Priority Questions.
31 Ms O. Mitchell asked the Minister for Health and Children the reason the increase in funding in 2004 for psychiatry is the lowest of all medical specialties; and the further reason for a drop in mental health services funding from 11% of the health budget in 1997 to 6% in 2004. [15735/04]
Amharc ar fhreagraIn recent years, significant additional resources have been committed to developing comprehensive, community based mental health services. This has resulted in a continuing decline in the number of in-patients from 5,192 in 1997 to 3,966 in 2002 with a corresponding increase in the provision of a range of care facilities based in the community to complement in-patient services. There are now 411 community psychiatric residences providing 3,146 places compared to 391 residences providing 2,878 places in 1997.
Since 1997, approximately €90 million additional revenue funding has been invested in the mental health services. This funding has been used to provide medical and health professional staff for expanding community mental health services, to increase child and adolescent services, to expand the old age psychiatric services, to provide liaison psychiatry services in general hospitals and to enhance the support provided to voluntary agencies.
Recent years have seen a considerable expansion in the number of professionals in the mental health sector. For example, in 1997 there were 207 consultant psychiatrist posts and by 2004 this had increased by 74 to a total of 281. This includes an extra 19 psychiatrists dealing with children and adolescents, eight dealing with learning disability, three with forensics, 28 with adults and an extra 16 dealing with geriatric patients.
Since 1997, five new acute psychiatric units have opened in general hospitals. These units are in the Mercy Hospital, Cork, as well as Tallaght and Ennis general hospitals and two units opened in 2003 in Kilkenny and Castlebar. There are now 21 acute psychiatric units attached to general hospitals. A new unit at the Midlands Regional Hospital, Portlaoise is due to open to clients next month. Other units are currently at various stages of planning.
The injection of capital funding in recent years has accelerated the shift from a predominantly institutional based mental health service to a more community directed service as set out in the 1984 report on the psychiatric services, Planning for the Future. A new capital development framework for the period 2004-08 is being prepared and will include further significant developments for the mental health services.
Additional information not given on the floor of the House.
The estimate for the mental health expenditure in 2004 is €661.35 million or 6.69% of the total health budget. It should, however, be considered that in the financial year 1956-57 the percentage spent on mental health services was 19.5% and rose by 2.3% to 21.8% in 1960-61. At that time there were almost 20,000 public in-patients, and this figure has since fallen to around 3,200 in 2003. In this regard, it must be noted that in-patient care has always been the most expensive element of the mental health service and with the consistent reduction in psychiatric hospital bed numbers and the ongoing transfer of intellectually disabled and elderly patients to other settings, it is to be expected that expenditure relative to other services would fall.
Recent years have seen a significant transfer of intellectually disabled and elderly patients from psychiatric hospitals to other, more appropriate settings. In this regard it is noteworthy that the percentage of health expenditure allocated to services for the intellectually disabled has increased substantially since 1997 and expenditure on services for older people has also increased in the same period.
Substantial progress has been made in recent years in ensuring that those in need of mental health services receive care and treatment in the most appropriate setting. However, much remains to be done. I am committed to the provision of quality care in the area of mental health and I will endeavour to secure additional funding for this sector in the coming years. The further development of our mental health services will be considered in the context of the Estimates process for 2005 and subsequent years.
I do not wish to be rude to the Minister of State, but one has to be deluded to believe there is a comprehensive community psychiatric service. There simply is not. He says there is a move from institutional beds to the community. The "community" does not exist. What exists is people living in doorways out there in Molesworth Street and elsewhere. This is often an acute service. Virtually no acute beds are ever available in this city or throughout the country. Some 45% of acute beds are blocked at any time. Does the Minister of State realise that if this was happening in the ordinary health service, and not in area of mental health, there would be revolution? Almost 50% of the beds are blocked.
