Patriotism, as I understand it, is a combination of love of country, pride in its history, traditions and culture, and a determination to add to its prestige and achievements” -Lemass

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Is mise le meas,

Senator Mark Daly

Seanadóir Marcus O’Dalaigh

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17/07/15 Senator Daly Speaks on the Judicial System

Senator Daly: Out of 47 European countries, Ireland has the fewest number of judges per 100,000 of population. I ask the Leader for a debate on that but also that the issue of barristers defending and prosecuting cases of sexual violence should, as they do in other jurisdictions including the United Kingdom, undertake training on the impact of sexual violence on victims. That does not happen currently but it should be mandatory.

Currently, only 17% of judges in the High Court and only 12.5% of judges in the Supreme Court are women. Again, we are not in proportion with the rest of Europe. Too often, the judges presiding over cases of rape, child abuse and those involving minorities are men who have been educated in private schools and are largely conservative and middle class. Their number is way out of proportion with the population, and that must change. However, it can only change by law, as we did in this House when we changed the requirement for political parties to have gender quotas. Forty per cent of members of State boards must be women, yet that has not happened. The problem with having the same group of people sitting on our Judiciary is that there is group think. They think the same way about the impact of violence on women. We have seen suspended sentences being handed down in cases in which—–

My time is not up yet. Those were cases in which the perpetrators admitted that they raped somebody—–

yet suspended sentences were handed down. We saw this week, in regard to the house of horrors, where three judges said that the sentence should be reduced for one of the most horrific cases of abuse in the history of the State.

All of these judges are male, middle class and privately schooled. That has got to change.

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16/07/15 Senator Daly Speaks on Budget Provision and Judicial System

Senator Daly: I ask the Leader to organise a debate on the current state of the economy as we will not have much time to discuss the budget provision. The economic policy being pursued by the Government is akin to economic Darwinism because it involves the survival of the fittest. Those who have get richer and those who have not get nothing. Those who are on the outside of our society keep looking in and those who are on the inside of our society keep getting more.

I would also like the Leader to organise a debate on our judicial system. It was widely reported during the week that a non-custodial sentence was applied in a horrific rape case. Some 69% of people are not satisfied with the way our Judiciary hands down sentences. A gender quota is needed in our Judiciary. Even though we have women at the highest ranks of our justice system, including the Garda Commissioner, some Supreme Court judges and the Attorney General, our judicial ranks are full of white middle-aged conservative men who hand down appalling sentences, unfortunately based to a large degree on prejudice.

—-Later—-

Senator Daly: I am asking for a debate on our judicial system because there needs to be a gender quota in the appointment of our judges. It is as simple as that. We have gender quotas in politics and in other areas, but we do not have such a quota in the Judiciary. As I have said, some 69% of people are not satisfied with our sentencing regime. There are mandatory sentences for murder, which is as it should be. The same thing should apply in areas like abuse and rape. A two-year sentence was handed out to a principal. I am not identifying anyone.

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15/07/15 Senator Daly Speaks on Ambulance Services Provision

Senator Daly: I thank the Minister for coming to the House to respond to this issue regarding the national ambulance service, which is an issue in Kerry but also nationwide. It is about joined up thinking with regard to our national ambulance service and how the lack of that has affected Kerry, Cork and many other rural areas.

The epitome of the position was highlighted by a response from officials within the national ambulance service when they were withdrawing ambulances from west Cork. They told a local action group concerned about the effect of that in terms of life and death situations that was what they got for living in a rural area. Kerry was at the tail end of this process of reconfiguration or, as they like to call it, dynamic deployment, which is basically guessing where the next heart attack will take place – it is like Russian roulette when it comes to an ambulance service. In Kerry, fewer than 60% of the ambulances arrive within the 19 minute response time set by the Health Information and Quality Authority, HIQA, for emergency cases such as heart attacks, strokes and car crashes. The only way they will meet those response times is if they expand the length of time.

