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Lately I've been ditching the makeup and focusing on skincare day-to-day. It's felt so nice to give my skin a break from makeup and I've really noticed a difference in how my complexion look + feels. Here are ten products I've been using daily! And don't be confused by the "makeup setting spray"…it has SPF, so I've been using it even when I don't apply a face of makeup 🙂
P.S. Scroll to the bottom of this post to enter a $750 Nordstrom Gift Card Giveaway!
It's officially Spring and time to treat yourself to some shopping!
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a chance to win a $750 Nordstrom Gift Card!
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*this giveaway is in no way sponsored by Nordstrom.


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On one of the last weeknights of the primary campaign, Tommi Makila pulls his car off Branch Avenue and parks in a quiet Clinton neighborhood.
It's 7 p.m. The energy consultant has already put in a full day's work at the office, in Columbia. And now he's setting off — clipboard, voter records and campaign fliers in hand — to knock on doors. The neighborhood he's chosen, in Maryland's 27th legislative district, is predominantly African-American and solidly middle class.
Makila, wearing a white T-shirt with his name across the chest, jeans and sneakers, has no volunteers and no staff to accompany him. He is alone, except for a reporter.
The streets of the neighborhood are mostly flat. But as he is quick to acknowledge, his quest is uphill all the way.
For Makila, an immigrant from Finland and a first-time candidate, is running against the most entrenched member of the Maryland legislature, Senate President Thomas V. Mike Miller Jr. (D). Senate candidate Tommi Makila chats with voters Clotia White (left) and Joy White in Clinton earlier this week. Photo by Bruce DePuyt
For quite a while, Makila's trek from house to house seems futile. Some folks aren't home from work yet; others clearly are, but for whatever reason, refuse to come to the door.
"On some nights you wonder if it's worth it," he says, unprompted. (Makila estimates he's knocked on more than 4,000 doors since December.)
As he turns a corner and enters a neighborhood with newer homes, nicer cars and manicured lawns, Makila's luck seems to change. Suddenly he's finding people willing to come to the door and engage.
"I'm running against Mike Miller. He's been in office nearly 50 years," is his opener.
People tend to look up, eyebrows raised, as he says "50 years," as if they have misheard this man with the vaguely Scandinavian accent at their door.
While he's taking direct aim at the most second most powerful man in Annapolis — a legendary and charismatic figure who inspires both respect and resentment — Makila is more flashlight than blowtorch.
"It's nothing personal against Mike Miller, I'm just thinking it may be time for someone with new ideas," he offers gently.
There is no talk of the Annapolis "machine." ("That's insider terminology," he says later.)
One woman and her adult daughter talk with Makila for nearly 15 minutes. They complain that some neighbors don't pay their homeowners' association fees, that lottery monies don't seem to reach the classroom and that many parents aren't as active in the schools as they should be.
Makila listens, and he talks about his own experience as a PTA president.
"That's what keeps you going," Makila says as he walks to the next home. "Door-knocking is my favorite thing."
At another home, a man asks, "When is the actual voting?"
In a follow-up interview, the voter, Keith Merritt, offers the view that anyone in office five decades (Miller was elected in 1970, the year Makila was born) is likely "stagnant."
At another home, a woman takes Makila's literature and says, "I like Mike Miller" but adds that she's drawn to the idea of "new blood."
She then asks, "If you win, are you going to have barbecues and send Christmas cards like Mike Miller?"
The candidate is non-committal on the barbecues.
