I welcome the Minister of State at the Department of the Environment, Climate and Communications, Deputy Hildegarde Naughton, to the Seanad Chamber. The first Commencement matter is Senator Rónán Mullen's.
Nithe i dtosach suíonna - Commencement Matters
Abortion Services
Go raibh míle maith agat agus cuirim fáilte roimh an Aire Stáit. I welcome the Minister of State although it has to be said that the issue I am raising today has nothing to do with international road transport and logistics or with postal policy and Eircodes. That is not to take from the Minister of State's very fine contribution as a politician and as a Minister of State. However, I requested that we postpone this until such time as there was a Minister from the actual Department dealing with the matter available but yet again the Seanad is not being treated with the respect that it deserves by the Government. I mean no disrespect to the Minister of State or to her commitment or indeed interest in the issue I am raising.
The concern I am raising today is about the remote consultation or so-called telemedicine abortion and specifically the suggestion that it will soon become permanent. It was reported in The Irish Times in an article of 12 November that the Government intends to make remote consultation and at home abortion a permanent fixture of Irish abortion policy. We have been living with this policy since April 2020 when it was first introduced as a response of the outbreak of Covid-19. However, the suggestion that telemedicine should now become a permanent feature of Irish abortion law is very serious. This is a radical change to the operation of the law, particularly in contrast to how it was envisioned when the Bill was drafted. When the Health (Regulation of Termination of Pregnancy) Act 2018 was being drafted, the then Minister for Health, Deputy Simon Harris, assured members of the health committee that under the law, women would be seen physically for consultations and that absolutely termination of pregnancy services in Ireland would not be done by telemedicine. That was stated at a meeting of the health committee on 6 November 2018.
In a letter from March 2021, the Secretary General of the Department of Health confirmed that once the pandemic ended, temporary telemedicine provisions in relation to abortion would lapse. Unfortunately, when most Covid regulations were lifted at the start of this year, the policy of remote consultations continued. This was despite the absence of an independent investigation or study into the operation of telemedicine abortion in this country. Indeed, the HSE acknowledged that it is wholly reliant on secondary literature from Britain.
If the Government intends to make this radical change to Ireland's abortion law, surely it should be done in a transparent and open way by bringing forth amending legislation to the current abortion Act to explicitly provide for terminations by remote consultation. At least then there would be an opportunity for parliamentarians to scrutinise proposals, highlighting some of the issues that have already been raised in this Chamber by Senator Sharon Keogan and me. There are many concerns about safeguarding and physical risk to women's health associated with telemedicine abortion.
The HSE acknowledged in a letter of 3 March 2022 that meeting the woman in person increases the likelihood of the provider being able to identify any coercion or domestic abuse. With remote consultations it is more likely that the most vulnerable women will fall through the cracks. Removing in-built safeguards like a physical consultation and the privacy afforded by a GP surgery is sheer recklessness. As was reported in the Irish Examiner on 24 October, a teenage Irish girl was locked in a room and given abortion tablets in order to force a termination. That is not an isolated incident. A recent Savanta ComRes poll in the UK found that 15% of women aged between 18 and 44 said they experienced pressure to go through with an abortion that they did not want. Telemedicine enables coercive abortion and makes it more difficult to help the women who desperately need help.
The Government's first priority should be protecting women in abusive relationships and the victims of human trafficking. In the light of these developments, one would have to wonder about that and about the Government's priorities.
I thank Senator Mullen. I am taking this matter on behalf of the Minister for Health, Deputy Stephen Donnelly. He welcomes this opportunity to update the House on this important matter. I would like to thank Senator Mullen for raising the issue. The model of care for the termination of pregnancy service became operational in January 2019 following the enactment and commencement of the Health (Regulation of Termination of Pregnancy) Act 2018.
