The first matter is in the name of Deputy Durkan. He wants to discuss something to which he is deeply committed, namely, the extent to which children's welfare and well-being is protected by Tusla in all situations in family law. The Minister of State, Deputy Peter Burke, will be dealing with this matter.
Saincheisteanna Tráthúla - Topical Issue Debate
Child Protection
The Ceann Comhairle kindly allowed discussion on this and associated subjects over the past six or seven months, eventually to the benefit of victims. Apropos the discussion we have just had, allowing debate when none was available was of huge, groundbreaking importance.
This matter relates to women who are mothers and who find themselves in particularly difficult family law situations. I refer to cases where the children and mothers - sometimes it is the fathers but more often it is the mothers - become the victims. In these cases, children are removed from the custody of their mothers and placed in the custody of the opposing party. That is done on a regular basis. That happens in almost 90% of cases, with the same result and the same procedure is followed. Invariably, the women in these cases appeal to the system to help them. The system in this instance is Tusla, whose responsibility it is to protect children. We were admonished in previous eras for not listening to or believing children. We have situations, as the Ceann Comhairle knows, where children have not been believed. Even Tusla has said it does not believe the children, that this is not its function and that the issues happen to be before the courts and nobody can interfere. That is not true and is unconstitutional if anyone was to take a case. The point is that the unfortunate women who find themselves in the circumstances to which I refer are in no position to take constitutional cases because they do not have the resources.
This will continue as long as it is allowed to do so, just like the previous topic we discussed. I seek an inquiry into the whole system insofar as it relates to Tusla and the family law courts. If this does not happen soon, there will be a tragic end to the situation. Children are in some cases put in cells away from their mothers; the mothers in some cases have been put in cells away from the children just to make sure. In some instances, children have been arrested and put in so-called places of safety, where there were previous allegations to the contrary. This still goes on.
The most annoying thing is the fact Tusla feels it cannot intervene on behalf of children, yet it is Tusla’s job to interfere on their behalf. In one situation, an employee of Tusla said they did not believe the child. That is a serious comment to make in any such situation. Who is going to believe the child? How will the child or children in such circumstances get protection? They cannot, of course, because there are too many oars in the water.
I thank the Minister of State for coming to the House to deal with this matter. I know he is familiar with the situation because I brought it to his attention before in the context of to his constituency. This is an important occasion. It will have a groundbreaking effect and be followed indefinitely.
I thank Deputy Durkan for raising this important issue, which I am taking on behalf of the Minister for Children, Equality, Disability, Integration and Youth. Under the Child Care Act 1991, Tusla, the Child and Family Agency, is the statutory body with responsibility to promote the welfare of children who are not receiving adequate care and protection. The Act is the key piece of legislation whereby the State, as a last resort and for the common good, may intervene to take the place of parents, as provided for under Article 42A.2.1o of the Constitution.
Tusla can apply to the court under the Child Care Act for a number of different orders when it believes that children are at risk or in need of care. These orders give the courts a range of powers including decision-making regarding the type of care necessary and access to the child or children for parents or other relatives. In such cases, the court has the power to direct Tusla regarding the care of the child. Under this Act, the court must regard the best interests of the child as the paramount consideration.
Section 26 of the Child Care Act 1991 provides for the appointment by the courts of a guardian ad litem in respect of childcare proceedings. The courts are, subject only to the Constitution and the law, independent in the exercise of their statutory functions and the conduct of any family law case is a matter for the presiding judge.
The programme for Government contains a commitment to enact legislation relating to the family courts. The Family Courts Bill will be a key element in the development of a more efficient and user-friendly family court system that puts families at the centre of its activities, provides access to specialist supports and encourages the use of alternative dispute resolution in family law proceedings. The Minister for Justice received Government approval in November to publish the Family Courts Bill and the first national family justice strategy, marking a significant step towards reform of the family justice system.
The Department of Children, Equality, Disability, Integration and Youth is represented on the family justice oversight group, which is led by the Department of Justice. It is closely involved in the planned reforms, particularly as they relate to childcare proceedings, and in ensuring that children’s best interests are central to this process.