Is there a plan or strategy of any sort to develop multi-disciplinary teams, as recommended by the Irish College of Psychiatrists. The Minister of State rightly says additional psychiatrists have been appointed. However, on their own they can do nothing except administer drugs. That is all they can do if they do not have multi-disciplinary teams to back up the service. Is the Minister of State aware of the major hardship being placed on families by the absence of any follow-up comprehensive treatment other than the fact that people can be doled out drugs week in week out?
As regards the 11%, anyone can play around with percentages. The funding for mental health services in 1997 was £326.8 million. Eight years later that funding had doubled. In 2004 it was €661.352 million. At the same time, on account of the large increase in expenditure in the whole area of health, the percentage has fallen from 8.96% to 6.69%.
I understand the points made by the Deputy, but it is not true to say there are not plans. Significant plans exist at the moment for all the health services. Even as regards the other disciplines, apart from the psychiatrists I mentioned in my reply, there has been a large increase in the number of psychologists, occupational and speech therapists. I agree the number in the services is not sufficient, but we have put in place a comprehensive range of new courses in several of the institutional colleges around the country, to educate more clinical psychologists. These will come on-stream in a few year's time.
I will also tell the Deputy about further plans for a comprehensive roll-out in a seamless fashion. She is right in so far as there is much debate about the mental services and how the money is being used. I have set up an expert group. It is diligently reviewing the entire area of mental health. It has had more than 140 submissions and I have attended two days of consultations in this regard, where the group has engaged with clients who use the mental health services, as well as providers. There is broad-ranging discussion as to the way forward and the need to change some of the current methods. In many cases there may not be a need for general practitioners to refer some of the patients in the mental health area directly to consultant psychiatrists. There should be a seamless way of doing it, through psychologists, counsellors and so on, and that is one of the topics which the expert group is examining. I met recently with the IMO which is also acutely aware of the problems in the education of doctors in the mental health area and it is trying to resolve those problems.
Will the Minister of State guarantee that he will not wait until this report is published at least to deal with child and adolescent psychiatry? That is a service that is acutely needed. When an adolescent presents with a psychiatric problem it is most acute and families are distraught to have a child in that condition, with no service. The only treatment available is pharmacological, which is totally unacceptable nowadays. Will the Minister of State guarantee that he will at least look at that area as a matter of priority?
I am looking at that area but it can be too easy and glib to say that medication is the only resource available. Often there are other reasons but I do not want to go into this in detail.
I understand that but it does not excuse the absence of all the other services needed.
32 Ms McManus asked the Minister for Health and Children the action he has taken or plans to take arising from public concern regarding persons paying very substantial sums of money to a doctor claiming to provide alternative treatment for cancer patients; if the next of kin of patients have met officials of his Department; the outcome of the meeting; and if he will make a statement on the matter. [15738/04]
Amharc ar fhreagraThe Medical Council is the statutory body established to provide for the registration and control of persons engaged in the practice of medicine under the Medical Practitioners Act 1978. To engage in medical practice, a doctor should be registered with the Medical Council. Investigations by the Medical Council and the Irish Medicines Board into the activities of a registered doctor who had been offering medicines and services to cancer patients resulted in that doctor's erasure from the General Register of Medical Practitioners and a successful prosecution by the Irish Medicines Board. The same doctor has been suspended by the Medical Council on foot of a High Court order since July 2003. The individual to whom the Deputy's question refers was not on the register of the Medical Council.
My Department is carrying out a comprehensive review of the Medical Practitioners Act 1978. I intend to put before Cabinet soon the heads of a Bill for an amendment to the 1978 Act, which are at an advanced stage. Some of the main issues which have been considered are: greater public interest representation on the Medical Council; measures to improve the public accountability and transparency of the council; improved efficiencies in the fitness to practise procedures, and measures to ensure the ongoing competence of all doctors to engage in their profession. An increased public advisory role for the council on its area of expertise is envisaged.
