Minister of State outlines to the Dáil that the Government will support the passage of a cross-party Private Members’ Bill on Symphysiotomy

April 24, 2013 § Leave a comment

I welcome the opportunity to address the House to summarise the main points on this important issue from the Government’s perspective. First, and most importantly, the Government has given its support to the passage of Deputy Ó Caoláin’s Bill. This support gives a strong message to the women involved that we wish and intend to bring closure to this dreadful chapter in the history of our health services, and will not block any feasible route to resolution. More importantly, we wish to bring closure and resolution for the women and their families.


The Minister said last night that he has been advised that there are flaws in the proposed legislation, and it may be open to constitutional and other legal challenges. However, I assure the House that we will work with the Department of Justice and Equality, and the Office of the Attorney General to address these challenges. Those legal and constitutional issues and the means by which they need to be resolved can be addressed on Committee Stage. I again emphasise that the Government does not oppose and is supporting the passage of the Bill on Second Stage. Committee Stage is the appropriate environment and context to tease out those issues. Deputy Pringle and others asked what the perceived flaws are. I do not have time to address those this evening in my closing speech other than to assure the House that they will be addressed and can be teased out and debated on Committee Stage.


As the Minister expressed unambiguously last night, there is a clear commitment on the part of Government to address this situation. Indeed, all parties in the House have acknowledged that symphysiotomy has been the cause of great distress and pain for those women who underwent the procedure, many of whom without their consent, for years after it had ceased being practised in other jurisdictions.


The first priority of the health system is to continue to ensure that the greatest possible supports and appropriate health services are available to women who have health problems as a result of having undergone this procedure. This is happening through the HSE and the Minister outlined the range of services provided, which are co-ordinated through a national lead officer for symphysiotomy and regional liaison officers. In circumstances where there is any doubt about this or any concern about access to those services, liaison officers are available to be contacted and to assist in addressing any such issues.


It is important to reassure women in general that Ireland has one of the lowest maternal mortality rates and perinatal mortality rates in the world. It is also important to emphasise that we are recognised internationally as leaders in the field of obstetrics. However, there is no room for complacency and there are continuing important developments based on the new multidisciplinary clinical programmes being put in place by the HSE and the Department. These clinical programmes are patient focused, generally include patient representatives – as is correct and proper – and are led by senior clinicians. In addition, the Minister referred to the new patient safety initiative, the national early warning score for Ireland. The early warning scores for obstetric patients have different points for escalation of care. The maternity early warning scores were issued to maternity units in early April and are in the process of being implemented.


There is also the national group established by the HSE to oversee the implementation of the recommendations arising from the investigation team’s draft report into the death of Ms Savita Halappanavar. These initiatives demonstrate the commitment of the Minister to ensure that the best possible care is available to patients, particularly maternity patients.


Prior to the publication of this Bill the Minister was already endeavouring to bring the issue of symphysiotomy to a satisfactory and fair conclusion. The report on the first stage of independent research, commissioned by the Department’s chief medical officer into the practice of symphysiotomy in Ireland in 2011, was made widely available by the researcher for consultation during mid-2012. This consultation involved patient groups, health professionals and in particular the women themselves. There may have been some suggestion, perhaps unwitting, given in the course of the debate that this was not so. The consultation involved patient groups, health professionals and, in particular, the women themselves. The report will provide crucial information and insights arising from the researcher’s conversations with women who have been affected and those involved in their care.


The second stage of the research report has been completed by the researcher in recent weeks and, in line with best practice, has been sent for peer review. It is expected that this process will be completed next month and the final report will then be submitted to the Minister. There can be no reasonable concern that the Walsh report would in any way delay the passage of this Bill. It will be available to the Minister next month and will help him to formulate proposals to Government on the best way forward to deal with the matter.


Even though Government is not persuaded that the particular course proposed by Deputy Ó Caoláin of lifting the bar on the Statute of Limitations will resolve the problems facing the women who wish to bring their cases to the courts, in order to demonstrate commitment and respect for the women and to move towards closure on the matter, the Government is supporting Deputy Ó Caoláin’s Bill. I congratulate him, his colleagues and all involved in the all-party group in respect of this. There will be legal and constitutional issues, which will require broader consideration and the Bill as it stands may not meet the stated objectives for the women concerned. However, I emphasise that the most important goal now is that this situation is brought to an appropriate and fair conclusion for all the women involved.


I also salute and congratulate the women who have brought their campaign to the people and ultimately to the Oireachtas. They have succeeded in doing that and have also another unique achievement in uniting every Member of the House, which is very rare. They have been tenacious, dignified and resolute. For our part we must now respond and respond we will as quickly as possible.


The Power of Local Community in Reducing Harmful Drinking

April 11, 2013 § 1 Comment

Speech delivered at the opening of Alcohol Forum Conference

I don’t need to tell the people here about the damage that problem drinking can do.  It does not only harm the individual drinker, but also harms the lives of those close to them – their partners, their children and their friends. 


It is right that so much emphasis is placed on individual responsibility.  But Alcohol Forum exists because individual responsibility alone often is not enough. You mobilise communities, bringing together parents, youth groups, community groups, sports clubs, schools, health services, businesses and law enforcement to pool their resources and deal with alcohol related harm.