We are in a very rural area and we have seen ambulances being withdrawn. The Millstreet ambulance was withdrawn almost two years ago. That also covered a large part of east Kerry. Subsequently, one of the two emergency ambulances in Killarney was withdrawn and the strain on the system is evidenced by the fact that every month or so, there is a headline in The Kerrymanor Kerry’s Eyeabout how it took 50 minutes for an ambulance to get to Kenmare, Caherciveen or Dingle. That is complicated by the fact that when the ambulance arrives, and it is an excellent service because the paramedics are highly trained, it then goes to Cork where there could be a three hour wait just to have the patient admitted to Cork University Hospital because of a systems failure that has been ongoing in that hospital for years, which is amazing. That has been acknowledged by the Health Service Executive, HSE, and yet it continues.

This situation is costing the HSE more money because as the Minister of State will be aware, if stroke or heart attack victims do not get help immediately, their chances of recovery are greatly lessened. If they do not die their recovery takes longer, which means they tie up those beds in Cork University Hospital and throughout our national hospital network. There are also physiotherapy, speech therapy and other ancillary costs because the ambulance did not get to those patients in time.

There was a tragic case in south Kerry, which resulted in a fatality. The ambulance in Caherciveen was not available and there was not one available in Killarney. The ambulance had to come from Kenmare, which is nearly 50 minutes away. By the time it arrived, it was decided that the victim, who was suffering a heart attack, should go to Cork University Hospital. The helicopter was called from Shannon. It was now two hours after the initial call. When that patient stepped onto the helicopter he said, “I am in trouble, aren’t I?”, and he ended up dying on the operating table because the ambulance in Caherciveen had been pulled, as had the ambulances in Killarney and Millstreet. Tragedies are occurring as a result of these ambulances being withdrawn.

Next weekend Cork will play Kerry and we will have 40,000 people in Killarney, but there will be only one ambulance in the town. Killarney is unique because its population can double on any given weekend and yet it has only one ambulance. Very few towns can say their population will double on any given weekend and to have just one emergency ambulance in that situation is far from ideal.

I ask the Minister of State to look into that because not having ambulances available, and the cost of rehabilitation for those who do not get an ambulance in time, is costing the taxpayer a fortune.

Minister Lynch: I thank the Senator for raising the issue. I am pleased to be able to outline to him the current developments in pre-hospital services, both nationally and in the Kerry area, in particular.

The national ambulance service, NAS, has undergone a huge programme of reform and modernisation in recent years, and it is important to acknowledge that progress is being made. The Minister, Deputy Varadkar, recently officially opened the new national emergency operations centre in Tallaght, which allows the NAS to operate on a national rather than a regional basis. All calls for ambulance services for the Kerry region are now taken in Tallaght, and resources are dispatched from that centre.

Additional funding of €5.4 million has been provided this year to improve technology and clinical audit, and address gaps in service. Improved technology is facilitating better co-ordination of the national fleet, and that is improving control and dispatch performance.

It is important to note that the NAS is not a static service, but rather deploys its resources in a dynamic manner. This ensures that the nearest available and appropriate resource is sent to an incident. The NAS continuously evaluates its services in tandem with available resources and activity levels.

Kerry has 14 emergency ambulances and one rapid response vehicle. Seven crews operate on a 24 hours a day, seven days a week basis. The service operates from six ambulance stations in Tralee, Killarney, Listowel, Dingle, Kenmare and Caherciveen. Paramedics and advanced paramedics are deployed across the county, which ensures that practitioners with the appropriate skill level are located strategically to provide the best possible cover.

We are continuing to develop the intermediate care service, ICS, which transports patients between facilities, allowing emergency vehicles to focus on emergency calls. The ICS now carries three quarters of the non-emergency workload. In the Kerry area, two intermediate care vehicles operate from Monday to Friday, 8 a.m. to 8 p.m, and one operates on Saturday and Sunday from 10 a.m. to 7 p.m.

We are expanding the number of community first responders, CFRs, particularly in more rural and sparsely populated areas. These are volunteer groups in the community who are registered and trained to a certified standard. We now have over 120 teams operating around the country. Four of these teams are operating in the Kerry region and are linked to the national control centre. On receipt of an emergency call in a geographic area served by a team, the NAS computer aided dispatch system will send out a text alert to the group and simultaneously deploy a NAS resource. CFR teams are dispatched to persons with cardiac and respiratory difficulties. The responder may get to the scene before the arrival of the ambulance crew and will apply their training, thus increasing the person’s chance of survival. It is a great community initiative, which I fully endorse, and is a real case of helping thy neighbour. I have seen it in operation, and it is impressive.