Termination up to nine weeks' gestation is carried out in the community by GPs or doctors working in family planning and women's health clinics, providing clinical supervision and supporting women's self-management. Women with a pregnancy between nine and 12 weeks' gestation are referred for hospital-based care. The arrival of Covid-19 in 2020 required a substantial shift in how care was provided across the health service, including the adoption of measures to facilitate social distancing and reduce personal contacts and footfall in medical facilities as appropriate. As part of the Government's ongoing efforts to protect public health and limit the spread of Covid-19, the Department of Health and the HSE worked together in 2020 to agree a revised model of care which put in place arrangements to allow termination-of-pregnancy services in early pregnancy to be provided remotely. For the duration of the Covid-19 public health emergency the need for social distancing, reducing personal contacts and reducing the burden on medical practitioners were paramount. It became possible for a woman to access a termination under section 12 of the Health (Regulation of the Termination of Pregnancy) Act 2018 before 12 weeks from her medical practitioner by telephone or via conference consultation. Engagement is ongoing between the Department of Health and the HSE to monitor service provision, to facilitate the smooth running of the termination-of-pregnancy service and to resolve any issues that may arise. However, as restrictions began to ease, it became timely to revisit the model of care, to review its operation and to consider whether remote consultation, as part of a blended approach to termination-of-pregnancy care, should be continued after the Covid-19 public health emergency period. At the request of the Department, the HSE conducted a review of the revised model of care of termination of pregnancy, taking into consideration the experiences of healthcare providers, service-users and international best practice. The review found that the majority of providers in primary care feel that a blend of remote and in-person care is optimal. In-person consultations allow provision of personalised care and allow potential problems to be identified and mitigated, while remote provision improves access for many women and addresses geographical and logistical barriers. It also alleviates some of the difficulties associated with the mandatory three-day waiting period. The review also found that the provision of a remote consultation as part of the termination-of-pregnancy services was safe, effective and acceptable to both service-users and providers.
I thank the Minister of State for her reply. What is going on is that the Government is driven by the advice promoted by campaigning groups that prioritise ease of access over various threats to women's health and well-being. I mentioned the issue of safeguarding, but the physical risks to women's health associated with telemedicine abortion should be also addressed. If no physical consultation takes place and a women self-reports the gestational age of her pregnancy incorrectly and the stage of pregnancy is underestimated, having an at-home, do-it-yourself abortion, with the pills supplied via telemedicine could lead to disastrous health consequences. Ectopic pregnancies could go unidentified. If a medical self-abortion is attempted on that, the potential for a ruptured ectopic pregnancy is heightened and that could lead to severe health risks. I wonder whether the Government cares about any of that or is simply interested in listening to what abortion activist groups want.
I thank the Senator. The Government is committed to providing timely access to a high-quality safe termination-of-pregnancy service as close to home or the community as possible. With this in mind, the Department continues to engage with the HSE on the most appropriate model of care for termination-of-pregnancy services and the findings of this review forms part of that deliberative process.
Health Services Staff
I welcome the Minister of State to the House.
It is often the case that the nature of a person's job changes over time and a re-evaluation process may be required to ensure fair remuneration and conditions for staff. Such an evaluation has been carried out in the health sector recently. However, while most workers received a recommendation of higher grades, it appears that some categories of employee were completely ignored. Those not recommended for any upgrade include cleaners, laundry workers, domestics, groundsmen and gardeners. Naturally, these staff feel they have been ignored by the process and are asking why. The evaluation was a joint exercise between the union and the employer using a pre-established formula from early phases. A report, including costs, was recently submitted to the Department of Health for review.
It is now with the Department of Public Expenditure and Reform awaiting sanction. None of the recommendations has been implemented to date as we await a response from the Department. As I outlined, the evaluation of support-staff grades was conducted and housekeeping-domestic staff were the only department not to move up a band. These staff are deeply disappointed by this decision. They feel undervalued and taken for granted and can see no logical explanation for this decision. They are disillusioned with the union, the communications process and the way the evaluation was completed and are now considering industrial action. They feel the whole job-evaluation process was flawed and ask the HSE to take immediate action to rectify the situation.
Hospitals cannot be run without housekeeping and domestic staff. They are vital members of the hospital team. They are a vital cog in the wheel who do difficult and demanding work. They worked through the pandemic in difficult circumstances and they are essential staff that simply cannot be done without. It would be deeply disappointing and disruptive to the hospital system if they felt the need to strike. I ask the Minister intervene on behalf of the hardworking and dedicated people affected by this.
I thank the Senator. I am taking this question on behalf of the Minister for Health. It is important to acknowledge the crucial work housekeeping staff carry out in our health service every day.
