Dáil Éireann díospóireacht -
Tuesday, 29 Nov 2016

Vol. 930 No. 3

Topical Issue Debate

Appointments to State Boards

Deputy Alan Kelly

I am raising the issue of appointments to State boards in the Department of Transport, Tourism and Sport because I would like to hear the Minister's proposals to fill the vacancies that exist. The volume of vacancies in the Department is quite phenomenal. My understanding, which is based on the figures I have seen, is that on 23 November last there were 36 vacancies across the various agencies under the Minister's remit. There are three vacancies in Iarnród Éireann, which has many issues, as we all know. There are vacancies in the Road Safety Authority and Sport Ireland. Some very important chairmanships are coming up as well. A further 16 places will become vacant by the end of the year, including a number of important roles and chairmanships. This is all public information. I have drawn it from information provided by the Department of Transport, Tourism and Sport.

Why is the Minister not filling these positions? Does he believe he is fulfilling his mandate - his seal of office - and doing his job on behalf of Irish taxpayers, which is to ensure all of these agencies are functioning to the best of their ability? Given that the Minister has made virtually no appointments - there have been some appointees - how can we be certain that many of these boards have the expertise to function? A range of organisations with massive budgets need auditors and people with audit and financial experience. Will the Minister confirm to the House that expertise in finance and other specialist areas is available across the suite of organisations under his remit to meet the needs of those organisations at board level? I want him to give the House a guarantee that this is the case. Why is the Minister not filling these positions? There is a need across these boards for these positions to be filled.

I have spoken to some of the people involved in these organisations. They simply cannot function if these roles are not filled. I have spoken to the chair of one of the larger and more important organisations under the Minister's remit. He told me that if this impasse continues for the next few weeks, the board of the organisation in question will not be able to function at the optimum level because it will not have the expertise in place. Will the Minister confirm to the House that he has met every chair of every organisation within his remit, or at least the chairs of the larger critically important organisations across the wide range of organisations under his remit? Will he confirm to me that he has the knowledge, capacity and awareness to be assured that despite the failure to fill these vacancies, he is not concerned that these boards will not be able to function? Does he trust his officials? Does he believe the Public Appointments Service system is fit for purpose? Does he trust that system? Does he trust his officials to put in front of him the names of people who are competent enough to fill these vital positions? If he does, why is he not accepting the Public Appointments Service system and the recommendations of his officials who give him a list from which to choose?

Minister for Transport, Tourism and Sport (Deputy Shane Ross)

I thank Deputy Kelly for raising this issue and for giving me an opportunity to respond and address the matter. I know he has a great deal of interest in these issues. I am sure he understands the complex nature of the system of making appointments to State boards and the extraordinary responsibility it entails. It is not a matter that can be treated in a trivial way by any Member of this House or any Minister. The system is in constant need of improvement. Indeed, the Government of which Deputy Kelly was a member attempted to improve the system in November 2014 by issuing new guidelines to address the issue of State boards.

Since my appointment as Minister for Transport, Tourism and Sport, I have made a number of reappointments but have not yet made any appointments to State boards from the Public Appointments Service process. To date, I have made 16 reappointments, with three further reappointments of employee representatives to the CIE subsidiary companies with effect from 1 December 2016. As Minister, I do not necessarily have to fill all of the vacancies on each board. I am currently considering the size of the boards under my remit and the need or otherwise to fill each vacancy. My view is that some of the boards are unnecessarily large for the size of the State body in question. I am reviewing this within the flexibility of the underlying statutory provisions. It is very important to review not just the individual membership of boards, but also the boards themselves by comparing them with the boards of companies of a similar size. We must consider whether some of them are top-heavy, whether some appointments have been made for the wrong reasons and whether it is necessary for some boards to have double-digit numbers of directors when that does not do the Exchequer or, necessarily, the company any favours.

I have stated in the past my view that, in seeking a process for the appointment of directors to State boards, I want to do so in a manner that gives me the greatest certainty that the best appointments are being made. The current guidelines for appointments to State boards do not go far enough, in my view. To answer the Deputy's question, I have asked my Department to review the guidelines with a view to putting in additional internal processes that would allow me to make appointments with greater confidence in the ability of the selected person to contribute effectively to a State board. I do not feel that appointing someone on the basis of their curriculum vitae alone is acceptable. There must be a more satisfactory way of doing these things, and I am trying to devise one that supplements the current procedures.