The amendments will also include: a new definition of "medical practitioner" which defines the activities of a medical practitioner and also defines that he or she must meet the criteria for enrolment on the register. There will be provision for the council, which is in part relevant to this situation, on its own initiative or on the advice of the Minister, or any member of the public, to investigate instances or reports of individuals falsely claiming to be medical practitioners or providing services proper only to registered medical practitioners. It will be an offence, with appropriate penalties, for a person to sign a certificate or prescription which should only be signed by a registered medical practitioner. There will be provision for an offence, with appropriate penalties, for a person to take any title implying that he or she is a registered medical practitioner or to perform any action proper only to a registered medical practitioner. The Medical Council will be able to investigate cases of individuals who are not registered with the council providing services proper only to registered medical practitioners.
Persons who avail of services, whether medical, alternative or otherwise, should endeavour to seek the services of reputable institutions. For significant procedures in respect of serious illnesses, such as cancer, persons would be strongly advised to check that the services are provided by, or under the direction of, a registered medical practitioner and that such a doctor is in good standing with the Medical Council in this country. The advice of the patient's GP or other clinician responsible for that person's medical care should be sought in advance of commencing alternative or complementary therapy.
While the proposed amendments to the Medical Practitioners Act will relate to conventional medical practitioners, it must be acknowledged that the public will continue to use the services of alternative and complementary practitioners and alternative and complementary remedies. Alternative and complementary practitioners are not regulated in Ireland and I have taken steps, with which the remainder of this reply deals, to move towards a regulatory framework for alternative practitioners.
A meeting had been arranged for Friday, 21 May between officials of my Department and certain relatives of patients of the doctor in question, but this was cancelled at the request of those due to attend. I have been informed a meeting has been arranged for tomorrow, Thursday, 27 May.
Additional information not given on the floor of the House.
As a first step towards strengthening the regulatory environment for complementary therapists, I convened a forum in June 2001 to examine and explore practical issues involved in establishing appropriate regulation. Arising from the work of the forum I asked the Institute of Public Administration to prepare a report on proposals for the way forward, taking into consideration the formal views of the representative groups that participated in the forum.
The report, which was launched in November 2002, delivers on action 106 of the health strategy, Quality and Fairness — A Health System For You, and makes several recommendations on proposals for the way forward including the establishment of a working group to examine and consider regulatory issues; the continuation and development of a consultation process; and support for individual therapies in developing or strengthening their systems of self-regulation. As recommended in the report, I established a national working group to advise me on future measures for the regulation of complementary therapists. The working group held its first meeting in May 2003, is continuing to meet regularly and is expected to report within the next 12 months.
I welcome the fact that a meeting will be held. Does the Minister not accept that this is an extremely serious matter involving one doctor who was struck off the Irish register and another who was struck off the register in America for gross negligence, both of whom appear to have been practising quack medicine and taking large sums of money — between €10,000 and €20,000 — from people who are extremely sick and vulnerable, and that this extended over a considerable time and appears to be continuing in regard to one individual.
To date, only the planning law has been used in this case. Has the Garda Síochána proceeded with its inquiries? Is the Minister not ashamed that he is further delaying the amendment to the Medical Practitioners Act, publication of which was promised for 2005? We have waited over seven years for this Act, for which the medical practitioners have called, yet the Minister is unable to say when it will be published because he has taken off on his venture of supposedly reforming the health service while leaving the nuts and bolts legislation aside.
What will he do to regulate alternative procedures and medicine? He has not stated whether legislation will be introduced to deal with alternative practice. It has been sought by people in that area. We have not seen the health care professionals Bill but I presume it is not included in that so where exactly will that area of activity be regulated so that people can be protected, at a time when they are vulnerable, from unscrupulous people who are willing to take their money and not provide the care and treatment they need.
I take the recent events particularly seriously and the behaviour that transpired was unacceptable. The Medical Council took action in respect of one individual.
The first complaint was in 1992.
May I please continue my reply? I did not interrupt the Deputy. That individual was taken off the register. The council had no authority over the second individual because he was not on the register.
That is the point.
My officials have done substantive work on a new medical council Bill. They have consulted widely and have taken submissions. The heads of the Bill are almost ready, they have gone through every other Department and are now in the Attorney General's office and will be cleared within a week.
When will it be published?