A line that resonated with me from your own published material is that “measures that influence the environment are more effective than targeting the individual drinker”.  This is not to absolve anyone of individual responsibility to deal with their problem behaviour, but it is to say that we deal with problems more effectively when we work together than when we work alone.


The problem is just too big and too entrenched to be dealt with effectively on an individual level, or even on a community level. Let me give some examples of what I mean.


–      Schools and parents tell our children that alcohol can be dangerous and must be approached very carefully.  At the same time these children are seeing advertisements on television and in cinemas and elsewhere at all hours of the day telling them that drink is fun, is consumed by cool and good-looking young people, and is an essential part of social success. How do we expect children to hear a clear message? 


–      Sports clubs to tell our children and teenagers that good sporting performance and good health are generally incompatible with significant alcohol consumption.  At the same time their sporting heroes are kitted out in branded gear, and the stadiums where they play or the backdrops against which they are interviewed are emblazoned with the branding of alcoholic drinks.  Again, how do we expect people to hear a clear message?


–      Many elements of vibrant healthy communities are here today and they all do their best to protect their communities from the ill effects of alcohol.  At the same time, throughout those communities there are massive billboards –  ads on bus stops, on buildings and on buses – representing booze as an experience that helps you transcend your mundane life and enter a world of beautiful people, sporting success and happiness.  Meanwhile throughout these communities there are supermarkets, off licences petrol stations and even newsagents selling ‘naggins’ of vodka for around a fiver and bottles of beer for less than 50 cent.

So there is a clear disconnect between what we as a society want to say to young people about alcohol, and what they are actually hearing.  Young people crave acceptance.  And they are being bombarded with messages telling them that they will gain acceptance through alcohol.


This is where Governments clearly have a role: to act in support of the individuals, and in support of the communities that are working to deal with the alcohol problem.


Every time governments decide to consider some form of regulation in order to address this problem, there are voices that say “that won’t work”.   We are told we should not consider restricting the sponsorship of sporting events because such sponsorship doesn’t increase consumption;  we shouldn’t bring in minimum prices, because this will only lead to cross border-shopping;  there are arguments made against clear health labelling of alcoholic drink;  against restricting advertising; indeed against just about every measure.


But despite all of this, the Government has been considering precisely these kinds of measures and will announce its conclusions and decisions shortly. And of course, we have to weigh up all of the different arguments before deciding how to proceed.  In this we are not alone.  Governments across Europe and elsewhere are looking at ways to tackle the alcohol problem.  Some have already taken measures. Others are considering measures that we are also addressing.


I cannot today give you final details, or the precise contents of our action plan but let me make one thing clear:  We won’t be deferring our decision, commissioning more research, or deciding to wait and see how other countries get along.  The National Substance Misuse Strategy Steering Group report was published last February. It provides us with a very robust analysis of the problem, and it also makes recommendations based on a thorough review of the national and international evidence. 


We have a good track record as leaders, not followers, when it comes to introducing measures to protect our health and our environment. We led within Europe on banning smoking in workplaces, and others have followed our lead in large numbers.  We took the lead again in taxing plastic bags, with excellent socially beneficial results.


Those who resist strong measures do make one valid point:  It is difficult to take measures in a single small country if they are not also taken in other countries too.   It is possible, for example, that minimum pricing in one country could lead people to buy their alcoholic drinks in another country.  That is why, in addition to our own national initiatives, we are working with other countries who have the same public policy objectives that we have.  For example in conjunction with Northern Ireland, a health impact assessment is being commissioned to study the impact of different minimum unit prices on a range of areas such as health, crime and likely economic impact.


We will watch what other countries do and learn from them.  But we will also take a lead, and allow other countries to learn from us. Yes, whatever we introduce will be a work in progress; it will not be the last word. And there will be voices arguing against some of what we are doing.  But we will not wait.  This generation of children will not wait.  You who work so hard in your communities to get across the correct message about alcohol in the face of very powerful alternative messages cannot wait.


I applaud and salute the work you all do, and I hope that the steps shortly to be announced by government will make your job easier, and create a more appropriate environment in which to bring up our teenagers and children.


There are many elements to the Substance Misuse Report’s recommendations – all of which are evidence based.  Those relating to minimum pricing, availability of alcohol, forecourt selling, how shops are laid out and such-like are aspects that have been discussed in the public arena over recent months. 


Less discussed perhaps has been the need to mobilise communities.  Mobilisation in this context needs to take place at both a national level and local level.  The Alcohol Forum has been active on both fronts, for instance at a national level along with others in promoting a ‘COALITION’ – ‘Ireland Against Harmful Drinking’. But at today’s conference  the emphasis is more on mobilising communities at a local level.


Alcohol Action Ireland have been very active over the years in guiding and advising policy and in creating public awareness. Their perspective on this theme will be of keen interest to us.

I am aware that the Alcohol Forum plans to take what they have learned and cause it to be exploited and followed in other parts of the country.  They intend working with other existing organisations that already have a strong presence in their local communities – in particular strong links are being forged with the network of Family Resource Centres. I compliment the Family Resource Centres for their ready receptiveness to this initiative.



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