Together with the Secretary General of my Department, other officials and other people, I am currently considering means by which the appointment processes within my Department can be enhanced to ensure, in so far as is possible, this can be achieved. The Deputy can expect news on this front very shortly. I do not want in any way to stray from the current guidelines at present, although the new ones are on the way. I wish to improve the guidelines and set in place a process whereby we can be more certain we are getting people who are qualified for the positions. Together with the Secretary General of my Department, I am considering means by which this can be done. I look forward to the outcome of the review of the guidelines on appointments to State boards being carried out by the Minister for Public Expenditure and Reform. I believe the report is currently with the Minister for his consideration.

Deputy Alan Kelly

I thank the Minister for coming to the House today, given that, previously, he was never available, and for explaining his position. I have to say it is perplexing. To be frank, pursuant to the relevant Acts of the Oireachtas, I do not believe the Minister is actually doing his job. There are a number of boards which will not be able to function if this vacuum persists. Will the Minister at least guarantee to the House, given he refused to answer the previous question, that all boards have all competencies covered and the Minister has met with all chairs of all the organisations to confirm same? If he has not, then he is in neglect of his duty as a Minister. I know this because I sat there and did a similar job. The Minister has to make sure that all boards have the competencies. According to my sources, some of them do not and others will not in the coming weeks. That is unacceptable and is negligence on the Minister's part.

The Minister is adopting a specific view in regard to the Public Appointments Service, PAS. I take it he does not have confidence in PAS. I take it he has little confidence in his own officials who make recommendations to him. He says there must be more than a curriculum vitae to decide somebody's competence. He often spoke when he was a journalist, and also last night with Claire Byrne, although it was not live, about cronyism. Cronyism is appointing people who are not competent to do the job. These people come through PAS and its officials. They are obviously competent or they would not have got through that strenuous process, a process that, dare I say it, was not used when it came to filling Ms Hunt's or Tony Williams' position as special adviser to the Minister. Why can there be one rule when it comes to appointing certain people to advise the Minister, and be on the taxpayers' payroll, and another rule when it comes to the fact the Minister will not fill the roles that are necessary across the board to keep the competencies in order to ensure taxpayers are protected and the Minister can have faith and confidence in board members?

Deputy Shane Ross

I thank the Deputy for raising this matter and giving me the opportunity to respond to some of the things he said, many of which he knows nothing about, quite obviously, from what he said.

Deputy Alan Kelly

That is frankly insulting.

Deputy Shane Ross

It is quite apparent, from what he says, that he has not done very thorough research. I would add that I have total confidence in all my officials, who are doing an extraordinarily good job. I would not agree with everything they put in front of me, and it is not my job to do so, but the idea they were doing things in bad faith is absolutely absurd.

Deputy Alan Kelly

Who said that?

Deputy Shane Ross

That is absurd. What we are doing is discussing-----

Deputy Alan Kelly

On a point of order, I do not know what the Minister is referring to. He might clarify who he is referring to in regard to bad faith.

Acting Chairman (Deputy Eugene Murphy)

The Minister might clarify that.

Deputy Shane Ross

The Deputy asked me if I had confidence in my officials and the answer to that is absolutely, yes.

Deputy Alan Kelly

He has not answered the question.

Deputy Shane Ross

Fully and totally, I have answered the question.

Deputy Alan Kelly

On a point of order, I asked a question in regard to bad faith and he still has not answered it.

Acting Chairman (Deputy Eugene Murphy)

I ask you to resume your seat and allow the Minister to continue.

Deputy Alan Kelly

He has not answered the question.

Acting Chairman (Deputy Eugene Murphy)

I will chair the debate. The Minister, without interruption.

Deputy Shane Ross

I have full confidence in them. I have full confidence in their advice. I have full confidence that what they are doing and what they are advising is done in good faith. I may not agree with them - I am not there to agree with them about everything. What we are trying to do, and the Deputy may find it difficult to understand, is improve the current PAS system. We will continue to try to improve that and we will be making some announcements shortly which will please the Deputy because I know he is genuinely, in good faith, looking for improvements in this system, which has many faults. It will be improved. I will improve it with the assistance of the officials who have sat looking at these things for a very long time.

Hospital Acquired Infections

Deputy Michael Harty

I thank the Minister for taking this matter. The incidence of multidrug resistant infections in University Hospital Limerick has not been adequately controlled, according to the Health Information and Quality Authority. It may have been a contributing factor in 29 deaths and is associated with increasing numbers of new cases. This is a cause of great concern to patients and their families, and requires an urgent examination of the infection control policies in the hospital. I ask the Minister of State, Deputy Corcoran Kennedy, to direct an investigation into this matter.

As background, in June 2014 HIQA found there were risks to patient safety when it reviewed the governance structure of University Hospital Limerick. In particular, overcrowding in emergency departments of the hospital resulted in significant compromises in maintaining adequate levels of environmental cleanliness, which in turn increased risk of health care-associated infections, including multidrug resistant infections. These infections are life-threatening if contracted by frail elderly patients who are placed at risk in trolley queues for prolonged periods of time in the emergency department or placed in congested, overcrowded wards.