One woman tells Makila earnestly, "We need someone with new energy and new ideas."
Whether she has read those words off his T-shirt, or it's just a coincidence, is unclear.
As storm clouds roll in and daylight starts to dissipate, Makila heads back to the car, where he encounters another man, walking home from shooting hoops with his son, a boy about nine, and the family dog. The man is well aware of Mike Miller and he's not a fan.
"The system is quite rigged," he says, launching into a diatribe about how residents in other parts of Prince George's have better services than this south county community.
"Everywhere else is exactly as it should be," he says. "This [area] is a joke."
The man, who gave his name as John Doe, tells Makila he will vote for him but he adds: "You know you're not going to win. You don't have a snowball's chance. I'll vote for you but it will be a protest vote."
The man's son, "David Doe," tells the candidate: "I think you will win."
Makila likes this prediction better. ("David" asks a reporter how old you have to be to vote.)
'Take a Hike, Mike'
Makila's long-shot campaign began with a bang.
The prominent Service Employees International Union Local 500 held a rally on Lawyers Mall, just outside the State House, on the last day of this year's legislative session. Speaker after speaker denounced Miller in harsh terms. Signs and banners announced the launch of the union-backed "Take a Hike, Mike" campaign – and there was lots of big talk about a primary effort to oust Miller and other incumbents seen as insufficiently progressive.
Also on hand, soaking in the Miller-bashing with a smile on his face, and drawing lots of media interest, was state Comptroller Peter V. R. Franchot (D), who has been engaged in a bitter feud with Miller for some time.
In an interview this week, Franchot said, "Hats off to him for having the courage to run against the boss of bosses, Mike Miller. I think he's done very well. When I was door-knocking with him, he was very well received."
Franchot, who has a large war chest but no Democratic primary opponent, took out full-page ads in Prince George's County and Southern Maryland newspapers this week denouncing Miller. The ads say in part: "A major reason for our broken political system is Senate President Mike Miller … a man who goes to work every day in a cathedral-like building that bears his name – even as tens of thousands of Maryland children go to school in classrooms that lack heat and air conditioning."
Miller had $1,009,321 in his campaign account as of June 10.
And Mark McLaurin, political director for SEIU Local 500, acknowledges that Makila faces a "massive imbalance in terms of resources."
But he remains optimistic, saying in an interview that, "In this environment, the Democratic primary electorate is looking for a more aggressive and energetic and progressive advocate … so I think Tommi's got a real shot."
McLaurin's union has targeted 10 incumbent Democrats who it feels have been insufficiently supportive of an increase in the minimum wage, earned sick leave, union representation for community college personnel and other issues.
He called Miller "the dictator of the Maryland Senate," adding that, "if you're at all progressive, you get marginalized."
McLaurin said the union has "absolutely" backed up its big talk from that April rally in Annapolis, saying, "We have been very active in just about every one of those districts, be it mail, be it digital, or be it direct contributions and field operations. … Our effort is making a critical difference." "I think you're going to see five, six, seven or eight of our folks win."
Whether Makila is going to be one of them — whether he can really knock off the longest-serving Senate president in history — will be decided in a matter of days. "I have no idea what's going to happen," he says. "It couldn't be more David vs. Goliath. But I think Senator Miller is much more vulnerable than people realize. … Even people who think he's done good things say he's overstayed his welcome." Photo by Bruce DePuyt