The Minister, Deputy O'Gorman, as the dedicated Minister with responsibility for children, is committed to upholding the best interests of children in all situations.
Ireland held the presidency of the Council of Europe in 2022. One of the priorities chosen for the Irish Presidency was "Hear our Voices", which had a particular focus on youth engagement. As part of this, the Minister was delighted to host a conference in October 2022 focusing on the rights and determination of the best interests of the child in parental separation and in care proceedings.
Last year the Minister oversaw the enactment of the Child Care (Amendment) Act 2022. The main purpose of the Act is to extend and regulate the guardian ad litem system for children involved in childcare proceedings. The provisions of this Act are intended to enhance the rights of children and the capacity of the courts to make the right decisions in helping children and their families. The Bill provides for reform of guardian ad litem arrangements in childcare proceedings, addressing significant shortcomings in the current system and providing a presumption in favour of appointment of a guardian ad litem in all childcare proceedings. However, private family law is not covered by this legislation.
Legislation related to private family law is under the remit of the Department of Justice. Section 32 of the Guardianship of Infants Act 1964, as inserted by section 63 of the Children and Family Relationships Act 2015, provides that a court may appoint an expert to determine and convey the child’s views, known as a voice of the child report.
I thank the Minister of State and the Ceann Comhairle for facilitating this debate. The problem is, of course, that the two Departments act independently. As long as this happens, this abuse, controlling and bullying will go on, as will this attempt to disregard children. I know of one case where someone said they had come to the conclusion they did not believe what the child said. That is a strong statement, particularly after all the things that have happened in this country. I challenge the right of anybody to come to this conclusion.
We have all dealt with these family law cases at our various constituency clinics over the years. It does not take rocket science to come to a conclusion about what is going on in certain circumstances. As the matter drifts along, my intention is to bring it to the next stage, whatever that stage may be, if it is not dealt with in the way it should be dealt with, which is resolutely and quickly, to protect the women and their children. There should be no situation where the things that have been brought to my attention are allowed to happen unchallenged.
I thank Deputy Durkan for raising this important issue. I know he has raised it on a number of occasions. I will revert to the Minister with responsibility for children with his concerns because these are very serious issues he is bringing to public attention in the Dáil, which is the highest forum in the country to do so. I will refer back to the Minister on it.
I suspect Deputy Durkan is not going away as far as this matter is concerned.
I thank the Ceann Comhairle.
Schools Building Projects
I want to speak about Gaelscoil Choláiste Mhuire, Parnell Square in Dublin 1. Some of the stories and the image given of the square paint a pretty negative picture of the building itself, but contained in it are incredible teachers and wonderful students who for decades have been failed by the infrastructure and not by the intention of those who teach and provide care within it. Gaelscoil Choláiste Mhuire has been housed in unsuitable emergency accommodation for 20 years. This is despite a suitable location being available since 2010. After waiting for what seemed like an eternity, it received news that contracts were ready for a new building on Dominick Street only for their hopes to be dashed by the Government's decision to hold the development of 58 schools.
Construction of Gaelscoil Choláiste Mhuire is still ready to commence in April. It is a project that would greatly benefit the regeneration of Dublin's north inner city and provide wider benefit for the surrounding community. This is a school that is located just off O'Connell Street. It would have ramifications for the entire city. Mindlessly delaying the project would result in children continuing to inhabit a building on Parnell Square that is nothing short of dangerous. This is the testimony of the students themselves and their parents. It is dilapidated and falling apart. It poses a serious risk to its young students. No child should have to risk harm to attend school. This is where we are with this school. I have spoken to parents who attended the school 20 years ago. They said it was unsuitable for habitation then, let alone now. Even if its occupants are fortunate enough to avoid getting hurt, they still face unsuitable conditions for an adequate education. The classrooms are cramped, with crumbling plasterwork. There is no universal access. The staircase poses risks to students and teachers, there is no assembly hall and the playground is a car park. It is quite a dystopian image I am presenting and I want to say it is not reflective of the teachers, the principal and all the great things that happen in the school.