The heads will be published very quickly, perhaps by the end of the next month, if not sooner. I caution against offering a panacea and pretending to people that a new medical practitioners Bill will suddenly eliminate this kind of practice and behaviour because it will not. There are limits to what we can do by regulation. It will strengthen certain aspects of it and perhaps give additional capacity to the Medical Council, but people visit various individuals seeking the ultimate solution to a very difficult and traumatic problem for themselves and their families, particularly when dealing with end stage terminal cancer or other terminal illnesses, and certain people come forward and offer solutions to that. People have travelled abroad for those kinds of services too.
We need to educate the public about the existence of the Medical Council, the idea of a register and so forth. I am the first Minister to move in this area, in conjunction with those involved in the field. There is a very wide continuum of alternative and complementary therapies available, all at varying stages of development. I outlined in my reply the up-to-date position on that. I convened a forum in June 2001 to examine and employ practical steps on the regulation of alternative and complementary therapists. I asked the Institute of Public Administration to prepare a report on proposals which it launched in November 2002. I established a national working group under Terry Garvey to advise me on future measures in the regulation and the group hopes to complete its work within the next 12 months. This is a wide continuum of somewhat complex people, some are pro-regulation, some are cautious about regulation and some have well developed self-regulatory mechanisms in place which will help us when we get to a regulatory framework, but I intend to bring forward proposals for the regulation of the alternative field.
33 Mr. Gormley asked the Minister for Health and Children the reason a person (details supplied), who was invited by the fluoridation forum to make a submission, has not yet received a response to his 50 reasons against fluoridation despite repeated assurances that this will be done; and if he will make a statement on the matter. [15889/04]
Amharc ar fhreagraThe use of fluoride technology is known to manifest a positive oral health outcome. Local and national surveys and studies conducted since the introduction of fluoridation in this country attest to the reduced dental decay levels of children and teenagers in fluoridated areas compared to those residing in non-fluoridated areas.
The safety and effectiveness of water fluoridation has been endorsed by a number of reputable international bodies such as the World Health Organisation, the European Centre for Disease Control and Prevention, the United States Public Health Service and the United States Surgeon General.
As the Deputy is aware, I established the Forum on Fluoridation to review the fluoridation of public piped water supplies in Ireland. The forum's report was launched on 10 September 2002 and its main conclusion was that the fluoridation of public piped water supplies should continue as a public health measure.
The forum also concluded that water fluoridation has been most effective in improving the oral health of the Irish population, especially of children, but also of adults and the elderly. The best available and most reliable scientific evidence indicates that, at the maximum permitted level of fluoride in drinking water, one part per million, human health is not adversely affected.
Dental fluorosis is a well-recognised condition and an indicator of overall fluoride absorption, whether from natural sources, fluoridated water, or from the inappropriate use of fluoride toothpaste at a young age. There is evidence that the prevalence of dental fluorosis is increasing in Ireland. The forum consisted of people with expert knowledge spanning the areas of public health, biochemistry, dental health, bone health, food safety, environmental protection, ethics, water quality, health promotion and representatives from the consumer and environmental areas. This diversity of professional backgrounds and representation was reflected in the comprehensive way the forum conducted its work and research. Ultimately, the forum took an evidence-based approach to its examination of water fluoridation.
The Deputy should be aware that, in its comprehensive report, the forum has already largely addressed the 50 reasons to oppose fluoridation, raised by the person concerned. The forum comprehensively examined the benefits and risks of fluoridation, including its alleged adverse general health effects. The forum concluded that human health is not adversely affected when fluoride is present in drinking water at one part fluoride per million parts of water. This is based on measured scientific results and the most reliable scientific evidence.
In spite of this, the oral health services research centre at University College Cork is preparing a direct response to these 50 reasons to oppose fluoridation. The institute, which is a World Health Organisation collaborating centre for oral health research, advised that work on a response is well advanced, and plan to make it available at the end of June. However, progress with completing this formal response has not been helped by the regular changes made by the person concerned to the text of these 50 reasons.