We have also seen the establishment of the emergency aeromedical service, EAS, operated from Athlone by the Air Corps and staffed by NAS advanced paramedics. The EAS provides swift transfers of seriously ill or injured patients to appropriate hospitals. Over 1,050 missions have been completed since June 2012.

These are all significant achievements. However, the House can be assured that this Government intends to drive further improvements in our pre-hospital emergency care services, which will benefit the people of Kerry and those in the rest of the country

Senator Daly: I thank the Minister of State for her outline of the services. The main issue is the paramedics in Kerry will tell one there are simply not enough ambulances. It is not the case that they were not there before; they were and they were withdrawn. The emergency ambulance in Millstreet was taken away. The second ambulance in Killarney was taken away. Will the Minister of State ask for a report on how much it costs us to have fewer ambulances? If one tracks the patients going through the system, one sees the extra stay as a result of the ambulance not arriving in time costs money. Unfortunately, in some cases, it costs lives. It is a simple fact that if the ambulance does not arrive in time for a heart attack or stroke patient, or at a car accident, the outcome will be fatal in some cases and tragic for the family in the long run in other cases. The reply does not state we have fewer ambulances. We have dynamic deployment but the paramedics tell me they cannot be everywhere. If they are in CUH when a call comes in, and the next nearest ambulance is in Caherciveen, which is 40 minutes away, this will lead to tragic outcomes. I ask the Minister of State for an evaluation and impact assessment on how much it costs over a one-year period. As one can see from the reports, ambulances in Kerry do not arrive within HIQA’s guidelines and, therefore, the outcomes are tragic.

Minister Lynch: I know Kerry fairly well, as does everyone in Cork, not just from the clashes in Killarney but from holidaying there. Ambulances are based in Tralee, Killarney, Listowel, Dingle, Kenmare and Caherciveen. I know getting from Caherciveen along the coast road can be quite difficult at times and it is not a short journey. On paper, it looks to me as though there is extensive coverage, but I promise the Senator I will inquire as to whether there are particular difficulties. On paper, it looks as though there is extensive coverage.

Senator Daly: I thank the Minister of State.

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15/07/15 Senator Daly Speaks on the Post Office Service in Ireland and Organ Transplantation

Senator Daly: I ask the Leader to organise a debate on the post office service. We saw what happened in recent days when the banks in Greece were shut. If we have a properly functioning post office service, in the event of a similar situation arising in Ireland, at least we would a post office service. What the Government is doing with the post office service is an omnishambles. This system will fall apart and many areas of rural Ireland will be left without a post office very shortly. We saw what happened in England, where the post office service was cut to a third of its former capacity.

I also support my colleagues who have called for the Minister for Health, Deputy Varadkar, to come into the House today for a debate on pancreatic transplants. I received an e-mail from a person who is awaiting a transplant. He stated that the speech given by the Minister, Deputy Varadkar, on Wednesday was unfortunately incorrect in several ways. He also stated that Beaumont Hospital had not written to all post-transplant patients and patients on the waiting list. It simply did not happen. I am not blaming the Minister, as he was reading from a script prepared by his officials, who are basically misleading him and telling him lies. We have had that with the Taoiseach in the Dáil, when he was given bad information in regard to lbrahim Halawa. Joint assessment clinics are not in place for these patients. None of the patients has been contacted.

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15/07/15 Senator Daly Speaks on Transplant Patient Services

Senator Daly: I move:

“That Seanad Éireann calls on the Government to ensure:

– that the vacant posts in Beaumont Hospital in urology, with an interest in transplantation, be categorised as very urgent and receive an exemption to the current pay scales on offer;

– that the recent practice of instructing transplant patients to attend hospital Emergency Departments be complemented by providing access to Senior Specialist Nurses or attending Renal Registrars first; and

– the commencement of the Treatment Abroad fund to provide dual kidney and pancreas and pancreas only transplants for people on the waiting list so that the available donated Irish organs can be utilised.”