All the while, public money is being misspent on exorbitant rents for subpar buildings. If these delays are being credited to a lack of funds, the Government should stop needlessly spending money on short-term solutions when long-term investment would pay greater dividends. When used by the Government, the word "commitment" seems to have truly lost its meaning. For this reason I ask that, in his response, the Minister of State avoids using it because the word stings for parents, teachers, the principal and the children in Gaelscoil Choláiste Mhuire who have heard about this commitment for 20 years. They need action. They have no reason to believe the Government is committed to redeveloping the school when, for more than 20 years, it simply has not, despite a location being available and we have a shovel-ready project ready to begin in April. They were convinced it was going to begin in April. They were told this but now it is not happening. They worry for their children's safety when they go to school each day. These empty promises remind them of the hopelessness they have faced for the past 20 years. I would love if the Minister of State and the Government were to take immediate action and make sure construction of Gaelscoil Choláiste Mhuire's new building on Dominick Street begins without delay.
I thank Deputy Gannon for raising this very important matter for his community. It provides me with an opportunity to outline on behalf of the Minister for Education, who is unable to attend this evening, the current position on the major building project for Gaelscoil Choláiste Mhuire on Parnell Square. The project is included in the Department of Education's construction programme, which will be delivered under the national development plan as part of the 2040 framework. The Department of Education's planning and building unit is assessing its work programme and priorities for 2023 in the context of overall requirements and available funding. The most immediate priorities are to cater for September 2023 requirements. I reassure Deputy Gannon and the Gaelscoil Choláiste Mhuire community that the school building projects on hold due to capital funding pressures will be progressed and delivered. It is a question of timing. We understand the urgency with this matter and other projects, and our aim is to get them progressed and delivered as quickly as possible. The Department will provide an update to the school authorities when there is further clarity on the progression of this significant project.
I thank the Minister of State for stepping in to give the response. I appreciate this is not his Department. I am also conscious that should an answer such as this be given about a school in his area, he would not be satisfied. None of us would be. I appreciate there are capital construction costs and increasing construction costs due to a number of factors, not least the war in Ukraine. However, this school is crumbling at the seams. Everyone comes here and speaks about the needs in their constituencies, and that is fair enough and par for the course in Parliament. This school is literally crumbling. The staircase is dangerous. The cornice is coming down from the ceiling.
This is a Gaelscoil in an area that has tried to prioritise the language. It was not suitable for purpose 20 years ago. Ten years ago it was a danger to the students who were there. Today we are at the point where it is a risk even to open the doors in the school. I would not raise this as a Topical Issue lightly. I am sure there are other schools in my area that will also be among the 58 delayed schools. This school is an emergency and it has to be treated as such. It is simply not acceptable that students would be asked to be educated in an environment where they are warned to be cautious before they walk up the stairs. The health and safety awareness classes in the school factor in that the school itself is dangerous. Students in very few other schools have to deal with this. This does not have anything to do with the wider environment or social issue. The school is lovely in every single way. Family members of mine have been there. It is just that the building itself is a danger. I would argue, and the Minister of State may say I would do so, that this school, more than any other school, requires urgent action.
Urgency and immediacy are required from the State. It must step in because this is grossly unfair to students and with regard to the advancement of the language and the dignity of the children, staff, parents and guardians who have to risk sending their kids to the school so they can learn the language. We need urgency. I thank the Minister of State for coming to the Chamber.
I thank Deputy Gannon for his remarks. I fully accept and appreciate the urgency of dealing with the conditions his community is facing in regard to this very important project. I will relay his dissatisfaction to the Minister for Education. I understand it is very important to get these projects progressed. One special school and one secondary school in the bundle are in my constituency. These schools are awaiting news and I hope they get it in the coming days. We will all press this issue. We discussed progressing these projects last night. They are so critical, especially to the special schools that are caught up in this. We will work in the next few days and hopefully get a good result on it.
