There is little disagreement in the House that a considerable challenge faces this country in terms of developing a quality child care infrastructure, but there is a clear need to establish a workable, flexible, equitable and affordable model of child care in Ireland. There are a number of problems and difficulties facing us in this country, one of which is that Irish child care services are provided largely on an informal basis which does not meet the needs of parents. CSO statistics show that child-minding or family home-based child care is still by far the largest sub-sector in Ireland, accounting for 80% of child care places for infants, pre-school and schoolgoing children. The remaining 20% of parents access private and community child care services which can take many different forms, including sessional services, full-day services, employer-based child care, after-school care and the Early Start Programme.Despite clear improvements to the child care system, unfortunately, the current provision does not address the demand. It would appear that the child care services have the capacity to support little more than 15% of the children aged up to three years, and we have the second lowest rate of coverage in Europe for those between the ages of three and six years, according to an OECD study of child care in Ireland of two years ago.The second problem in terms of developing an adequate model of child care is that traditionally we have viewed child care as an adjunct to employment policies rather than as a highly complex and important issue in its own right. Much international research shows that the early years of a child’s life are crucial to his or her cognitive, emotional and social development and that many of the benefits are transferred to the family and to the wider community. Child care is not just about employment or even about educating children; it is an important social support mechanism and developmental service. Research has demonstrated that the influence of the first few years of a child’s life can determine whether he or she will remain in school, will access employment and-or proceed to third level education. We need to take all of these factors into consideration when considering the development of child care services.On Saturday morning last I attended a SIPTU meeting which examined the organisation of people who work in the community child care sector, and these issues arose repeatedly. I would welcome a proposal to organise workers in this sector because part of the difficulty is that the sector, because it is largely informal, has been relatively invisible and its workers have not pushed for issues such as proper training, better standards and, obviously, pay and conditions, which also would come into the equation. It is in everybody’s interest that the sector organises itself to a greater extent, and I think the Government has been trying to do this. It has been trying to put in place structures to help the child care sector organise itself in a way that will benefit the children who are in receipt of the services.In 2000, 33 city and county child care committees were established to deliver local child care strategies and these committees received funding under the Equality Opportunities Childcare Programme. They also have strategic plans, employ staff and implement actions. Will the Minister comment on whether the effectiveness of these child care committees has been evaluated, and whether the area is regularly evaluated to learn from best practice and from those who are succeeding in making good inroads into developing good child care structures and programmes in their areas?One of my aims today, rather than focusing on the challenges and the negatives, is to point to one programme of which I became aware recently, which is funded by the Government and which is a positive model that I hope will be replicated around the country in years to come, namely, the Fledglings Childcare project. The first of a number of sites opened in Fettercairn in Tallaght on 1 September last and the second site is due to open at Brookfield probably at the beginning of January.I will outline the background to how this project arose. The original project, The Shanty Educational Project, was founded 21 years ago by Ms Ann Louise Gilligan and Ms Katherine Zappone. Their belief was that education was the key to eradicating poverty. The Shanty programme has provided an extensive range of second-chance education and training opportunity for thousands of women in Tallaght West.In 1999, the Government provided a grant of €1 million to help build An Cosán and Rainbow House was established. This is the organisation’s in-house early childhood education and care centre and provides high quality education and care. This enabled many parents in the locality to avail of education and training. At a later stage, an innovative social enterprise project was developed and Fledglings Childcare was then registered and created. This centre was set up to provide child care training for local women. By May 2007, it had more than 220 women on 11 different courses including FETAC level five child care, FETAC level six supervisory and management and other courses including child-minding and parenting.This is an innovative and radical new social enterprise which can be replicated. The hope is that it will be replicated outside Tallaght west in the Dublin area and nationally in due course. Economies of scale will apply and once the front-end set-up costs have been covered, the costs of the extended roll out will be much lower. The model is based on research into local community needs and responds to the real unmet need for affordable early childhood education and care, particularly in disadvantaged areas. It is also a social franchise model
that has been recognised by Social Entrepreneurs Ireland.Under its contract with the Office of the Minister for Children and Youth Affairs, Fledglings Childcare has committed to opening ten child care centres using this social franchise model. When operating at full capacity, the first four of these locations will provide more than 115 additional child care places and more than 20 new child care jobs.I congratulate the Government and the Office of the Minister for Children and Youth Affairs on having had the foresight to support a project like this, but also argue strongly for the replication of this type of project in the rest of the greater Dublin area and around the country. 