I welcome the fact that some response will be made. Even though it will be denied, the body referred to by the Minister is a well known pro-fluoridation body and he is trotting out the usual pro-fluoridation propaganda. The person referred to is Professor Paul Connett, who came before the Oireachtas Joint Committee on Health and Children. The reason we have not had a response to date is that the forum could not make one. It has been unable to come up with a response to the 50 reasons in three and a half years. Professor Connett asked those who are pro-fluoridation to come and debate the issues with him, but they all refused. Does the Minister agree this would appear to suggest they have no case and they are afraid to come out in the open and debate the issues properly and fully?
Does the Minister now accept that fluoride acts topically rather than systemically? It was previously thought it acted systemically which is why it had to be ingested. We now know that it acts on teeth in a topical way and, therefore, it does not need to be ingested.
I also wish to ask the Minister about the submission made by Dr. Hardy Limeback, who also came before the joint Oireachtas committee. He gave a most convincing presentation in regard to the use of fluoridated water for bottle-fed babies. Is the Minister happy about the manner in which this was discussed in the forum? Initially, the Food Safety Authority made a recommendation that fluoridated water should not be used for the bottle-feeding of babies, yet this recommendation was overturned after a few phone calls made by people who were not on that sub-committee. Is the Minister happy this is the proper way to conduct business? We know this took place because of a freedom of information request.
The Minister for Health and Children should be interested in the health of the general public. Why were no health studies conducted under the original legislation? Is it not about time we had a comprehensive study about the levels of fluoride in the bone, blood and urine of Irish people to see if there is too much fluoride, which is a toxic substance, in their bodies?
Regarding the Deputy's opening comments, I am not interested in propaganda. I have no vested interest in the issue of fluoridation, other than as a citizen like the Deputy and as Minister for Health and Children. I would need to hear a convincing argument to remove mandatory fluoridation of public water, given the indisputable fact of the positive impact it has had on the oral health of the nation.
It has not.
If one looks at the oral health of 12 year olds in Dublin, the average incidence of decayed, missing or filled teeth in 1961 was5.2%, in 1970 it was 4.5%, in 1984 it was2.2%, in 1993——
They were better 40 years ago.
——it was 1.2%. That has been shown in a range of studies. It is ridiculous to suggest it has not had an impact on oral health. Let us park that issue for a moment.
It is not ridiculous.
Improved dental health cannot be attributed to fluoride.
Order, please.
The studies comparing fluoridated areas with non-fluoridated areas show a marked contrast in the status of oral health.
They do not stand up.
They do. I have seen them.
They do not. I can show the Minister the studies.
I can show them to the Deputy also.
Order, please.
The forum was a public one. Professor Connett's position was widely reported at the time of his presentation to the forum. The forum argued it dealt with many of the issues contained in the 50 reasons relating to toxicity and osteoporosis, for example, which was strongly rebutted by it, or the lowering of IQ.
Regarding infant feed formula, the Food Safety Authority of Ireland was asked to conduct a risk assessment on potential adverse effects on infants. The final report of the FSAI concluded there was no significant evidence of any adverse effect, other than dental fluorosis when assessing the intake of fluoride intake on young infants. The Deputy's description of what happened is very much at odds with the information I received.
They came before the committee and we know exactly what went on.
The final conclusions of the FSAI were not changed in any way by the fluoridation forum. We must be careful we do not raise fears among the general public without using an evidence-based approach.
Forum members were not all from the dental world, many others were from other specialist areas who had no axe to grind one way or the other in regard to fluoridation. They have their own personal reputations as scientists and experts in certain fields to protect. They did not go out with the view that they must ensure fluoridation continued and that the report must reflect that.
What about health studies? That is an important point.
The only regret I have is that those who were against fluoridation and who I invited to become forum members, declined to do so. That is not acceptable. There comes a stage when one needs to engage. The only people who refused to engage were those who were against fluoridation.
On a point of order. The most important question I asked the Minister was about the health studies.
That is not a point of order.
Why has the Minister not conducted health studies? Will he please answer that one?
I do not conduct research. The Health Research Board funds research when it is required.