subset: commoncrawl


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Villa Limonar
Villa Limonar can only be described as spectacular from just about every standpoint. The huge 5,000 m2 beach front plot and 500 m2 villa, built in Mediterranean style, has the best sea views across the Mediterranean towards Gibraltar and Africa.
Direct access to the beach, dining terrace, pool-house with fully fitted kitchen, bar, fridge and barbecue, an enormous 28 m heated, walk-in pool with Jacuzzi, jet-streams and waterfall, are just some of the garden's features.
This exceptional villa is located in one of the best beaches of Marbella, right next to beach restaurants, close to golf courses, tennis courts and 5 star hotels.
This villa enjoys wonderful first quality marble floors, wooden beam ceilings, and it fitted with A/C in all the rooms, fireplace, high speed Internet, alarm system…
Type: sleeps 14
Duration: minimum 3 nights
Price: from 4.000€ per night
Bedrooms: 7
Bathrooms: 8
At a glance
- Marbella Beach Front Villa with 7 bedrooms, 5 ensuite, sleeps 14 with 500m2 property on 5,000m2 plot
- Spectacular views from every room; panoramas of the Mediterranean, Costa del Sol, Gibraltar and Africa
- Expansive 28m swimming pool which can be heated in winter
- Boutique hotel service; daily housekeeping, breakfast service and one other daily meal possible
- Prized location 1st line beach in East of Marbella
Our villas include Hospitality services and Concierge 24x7 for the holiday of a life-time
The outside area is finished to the highest standard, constructed with the best materials and designed with excellent taste.
The pool & garden area is in fantastic condition and presents it self superbly.
This fantastic beach front villa offers a large (28 meters) heated swimming pool with massage-jet streams, waterfall, trampoline and lights. There is also a heated jacuzzi by the pool area.
In the garden there is a 18 hole putting green, designed by Miguel Angel Jimenez's brother.
The large pergola includes a bar, a large dining area and a fully fitted Gaggenau kitchen, including BBQ, oven and fridges.
Here guests can relax outside in a lounge-bar area furnished with padded wicker sofas and, as palm trees waft in the seafront breeze, you can dine in a most gracious setting that is adjacent to the large swimming pool.
The villa is built on two levels.
Main floor consist of an elegant entrance hall, large living room with fireplace, dining room, fully fitted kitchen and laundry room, guest toilet; 3 bedrooms, two sharing a bathroom with shower and tub, and one ensuite.
From the living room you can walk strait out to the wonderful terrace, partially covered, along the length of the salon with staircases down to the fantastic garden and pool area.
Majestic white stairs leading to the second floor.
The second floor consists of a big master bedroom suite with seating area, dressing room, private terrace and a marble bathroom with jacuzzi, separated toilet and two showers.
Also three more bedrooms all with bathroom ensuite. Terraces and fantastic views from every room.
- 7 Bedrooms / 6 Bathrooms / 1 Toilet
- Parking space for 6 cars
- Pool House with BBQ
- Outdoor jacuzzi
- Indoor jacuzzi
- Heated pool
- SONOS system
- Samsung Smart TVs on every room
- Free high speed Internet
- 2 Pool toilets
- 18 holes mini golf
- Direct beach access
- Automatic gates
- Alarm system
Hospitality Services
We are specialists in providing in-villa hospitality services, including:
- Concierge: on-call during your stay to give you recommendations and manage your bookings/reservations
- Chef: to prepare daily breakfast, lunch and dinner, or just for that special occasion
- Butler: to pamper you with cocktails on the pool, running errands, etc.
Villa Limonar
When booking a Villa with Marbella in Style you will have available our hospitality Services
Our Lifestyle Managers are your point of contact for all requests you may have whilst in Marbella
Private driver services for transfers, disposal services, weddings and tours.
Chefs & Catering
We are specialized in villa catering: breakfasts, lunch, dinner, BBQ, or private events
Licensed armed or unarmed security officers for your peace of mind
If you require a nanny during your holidays we can provide it
Discover the stunning Gastronomy, Cultural Heritage and Landscapes of Southern Spain with our Tours and Experiences
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Since 2008 offering luxury travel and lifestyle services in Marbella and Costa del Sol
Customized, door-to-door and private services tailored to your needs and requirements


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About Our Department
Romance Languages and Literatures offers vibrant programs in French, Italian, Portuguese, and Spanish. Our language classes have long been popular with undergraduates, including those interested in international travel and those who anticipate a global dimension to their future careers. All of our classes focus on culture writ large: we study great texts, and we do so with an eye to gender roles, traditions, communities, individual freedom, social obligations, and many other topics of critical importance today.
We offer concentrations in French, Italian, and Spanish, as well as a composite major in Romance Languages, and courses in introductory Portuguese. Our PhD programs in French and Spanish are comprehensive and designed to prepare careers in academia, with a focus on research and teaching.
Our Alumni
Our alumni go on to do amazing things. Our undergraduate programs prepare students to follow their dreams in careers around the globe, in diverse industries from finance to consulting, government to academia. Graduate students from our department go on to great careers as well, with successful placements in academia, or careers tied to cultures around the world.Alumni Profiles


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Monthly Archives: May 2014
What makes a great tech investor
Posted on May 6, 2014 Leave a Comment
Way too often entrepreneurs rank potential investors by only one factor; expected willingness to invest. A willingness to invest is essential but there are other factors to consider before taking someone's money, and here are six: 1. Entrepreneurial experience. I believe the most important thing to look for in an investor is whether or not […]