Multidrug resistant infections pose a problem in all acute hospitals and their origin is multifactorial. Antibiotic resistant infections arise from overuse and misuse of antibiotics both in hospital and in the community, resulting in increased numbers of new multiresistant bacteria. This poses huge challenges for hospitals where these infections predominate and require intense efforts to control and eradicate. However, University Hospital Limerick seems to have a much higher incidence of infections than other hospitals. In July 2014, the infection prevention and control team at University Hospital Limerick wrote to the executive management team to highlight its serious ongoing concerns regarding the management of patients with multidrug resistant micro-organisms. They highlighted the difficulties with identification of patients who are infected, lack of single rooms to isolate infected patients, serious environmental hygiene concerns with current cleaning standards and lack of basic education of cleaning staff in their role in controlling the spread of infection. The cleaning of patient equipment was sub-optimal and poor environmental cleaning, hand hygiene and antibiotic prescribing contributed to clusters of infection in the hospital. Finally, it was stated there should be a dedicated infection prevention and control clinical nurse specialist for the management of infected patients.

Between 2009 and 2014, there are were in excess of 50 cases of CPE-produced enterobacteria. As a result, in 2014, a member of the infection control team at University Hospital Limerick became so concerned about the escalation of multidrug resistant infections in the hospital that she made a protected disclosure to HIQA.

Subsequently, HIQA carried out an unannounced inspection in November 2014 whose findings were summarised as especially poor standards of environmental hygiene; ward maintenance not carried out in a timely fashion; long-standing extra beds in wards; and inappropriate bed spacing which led to increased risk of spread of infection between patients. This has a knock-on effect on planned admissions and elective procedures. Given the incidence of multidrug resistant infection in Limerick University Hospital, an external investigation needs to be urgently carried out to identify the cause of this cluster of infection.

Minister of State at the Department of Health (Deputy Marcella Corcoran Kennedy)

I thank Deputy Harty for raising this very important matter today. Multidrug resistant infections and resistance to antibiotics are an ongoing and evolving international risk for all health care providers. I can assure the House that the prevention and control of health care associated infections, HCAIs, and antimicrobial resistance, AMR, is a significant patient safety and public health priority for the Government.

I am advised that Irish hospitals, like other hospitals internationally, are taking steps to reduce health care associated infections and antimicrobial resistance including the prudent use of antibiotics. I am aware of the challenges in tackling multidrug resistant superbug infection rates in all hospitals including at University Hospital Limerick. The hospital has confirmed that it has a focused quality improvement plan in place to tackle the issues of control of HCAIs and AMR. This is in line with recommendations of the HIQA unannounced inspection reports at the hospital on 28 November 2014 and 13 January 2015. These include an intensive screening programme for the detection of carbapenem resistant enterobacteriaceae, or CRE as it is known, among high risk patients; an isolation ward for the mitigation of any risk of cross-transmission of newly detected or known positive patients; adoption of strict contact precautions, dedicated equipment and a highly intensive cleaning regimen; speedy laboratory procedures to ensure results regarding infections available within 24 hours; good communication among microbiologists and with all relevant parties on detection of a new case; and good communication with patients and GPs and other health care worker contacts to inform GPs of their patients’ status.

A wide range of initiatives has been put in place in the Irish health system over several years to tackle HCAIs and AMR, covering improved surveillance of infections, prescribing, infection prevention and control processes. It also includes antimicrobial stewardship initiatives and public and professional awareness-raising with a significant emphasis on the education and training of health care professionals. Ireland is also developing a national action plan on AMR in line with the World Health Organization’s 2015 global action plan on AMR and the European Council’s 2016 conclusions, "The next steps under a 'One Health' approach to combat antimicrobial resistance". The national action plan is being developed with the oversight and guidance of the interdepartmental AMR consultative committee. The committee was established in 2014 by our Department’s Chief Medical Officer and the Chief Veterinary Officer of the Department of Agriculture, Food and the Marine in recognition of the need for a whole of Government approach to tackling the issue of AMR. This intersectoral approach crosses the health, veterinary and environmental spheres to encompass all stakeholders' efforts to address what is a worldwide concern. This work will continue in 2017. It is intended that the national action plan will be published in 2017. Tackling AMR will require the whole system to prioritise key initiatives, working with our international colleagues. Ireland is fully committed to, and engaged in, addressing resolution of the problem of AMR and will continue to collaborate at international, EU and national levels to this end.