“The Green Party wants to ensure that the vast majority of people over 70 retain their medical cards. We are working with our coalition partners to arrive at a Government decision that will facilitate this outcome.

“We are investigating possibilities for allowing existing older medical card holders to maintain full coverage. In addition, we believe that the income limits for eligibility for the over 70s medical card need to be set much higher, as even people with a small private pension are fearful that they would be required to choose between the medical card or the pension.

“We are also insisting that the contract with the Irish Medical Organisation for the provision of the medical card service for older people needs to be urgently reviewed.

“We are committed to a fair and equitable health system, and believe that any changes proposed to the medical card system must also be fair and equitable.” 

Irish Cancer Society request to Government to increase the price of a packet of cigarettes by €2 supported by Deputies and Senators at Leinster House

 Green Party spokesperson on European Affairs Senator Deirdre de Burca said: “Longer maternity protection has positive impacts on the health of the mother and child and this is a huge step forward by the Commission. I welcome the proposals to ensure proper financial protection for women at what can be a very stressful time both emotionally and financially.

 “The new proposals also state that those on maternity leave must be guaranteed an equally favourable position on return to work and be entitled to the same improvements in working conditions that they would have been if in post.”

 Senator de Burca says the changes follow recommendations put forward by the International Labour Organisation.

 “These recommendations come under two legal frameworks – the Directive on Health and Safety, and the application of the principle of equal opportunities. Recent research has found that some employers do deliberately discriminate against women on maternity leave when it comes to increasing their pay and awarding benefits. These new amendments should help to protect women from such treatment. It’s essential that women are able to break from their careers, confident in the knowledge that they will not lose out in the workplace.”

 “This proposal improves the minimum standards, but pregnant workers still need better legal protection. Entitlement to paid parental leave also needs to be introduced to help men and women who want to share responsibility for caring for their children. In Sweden, a year of parental leave is offered at full pay, which can be transferred to the father.”

 The proposals will be discussed by the European Parliament and member states and it is hoped that agreement will be reached during 2009. EU countries will have two years following agreement to implement the changes. Under current laws in Ireland, women are entitled to take 26 weeks maternity leave, with an option of 16 weeks extra unpaid leave. Entitlements depend on employment contracts and employers are not obliged to pay women on maternity leave.  

The Green Party has welcomed the start of a nationwide tour of a play that raises breast cancer awareness. ‘Unravelling the Ribbon’ is a moving play about the impact cancer has on women and will tour in theatres all over Ireland.

Green Party Women’s Affairs spokesperson Mary White TD called on people to play their part in the upcoming events to promote breast cancer awareness. “This evening marks the beginning of a series of events over the next six weeks to promote breast cancer awareness in Ireland. A moving play about the impact this cancer has on ordinary women is taking to theatres this week and we hope as many people as possible avail of the chance to see it. The next six weeks offer an opportunity to raise awareness and understanding of breast cancer. When art mirrors life it can teach and enlighten.”

Green Party Health spokesperson Senator Déirdre de Búrca said: “The next six weeks will also give time to reflect on the progress that has been made in providing breast screening and to discuss what further progress needs to be made. Irish women have a one in twelve chance of developing breast cancer in their lifetime. This is an important opportunity to remind people of that.”

 ‘Unravelling the Ribbon’ runs from September 16th to October 11th. It is presented by Gúna Nua Theatre and Plan B Productions, and is being run in association with Action Breast Cancer and sponsored by BreastCheck. To view a list of scheduled productions visit http://www.gunanua.com/forthcoming-productions/  

An article in your paper (Aug 26th) reported that an international conference on agricultural biotechnology in Cork heard calls from representatives of Teagasc for a more “open, transparent and inclusive” debate on the merits of genetically modified foods. 