The issue with respect to Beaumont Hospital and the situation regarding the retirement of Professor David Hickey is causing great anxiety among the 526 people who are awaiting kidney transplants and the eight people who are awaiting pancreatic transplants. As we can imagine, the uncertainty surrounding organ donations services in such a life and death situation is a concern for a patient who is waiting for a telephone call regarding their situation.

We included the first point in the motion following consultation with those who are experts in the organ donation area. The current pay scale being offered to recruit a new surgeon is €110,000. That can be compared to a pay scale of €700,000 on offer in the United States for the same level of expertise. It is little wonder that the four attempts to fill the post have not succeeded. The description for the post needs to be changed to some extent and the pay scale on offer must be breached. Otherwise, it does to matter how many times the HSE advertises the post, when we are competing with Canada, the United States, England and Australia for the same very small pool of experts we will not win that battle. The Minister must overcome the issue of breaching the pay scale for this post.

I note from a reply the Minister gave Senator Colm Burke in response to a Commencement matter he raised on this issue – I look forward to hearing the Minister’s reply to this motion – that the Minister did not address the issue that these patients are being instructed to attend accident and emergency departments. As the Minister will be well aware, the last thing a transplant patient, who is ill, should do, or should be told to do, is to go to an accident and emergency department but that is what these patients have been told to do. A clear message needs to be sent form the Department that such advise is being reversed and that access to specialist nurses will be made available for these patients, as it was available in the past. The advice that has been given beggars belief and obviously that came from someone who does not understand the risks of sending a transplant patient into an accident and emergency department where he or she will pick up an additional infection, if he or she does not have one already. It can life threatening for a person to go there. Those patients need to access to specialist nurses and to the treatment abroad fund. I look forward to the Minister’s reply on that point. I note the Minister stated in that reply that every effort is being made. Four attempts have been made to fill this post without success. A fifth attempt will hardly be successful if the same pay scale and conditions are offered. Unless additional funding is put in place, we will get the same result.

The most important point is that the hundreds of people who are awaiting organ transplants are suffering anxiety and are in a state of distress as a result of this uncertainty.

—-Later—-

Minister Varadkar: I welcome this opportunity to update the House on the current situation in relation to pancreas transplants. Two consultant transplant surgeons left the renal and pancreas transplant programme at Beaumont Hospital at the end of last year, one on early retirement and the other on leave of absence for professional development purposes. Four consultant transplant surgeons remain and the renal transplant programme in Beaumont Hospital is continuing. Every effort will be made to fill the posts. Given the limited number of surgeons who specialise in transplantation, the filling of such vacancies poses a real challenge. Mr. David Hickey, who retired at the end of last year, performed pancreas transplants in Beaumont Hospital as well as his kidney transplant work. I acknowledge the work he did and the outstanding care he provided to his patients over the years.

Beaumont Hospital is now collaborating with St. Vincent’s Hospital on a combined approach to kidney and pancreas transplants. It is proposed that pancreas transplants, of which six were performed in 2014, will move to St. Vincent’s Hospital. Most pancreas transplants are combined with a kidney transplant. The arrangements being put in place for such cases will involve transplant surgeons from St. Vincent’s Hospital and Beaumont Hospital working together on the St. Vincent’s campus. I am informed that the pancreas transplants will be carried out by an existing surgeon who is already a member of staff at St. Vincent’s Hospital. As Senator Crown mentioned, other interviews are now planned by the hospital to fill other posts.A joint assessment clinic for patients who are waiting for a kidney and pancreas transplant, involving consultants and nurses from both Beaumont and St. Vincent’s, will be held on 24 July. Arrangements will be made shortly for the assessment of the three patients who are awaiting a pancreas transplant only.

Management and clinical staff at both hospitals are committed to ensuring that an optimal service will be put in place for the long-term benefit of those in need of pancreas transplants. As St. Vincent’s is already established as the national liver transplant centre, and is a designated centre for pancreatic cancer services, it is well placed to undertake these transplants.

On exempting transplant surgeons from current pay scales, as has been suggested by Senators, revised scales were agreed for new entrant consultants in January and were endorsed by the IMO in a ballot. Under the agreed pay structures, it is possible for consultants with experience to commence at the sixth point of the incremental scale, that is €155,000, rising to €175,000. It is also possible to appoint a consultant to a type C contract, which could mean somewhat lower remuneration but the ability to make substantial private practice income as well. Furthermore, it is open to health service employers to seek approval from the Department of Public Expenditure and Reform for entry of new consultants at a higher point on the scale in exceptional circumstances. If it is considered appropriate, this mechanism will be available in the case of a very experienced applicant for a transplant consultant appointment in Beaumont Hospital or St. Vincent’s, should one apply.