I beg the Minister's pardon, but under the legislation he is required to carry out a health study and that has not been done to date.
I know that.
The reason it has not been done is that, quite simply, people have too much fluoride in their bodies. That is what would be discovered.
We must move on. We are way over the time limit for this question.
We are not fluoride deficient.
We are not deficient in a lot of things.
Some of us are deficient in health services.
We are deficient in the health service.
34 Ms O. Mitchell asked the Minister for Health and Children when he will release funding for interim improvement measures at the National Maternity Hospital, Holles Street, Dublin; and when he will sanction the appointment of the design team for the urgently needed new maternity hospital at St. Vincent’s University Hospital, Dublin. [15736/04]
Amharc ar fhreagraAny proposal to develop services at the National Maternity Hospital is a matter for consideration by the Eastern Regional Health Authority in the first instance. My Department is advised by the authority that since the foundation of the hospital in 1894, its premises have been extended and modified as required to meet patient and clinical needs. In common with many older buildings, the infrastructural layout and configuration of the buildings are a constraint on the delivery of optimal services.
Coupled with this infrastructural issue is the growing demand for obstetric and gynaecological services over recent years. Against this background, my Department approved the establishment of a project team comprising representatives of my Department, the hospital and the authority, to examine the future role and accommodation needs of the hospital.
In light of particular concerns which have arisen in respect of overcrowding and consequential health and safety risks in some areas of service delivery, I understand that the project team is finalising a brief for interim developments which will broadly address the following key areas of concern: laboratory; post mortem facilities; out-patient clinics; patient waiting areas; pharmacy; neo-natal ICU; ward accommodation; delivery unit; physiotherapy; social work department; and theatre sterile supplies unit.
On receipt of the completed brief by the authority, it will be examined as a priority in conjunction with my Department. That is a matter on which we want to move relatively quickly. My officials met the board of the hospital recently and I am due to meet it shortly.
Did the Minister visit the hospital?
I have done so on numerous occasions.
If he had done so, he would have closed the hospital down because of the bad conditions that obtain there. Holles Street is a sorry excuse for a National Maternity Hospital. It is a fire hazard and it is dangerous. It is a disgrace that we are asking mothers to have their babies in such unsafe conditions, irrespective the best efforts of the staff to alleviate the difficulties.
Is the Minister aware of the conditions at the hospital? Corridors are blocked by laboratory and other equipment, including bins. There is virtually no access to the lifts. Acutely ill and premature babies must be brought through the staff canteen to the intensive care unit. If there was a fire, every baby and the nurses in that unit would die because there is no way they would be able to get out of the building. This matter is urgent and the Minister must take action.
The staff in Holles Street and St. Vincent's, when contacted, were of the opinion that the National Maternity Hospital would be moving to the St. Vincent's site. Is the plan in this regard progressing? The Minister's Department appears to know nothing about this plan, despite that everyone else seemed to assume that it had been agreed. When will the Minister appoint the project team and sanction the detailed design and funding of the hospital?
Is the Deputy referring to the new hospital?
Yes. I am glad that the Minister regards the interim arrangement as a priority. However, it cannot be regarded as enough of a priority. What is happening is appalling and the interim arrangement can only provide a temporary solution. The Minister is correct that the laboratory is one of the worst areas in the hospital. The conditions there are Dickensian. The laboratory is significantly under-resourced and has not benefited from investment in 30 years. Is the Minister aware that mothers are not now automatically called back for cervical screening? This service was available to their grandmothers but it is not available to them. Up to 8,000 babies will be born in the hospital this year and their mothers will not be able to avail of the services their grandmothers could avail of.
This is an indictment of the health service and we must make the required investment to improve conditions at the hospital in the short term to allow it to continue to operate until the new hospital is built. The new hospital is essential and its construction must be sanctioned. Will the Minister provide a timescale for the interim arrangement and the construction of the new hospital?