As a Green Party public representative with a strong interest in the issue of GM, I would welcome such a debate. However, nothing I have read about the conference in Cork would suggest that the debate was inclusive or balanced. 

In fact, Professor Patrick Cunningham, Chief Scientific Advisor to the Government is reported to have spoken at the conference of the “urgency of the development and application of the technology on the one hand, and fear of change on the other”. 

In my opinion, Professor Cunningham does a great dis-service to those who continue to raise concerns about this relatively new, and as yet not fully understood technology. In fact, the urgency of which the professor speaks has been generated by large multi-national biotechnology companies who see enormous commercial opportunities in the immediate application of this technology, regardless of its prematurity. 

Many of the risk assessments of new GM products have been carried out  by these same biotech companies, and their findings largely accepted by regulatory bodies such as the European Food and Safety Authority who currently lack the resources to carry out their own independent studies. 

Proponents of GM also regularly make sweeping statements about the safety of these products as far as human health is concerned. Unfortunately they make these claims in the absence of any reliable body of longitudinal studies into the health effects of consuming GM foods over a lifetime. A growing body of research does suggest that GM foods have very negative health impacts for human beings, including organ failure and allergic responses amongst others. 

While it is extremely important that scientific progress is not inhibited, the danger of pushing GM technology on an unwilling public in the face of very real and legitimate concerns about its health and environmental impacts must be recognised.

We must have a full and open debate about the issue of GM in this country but please – let it be balanced and not just a propaganda exercise for the biotech multi-nationals. 

Yours etc

Senator Deirdre de Burca

Green Party Spokesperson on Health and Children

I also welcome the Minister of State to the House.  On behalf of the Green Party, I am very happy to move this Bill.  It is quite limited in its scope, which is deliberate.  There is a much wider debate about the appropriateness of certain psychiatric practices and the model that underpins them.  Those of us who have been involved in the mental health services are very aware that the traditional biological or medical model is increasingly being challenged in the field of mental health.  There is a very strong call for its replacement by a much more comprehensive bio-psycho-social model.   This debate is very important because of the treatments prescribed by each model of mental health disorders.  The focus of the Bill is on a couple of procedures that are currently on our statute books and which the Green Party wishes to see amended. 

The scope of our Bill relates to  involuntary procedures that are prescribed under the biological or medical model.  We specifically refer to the practices of psychosurgery and ECT.  Section 1 of the Bill seeks to amend Section 58 of the Mental Health Act 2001, which concerns use of psychosurgery.  Most of us became familiar with the treatment of psychosurgery – commonly known as lobotomies – through the famous film starring Jack Nicholson, One flew over the Cuckoo’s Nest.  Public awareness of the procedure has meant that over time, its use has almost completely died out.  It does not appear to have been used in this State over the last 20 years.  However, it is still left on our statute books and the option to use it still remains.  We are attempting to delete this section in section 1 of our Bill, and to introduce on Committee Stage a prohibition on its use. 

Section 2 of the Bill seeks to amend section 59 of the Mental Health Act 2001, which allows for the involuntary use of ECT in certain circumstances.  We are looking for this section to be deleted and replaced with the following wording.  “A programme of electroconvulsive therapy shall not be administered to a patient unless the patient gives his or her informed consent in writing to the administration of the programme of therapy.”  The issue of consent and informed consent is central to the amendment proposed  today.  The Mental Health Commission rules for 2006, governing the use of electroconvulsive therapy, are very specific on the issue of consent.  These rules state that a patient must be considered capable of giving informed consent for ECT, including anaesthesia, unless there is evidence to the contrary.  They also state that capacity to consent must ensure that the patient can understand the nature of ECT, understand why ECT is being proposed, understand the benefits, risks and alternatives to receiving ECT, understand the broad consequences of not receiving ECT, retain the information long enough to make a decision to receive or not receive ECT, make a free choice to receive ECT and communicate the decision to consent to ECT.  Consent must be received in written form. 