The job evaluation scheme is an assessment of the responsibilities and tasks undertaken by support staff across the health service. Under the provisions of the Lansdowne Road agreement, it was agreed that this job evaluation process would be conducted in four phases. Phase one commenced in 2017 and examined personnel employed in central sterile services departments, CSSD; endoscopy and laboratory aides and assistants; and the broader laboratory family and theatre group. Phase 2 comprised healthcare assistants and multi-task attendants. Phase 3 looked at home help and home care workers. The scheme is now in its fourth phase and is evaluating the work undertaken by household attendants, catering staff and porters, together with any remaining grades provided for under the existing scheme that were not evaluated in phases 1, 2 or 3.
The methodology for evaluating the roles during the different phases involved an examination of a cross-section of staff by role type in a number of agreed locations covering healthcare services in acute hospitals, care of the elderly facilities, mental health facilities, community and other relevant services. At the beginning of the job-evaluation process, the national monitoring group was established, comprising senior HSE and SIPTU officials. During phase 4 the national monitoring group held regular meetings to discuss and review progress. Both sides worked to identify employees in these roles who would be willing to participate in the review process. The phase 4 evaluation team consisted of four evaluators. The methodology for the evaluation process was agreed by the national monitoring group. Job holders completed questionnaires that were analysed by evaluators. Site visits took place and in-depth interviews were held. The evaluators' job was to determine the nature of the role; the skills and competencies required to undertake the role; the size and scope of the role; and the range of tasks, responsibilities and demands placed upon a suitably-qualified employee performing it. Upon completion of each job-specific interview, the evaluation team scored the job. This score determined the grade band the role should fall into. The job evaluation scheme was established to assess the work undertaken by staff and, subsequently, to determine whether any changes in their bands of pay were necessary based of the specific set of determiners. Depending on the number of points received, a particular grade may be recommended to move from one band to another. However, equally and without prejudice, the number of points received may also determine that a particular grade should remain on the same pay going forward. All recommendations made were evidence based and determined without prejudice. The phase 4 report is under consideration by the Department of Health and the Department of Public Expenditure and Reform.
I thank the Minister of State for her response.
I said at the outset that these people - domestics, porters and other staff affected by this - are deeply disappointed that they have been overlooked. It is fair to say that many of these people are not on the highest grades to begin with.
Many of them will be struggling financially, like many other people, to make ends meet. From a simple base, I find it difficult to understand how such an important cog in a wheel and such an important member of the hospital team has been left out. We can talk about methodology and all the rest until the cows come home but these people have been left behind. They put their shoulders to the wheel, as many other health professionals did, during the pandemic. Now, it would appear that through this process they are being forgotten. It is deeply unfair. I ask that the Government, the Minister for Health and others look at this again so that these people will be included, as they are entitled to be.
I thank the Senator. The Government acknowledges that current inflationary pressures present challenges and are a source of concern for public service workers. In acknowledgement of inflationary pressures and the rising cost of living, a review of the existing public service agreement, Building Momentum, was conducted this summer. This led to parties agreeing to an extension of the terms of Building Momentum by 12 months to 31 December 2023. As such, along with the pay increases due under the original agreement, public servants will also receive a further increase in basic salaries of 3% backdated to 2 February 2022, an increase of 2% from 1 March 2023 and an increase of 1.5% or €750, whichever is higher, on 1 October 2023. These additional pay increases due under the extension to Building Momentum were cost-of-living measures to help public servants over the next number of years. The Government is keen that all pay rises due are paid to public and civil servants as soon as possible.
Regarding the job evaluation scheme, there was no guarantee from the beginning that all grades evaluated would receive an uplift. The recommendations under phase 4 of the scheme were made without prejudice based on a specific set of criteria and scoring methodology. It is important to remind the Senator that no sanction has yet been received on the findings of phase 4 of the job evaluation scheme and therefore no recommendations have been implemented. As this is an ongoing process, it would be inappropriate to advise further at this point.
