Further to the cases I outlined earlier, Judge Clarke has dismissed claims regarding urinary incontinence as a direct consequence of the invasive procedure, arguing that it is just as likely to be a product of the ageing process, and has disputed claims of mental ill-health resulting from symphysiotomy. I do not know anyone else who would dismiss victims' claims of depression, anguish and social withdrawal. Let us not forget that the UN Human Rights Committee has condemned this so-called surgery as torture.
I do not doubt that the Minister believes the response he has given but I ask him to heed the voices not of this Deputy, but of the women who have spoken to me in this institution and elsewhere. If he has a difficulty in doing that, a number of them are currently in the Gallery and they can inform him personally about the reality of their experiences. It is not good enough for the Minister to simply accept that everything is well and is going as he intends. Nothing could be further from the truth. I invite him to make an intervention to ensure that the process is indeed non-adversarial and has the compassion required.
The scheme is voluntary and participants can withdraw at any time if they are not satisfied, and can pursue their case through the courts in the normal way. It remains voluntary until the point at which somebody accepts an award. Judge Clarke receives advice from medical experts but she was appointed to act as an independent assessor. That is why I will not attempt to go over her head or overrule her. Her medical advisers include an eminent consultant, an obstetrician, a gynaecologist, an eminent consultant radiologist and an eminent consultant orthopaedic surgeon. I do not know whether the Deputy's claims are correct but I am sure-----
Will the Minister undertake to check them?
-----any decision she makes is based on medical advice.
Will the Minister undertake to check them?
3. Deputy Maureen O'Sullivan asked the Minister for Health the extent of Government funding to drug addiction services and alcohol addiction services; his views that there are adequate services and resources for those seeking to address their alcohol issues; and if he will make a statement on the matter. [27727/15]
Individuals with an addiction to drugs and alcohol can access the full range of general health services including primary care, secondary care, social care and mental health services. There are also specific services for addiction. Health Service Executive funding of €109 million is provided for alcohol and drug addiction services in 2015.
People who present for alcohol addiction treatment are offered a range of interventions based on the four tier model of treatment intervention. The quality of client care remains a central focus of the addiction service. The HSE is aware of the growing need for interventions to address those addicted to drugs and alcohol. The issue of support for those with alcohol addiction will also be considered as part of national strategy development, most particularly in developing the new drugs strategy and in the forthcoming review of A Vision for Change. The resources available to address substance misuse will be kept under review in the context of the overall resources available to the health services.
It is essential to have a public health policy response which seeks to reduce the number of people engaged in the harmful use of alcohol. The Government approved the general scheme of a public health (alcohol) Bill in February. The scheme includes provisions for minimum unit pricing, health labelling on products that contain alcohol, restrictions on the advertising and marketing of alcohol and the regulation of sports sponsorship. Work is ongoing on the preparation of the legislation and it is expected that the Bill will be published in the autumn. The other measures set out in the steering group report on a national substance misuse strategy were endorsed by the Government. The first annual report on the national substance misuse strategy is due later this year. A range of services is provided for those with drug and alcohol addictions. Work is under way to review these services to ensure that they are developed in line with evolving needs and best practice.
Alcohol-related harm costs the country €3.7 billion, of which €1.2 billion is due to alcohol-related crime. Some 97% of public order offences recorded on the PULSE system are due to alcohol. These figures do not include the human cost to the individual and his or her family. I recently met a group of people in recovery who outlined the cost of their alcoholism. These costs include €100 every time they presented to an emergency department, €1,000 per night when they were hospitalised and additional sums for GP visits and medication, as well as the costs associated with accidents and being out of work. These expenses create further stress for themselves and their families. Now that they are in recovery, they are back at work and paying taxes. Some of them run businesses and employ people. Furthermore, they are also supporting others in recovery. There are also knock-on effects for their families and communities.
I ask the Minister to give specific details on the range of interventions available. If individuals present to an emergency department with an alcohol-related illness, to where are they referred and what information are they given?