Nationally, I expect that the HSE will place particular emphasis on prevention and management of HCAIs and AMR in its service planning for 2017.

Deputy Michael Harty

As the Minister of State mentioned, there were unannounced inspections in November 2014 and January 2015, yet the incidence of multidrug resistant infections continues to increase in the hospital in spite of many of the deficiencies identified in the HIQA inspection being addressed. The incidence of CPE infection, which is just one of several multidrug resistant infections, is increasing at an alarming rate in the hospital and new cases continue to occur. An internal report dated July 2016 highlighted the extent of the problem. In 2009, there was one case; in 2010, two; in 2011, 11; in 2012, nine; in 2013, three, yet in 2014 there were 33 and in 2015, 53, and in the first two quarters of this year 19 new cases were identified. Those charged with identification of infected patients are obviously efficient in detecting and identifying the problem, yet infection prevention measures in the hospital are failing to adequately control the spread of multidrug infection. Inappropriate antibiotic prescribing is undoubtedly an underlying factor. However, factors which contribute to the spread of the infection continue to be poor quality of cleanliness in the environment, inattention to hand hygiene, overcrowding in the emergency departments and overcrowding in the corridors and wards with lack of isolation rooms. The physical capacity of the hospital to accommodate the population of the catchment area and the number of frail elderly patients exposed to the high risk of infection is inadequate.

All these factors contribute to infection risk and lead to failure to control the problem. Overcrowding in University Hospital Limerick and presumably in other hospitals is putting patients’ health and lives at risk for many reasons, in particular exposing patients to multidrug resistant infections. An external independent investigation needs to be carried out urgently, especially in the light of information that at least 29 patients may have had multidrug resistant infection as a contributory cause in their deaths.

Deputy Marcella Corcoran Kennedy

I can hear that Deputy Harty is concerned as any of us would be. However, I am advised that, based on the unannounced HIQA reports, the hospital has put in place the recommendations I outlined earlier. I will certainly bring the Deputy’s suggestion that there be an independent report to HIQA and the Minister and see what can be done.

The Deputy has put his finger on the bigger global picture in that this is not just an issue for one hospital in this country; AMR is of global concern. Those of us who have been a few decades on this planet can recall that 20 years ago we were given an antibiotic for a cold. Over-prescription of antibiotics has brought us to this situation globally. The HSE’s website www.undertheweather.ie is a great resource. It is well worth people’s while to look at it.

The HIQA report, which is a review of the antimicrobial stewardship in public acute hospitals, found that overall a progressive approach is being taken in the hospitals. I will certainly raise the matter at higher levels.

Symphysiotomy Payment Scheme

Deputy Clare Daly

The Harding Clark report into the symphysiotomy redress scheme has been described as deeply skewed, profoundly unfair, subjective and selective, intellectually dishonest, morally bankrupt, replete with false allegations, omissions, distortions, misrepresentations and contradictions and biased throughout. Those who said that are being soft on Judge Harding Clark whose report cannot go unchallenged or uncorrected. She goes way beyond the terms of reference of her assessor report to the Minister for Health when all she was asked to do was deal with the activities and expenditure of the scheme. Instead, she deviated into personal and unsubstantiated commentary, which is highly inappropriate in the context of outstanding litigation. Her report is riddled with false allegations, such as alleging that leading campaigners against symphysiotomy had alleged they had the procedure when they had not. That is completely and utterly untrue.

The only interpretation one can draw from this report is that it is a defence of the uniquely Irish practice of non-emergency symphysiotomy. It serves to diminish survivors’ claims and is a further violation of those women’s human rights. Symphysiotomy as practised in Ireland is a human rights abuse and that is the case regardless of this report. There can be no denying that the State has been culpable in this but, rather than address these matters honestly, the report has served to diminish the suffering caused and undermined the experiences of the women. There is a continued suggestion that the women were lying. Nobody who met these women could ever believe that.

Of course, Judge Harding Clark met hardly any of them. It was a paper review with no right to appeal any of her decisions. It was her opinion and her opinion only. It is hugely traumatic for the women involved that this horrific report has been published. I believe the Minister needs to intervene to have it withdrawn. It is hostile in its tone and it smears and discredits survivors rather than dealing with a bad and deliberate policy and a poorly administered scheme. It needs to be withdrawn and we need clarification on this matter.

Deputy Ruth Coppinger

I, too, have been absolutely appalled by the media coverage and the commentary of certain people in the media in the last week in response to this report. I agree that the methods of assessment were defective. I agree with Deputy Daly on the policy of Judge Harding Clark of taking oral evidence and meeting only a handful of the women involved. If she had met more, she would have seen for herself some of the injuries and limping, etc., that these women endure. Using contemporaneous radiology in one particular case, the judge stated that a 2004 X-ray did not show injuries to the women and that therefore the injury had happened afterwards. The judge went way beyond her brief, showed her own bias and showed contempt for these women. I believe it is absolutely vital that this Dáil and the Government agree to set aside time to have a proper analysis of this report.