However, in part 2, section 4 of the guidelines entitled “Absence of consent”, it is stated that where a patient is unable to give consent or is unwilling to give consent, Section 59 (1) (b) of the Mental health Act 2001 applies.  This section states: 

Where the patient is unable or unwilling to give such consent, the programme of therapy is approved (in a form specified by the Commission) by the consultant psychiatrist responsible for the care and treatment of the patient and the programme of therapy is also authorised (in a form specified by the Commission) by another consultant psychiatrist following referral of the matter to him or her by the first mentioned psychiatrist. 

A form 16, entitled “Treatment without consent Electro Convulsive Therapy Involuntary Patient (Adult)” must be completed by both consultant psychiatrists and placed in the patient’s clinical file. 

Our Bill seeks to prohibit the involuntary administration of ECT to a patient.  We will propose on Committee Stage that during a period before he or she becomes unwell, and following a full and comprehensive explanation of the procedure of ECT, a patient will be asked to sign an advanced directive, giving or refusing consent for the ECT procedure on them at any stage in the future.  We accept that the advanced directive could contain a provision where the patient is empowered to name an individual to make a decision on his or her behalf, in the event that he or she was likely to become unwell.  However, this safeguard would deal with the issue of consent and ensure that the patient was consenting in a situation where he or she understood the implications of the decision, and was not under the influence of heavy doses of anti-psychotic or anti-depression drugs while making the decision. 

Why is the issue of informed consent by patients to the use of electro convulsive therapy on them so important?  Electro convulsive therapy is a procedure that  is primarily used for patients suffering from severe depression – in some cases psychotic depression.  It is also used for patients with catatonia or mania.  It is certainly a highly controversial treatment, and while it is supported by many in the traditional psychiatric profession, it is bitterly opposed by many patients and their families as well as a growing number of mental health professionals.  

According to a recent article by Dr. Brian O’Shea in Irish Psychiatrist, October-November 2007, the use of electro convulsive therapy in Ireland was first officially reported in 2003.  He refers to a study by Daly et. al., which stated that in 2003 in Ireland, 859 had received this treatment, although the use of ECT had varied per region.  The figure was 38.7 people per 100,000 in the southern health board region compared to 8.4 per 100,000 in the south-eastern health board region.  This issue raises two important questions.  Why is it that, given the controversial nature of electro convulsive therapy, no official records have been available for those investigating and concerned about its use, until 2003?  The second issue that arises is why there is such a level of variability between the different health board regions in terms of the use of electro convulsive therapy.  This is something that must be investigated further by the Department of Health and Children.  I have no doubt that, following our debate today, this type of investigation will occur.  

Most individuals undergo a course of between four and six treatments of electro convulsive therapy, usually two per week.  The procedure is reported to work quickly, although its effect may not last longer than one month.  The literature reports that it is usual to have a memory blank for the time surrounding a course of electro convulsive therapy.  The article I referred to by Dr. Brian O’Shea makes a couple of very worrying remarks about the use of electro convulsive therapy.  It opens with a quotation which basically questions whether electro convulsive therapy should be a treatment of last resort and seems to be encouraging a much more widespread use of it.  There are other comments in the article, however, which should cause concern.  Dr. O’Shea says that dementia per se is not a contraindication to the use of electro convulsive therapy, although confusion among dementia patients after ECT can be severe and prolonged.  He says Down’s syndrome patients can also be given ECT and mentions that psychiatrists do not consider age to be a contraindication in giving electro convulsive therapy.  He refers to a study that predicts an increased use of electro convulsive therapy in elderly depressives.  Another study he refers to stated that electro convulsive therapy might actually be under-used among the intellectually disabled.  