Citizens' Assembly
I welcome the Minister of State, Deputy Naughton, to the House on this important issue. We all know that families the length and breadth of the country have been impacted by the drugs crisis. This crisis is impacting on counties, cities, towns, parishes, villages, streets and street corners and young, middle-aged and even older people. It is an epidemic, which Governments throughout the world are struggling to come to terms with. It is important to acknowledge the work of Europol in recent days and the astronomical success it had seizing so much cocaine. Unfortunately, that is on the tip of the iceberg; drugs are all over Europe and the world. This country is no different.
Traditionally, people who were caught with illegal substances were dealt with through the justice system. Slowly but surely, we are seeing a health-led approach, rightly so. When I was member of the Joint Oireachtas Committee on Justice I visited Portugal to see how the Portuguese were dealing with people who had an addiction to drugs and also those caught with drugs on a first offence. They adopted a health-led approach. They put a suite of services around these people, such as addiction counselling, health services and various supports. It was remarkably successful in helping to encourage people off drugs. The system that pertained in this country was a legalistic approach whereby people who were caught with drugs received a conviction. Convictions did not become spent and this could become an issue for anyone trying to go to America or other countries a few years later.
I am glad to say the mindset in this country is moving towards taking a health-led approach. That is largely due to the work the justice committee did under the leadership of its former Chair, Deputy Stanton. The report the committee commissioned was ground-breaking and challenged the system at the time. It was supported by a suite of NGOs that believed the same thing. The problem is the prevalence of drugs in our society and how to deal with it in a more fundamental way. I welcome the proposal to set up a citizens' assembly to engage with citizens from all backgrounds and none on how to frame future policy on drugs. This will probably be the most important citizens' assembly done during the lifetime of this Government. I struggle to understand why there were citizens' assemblies on biodiversity and having an elected mayor of Dublin ahead of a citizens' assembly on drugs.
Drugs destroy lives; the Lord Mayor of Dublin does not. While biodiversity is an important issue, the more immediate issue is how to help save our communities from the ravages of drugs.
When can we expect the citizens' assembly on drugs to be established? What will its terms of reference be? It cannot be pigeonholed into the single issue of whether we should legalise cannabis or take other specific approaches. The cannabis lobby is strong and we all have engaged and listened to arguments about medicinal cannabis. That is a separate debate. I want the terms of reference of the citizens' assembly on drugs to be broad and to allow scope to drill down and look at best international practice and how we can bring those good practices in other countries into play in Ireland. I worry that the terms of reference could be too focused and narrow. While they are important, what is most important at this stage is that we get a date for when the citizens' assembly will be established and we will be able to study the terms of reference. Perhaps we could have a debate in the Houses on the terms of reference when they are made available.
I thank the Senator. I am taking this Commencement matter on behalf of the Minister for Health, Deputy Stephen Donnelly. I welcome the opportunity to update the House regarding this topic. Senators will be aware that the Department of Health co-ordinates the implementation of the national drugs strategy, Reducing Harm, Supporting Recovery, which is a health-led response to drugs and alcohol use. We have identified six strategic priorities for the remaining period up to 2025. These priorities reinforce the health-led approach to drug and alcohol use and capture the commitments in the programme for Government. Strategic implementation groups have identified actions to implement the priorities under auspices of the national oversight committee. The groups reflect the partnership approach and give a stronger voice to civil society in implementation of the strategy.
As Senators are aware, the programme for Government includes a commitment to convene a citizens' assembly to consider matters relating to drug use. The Government is committed to establishing the citizens' assembly on drug use, along with a citizens' assembly on the future of education, at the earliest opportunity in 2023 following the completion of the assemblies currently under way. The timelines and terms of reference for the next assemblies will be a matter for the Oireachtas to agree. It is anticipated that the Government will consider the matter early in the new ear, following which motions will be put before Dáil Éireann and Seanad Éireann for debate, setting out timelines and terms of reference for the new assemblies.
The Department of Health has commenced preparations for the citizens' assembly on drug use and discussions regarding the assembly have taken place at the national oversight committee for the national drug strategy. The Minister of State, Deputy Feighan, is positive about the potential contribution of the citizens' assembly to the Government's health-led response to drug use. Drug use affects all members of society, as the Senator said, whether directly or indirectly, and imposes a significant financial and social cost. Involving citizens in decision-making on drugs policy is therefore appropriate.