If individuals present to an emergency department, they are treated as an emergency and their injuries or other acute medical illnesses are dealt with. Two thirds of patients who attend emergency departments are discharged and the remaining third are admitted. If they are admitted, I imagine they would receive some sort of referral to the addiction services while they are in hospital but they are probably not referred if they are discharged because that is how an emergency department appropriately works. It would be a matter for the patient's GP or regular doctor to make the necessary referral. The purpose of an emergency department is to deal with the presenting complaint or emergency, while the underlying conditions should be dealt with by the community or admitting doctor.
The budget for the HSE's addiction services has increased slightly this year from €86.122 million to €86.279 million. Funding for the HSE's drugs and alcohol task force projects has also increased slightly this year.
I do not believe the medical model provides the sole answer because the majority of the two thirds who are discharged will end up back in the emergency department. There are very few projects and facilities on the northside of Dublin. One of the few services that exists on the northside manages to cover the cost of qualified therapists and counsellors, its premises, its information technology equipment and its other overheads on a budget of €150,000 per year. Despite working actively with 74 clients, it has no funding from the HSE. This service is working and similar services should be established in every town in this country.
I have tabled a later question on the €2.2 billion raised in taxes on alcohol products. Can some of this money be allocated specifically for treatment services? Proposals are being considered for the minimum pricing of alcohol but could we set a maximum price for soft drinks? When people go out for drinks sometimes the cost of alcohol is the same if not cheaper than that of a soft drink.
I am not familiar with the particular project mentioned by Deputy O'Sullivan but it is open to any project to apply for funding from the HSE or the local drugs task force. I do not know the people involved and I do not dispute what they say but I have never met a group that did not tell me that its service was great. That is the nature of these things. It is important that any project is objectively assessed, and that is where the HSE's addiction services come in to allocate its budget as efficiently and effectively as possible, and to assess how it can be best spent and best delivered.
4. Deputy Colm Keaveney asked the Minister for Health the action he will take on foot of recent Health Information and Quality Authority inspection reports of residential centres for persons with intellectual disabilities; and if he will make a statement on the matter. [27792/15]
We have seen a number of damning HIQA reports that were recently published which highlighted the Government's serious failure with respect to disability services. I refer to reports on the St. John of God service in Drumcar and Cregg House in Sligo. Is the Minister concerned about the reports? Is it not evidence of the lack of political will at Cabinet with respect to providing the best quality of services for people with disability in this country?
The Government is very committed to the protection and safety of our most vulnerable citizens and placed regulation and inspection of residential disability centres on a statutory footing in November 2013. Every person who uses disability services is entitled to expect and receive care of the highest standard and to live in dignity and safety. People with a disability should be able to maximise their potential and live rich and fulfilling lives.
Compliance with HIQA standards for disability residential centres is a requirement under the service level arrangements between the HSE and voluntary service providers. A total of 66% of designated centres for people with a disability were inspected by HIQA by the end of quarter 1 in 2015, including inspections triggered by complaints or allegations of mistreatment. The lessons learned from them are continuing to improve the quality of services. Clients and their families can be assured that this regulatory regime is being rolled out across all residential facilities for people with a disability.
HIQA has reported evidence of very good practice in the delivery of many residential services to people with disabilities where the support and care needs of residents have been prioritised and there is a strong focus on the needs of service users. While HIQA’s findings, in some cases may make for difficult reading, they serve as evidence that the regulatory process works effectively and in the interests of protecting vulnerable people in the care of the State. In that respect, for example, it is noted that HIQA’s most recent report on Áras Attracta has found significant improvements in the lives of many residents.
The Department of Health has requested the HSE to develop action plans to address cases where HIQA has raised serious concerns regarding the level of care people with a disability are receiving in a number of disability centres, including safeguarding the human rights of residents.
The HSE is implementing a comprehensive change programme of measures to improve the quality and safety of residential services for people with disabilities. Much work remains to be carried out on an ongoing basis to ensure all facilities comply with disability residential standards. While this programme will be challenging for the HSE, it is crucial in safeguarding vulnerable people in the care of the State.