There is a passing reference in Dr. O’Shea’s article to the possible side-effects of electro convulsive therapy.  These are side-effects such as amnesia, fractured limb  bones, dislocated jaw, broken teeth, bitten tongue, myocardial infarction and angina.  There is some reference to cognitive patients who have undergone electro convulsive therapy, and who experienced cognitive difficulties afterwards.  Again, not very much attention is given to that issue in the article.  However, I should like to read a short passage from a psychiatrist who has been a very vocal critic of the practice of electro convulsive therapy, Dr. Peter Breggin.  This highlights why there is a campaign among those who have experienced electro convulsive therapy and object strongly to its involuntary use, in particular, Dr Breggin writes as follows:  

It is impossible to find words that are sufficient to communicate the tragic personal cost to many of the patients who undergo ECT.  In my own experience, spanning more than thirty years, I have encountered dozens of individuals whose lives have been wrecked by the effects of ECT on their mental function…Many have been left with such devastating retrograde amnesia that they can no longer function as professional persons or homemakers.  Years of professional training and other key aspects of their lives have been obliterated.  Even portions of their past that they can remember may seem remote and alien as if they are watching a movie rather than recalling their own lives.  Often they have been impaired in their ongoing ability to focus or pay attention, to concentrate, to make sense out of complex situations, to remember names and places, to learn anything new, to find their way around and to read and think effectively.  Frequently they have become irritable and easily frustrated, emotionally unstable and shallow in their ability to feel.  Often they feel depressed and even suicidal over the loss of their mental function.  In short, they have shown all the typical signs of close head injury, including frontal and temporal lobe dysfunction.  Often their families have been irreparably damaged by their inability to function as wage earners, husbands or wives, mothers or fathers.  A treatment that can cause such devastation, while producing such limited and questionable results, has no place in the practice of medicine.  

Having looked at the research in the area of electro convulsive therapy in preparing for our Private Members’ Bill today, it seems to me that there is a great deal of uncertainty as to why it is that the ECT procedure is effective at all  - where it is effective in some patients.  Given the scientific uncertainty surrounding it, the point that the Green Party is making is that its use without the consent of the patient must be prevented until we have the scientific knowledge that can explain how and why it works and on what patients it can be effective. I move the motion and ask other Members of the House to support it.

Reference was made to the ‘Prime Time’ programme on the issue of drugs. The message I took from that was that policy makers and politicians need to be courageous in their approach to the problem of tacking drug abuse and substance abuse generally in society because it appears the older prohibition model has its limits. If we are to seriously tackle some of the social and crime related problems attached to substance abuse, we may have to look at a model other than prohibition. It does not always have huge social support and much public education and so on is needed. I hope that in the new drugs strategy that thinking will be reflected. 

I will be quoting from the recommendations of the Merchants Quay Project which has developed much expertise in the area of working with drug abusers. It has welcomed the inclusion of alcohol into a single national drugs strategy. Most members will be aware that a motion was agreed by the Seanad last year on the issue of alcohol abuse in society. It is a good idea to integrate the issue of alcohol. 

Alcohol is the drug of choice for many Irish people. We do not think of it as a drug because we use it so widely in so many social contexts. It is one that needs to be addressed within the drugs strategy in the same way as other substances that are being abused. The point made by the Merchants Quay Project is that appropriate resources and funding need to be provided to facilitate service development and staff upskilling and not to assume that alcohol can be included and that the resources that have been used to tackle other substances can be automatically applied to address the issue of alcohol abuse. 

The submission from the Merchants Quay Project highlights some of the structural and reporting mechanism changes it would like to see. These are sensible suggestions. It seeks clear formal mechanisms for ongoing consultation with drug users and users of drug services. That would be a welcome element of any new drugs strategy. The Minister of State and his predecessor have been involved in the national consultation process which has involved consulting former drug addicts and those using and providing State services, as well as medical experts. The expertise and the experience that substance abusers have of the services is invaluable in terms of ongoing evaluation of the services. That those clear structures would be established as part of the process of implementing the new drugs strategy would be welcome. The timely reporting of data submitted to the national treatment reporting system has been mentioned. Timely reporting is important. It is impossible to assess how the strategy is being implemented and to respond to new trends emerging unless that data are available. 

The Merchants Quay Project has called for needle exchange to be included and counted as a treatment intervention within the national drug treatment reporting system. I hope the Minister will consider that recommendation and also the establishment of a drug trend monitoring system as a matter or priority. The level of cocaine use has exploded in recent years. It appears the profile of people who abuse cocaine is very different from that of those who abuse heroin and so on. Research has identified that it is predominantly the 15 to 34 age group who abuse cocaine. The side effects and the problems associated with cocaine use are different from other drugs. The drug trend monitoring system is a good idea and it is to be hoped that it is one that will be established with the new drugs strategy. 