There are two issues in particular that the citizens' assembly on drug use could consider. The first is how to better meet the diverse health needs of people who use drugs, while the second is how to prevent the harmful impact of drugs on children, families and communities. It is important to have an international component to the citizens' assembly so there is an exchange of good practice from the British-Irish Council work sector on drugs and the EU drugs strategy and action plan, especially on alternative approaches to coercive sanctions. The voices and perspectives of young people on issues regarding drug policy should also inform the deliberation of the citizens' assembly on drug use. Officials from the Department of Health are engaging with the Department of Children, Equality, Disability, Integration and Youth to undertake a consultation with young people.
I thank the Minister of State for giving a specific timeline. I take it the citizens' assembly on drugs will be up and running by the end of quarter 1 2023, which is welcome.
I also welcome the suggested potential discussion points that will be in the terms of reference regarding the health implications of drugs on our citizens, and indeed, the implications of drugs on young people and children. They are certainly areas which should be examined by the citizens' assembly on drugs which is now anticipated to take place early in the new year. That is very welcome. I also encourage people with an interest who are watching in today to contact the Minister of Health and write to him with their views, ideas, and suggestions as to what the citizens' assembly should do because this will be a once in a generation opportunity for the people of Ireland to frame drugs policy going forward. That is something that is very welcome and I encourage all stakeholders and citizens to engage ahead of the drafting of the terms of reference. I look forward to debating the timelines, and indeed the terms of reference, in this House when they are published and when the motions are brought before us by Government. Again, I thank the Minister for providing a very specific timeline which is welcome because I know this issue is coming up in Dáil Éireann later on today - or certainly this week. I think we are in a position today in the Seanad to announce that this citizens' assembly will take place early in the new year.
I thank the Senator and assure him of the Government’s commitment and determination to implement the health-led approach to drug use as set out in the national drug strategy. Not only does the programme for Government commit to the citizens' assembly on drug use but it also commits to implementing the health diversion programme for people who are in possession of drugs for personal use. This programme will connect participants with health services, provide a pathway to recovery and allow participants to avoid a criminal conviction. An implementation group chaired by the Department of Health is finalising plans for the commencement of this programme and the HSE is actively expanding its capacity to provide health interventions and support for people who are found in possession of any drugs for personal use. The Minister of State at the Department of Health, with responsibility for public health, well-being and the national drugs strategy, Deputy Feighan, looks forward to the commencement of the health diversion programme which will represent a radical change in how people who use drugs are engaged with by the State.
Go raibh maith agat, a Chathaoirligh Gníomhaigh, agus cuirim fáilte roimh an Aire Stáit. I appreciate him taking the time to address this issue. This is an issue which I also raised as a Commencement matter on 11 May. It concerns two healthcare facilities in north Wexford. One is the opening of the planned primary care centre in Gorey and the other is the case of a building which has being closed for eight years but is still owned by the HSE; that is the health centre based at Camolin, County Wexford.
We have been told consistently about the opening of the primary care centre in Gorey. In fact, 18 months ago the HSE said everything was on track. On the basis of answers it gave then regarding the developer being in place and planning permission and so on, it should have been opened by now. The most recent correspondence I received from the HSE was from 14 October when its representatives said that the project at Gorey was ready to proceed once some parking issues had been removed. I was told on 14 October that everything else such as planning permission and funding was in order. I have since been seeking an update as to what the position is. Gorey in north Wexford, as members know, is one of the fastest growing areas in the country. There is an urgent need for further primary care in healthcare and we had anticipated that this new primary care centre would be open by now. I am hoping the Minister of State will provide an update on the position of this centre in her response.
The second issue I raise concerns the health centre in Camolin. This is a fine building which is owned by the HSE. It was closed amid much local opposition in 2014 and essentially the HSE has done - as far as I can see - nothing about it in the eight years since. It has not been operating as a health centre and it has not been converted to accommodation or for use by community groups. In 2018, the HSE stated it would approach various agencies and if they were not interested, it would put the building on the market. This is, of course, where they did not respond to the interests of locals about taking it over. When I asked the question in May this year, I was told that this was still being done and that the title of the property was being checked. Therefore, eight years after the HSE closed this very fine building and after many queries going in, the HSE was still checking the title. The Minister of State, Deputy Feighan, who took the Commencement matter in May, indicated and agreed with me that it was simply not acceptable that it was taking that long.