There are a couple of myths that the report tries to knock down. The first is that symphysiotomy was a normal procedure practised in many countries, as argued by Paul Cullen, for example, in The Irish Times. In 1944, there were four of these operations in the national maternity hospital. In 1948, there were 43. That was because of the arrival of Dr. Alex Spain, an arch-Catholic, as head of the hospital, who refused caesarean sections and said that their result would be contraception, the mutilating operating of sterilisation and marital difficulty. It is utterly wrong to say that. They also argue that symphysiotomy was not dangerous. Clearly, it was. It was not a benign procedure. It was not used in other countries as a first resort; it was used as a last resort. This is the third whitewash report there has been. It is a disgraceful indictment of the system that it does this to women who were brutalised in the Catholic Ireland of the past.

Deputy Marcella Corcoran Kennedy

I thank Deputies Daly and Coppinger for raising this very important matter. It occupied quite a considerable amount of time in the last Dáil, particularly with the cross-party report into symphysiotomy.

Judge Maureen Harding Clark submitted her report on the surgical symphysiotomy scheme on 19 October last. The Minister for Health, Deputy Harris, examined the report and submitted it to Government last week prior to its publication on the Department’s website on 22 November. The Minister, Deputy Harris, has asked me to convey his apologies to the Deputies that he cannot be here this evening. The Government agreed in July 2014 to establish an ex gratia scheme for women who underwent the procedure. The surgical symphysiotomy payment scheme was established in November 2014 and Judge Clark was appointed independent assessor. The scheme provided an alternative, non-adversarial option for women, many of whom were elderly and did not wish to pursue their cases through the courts.

The total cost of the scheme was just less than €34 million and payments of €50,000, €100,000 or €150,000 were made to 399 women who met the criteria for an award. All of the women have received their respective payments, totalling €29.85 million. The majority of claimants were aged more than 75 years and payments were made to women between the ages of 51 and 96 years of age.

A total of 185 women who applied to the scheme could not establish that they had a surgical symphysiotomy. Pubiotomy was frequently claimed but was established in only one case. Significant disability was established in this case. As the scheme was designed to be simple, straightforward and non-adversarial, the women were not expected to give oral testimonies as they might do in a court setting.

In the interests of accountability, the scheme required each applicant to prove that she had a surgical symphysiotomy or pubiotomy in order to be considered for the assessment of an award. The level of proof required was clearly set out in the terms of the scheme. Judge Clark worked with each woman or her legal representative to locate medical records. The judge met some women in different parts of the county when she considered necessary. Where claims could not be reconciled with established facts, women were examined by relevant medical experts. Judge Clark encouraged women who believed they had a symphysiotomy to apply to the scheme, advising them that they did not give up their right to pursue their case through the courts by doing so. It was only on accepting an award under the scheme that a woman had to discontinue her legal proceedings. The vast majority of women opted to do so.

The scheme was established following two independent reports which were commissioned by the Department of Health and following consultation with all three support groups by the then Minister for Health. Two of the support groups welcomed the scheme and one support group did not. The first of these reports was commissioned in 2011, when the Department commissioned Professor Oonagh Walsh to undertake independent research into the practice of symphysiotomy. Professor Walsh’s research also included a public consultation. The report recommended that an ex gratia scheme be established. In 2013, retired Judge Yvonne Murphy, now retired, was commissioned by the Government to undertake a further independent review of the legal aspects of symphysiotomy in Ireland. Judge Murphy advised the Government on the merits and costs of proceeding with an ex gratia scheme relative to taking no action and allowing the court process to proceed.

Symphysiotomy was an exceptional and rare intervention in obstetric practice in Ireland. It occurred in fewer than 0.05% of deliveries between 1940 and 1985. It is estimated that around 1,500 symphysiotomy procedures were undertaken in Irish hospitals and that there are around 450 women still living who underwent the procedure. In most of the world, especially in Europe, the symphysiotomy procedure had been replaced mainly with the caesarean section procedure by the 1950s. Currently, the procedure is rarely performed in developed countries, but is still performed in rural areas and resource-poor settings of developing countries where caesarean sections are not available or obstetricians may not be available to deliver subsequent pregnancies. The brief given to Judge Clark in November 2014 was not an easy one. At that time, the advice to the Department of Health was that many women would face an uphill struggle in proving their claims in the courts, with an uncertain outcome, as each case would be adjudicated on its merits. In her substantial report, Judge Clark has provided a comprehensive overview of the historical and medical context of symphysiotomy. Judge Clark had a unique opportunity to do this and her findings support the earlier findings of Professor Walsh.

