Marcella Corcoran Kennedy (Offaly, Fine Gael) | Oireachtas source

I thank Senators for the contributions. I acknowledge Senator Reilly's role in establishing the scheme in his time as Minister for Health. The aim of the Government was to put in place a person-centred scheme for those who had a surgical symphysiotomy, to help to bring closure for as many women as possible.I believe the scheme has helped to bring that closure to a large number of women, and I welcome that.

The surgical symphysiotomy payment scheme was established in November 2014 following engagement by the then Minister for Health with the three patient advocacy groups that support women who underwent the procedure; and following consideration of two independent reports, the first from Professor Oonagh Walsh and the second from Judge Yvonne Murphy. Both of these expert reports recommended redress for the women who had undergone this procedure.

Two of the support groups welcomed the scheme and stressed the importance of providing redress for the women, given the older age group to which many of the women belong. One of the groups rejected the scheme. The scheme provided an alternative, non- adversarial and person-centred option for women, many of whom were elderly, and did not wish to pursue their cases through the courts. It was important that the women themselves had an opportunity to express their views regarding what might bring closure and Professor Walsh's research included a national public consultation process, with the women themselves and with other interested bodies. The report prepared by Judge Murphy also included direct meetings with the women regarding what would bring closure for them.

Ms Justice Harding Clark also provided a comprehensive report on the surgical symphysiotomy payment scheme in October last year and we now have available a thorough overview of the historical and medical context of symphysiotomy, including published material from the annual clinical reports of the major maternity hospitals between 1940 and 1960 and extracts from the transactions of the Royal Academy of Medicine between the 1940s and the 1960s. This shows that symphysiotomy was not a secret procedure or an illegal procedure, but its rare use was reviewed and discussed by obstetricians at the time.

The total cost of the symphysiotomy payment scheme was just under €34 million and payments of €50,000, €100,000 or €150,000 were made to 399 women, who met the criteria for an award, the majority of whom were aged over 75 years. Although the scheme was non-adversarial, it provided for women to have their own independent legal advice and assistance in submitting their applications to the scheme. In the interests of accountability, the scheme required each applicant to prove that she had a surgical symphysiotomy or pubiotomy in order to be considered for the assessment of an award. All assistance possible was given to the women by Ms Justice Harding Clark and her team in establishing this proof, which was considerably lower than the burden of proof required by the courts. It was only on accepting an award under the scheme that a woman had to discontinue her legal proceedings. The vast majority of women opted to do so.

The scheme was administered to the highest standards in line with its terms of reference. Many hundreds of hours were spent examining the applicants' medical records and each application received an individual, careful and fair assessment. The scheme did not hold any original medical records and at the end of the scheme, all applications and supporting documents were returned to the applicants or were confidentially shredded in line with each applicant's wishes. Regarding those women who were unable to establish that they had a surgical symphysiotomy, the report states that all of these applicants were assisted by members of the team in trying to establish their claims and the scheme's resources were applied in rigorous investigations before a claim was declared ineligible for the scheme.

Symphysiotomy is cited in several modern obstetric text books and has its place in obstetrics limited circumstances, for example, it may still be used in the western world in the delivery of a trapped head in breech delivery or in emergency obstetric situations. It is not a banned procedure. One of the principal reasons for use of symphysiotomy in rare circumstances historically was the danger associated with caesarean section which was very real in Ireland in the 1950s and 1960s.

On the question of consent, based on the evidence available to the Department of Health, it would appear that in a number of cases the procedure was carried out with a woman's knowledge or consent. However, this was not the case in all hospitals. Hospital records in some instances showed that it was an elective procedure. The symphysiotomies in Our Lady of Lourdes Hospital, Drogheda, include a high number of elective procedures which would have been carried out with patient consent. Some 20% of respondents to Professor Walsh during her research were private patients. As I referred to earlier, the outmoded procedure of pubiotomy was only found to have been performed in one case and significant disability was established in this case.

The health of women affected by symphysiotomy has continued to be a priority. Medical services, including medical cards, are facilitated for the women by HSE nominated symphysiotomy liaison officers based around the country. These services are available whether or not a woman has availed of the scheme. Ms Justice Harding Clark noted in her report that very detailed and forensic examination of available contemporaneous medical records failed to find evidence of religious as opposed to obstetric reasons why a symphysiotomy operation was performed. She also noted that the medical indications for symphysiotomy was always provided.

The Government hopes that the payments made to women under the surgical symphysiotomy payment scheme have helped to bring closure to women who underwent surgical symphysiotomy and to their families.