I fail to see how the Minister is committed to the disability sector. The parliamentary question was not about the regulatory standards, it was about providing resources for people with disability. Is the Minister not appalled at the Cregg House report, which found that the chronic staffing levels due to cuts to staff resources had "a direct impact on the quality of life for residents"?
In the week the Government granted significant increases in the pensions of retired politicians, does the Minister not find it appalling that he could say in the House today that he is committed to the disability sector when it has been affected by massive cuts, which have resulted in the slippage of standards? The damning reports demonstrate the failure of the Government and highlight the lack of political will to protect vulnerable people. As we approach the next budget, does the Minister intend to reverse the cuts?
Of course I am appalled at the negative reports that were published about some disability centres. Often, there are a number of issues as to why care is substandard. Resources are often only part of the picture. Deputy Keaveney will be aware that Áras Attracta was very well staffed but, none the less, there were major failings in care.
First, more than 500 reports on residential centres were published in 2014. We probably only heard about six or seven of those, or perhaps ten, because they were the bad ones but let us not forget about the 490 or so that are very good, and the very good people who provide an excellent standard of care in residential centres. We should point out as well that before November 2013, there were no inspections. The sector was totally unregulated. I do not believe for a second that the problems did not exist during the 14 years in which Deputy Keaveney's party was in office but it did not regulate the sector. It was left unregulated and people were totally vulnerable and unprotected. He did not give a damn about them whatsoever. It is only since November 2013 that the sector is now regulated and properly inspected. Things are changing now, whereas for 14 years under a Government of which the Deputy's party was involved, which had massive funding available to it, the Government did not even want to look inside those centres to know what was going on.
The Minister's unedifying response is a distraction from his commitment to provide for the most vulnerable people. If he was less focused on providing for the pensions of retired politicians and more enthusiastic about providing resources for people with disability, I would not be asking this question today. Will the Minister reverse the cuts he strategically planned against people with disabilities? The Government's tax profile was allegedly ahead by €800 million. Is it on the back of cuts to disability services that the Minister approached the budget and tax profile?
As is always the case, the Minister of State, Deputy Kathleen Lynch, and I will do our very best to make as strong a case as we can for all health and social care services, not just disability but also for mental health, acute hospitals and primary care. Funding is limited but the Deputy can rest assured that we will make as strong a case as we can to the Government to provide the additional resources we need in the years to come.
5. Deputy Maureen O'Sullivan asked the Minister for Health his views that the national drugs rehabilitation implementation committee framework is responding effectively to the drug and alcohol issues present in Irish society; and if he will make a statement on the matter. [27728/15]
My question relates to the national drugs rehabilitation implementation committee, NDRIC, framework. Does the Minister believe the committee is responding effectively to the drugs and alcohol issues that continue to present in the country?
The national drugs rehabilitation implementation committee, chaired by the HSE, has developed a national drugs rehabilitation framework. As Deputy O'Sullivan is aware, people in recovery have complex needs and may require multiple interventions from a range of agencies to assist them in their recovery. The aim of the framework is to provide a continuum of care for the recovering drug user through promoting a more integrated and person-centred approach to rehabilitation based on shared care planning. The roll-out of the framework is currently being advanced through the HSE's addiction services and the local and regional drug and alcohol task forces.
An evaluation of the framework, which was piloted in ten sites during 2013, found that both service users and the agencies involved in service provision, expressed a high level of enthusiasm for the framework. Those participating generally agreed that the objectives of the framework could be achieved if all agencies were committed to inter-agency working. The committee has developed national protocols under the framework to facilitate inter-agency co-operation. In addition, competency-based training is currently being designed which focuses on key working and care planning. The intention is to provide training to treatment providers and relevant agencies in 12 task force areas by the end of the year, with the remainder to receive training next year.