Payments under this scheme, together with the ongoing provision of medical services by the HSE, including medical cards, represent a comprehensive response to this issue by Government, which should help bring resolution to the women, many of whom are now elderly, and also to their families.

Deputy Clare Daly

I have to say that there has been a certain rewriting of history again. We know that the majority of survivors never accepted this redress scheme to begin with. The Minister of State is dodging the elephant in the room, which is that this report goes one step even further from that. It is riddled with factual inaccuracies, unverifiable anecdotes and is severely damaging. It is well known that people experience trauma and upset as victims of abuse if their stories are not believed. The report is done in a manner which disbelieves the testimony of the women involved. It makes outrageous claims. We know that not one woman anywhere submitted that she had consented to or was aware of that procedure, yet the judge said that she found it very difficult to believe that is the case. There is no evidence to support her view in that situation. This is the same judge who, when awarding payments previously, told the women they were getting the money to redress their "unhappy experience". This was deliberate butchery that was carried out on people for ideological reasons.

What the report shows is a deliberate undermining of the human rights campaigners and groups whose work actually led to the setting up of this scheme to begin with, bad and all as it is. I remind the Minister of State that it took a former Minister to go to court to get the Guerin report withdrawn. We know the McAleese report into the Magdalen laundries was hugely criticised and controversial. The point that is being made here is that this document cannot stand. In and of itself, it abuses the women involved. It has to be withdrawn and considered further by this House.

Deputy Ruth Coppinger

There has been an attempt by the Catholic right to seize on this highly flawed report to argue against the whole question of Catholic control of maternity hospitals. There is no question that this was done and motivated by a Catholic medical theology. It is also argued very patronisingly that these women did not know the difference between a caesarean section, a symphysiotomy or anything else that was happening to them.

I know women were kept in ignorance but I think most women would know if they had their pelvic bones broken.

The scheme relied on written and radiological evidence which was extremely unfair because proving a symphysiotomy happened over 50 years ago is incredibly difficult if medical records do not exist. In that sense, the scheme militated against the older women and some younger women were able to pursue their claims successfully. The fact that there were 185 unsuccessful applications does not mean that 185 symphysiotomies were not carried out. As I said, it was difficult to prove. People were also only given 20 days to apply to the scheme which is highly restrictive in the context of gathering up information.

There is no way that this Dáil could or should stand over this report. A debate must take place in this Chamber to question the rationale of Judge Harding Clark.

Minister of State at the Department of Health (Deputy Marcella Corcoran Kennedy)

Any of us who have had the privilege of delivering healthy children and who have had good childbirth experiences cannot but have sympathy for those women who underwent such a dreadful procedure.

I will provide some information on Judge Harding Clark's methodology in carrying out her role as the assessor to the scheme. The terms of reference informed Judge Harding Clark to draw together a team of medical experts in obstetrics, radiology, orthopaedic surgery, pelvic injury, urology and urogynaecology who advised her throughout the process. Hundreds of hours were spent going through each applicant's medical records. Each applicant received an individual, careful and fair assessment. Medical evidence was sought to explain delivery records and when claims could not be reconciled with facts, the applicant was examined by an orthopaedic surgeon or a gynaecologist. Some applicants were examined by several experts. When all efforts to obtain records failed, the scheme moved to seeking secondary proof of symphysiotomy by scar and radiology evidence. In 12 especially difficult applications, Judge Harding Clark held a discussion conference between her own medical team and the medical experts representing the women and a consensus was reached based on the medical facts in the cases.

It is probably cold comfort to the people represented by Deputies Coppinger and Daly but I would remind them that there were three organisations advancing the cause of women who were scarred by symphysiotomy and the scheme was accepted by two out of those three organisations.

Garda Deployment

Deputy James Lawless

I raise the issue of policing resources in my constituency of Kildare North. While this issue is often aired in this House, I believe my constituency to be more poorly served than others and the census figures bear that out. Kildare North currently has the worst policing figures per head of population in the entire State. This is an historical anomaly that predates the recruitment embargo and other recent difficulties. Currently, Kildare North has one garda for every 751 residents. Based on the 2016 census figures, correcting this would require the hiring of more than 250 additional gardaí immediately but the constituency has only been given an extra 25 gardaí or 10% of what is needed. Kildare does not want to retain the title of the worst policed county in the State.