If a patient who is under the care of Beaumont Hospital after receiving a transplant encounters problems, they are asked to contact the renal registrar via Beaumont Hospital’s switchboard. If this occurs during daytime, they may be asked to present to the renal day ward for assessment. If the renal registrar is contacted by a patient out of hours, she or he will be advised to present to the emergency department first, where the patient will be assessed by the emergency department staff and also reviewed by the renal registrar, and-or the consultant nephrologist, if required. In addition, the patient can contact the transplant co-ordinators at Beaumont Hospital for guidance.

The treatment abroad scheme allows for public patients to be referred to another EU or EEA country or Switzerland for specific treatments not available in Ireland. It can also allow for the referral of patients where an undue delay is being experienced in access to a necessary treatment in Ireland. Given the logistical and time constraints involved, it is not practical to utilise the treatment abroad scheme to provide pancreas transplants in another country to patients who are living in Ireland, using an organ procured somewhere in Ireland. Furthermore, it would be necessary to develop protocols and service level agreements with the other country, something that would be unlikely to be achieved within the timescale of the proposed transfer of pancreas transplantation to St Vincent’s, which is a matter of weeks away, all going to plan.

I share the commitment of Members of Seanad Éireann to organ transplantation. I know it has been raised on many occasions in this Chamber. I want to see a further improvement in organ donation and transplantation rates in the coming years. I realise that the potential for transplantation depends on suitable donors becoming available, but there are a number of areas on which we could concentrate to maximise the potential supply of organs, to match them up effectively with potential recipients – most organs are not matches, unfortunately – and to carry out successful transplantations.

I believe that we need to ensure that the most appropriate infrastructure is in place to support organ donation and transplantation; to ensure that appropriate capacity and resources exist in our transplant hospitals to facilitate increased transplantation; to ensure that all those who die in circumstances where organ donation is a possibility are recognised and that their families are made aware of the possibilities of helping others; to build on the progress being made on the living kidney donor programme; and to strive to reach the point where organ donation will become the norm when opportunities arise.

This year, additional funding of almost €3 million has been provided to Organ Donation and Transplant Ireland, ODTI, which is part of the HSE, to facilitate the development of the most appropriate infrastructure to support organ donation and transplantation. The extra investment includes provision for the appointment of 19 whole-time-equivalent staff dedicated to organ donation and transplantation across the country.

Organ transplant can make an enormous difference to a patient, and to the lives of those around them. As Minister for Health, I am keen to ensure that we do all that we can to ensure that as many people as possible benefit from this gift of life. I can assure the House that every effort is being made to have all the necessary arrangements and protocols in place to facilitate St. Vincent’s being in a position to undertake pancreas transplants from mid-September, should a suitable donor-recipient match occur.

Senator Daly: It is a disappointing reply even on the practical matter of continuing to ask transplant candidates to attend emergency departments given that we know their very attendance could affect their health and lead to a catastrophic result for them. I understand the issue of staff not being available, but to continue to ask people to put themselves in harm’s way in a health service is deeply concerning.

I know this is the reply written up by the Minister, but it is the same reply that was written up for Senator Burke last week. It states that “[g]iven the logistical and time constraints involved, it is not practical to utilise the treatment abroad scheme”. Can the Minister imagine if he was on the organ donor list? He would have all the time in the world. He would go through hell and high water, all the logistical challenges and use all the time he had left to get treatment, whether at home or abroad. We do not have a surgeon for pancreatic transplants, we apparently do not know how many consultants are going to retire in our other organ donation areas and we will not even give patients the benefit of finding treatment abroad.

The Minister was not here when we recalled the Seanad to debate this issue, but having met people who are meeting for a life-or-death phone call, the simple act of telling them they must continue to go to emergency departments is a travesty. I know that is the reply we are given, but it is not even best practice. It is actually harmful. The least they could expect is that they would not be asked to do something that would harm them by their health service of all things.

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