I sought an update from the HSE on 14 October and 11 November but failed to get a response on what is happening with this closed health centre in Camolin. The HSE said it was going to approach various agencies and, if that did not work, it would put the building on the market. I am not aware of any other local State agencies that have been approached about taking the building over and, as far as I am aware, it is not on the market. Following eight years of closure and complete inaction by the HSE, I hope the Minister of State will be able to impart some knowledge as to what is happening with this building, particularly when, as we know, there is a huge demand for property whether for housing to home displaced persons or refugees, or for community groups or other purposes. The fact that this fine building remains there and the HSE has done nothing about it remains a big concern. I hope the Minister of State will be able to update us.
I am taking this matter on behalf of the Minister for Health, who asked me to thank the Senator for raising the issue and welcomes the opportunity to provide an update to the House on this matter.
With regard to the HSE clinic building at Camolin, County Wexford, which is a former health centre that is currently vacant, this is a detached building on its own site that is owned freehold by the HSE. In line with the ongoing Government initiatives in respect of sourcing suitable properties for use in the provision of accommodation under Housing for All, and also as part of the Ukrainian accommodation response, the HSE has offered the site to the Land Development Agency, local authorities and the Department of Housing, Local Government and Heritage. The Department of Health and the HSE acknowledge the urgent and important work done in conjunction with other Departments and bodies to source properties suitable for providing accommodation and will continue to contribute to efforts to address the current urgent policy imperatives supporting Housing for All, in addition to the provision of accommodation to Ukrainian refugees arriving in Ireland.
I thank the Minister of State for taking the question. With regard to the primary care centre in Gorey, I note the words used by the Minister of State were that the "process was almost complete", which is the same answer I got previously and the time before that. I do not see why we cannot proceed. I realise there is an issue around parking but if everything else can proceed, let us, for want of a better phrase, park that issue and resolve it separately. We need the primary care centre. The parking issue can be resolved. I do not want to have to stand in the Chamber again next year asking the same question and be told once more the centre is almost complete.
At least, we have some further information regarding the clinic building in Camolin. It is not entirely clear. What looks like has finally happened in the past few weeks is that the HSE is offering this building to house displaced persons from Ukraine. From reading the Minister of State's response, that looks like what is being offered. I would like clarity on that. I am quite happy that the building be used for some purpose. This seems to be what the HSE is indicating will happen.
I welcome it if it is the case that at least it is put to short-term use but it is not entirely clear from the answer if this is what is planned, or if it is once again just some form of speculation. It is also not clear that the legal title issue has been resolved.
I can ask the Minister, Deputy Donnelly, to come back to the Senator to give him specific clarification as I am taking this question on his behalf. On behalf of the Minister, I again thank the Senator for raising this matter. The Minister understands how vital these developments are for local communities across the country. With regard to the vacant clinic building, as mentioned, the Department of Health and the HSE are committed to supporting the work being done to address the urgent need for properties. At the present time, no decision has been communicated to the Department of Health in respect of the use of Camolin health centre.
Investment in primary care services and facilities is an important part of the Sláintecare vision and the development of primary care centres remains a strategic priority for the Government. These facilities provide a single point of access to health services and offer a means of supporting people to live independently in their own communities for as long as possible. Significant progress continues to be made in the development and roll-out of primary care centres and 160 are now fully operational. Thirteen of these have opened this year alone and a further 19 are at various stages of the construction and equipping process, with five of these scheduled to become operational before the end of the year.
The Senator will, I am sure, be aware that Wexford has benefited and will continue to benefit from the Government's investment in primary care. Further to the new primary care centre for Gorey that we have been discussing today, a centre in New Ross is also in the early stages of planning. This is in addition to the four Wexford primary care centres already operational, including a new primary care centre in Enniscorthy which opened this year. I am sure we can all agree that these purpose-built facilities have a key role to play in supporting the health of local communities and in transforming the way we deliver healthcare in Ireland.
Cuireadh an Seanad ar fionraí ar 1.42 p.m. agus cuireadh tús leis arís ar 2 p.m.
Sitting suspended at 1.42 p.m. and resumed at 2 p.m.