Health Services
The Multiple Sclerosis Society of Ireland, or MS Ireland as it is more commonly known, has set out a clear business case for the employment of nine physiotherapists, one in each of the HSE community healthcare organisation, CHO, areas. It has done so as a result of research and work done in the CHO 2 area where a physiotherapist is working. It is clear that the employment of a physiotherapist in that area has hugely helped all the people who have multiple sclerosis. We must remember that more than 9,000 people have MS in this country. This is about saving money, not costing money. If the scheme is introduced and one designated physiotherapist is appointed in each of the CHO areas, it will save approximately €19 million per annum.
Under the programme, approximately 1,400 people would participate in treatment in group physiotherapy programmes and another 3,700 people would have individual appointments each year. This would assist people with MS by providing them with a better level of care. A person who has MS has a higher tendency to fall and suffer injury. The cost of providing hip replacements for four people is the same as the cost of one physiotherapist. MS Ireland has clear evidence that its proposal would reduce the number of falls by up to 50%. It would also help people to be more proactive as regards their own care. Making sure people have the support they require would also help their mental health.
MS Ireland has produced a clear business plan for this measure. The total cost of employing nine people would be approximately €880,000. The current programme in the CHO 2 area is funded by MS Ireland. It believes its proposal could deliver a huge saving for the health service and assist up to 9,000 people across the country. I ask that the Department and HSE give serious consideration to the proposal. MS Ireland presented a very detailed business case. That now needs to be given consideration and the funding provided at an early date.
I thank Deputy Colm Burke for raising this issue. I apologise again on behalf of the Minister for Health.
The Sláintecare integration fund formed part of the Sláintecare Action Plan 2019, which established the building blocks for a significant shift in the way in which health services are delivered in Ireland. Budget 2019 provided €20 million for the establishment of a ring-fenced Sláintecare integration fund to support service delivery with a focus on prevention, community care and integration of care across all health and social care settings.
Round one of the Sláintecare integration fund supported 123 HSE and NGO sector projects to test and evaluate innovative models of care, providing a proof of concept with a view to mainstreaming and scaling successful projects through the annual budget Estimates process. The selection criteria for funding were to encourage innovations in the shift of care to the community or provide hospital avoidance measures, scale and share examples of best practice and processes for chronic disease management and care of older people and promote the engagement and empowerment of citizens in the care of their own health. Successful Sláintecare integration fund projects were mainstreamed via the national service plans in 2021 and 2022 at an estimated cost of €24 million.
The MS Ireland Active Neuro project was mainstreamed with ring-fenced funding allocated in budget 2022 to the HSE to continue the project in 2022, and this has continued in 2023. I note MS Ireland is advocating for expansion of the service, with a specific ask for a physiotherapist to be employed in every CHO. Ultimately, any consideration of whether and how best to expand this service within the HSE would be a matter for the HSE to consider and make a business case to the Department of Health as part of the annual Estimates process in advance of the budget later in the year.
I fully agree with the Minister of State in this regard. In fairness, the project in the CHO 2 area is working very effectively. It clearly sets out that progress is being made. Let us look at the figures. The 9,000 people who suffer with MS will account for 54,000 GP visits, approximately 16,450 nights in hospital and approximately 1,544 emergency department attendances per annum. Their challenge is not only that they have to suffer, but their families who are providing support have to be catered for as well. This is a clear, positive proposal for reducing the number of people attending accident and emergency departments and GPs and the number of nights they have to spend in hospital. Every night someone spends in hospital means a bed is not available for someone else.
MS Ireland has set out a clear business case, which it has researched very well. It is working on what has occurred in the area in which it has a physiotherapist working. In one of the other areas, which I believe is CHO 3, a physiotherapist is working three quarters of a week. Assistance is being provided in that area and it is proving to be extremely beneficial to MS sufferers. MS Ireland has pioneered, progressed and developed this proposal and is pushing for it. It has set out a clear plan involving one physiotherapist in each of the nine CHO areas. This would have benefits across the country for people who have MS. As the Minister of State knows, once MS is diagnosed, there is no healthcare plan that can resolve the issue. People will require continuing care and support. Now is the time to put in place this plan.