I wish to draw the Minister of State's attention to some of the difficulties in the county. As well as having the lowest number of gardaí per capita, Kildare also has the second lowest number of Garda stations in the State. This began with the closure of Garda stations in Kill and Ballymore Eustace in 2013 and 2014, along with three stations in west Wicklow which bordered Kildare. The response at the time from the then Minister for Justice and Equality, Alan Shatter, was that mobile garda units would be deployed and Facebook clinics would employed as an alternative method of community policing. The stations closed but there were no increased patrols and no Facebook clinics, but there was an increase in burglaries. Added to that, local residents said that, when they rang their new nearest Garda station, they were often asked for directions because the gardaí were simply not familiar with the area.

At the other end of the constituency, Celbridge Garda station is said to be the busiest of the five stations in the Leixlip Garda division. However, it is only a part-time station that opens for three hours per day during the week and not at all on a Sunday. The integrated services report produced in conjunction with Kildare County Council, a State body which is not prone to exaggeration or hyperbole, shows that there was a 12.5% decrease in Garda numbers nationally in the period 2008 to 2016, but Celbridge Garda station lost 54% of its personnel. The level of staffing was cut by more than half. I received an e-mail recently from a local businessman who has been subject to 13 armed robberies. At this stage, some of his staff are too frightened to come into work. This is somebody who is trying to run a business and make a living in the town.

I will turn my attention now to Maynooth, which is a university town. The Minister of State and all Members of the House will be aware that there was an horrific attack on a young female student in the town just over a week ago. My own daughter is a first year student in the same university and my heart goes out to the family of Ms Kym Owens. I wish her a speedy recovery. It was an horrific attack and, while it could be argued that additional Garda resources may not have prevented such an act of barbarism, the fact remains that Maynooth is a university town whose population doubles from 12,000 to in excess of 24,000 during term time and yet there are no additional Garda resources. In fact, there is not even a full-time Garda station in the town. My party colleague, Councillor Naoise Ó Cearúil, pointed out in the Irish Independent a number of days ago that Maynooth is the only university town in Ireland that does not have a full-time Garda station.

Regarding Carbury in north-west Kildare, last night we saw Mr. Paul Williams do an exposé on TV3 which showed that certain well-known criminal characters are resident in the north-west Kildare area. However, Carbury Garda station has been decimated. The number of Garda stations across north Kildare has been slashed, as has the number of gardaí. Garda resources are at an historical low and are the worst in the country. It is simply not good enough. Direct intervention is required to increase the resources available and address the anomaly. North Kildare has a large urban and rural population. The area is very close to the national motorway network and is being hit repeatedly by opportunist burglars and armed robbers and by horrific acts of sporadic violence like the recent incident in Maynooth. I call on the Minister for Justice and Equality to intervene and address the situation immediately.

Minister of State at the Department of Defence (Deputy Paul Kehoe)

I thank Deputy Lawless for raising this important issue and apologise on behalf of the Tánaiste and Minister for Justice and Equality who cannot be in the Chamber to respond to the Deputy directly.

The Government is committed to ensuring a strong and visible police presence throughout the country to maintain and strengthen community engagement, provide reassurance to citizens and deter crime. To make this a reality for all, the Government has in place a plan to achieve an overall Garda workforce of 21,000 personnel by 2021, comprising 15,000 Garda members, 2,000 reserve members and 4,000 civilians. Funding has been provided for the recruitment of 800 Garda recruits and up to 500 civilians in 2017 to support the wide-ranging reform plan in train in An Garda Síochána, and 300 appointments will also be made to the Garda Reserve.

As the Deputy will appreciate, the Garda Commissioner is responsible for the distribution of resources, including personnel, among the various Garda divisions, and the Tánaiste has no direct role in the matter. The Tánaiste is informed by the Garda Commissioner that, in regard to the deployment of Garda personnel, a distribution model is used which takes into account all relevant factors, including population, crime trends and the policing needs of each individual Garda division, including the Kildare division, with a view to providing an effective and responsive police service. As of 31 October 2016, the latest date for which figures are readily available, there were 307 members of An Garda Síochána assigned to the Kildare division, supported by 22 members of the Garda Reserve and 29 civilian staff. When appropriate, the work of local gardaí is supported by a number of Garda national units such as the national bureau of criminal investigation, the Garda national economic crime bureau and the Garda national drugs and organised crime bureau. Local Garda management in Kildare have also implemented additional policing measures in response to recent incidents in the division, including additional Garda foot patrols, checkpoints and patrols by the regional support unit.

The Tánaiste recently met a group of local public representatives from Kildare and listened carefully to their concerns about crime and policing. She is happy to highlight particular matters of local concern for attention by the Garda authorities.

