Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I thank the Ceann Comhairle for this opportunity to raise this matter on the Adjournment of the House but it is a disgrace on the part of the Government that we should have to return to the issue of symphysiotomy by way of an Adjournment debate. An inquiry into this barbaric practice should already have been held, reported and acted upon. It is shame on the Minister for Health and Children and her Department, for refusing to do so.

I understand that the Minister is announcing tonight that she is to ask the Institute of Obstetricians and Gynaecologists to carry out a review and report on the practice of symphysiotomy. I await the Minister's full statement but if that is the extent of what is being done, it is not good enough. The institution responsible for the abuse is being asked to investigate itself. It is not a proper inquiry, although it is clear its establishment has come about as a result of pressure on the Minister to act. That pressure for a proper inquiry needs to be maintained.

The RTE "Prime Time" programme of 18 February 2010, made a compelling case for an inquiry. It included new evidence. One of the most extraordinary pieces of evidence was one that did not take a great deal of research to uncover. This information was about the number of symphysiotomies actually carried out. The Department of Health and Children was asked for and supplied a figure which it said was incomplete because the Department did not have all the relevant health board reports. Yet, a reporter from "Prime Time" was able to go the National Library of Ireland - which has the relevant reports - and find the correct figure which was three times the Department's estimate. This is a very sorry and embarrassing state of affairs for the Department.

People commented to me after the programme that it confirmed that not only should Michael Neary have been struck off the medical register - as he was - but he should have been brought before the courts. Interviewed on national television he accused the abused and traumatised survivors of symphysiotomy of being motivated by what he termed the "smell of money".

Arthur Morgan (Louth, Sinn Fein)
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Disgraceful.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It was a sickening sight. This is the man who carried out numerous mutilations of women through unnecessary hysterectomies. The programme revealed he is implicated in the symphysiotomy scandal as well. This alone merits full inquiry.

I call on the Minister for Health and Children to act immediately to establish an inquiry into this scandal. It should be headed by a competent and independent figure from outside of the medical establishment. It is time for the Minister to stop shielding the medical establishment and start acting on behalf of our citizens who were victims of this barbaric practice.

I wish to quote in full and put on the record of the House an open letter to the Minister published today in The Irish Times.

Symphysiotomy is an 18th-century childbirth operation that effectively unhinges the pelvis by severing the pubic bones. The surgery was revived here in the mid-1940s for religious reasons and carried out, reportedly, without consent. More than 100 casualties survive today.

The Minister for Health has declined to accede to calls for an inquiry, most recently from the Joint Oireachtas Committee on Health.

Her refusal rests on advice supplied by the Institute of Obstetricians and Gynaecologists. Wrongly, the institute has led successive Ministers to believe that symphysiotomy was done out of medical necessity, that the surgery was a norm for obstructed labour until 1960, that results were "excellent" and complications "rare".

Symphysiotomy was never a norm, however. Ireland is the only country in the developed world where symphysiotomy was widely practised during the 20th century.

More than 1,000 of these operations were performed here from 1944 to 1984.

The surgery left babies dead or damaged and mothers with genital and pelvic injuries, persistent wounds and other infections; and sexual, marital and family difficulties. Many report decades of depression, impaired mobility, incontinence and chronic pain.

Symphysiotomy was a blatant abuse of authority and of medicine, one that showed a callous and cavalier disregard for mothers and babies.

For the Minister to persist in refusing an independent inquiry into this mutilating operation is to make a mockery of patient safety and to deny these women justice.

Like other victims of institutional abuse, they, too, are entitled to truth, validation, redress and closure.

The letter was signed by a long list of people from a cross-section of roles in society but I ask the House to note that three of the Deputies present in the Chamber were signatories to this letter: I signed the letter as Sinn Féin spokesperson on health and children, as did Deputy Arthur Morgan, in whose constituency many of the victims reside and the Acting Chairman, Deputy Jan O'Sullivan.

John Moloney (Laois-Offaly, Fianna Fail)
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I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney, who is unable to attend this evening. I thank Deputy Ó Caoláin for raising this important issue.

Symphysiotomy is a medical intervention that is now very rarely used in Ireland. It is an obstetric procedure and is a matter primarily for the Institute of Obstetricians and Gynaecologists to advise and lead upon. Accordingly, the Minister for Health and Children has asked the institute to prepare a report for her concerning the practice of symphysiotomy in Ireland. She has asked that the report would provide the institute's assessment of the circumstances in which symphysiotomy was carried out in Irish obstetric units; indicate what protocols or guidance existed over the years to guide professional practice; specify when the practice changed and why it changed at that time in Ireland.

The Minister has asked the institute to have the report completed by the end of April. I understand that the institute has indicated it will examine the practice of symphysiotomy as requested by the Minister and that it is willing to meet with the group representing those who have had the procedure. Symphysiotomy has been superseded for many years by Caesarean section and the Minister is satisfied that current medical practice in this regard is not in need of review.

The Minister is committed to ensuring that the greatest possible support and services are made available to women who continue to suffer the effects of having undergone this procedure. The women concerned continue to receive attention and care through a number of services which have been put in place including the provision of medical cards to all survivors of symphysiotomy patients who requested them; the nomination, since 2003, of a liaison officer for a patients' group comprised of women who underwent a symphysiotomy procedure; the availability of independent clinical advice for former patients by liaison officers who assist in co-ordinating the provision of services to those patients; the organisation of individual pathways of care; and the arrangement of appropriate follow-up, including medical assessment, gynaecology assessment, orthopaedic assessment, counselling, physiotherapy, reflexology, home help, acupuncture, osteopathy and fast-tracked hospital appointments. I understand that to date, 125 women have availed of some or all of the services offered by the HSE. I refer to the refund of medical expenses related to symphysiotomy in respect of medication or private treatments and the establishment of a triple assessment service for patients at Cappagh Hospital, Dublin in January 2005. A support group facilitated by a counsellor was set up in 2004 in Dundalk and Drogheda for women living in the north-east region.

The Minister has been assured by the HSE that it will continue to monitor and oversee the provision of necessary support services for women. In doing so, the HSE is committed to being proactive in seeking out and offering help to women who had symphysiotomies and who may wish to avail of the services offered by the HSE.