I thank Deputy Burke for his contribution and for raising awareness on behalf MS sufferers. He outlined the key metrics for GP attendances, emergency department attendances, hospital overnight stays and the number of people who suffer from MS. It should be a priority of the Government to support them in any way we can.
As I said, this business case can be considered as part of the Estimates process. I will raise the important metrics the Deputy mentioned with the Minister for Health and ask him to revert directly to the Deputy regarding this case. There is huge value in what the Deputy said. He has made an important contribution.
Healthcare Policy
This is not the first time I have raised this issue. In fact, I have been raising it for more than two years now, during which time many people have had to suffer unnecessary and avoidable difficulties in pregnancies because of hyperemesis gravidarum.
It is not just difficulties, which is such a light word to use when it comes to what hyperemesis can do to people who are pregnant. I have spoken to pregnant women who have said that it leaves them vomiting hundreds of times a day. They vomit so much and so hard that they burst blood vessels in their eyes. They rip their oesophagi. Some of them suffer and have to terminate much-wanted pregnancies because they do not believe they can go through the whole pregnancy without support. Some also consider and contemplate suicide. It is an incredibly difficult condition to have to go through. There is relief. Relief can be found in medications such as Cariban. I recognise that inroads have been made on the side of the Government and that Cariban was made available under the drugs payment scheme in the new year. This was very much welcomed at the time but the system that has been put in place by the HSE means, essentially, that it is impossible for the majority of women to access this drug through the scheme. Rather than just getting it from their GP, which is what would happen if they were paying directly and privately, they must have a consultant sign off on the first prescription. For the majority of women they will not see the consultant for the first 14 or 15 weeks of pregnancy, by which time if they are suffering from hyperemesis, they are in dire straits.
When I raised this previously with the Minister for Health, he told me a number of things, one being that because this is an unlicensed medication the HSE cannot include it under the drugs payment scheme to be prescribed in the first instance by a GP. I have spoken to GPs, and there are many, many drugs that are unlicensed but have been given a drug code, which makes them notified medications. A GP can, therefore, prescribe them. There are a number of them, including the antibiotic Chloramphenicol, Scopoderm and a melatonin medication for children called KidNaps. These are all unlicensed products but they can be prescribed by a GP. We ask that the HSE applies the same conditions as those other notified medications, and assists women to get this medication when it is needed.
The Minister also said that the HSE was going to review the policy and the process. That was two months ago. Will the Minister of State please bring some sense of urgency to this? On a daily basis women are suffering badly with this condition. It is completely unnecessary. Will the Minister of State give the House an update on that review? If it is not finalised, when does he anticipate it will be? It is important that this be communicated. I have asked that the Minister meet with Hyperemesis Ireland, which he said he would do once the review was conducted. I ask that he would at least reply to their emails. I know that they have been in contact with him.
I really hope that the Minister of State has a good news update for me today, that he will be able to tell me the HSE has conducted the review and this medication for hyperemesis sufferers will be made available from GPs and under the drugs payment scheme as soon as possible.
I thank the Deputy for raising this very important issue. Again, I must give apologies for the Minister for Health, who obviously would be more aware of this topic and the review at the moment.
Hyperemesis gravidarum is a severe form of nausea and vomiting during pregnancy, which the Deputy articulated very well. It affects approximately 1% of the pregnant population and must be diagnosed and treated appropriately. The Government is keen to ensure that anyone encountering this condition receives the support they need.
As part of budget 2023, the Minister announced €32.2 million in funding for women’s health in 2023. This included general dedicated funding for Cariban, a medicine used to treat hyperemesis gravidarum. As of January 2023, this medicine is now available to those women who need it. Unfortunately, reaching this point has not been straightforward. Under the Health (Pricing and Supply of Medical Goods) Act 2013, only medicines that are licensed and have marketing authorisation from the European Medicines Agency or the Health Products Regulatory Authority can be added to the HSE’s formal reimbursement list. Cariban is not licensed and, therefore, cannot be added to the reimbursement list. It is instead classed as an exempt medicinal product.