Taking account of projected retirements, reaching a strength of 15,000 will require 3,200 new Garda members to be recruited on a phased basis over the next four years in addition to the 1,200 that will have been recruited by the end of this year since the reopening of the Garda College in Templemore in September 2014. Since the reopening of the Garda College, 679 recruits have attested as members of An Garda Síochána, of whom 35 have been assigned to the Kildare division.

The Government’s plan for an overall Garda workforce of 21,000 is complemented by substantial investment in resources across the board for An Garda Síochána. The Deputy will be aware of the significant resources that have been made available to An Garda Síochána under the Government’s capital plan 2016-2021. In particular, some €205 million in additional funding for Garda information and communications technology, ICT, and €46 million for new Garda vehicles has been allocated over the lifetime of the plan. This investment will facilitate the provision of more effective policing services and the Tánaiste expects that the Kildare division, like all other Garda divisions, will benefit from these new resources becoming available.

I refer to the incident that took place in Maynooth on 20 November which the Deputy raised. In recent days, gardaí have renewed their appeal for information on the very serious assault of a university student in Maynooth. They are appealing for witnesses and anyone with information, particularly those who were in the vicinity of Maynooth between 7.30 p.m. and 9.15 p.m. on Sunday, 20 November 2016, to contact the incident room in Leixlip Garda station on 01 666 7800, the Garda confidential telephone line, 1800 666 111, or any Garda station. The Tánaiste recognises that this was a very serious incident and asks that if anyone has any information on it-----

An Leas-Cheann Comhairle

The Minister of State will have another two minutes. He has exceeded by a minute.

Deputy Paul Kehoe

-----they would come forward.

Deputy James Lawless

I thank the Minister of State for stepping into the breach. With respect, that answer could have been given to any question about policing in the country. My question is specifically about my constituency, north Kildare, and my county, which is the worst served in the country per capita. It is not just me saying that but also the joint policing committee, Kildare County Council, the integrated service providers and every public representative in both north and south constituencies. In fact, in recent years the ratio has worsened. In 2015, the figure suggested a ratio of one garda for every 697 members of the population of County Kildare. In 2016, despite the Minister of State's suggestion of extra resources being deployed, the ratio was actually worse at 1:751. For every 751 residents of the county, there is one garda. That is the worst ratio in the entire State. In terms of Garda stations, the ratio is a little better.

With regard to the 307 gardaí deployed to County Kildare mentioned by the Minister, the census would suggest we need 513. If we include reservists, community and other types of garda, we are almost 270 short of what we need. We got 25, or 10% of what we need. The Minister of State suggested that this is an operational matter for the Garda Commissioner. Does he consider the Commissioner to be performing satisfactorily when one county has less than 10% of its required additional allocation, a stark difference in ratios, is at the bottom of the league table and has up to 250 fewer gardaí than are actually needed?

The increase that has been given is in line with the population in that it is a 4.7% increase for 4.7% of the country's population. The point we need to drive home, however, is that the imbalance is historical. It goes back decades. Is it that Kildare is in the Pale where the people are considered to be better behaved and therefore did not require the same policing as other counties? Those historical anomalies must be addressed and I ask the Tánaiste to do that as a matter of urgency. We have highlighted a particular horrific incident but there have been numerous incidents. There is the shopkeeper whose staff are afraid to go to work. There is the opportunist crime carried out by burglars coming down the motorways. People are being hit every day of the week. People are afraid, be they students in the university town, business keepers or staff going to work. The Tánaiste has to intervene to address what is a shocking anomaly, the worst in the entire State. I ask the Minister of State to take it on board.

Deputy Paul Kehoe

I thank the Deputy. As I outlined to him, the Garda Commissioner is responsible for the location of Garda deployment where she sees fit. That is done in accordance with population trends and crime figures. I will personally bring the Deputy's concerns to the Tánaiste and Minister for Justice and Equality but I encourage him either to send a copy of his transcript to the Garda Commissioner or write personally to her about his concerns. I understand the Tánaiste will be in contact with the Commissioner and the Garda authorities with a view to raising the Deputy's concerns with them but I encourage him to write to the Garda Commissioner stating that he raised this issue in the Dáil and that the reply he got was that the Commissioner is responsible for deploying gardaí in whatever location she sees most needs the resources.

The Deputy will be aware that, in the most recent CSO figures for the second quarter of 2016, there were decreases in many crime categories, including a 26% reduction in burglaries. I understand the Deputy's concerns about a huge number of people travelling down the motorways to commit crime. That is happening in my constituency in County Wexford. It is not the local gangs but gangs mainly from the greater Dublin area that are carrying out most burglaries and other crimes. I encourage the Deputy to write to the Garda Commissioner and I will bring his concerns directly to the Tánaiste and Minister for Justice and Equality.