As Minister of State with responsibility for the national drugs strategy, I am leading the development of a new national drugs strategy after 2016. The process will involve a comprehensive consultation with key stakeholders and the public on the current national drugs policy and future priorities. This will provide an opportunity to ensure that our strategic approach into the future continues to be firmly focused on recovery. I have also asked my Department to examine the feasibility of utilising social impact bonds as a funding model to improve both treatment and rehabilitation service outcomes. The outcome of this work will inform decisions as to the viability of this approach to maximising the social benefits which the national drugs strategy seeks to achieve.
The Minister of State heard the reality when he attended the North Inner City Drugs Task Force this week, which is that an increasing range of drugs is appearing on the streets, in particular the benzodiazepines, Z drugs, zopiclone and zimovane. He heard about the massive profits involved. It is possible to make €1,000 a week, which beats a summer job packing shelves in one of the local supermarkets. The Garda is powerless to deal with the Z drugs. There is a need for a personal detox from benzodiazepines before people can access the official programme. We know about the street crime, drug paraphernalia and intimidation and the length of time people are on methadone. In 2010 a Department of Health recommendation suggested suboxone would be used as an alternative to methadone because fewer overdoses occur on it. We are also aware of the housing and homelessness problems and the dual diagnosis of people presenting with mental health issues, not to mention those in prison who are addicted but sometimes manage to mask that addiction when they are in prison but one must ask what they come out to.
I have to ask where is the role of the national drugs rehabilitation implementation committee in all of this. As people on the ground are telling me, the situation is getting worse and there is no urgency in addressing it.
I appreciate what the Deputy has said. We had an interesting conversation at the North Inner City Drugs Task Force. I have visited various drugs task forces around the country, particularly in the Dublin area, since my appointment to this post. I share the Deputy's concern about how this situation is changing, in that it is worsening and becoming more acute in certain parts of the country and among certain age cohorts.
Today I will take part in a discussion at a joint meeting of the Joint Committee on Health and Children and the Joint Committee on Justice, Defence and Equality on the issue of decriminalisation of drugs, on which the justice committee wants to initiate a public consultation. In that, I have a lengthy contribution to make in regard to many of the issues the Deputy has raised. I am also proposing to have a conference at the end of this month in the Mansion House, with the new Lord Mayor of Dublin, in order to bring together the drugs task forces and people who are working in this sector, because I do not consider that I can wait for the review of the national drugs strategy in order to get a proper snapshot in time as to the nature of the problem we have in Ireland at the moment. That is on 29 July, and I would appreciate the Deputy's attendance and input into that conference.
I will give the Minister of State an example. The Irish Medicines Board reacted very quickly when fake Viagra appeared on the streets. We need the same urgency with these drugs. As the Minister of State knows, the hands of gardaí are tied because these are controlled drugs, and we know that as soon as they are controlled another one will appear. Therefore, there is a need for urgency each time one of these drugs appears. We must ensure the legislation is in place so gardaí can tackle this immediately.
The rehabilitation posts that had been promised through the HSE, which would ensure consistency and quality of service provision, have not appeared. Prevention and education is a particular baby of mine. Again, we do not see enough urgency when it comes to that and to listening to the voices of young people. There is a suggestion that recovery should become the sixth pillar of the national drugs strategy and, again, I hope that will emerge. While we know that harm reduction measures, including medically supervised injecting rooms, on which we had a presentation recently, are a possibility - we hope it will go forward - recovery is still the optimum. I would hope to see that as the sixth pillar.
I agree with everything the Deputy has said. In regard to controlled substances, I found quite disturbing what Inspector Des McTiernan of the inner city drugs task force had to say about the mother who told him it would be almost impossible for him to convince her child to get a minimum wage job in Dunnes when there is €1,000 a week to be made selling certain substances on the street corners of the inner city. We have a misuse of drugs Bill in front of the House this year and we can use that vehicle to address many of the issues the Deputy has raised. Certainly, the prevention and education element is crucial. We have to get away from the idea of victim blaming of young people who have inherited this problem that we have passed on to them. We have to have a more expansive idea of how we can engage and connect with young people. The schools system is part of that, but it is not the whole answer because children and young people do not live in schools and are influenced by many of the things that happen around them.