Three medicines containing doxylamine pyridoxine are licensed in Ireland: Xonvea, Exeltis and Navalem. The respective market authorisation holders of these three products have not, however, progressed with a pricing and reimbursement application to the HSE under the 2013 Act. The HSE, therefore, encourages clinicians, along with the Institute of Obstetricians and Gynaecologists, the national clinical programme for obstetrics and gynaecology and other healthcare professionals to encourage the market authorisation holders of these licensed medicinal products to progress with the formal pricing and reimbursement process in Ireland.
Following the recommendations of the HSE medicines management programme, reimbursement support for Cariban to women suffering with hyperemesis gravidarum was made available from 1 January 2023 under an exceptional arrangement. The exceptional arrangement requires that treatment be consultant initiated, which is a long-standing governance practice in respect of exempt medicinal products. However, women would only need to see a consultant in order to be initiated on the product, and thereafter it can be prescribed by their GP. This exceptional arrangement has been put in place to ensure that women suffering from hyperemesis gravidarum have access to Cariban.
As of 27 March 2023, 847 applications for Cariban had been received and 825 women had been approved for the product. As the Minister recognises that women suffering from hyperemesis gravidarum may need access to Cariban before their first scheduled consultation with their specialist obstetrician, and in light of the fact that GPs prescribe it for private patients without an initial prescription from a specialist, the Minister has asked that the HSE review the current arrangement and report back to him.
I will raise the Deputy's issue about the timing of the review. She said that she had raised it with the Minster prior to this. I will ask him to also revert to her urgently with an update on the review. I do not have that information to hand.
I thank the Minister of State. I understand that this is not within his remit but it has taken the Minister two months to come up with a response that he gave me two months ago. It is an absolute disgrace.
I would also like to point out that I cannot recall the last time the Minister for Health came into this Chamber to respond to a Topical Issues matter and gave the Members raising these issues respect. It is not only for us as Deputies, but for all the women who are suffering from this. It is absolutely disgraceful that the Minister did not even provide an update on the review. It just goes to show the contempt that he shows to all of the women who are suffering. With all due respect, the Minister of State has been put into a very difficult position here. The Minister should have given him a considered and proper reply. We come across women who are considering suicide and terminations because of this condition. This is a BS response, if the Chair will excuse the language.
The Minister talks about an exceptional arrangement that has been put in place to ensure that women suffering from hyperemesis have access to the medication. The only exceptional thing about this system is that it is exceptionally bad. Women cannot access the drug under the drugs payment scheme unless they see their consultants, and that is an impossibility in the current medical system. It takes 16 weeks to see the consultant. It is okay for women who can afford to pay for it, but this is not acceptable. It is a very poor policy that has been put in place.
The Minister of State referred to exempt medicinal products and the need to see a consultant but that is not true. There are many other drugs, some of which I read out. There are dozens of exempt medicinal products that a person can get from their GP where the person does not need to see a consultant first. I ask that the Minister would put some time and effort into talking through those potential solutions. This is what women need. They need him to put solutions in place that will work for them and not something where he can just issue a big press release at Christmas time saying that he is giving this drug free to all of these women, and then putting these barriers up so that they cannot actually access it.
The Deputy is being supported here by Deputy Martin Kenny.
But I cannot come in.
We cannot let everybody in as it may set a dangerous precedent.
I will refer back to the Minister for Health on the issues Deputy Whitmore has raised quite rightly.
I hear the Deputy's frustration in regard to this issue. She has articulated the points. I outlined the significant funding for women's health, which the Government takes as a significant priority in regard to the programme for Government. However, I will raise this with the Minister, Deputy Donnelly, in terms of the review and where it is at. I will ask him to revert back to Deputy Whitmore urgently because I understand the issue. As a father, I absolutely hear how important this issue is for women.