I look forward to meeting the board in respect of the new hospital because when the first national development plan was being drawn up, what is now the Eastern Regional Health Authority would have submitted its priorities for the east and it seemed to me that, at the time, the emphasis and focus was on redeveloping Holles Street on the existing site. Subsequently, there was an idea floating around to move it to St. Vincent's. When the St. Vincent's project came before us — we increased the allocation in respect of it by up to €40 million or €50 million to accommodate additionality on the campus at the hospital in terms of theatre suites, etc. — the moving of the National Maternity Hospital to that site was not on the agenda in any documentation put before me in terms of the national development plan allocation. At that time, the emphasis seemed to be on developing the hospital on the existing site.
I would have no difficulty with locating the National Maternity Hospital on the St. Vincent's campus but this would depend on the feasibility of doing so. The Hanly report recommends that ultimately, if possible, the National Maternity Hospital should be located on the St. Vincent's site. I would be responsive to any plans that come forward from the hospital and the authority in terms of what can be done to improve facilities in the interim.
We have already made significant investment in the Rotunda and the Coombe. There has been huge investment in most of the major hospitals at this stage and the lack of development is a legacy from decades of under-investment in health. In the past six or seven years there has been significant investment. I am anxious to proceed with improving the position in Holles Street and I look forward to meeting the board to see how this can be done immediately in terms of the interim solution and settling the question of relocation.
I do not believe it is fair to go back to the hospital and seek suggestions as to what can be done. It has already provided those suggestions and it knows what needs to be done. The money must be allocated so that the project can proceed.
I was perturbed by the Minister's statement that the plan regarding the possible move to St. Vincent's was "floating around". At that time, it was realised that it would not be possible to redevelop on the Holles Street site because it is too small and constrained and also that babies could not be born there during reconstruction. The thinking, even before publication of the Hanly report, was to move to a single site. St. Vincent's has a site allocated for the National Maternity Hospital in its new development. All that is required is funding from the Department which does not even appear to know about the existence of the site. I am concerned that there appears to be no joined-up thinking in the Department.
The Department knows about it.
The Minister is referring to a plan which came into existence several years ago.
There are many issues which have to be investigated, particularly the situation regarding the site at St. Vincent's and whether it is large enough to accommodate the National Maternity Hospital.
That matter has already been investigated.
Yes, and there are certain conclusions in that regard which I wish to discuss with the board.
Does the Minister understand that urgency is required?
I do.
He should visit the hospital now and he would make the decision after doing so.
I have appointed the project team and it must do the necessary work in terms of putting forward the plan for what will be done in the interim period. The team is due to report back to the authority which will come back to us with a brief.
It is money that is needed.
35 Ms McManus asked the Minister for Health and Children if the terms of reference of the inquiry to be chaired by Judge Maureen Harding Clark into the activities of a person (details supplied) have been finalised; when the inquiry will begin; the form it will take; the steps being taken to address the serious concerns regarding the adequacy of the proposed inquiry raised by Patient Focus and others; and if he will make a statement on the matter. [15739/04]
Amharc ar fhreagraFollowing the Medical Council's investigation into the conduct of Dr. Michael Neary, which found him guilty of professional misconduct regarding ten patients, the Government decided to establish a non-statutory inquiry chaired by Judge Maureen Harding Clark. A formal announcement of the terms of reference will be made shortly. In broad terms, it will inquire into whether Dr. Neary's practice was commented or acted upon by others at the hospital. It will examine whether internal or external reviews were conducted. It will also inquire into the measures put in place to prevent a repeat of those events at the hospital and offer advice on any additional systems that should be put in place. A number of meetings have been held with Patient Focus, the patient support group, with the most recent being on 20 May, 2004. As part of this process the group has been briefed by counsel to the inquiry in respect of how it proposes to conduct its investigations. In particular, the group has been assured that any woman who wishes to give evidence will be facilitated in doing so. I am aware that the group has some concerns about the scope of the report to be furnished by the inquiry and about the compellability of witnesses. As regards the report, I asked my Department, following a meeting I had last week with Patient Focus, to raise the group's concerns with the inquiry. I will revert to the group in due course. As regards compellability, if the inquiry finds itself unable to fully discharge its remit due to non co-operation by relevant persons or bodies, the judge will report that to me and I will ask the Government to consider what further action may be necessary. Such action may include recourse to an investigation under the Commissions of Investigation Bill 2003, particularly if the inquiry is undermined by such non co-operation. The inquiry team has already examined a substantial amount of documents and records which relate to the inquiry and the latter has been asked to report within a nine-month timescale.