The issue of funding has also been highlighted by the Merchants Quay Project. This is the key issue. It states that the following are essential in regard to funding. There should be a single funding channel for the national drugs strategy, annual funding for the regional development task force and also the local development drugs task force and funding for projects for three years.  There should be ring-fenced budgets for each pillar of the national drugs strategy, full cost recovery for projects paid in advance and a commitment to multi-annual funding to facilitate proactive service planning and delivery. I realise that in difficult budgetary situations it is not always possible to do that but that is the ideal in terms of funding certainty.  It also seeks regular reporting on the progress of the strategy. I am interested to hear whether the Minister of State has plans in regard to regular reporting. It also recommends that the Oireachtas committee on drugs link in to existing national drugs strategy structures.

In the area of harm reduction, some of the suggestions made by the Merchants Quay Project are interesting. In terms of the new thinking, one of its new proposals is that the new drugs strategy would look at establishing a pilot safer injecting facility or facilities in Dublin city and, perhaps, in one or two other cities with a view to assessing the impact of such a service on drug related harm.  Certainly the “Prime Time” programme, which looked at the issue of drug abuse, featured a number of models of this kind, based in the Netherlands, and which appeared to be successful in terms of harm reduction. While they do not cure the problem or wean the users off the drugs, they are injecting in a much safer way and avoid many of the problems, infections and diseases that go with hard drug abuse.

The Merchants Quay Project is also seeking a full spectrum of outreach services for hard-to-reach groups, better access to primary health care for drug users and more immediate access to mental health services for drug users experiencing acute mental health issues. I hope the Minister of State will take all these points on boards in putting the new strategy together.

The Minister of State mentioned prevention in his contribution. The Green Party believe the targeted Garda anti-drug use programmes in schools and third level institutions are very important.  We hope the programmes will continue and that the Garda will be properly resourced to provide them. We also recommend that the Garda be given search powers along the lines of the new random breath testing model for drink driving to allow for random searches at particular places, times and events where senior Garda believe there is a risk of drugs being present.

The Green Party has raised concerns about changes to the EU Food Supplements Directive that will limit off-the-shelf access to vitamins and mineral supplements. Green Party Spokesperson on Health, Senator Déirdre de Búrca said the regulatory changes agreed by the Department of Health amount to over-regulation and will impose unnecessary restrictions on consumer rights.Senator De Búrca said: ‘Under the terms of this directive the Department of Health has agreed that the vitamins and minerals currently available for purchas off-the-shelf should be reduced to low levels. This will mean that consumers will not be able to self- select food supplements at strengths above the Recommended Daily Allowance (RDA).
 
“In practice this will mean that Vitamin C for example would only be available at 60mg instead of levels of 1,000 mg and above, representing a reduction of over 90 per cent in dosage, despite thousands of scientific studies that testify to the safety of Vitamin C at higher levels”.
 
“If the Department of Health proceeds to sign up to the regulatory changes proposed, higher level food supplements such as vitamins and minerals will only be available to consumers by prescription, which will add significantly to the cost of purchasing them.
 
“Substances currently permitted on open sale with no restrictions, including cigarettes and alcohol, actually damage health. And yet despite a 40 year record of safe usage of higher level food supplements this country, as well as others, the Irish Government is about to agree to impose serious restrictions on their availability. This makes no sense.
 
“Nutrient supplements are not dangerous. On the contrary, a deficiency in nutrients can seriously damage an individual’s health. I am calling on Minister for Health Mary Harney and the European Commission to reconsider the proposed regulations. I believe that Minister Harney and the EU Commission should respect the basic rights of consumers to decide for themselves on matters concerning their own health and well-being given that no proven risk exists in relation to the use of higher-level food supplements.”
 
 
Information
Senator Déirdre de Búrca • (086) 806 14 50
Nicola Cassidy, Press Office • (01) 618 40 88 or (087) 914 81 75