Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

As Deputy Kelleher has said, I am conscious that we will have a dedicated opportunity on Tuesday to address with the HSE the matters arising from the Midland Regional Hospital report. Last week the Minister announced the appointment of a steering group to help prepare a national maternity strategy. Yesterday, speaking to the media in Portlaoise, he speculated on the closure of a number of smaller so-called maternity units. It is very premature to talk in those terms when any number of measures that would warrant consideration should be examined before such a serious step would even be contemplated. I would have liked to have heard him acknowledge the inadequate staffing provision leading to an impossible situation for many who provide excellent maternity services across our 19 maternity units. We need to recognise that there were 33 unfilled vacancies at Portlaoise hospital. The recruitment to fill these positions is only now being seriously addressed. It is very premature and I am very concerned because it only fuels the upset and confusion. The director general spoke about negative publicity. Again, suggesting more closures is a negative step. It is not dealing with the problem at all. Women do not want to be displaced and herded into factory production in over-centralised settings which clearly lack the compassion, care, time and attention they deserve in these situations. The overwhelming number of them are not sick; they are having a child.

The director general said that the HSE received the final report of the investigation into Portlaoise hospital on Friday. What differences were there between the final report and the report that gave rise to his very strong intervention that went so far as to threaten legal action to injunct the publication of that draft report? What was the difference between the draft report and the final one, when apparently, from what the director general has said and the Minister has indicated, the HSE is accepting all the recommendations that directly impact on the HSE? What was the difference? What gave rise to his first reaction and his more accepting stance to the report in its final presentation?

I will not continue to address the Portlaoise report at this point, knowing that we have the debate on Tuesday. I do not want the issues I had highlighted for quarterly address to be completely lost.

They merited it and I would like to refer to it. The first concerned question No. 9, in which I raised the issue of vulnerable adults and their safe care in a variety of settings. We are talking about aged and vulnerable adults who are unable to articulate and represent themselves. Áras Attracta might be a backdrop to the question, although I am not specifically or solely addressing that setting. The Minister's reply states that under the policy, that is, the safeguarding of vulnerable persons at risk of abuse national policy procedures, all service providers are required to have a publicly stated no-tolerance approach to abuse. What does "no tolerance" mean? Could the Minister translate that for me? Despite all the public attention and the exposé on national television, I am not convinced that this issue has been satisfactorily addressed. The fears and concerns still remain.

I note that at the end of the subsequent paragraph the Minister states that in cases of suspected sexual abuse, An Garda Síochána would always be notified. Why would the Garda not always be notified in cases of physical abuse and assault? Why does the answer refer specifically only to cases of suspected sexual abuse? Would cases of suspected or actual physical abuse and assault not always be notified to the Garda? If this has not been the case, will the Minister give us an assurance that it is now and always will be in the future? Abuse of an elderly person or a vulnerable adult should always carry both criminal and civil penalties and strong legislation is required in this area. Elderly persons and dependent adults are a disadvantaged section of society. I have such adults in my immediate family and I am sure many others in this room can identify and empathise with this critically important situation. I want to see the very best guarantees enshrined in legislation. I do not ever again want to wake up to new revelations of elder abuse or the abuse of dependent adults.

My question No. 10 concerns the vaccine for meningitis B. We have seen examples of the impact of meningitis, and meningitis B accounts for the majority of cases in Ireland. We have the highest incidence of meningococcal disease in Europe and there was a significant increase of up to 25% in cases in 2013. Children under five are the highest risk age group. I am very concerned about the response to my question, which states that the introduction of any new vaccine into the primary childhood immunisation schedule will be considered in the context of recommendations from the national immunisation advisory committee, NIAC, the outcome of cost-effectiveness analysis, the conclusions of the review of the HSE vaccination services currently being carried out, and resource availability. This is not an answer. The issue is not being actively and seriously considered. I am anxious to know if it will be revisited. Is it the case that only parents who can afford to buy the vaccine will be able to protect their children from meningococcal disease?

My question No. 11 raises access to emergency dental general anaesthetic services in Dublin city. Those services were withdrawn last year, yet the Minister's answer states that a protocol is now in place requiring this service remain under regular review. Heaven protect us all. What is being done to ensure a public service of a high standard is in place which children who are dependent on the public service and require an anaesthetic for extractions will be able to access? The service was in place in St. James's Hospital until it ceased last year. The consequences are very serious for the families who are directly impacted.