I thank the Minister for his reply. It is not absolutely reassuring for him to say that on the issue of compellability, which is central to the success or otherwise of the inquiry, he may consider using the legislation that is in the process of going through the Houses. Is he giving to Patient Focus and the women who were so brutally and barbarously mutilated a guarantee that the Government will use the legislation that will be available to it if the compellability issue is not resolved under the current arrangements? Is he in a position to provide that guarantee now?
Will the full investigation sought by the women take place? They want included in the investigation, other than caesarean hysterectomies, gynaecological procedures, the death of babies and other issues. Will the investigation extend back to 1974 when Dr. Neary began his practice? What kind of co-operation or communication will be put in place with the women regarding the ongoing work of the inquiry? Has the Minister set up arrangements for keeping in contact with the women on an ongoing basis with regard to the progress of the inquiry?
I met the group last week in regard to the issues about which the Deputy has asked. The chairperson is an esteemed judge of an international court. It is clear that the Medical Council has set the parameters in the context that it found Dr. Neary guilty of malpractice in his performance, particularly with regard to a number of caesarean hysterectomies which came before the council for adjudication and on which he was found guilty. Our first objective and the ultimate objective of the inquiry is to ensure that such events never happen again, not just in Drogheda hospital but in any other maternity hospital in the country. We must also facilitate the women who were so badly treated by providing them with the opportunity to give evidence, tell their story and inform the inquiry about what happened.
On the issue of the scope of the inquiry, the group has said clearly that it does not expect the chairperson to investigate every procedure that took place in the hospital or to reach definitive conclusions on each adverse event or incident that might be brought to the inquiry's attention. In other words, the judge is in a position to find matters of fact or conclusions regarding events not covered by the Medical Council, and which may be the subject matter of individual presentations to the inquiry. The group does not expect every incident that happened to be investigated but it wants the opportunity to have them heard and, perhaps, reflected in the report.
The terms of reference relate to the systems in place at the time, the absence or presence of a clinical audit, peer review etc. The terms will encompass a systems approach to what did or did not happen in Drogheda. This will facilitate the women and ensure they have the opportunity to present their individual cases to the inquiry team.
On the issue of compellability, the chairperson is assertive and strong in her view that she can conduct an effective inquiry under the current arrangements.
What if she is wrong?
I do not want to say or do anything that would undermine her function in that regard, other than what I said in my reply. Action the Government may take in the event of non-co-operation will depend on the report we receive from the judge and the degree to which her inquiry was or would be hampered by the absence of co-operation. We want to get to the bottom of the issue. We want answers as to how matters went wrong. We know they went wrong and that appalling acts were carried out. The Medical Council has adjudicated on that. We must find out the reason such acts were allowed to continue for such a length of time and we are determined to do that.
Is the Minister saying that even though the legislation, which is at the end of the legislative process now, will be in place, he will not undertake to use it to ensure issues of compellability that exist are addressed? Let us assume that it is likely compellability will be an issue. Is he willing to give the guarantee now that if the issue arises as a problem, as is likely no matter how good the judge, he will use the legislation, which everybody in the House supports, that will be available to him? Is he willing to give that undertaking now?
That is not what I said, the Deputy is putting words in my mouth. I have clearance from Government to move on to the statutory phase in the context of the new commission of inquiry Bill. If co-operation is not forthcoming or if the degree of co-operation is such as to render the inquiry fatally flawed or undermined, there will be no difficulty about moving on to the commission of inquiry format. I want to respect the judge's position. She, as chairperson of the inquiry, is of the view that an effective inquiry can be conducted under the current format.