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Rabbi Robert Silverman helps same sex couples celebrate their love through marriage. (MIAMI BEACH. FL) MARCH 10, 2015— Rabbi Robert Silverman is pleased to announce Miami same sex officiant services to couples throughout South Florida. Now that same sex marriages are legal in Florida, many couples are already hardRead More
Ryan Reporting Offering Services Along the Space Coast
Ryan Reporting is providing the very latest court reporting tools along the Space Coast. (ORLANDO, FL) MARCH 10, 2015— Ryan Reporting, a top team of Orlando court reporters, is pleased to announce a new effort to serve legal professionals along the Space Coast. In communities like Titusville, Rockledge, Cocoa Beach,Read More
Summit Court Reporting Offers All Services to New Jersey Attorneys
A New Jersey Court Reporting Firm is offering new services to assist legal professionals in the Garden State. (TRENTON, NJ) MARCH 10, 2015— New Jersey court reporters at Summit Court Reporting are pleased to announce a new effort to meet the needs of attorneys in the Garden State. Every day,Read More


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Tango is a golden orange (that's a description, really …), iridescent and with a shimmer finish.
Application was two coats, and I noticed that I had already prepared a draft of this post. That's why you find the initial pictures at the end, before the close-up.
These are pics of the previous swatch.
Close-up view.


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The lives of Stompin' Tom Connors.
Yesterday, Canadian country singer Stompin' Tom Connors passed away at age 77. Connors' made Canada central to his identity as he sang songs that celebrated its working men and women in songs deliberately dotted with specific geographic references. One of his most famous songs, "Bud the Spud," was about the trucker who brought potatoes from Prince Edward Island to market in Ontario, while "Sudbury Saturday Night" was about what happens in a nickel-mining town in Central Ontario when the weekend comes. "TTC Skidaddler" personified the guy who utilized public transit in Toronto. Most were tailor-made for a sing-along with a slightly beery enthusiasm.
When his concert film, Across This Land with Stompin' Tom Connors, came out in 1973, these songs had one sort of currency. Together, his songs created a slightly mundane but charming set of Canadian heroes, and he was one of them. The source of his name is documented in the movie as he stomps his bootheel on a sheet of plywood to keep time, and by the end of his set, he had stomped his way through it.
Within 10 years, times had changed so much that his songs came to sound not like folk music but like folk art. The language that once helped his songs connect dated quickly and comically, and the characters were so one dimensional that they could have come out of '60s sitcoms and comic strips:
It's Bud the Spud from the bright red mud
Rollin' down the Highway smiling-
The spuds are big on the back of Bud's rig
And they're from Prince Edward Island
They're from Prince Edward Island
Connors' strong Maritime accent and earnest positivity further marked the songs as things that likely came from an alternate universe, one that seemed quaint and odd next to punk rock and new wave.
But hang around long enough and the context will change again. As far as I can tell, the impulses behind his work - his patriotism and desire create a distinctly Canadian body of work - came to be recognized and valued, and the details that dated the songs became charming pieces of yesteryear. He and his songs were endearing in the way that grandparents' idiosyncrasies become eventually drift from maddening to lovable.
Right now, I'm working through a review of Roger Knox's Stranger in My Land, and it can't be a coincidence that Connors and Knox - an Aborigine in Australia - found country music as the way to speak to the cultural realities they confronted. It gives Knox the tool to address love, pride, prejudice, and alienation, just as it provided Connors with a popular framework that he could fill with the populist icons he thought were missing from Canadian popular culture. The two artists are a reminder that what country music has lost is not its sound but its connection with working class life as it has become suburban, and thinking about Connors' work as "Canadiana" helps give the label "Americana" some definition.


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Florence – Lungarno Restaurants
La Toscana: Restaurants
Piazza degli Scarlatti 1/r
Lungarno Guicciardini
Phone: 055 290 076 begin_of_the_skype_highlighting 055 290 076 end_of_the_skype_highlighting
Area: Lungarno
No lunch Mon.-Sat.
This urban- style furnished restaurant, that also doubles up as a wine bar, easily gets full and serves some great dishes and accompanying wines. Booking is recommended.
Borgo Sant'Jacopo 57/r
Phone: 055 212 427 begin_of_the_skype_highlighting 055 212 427 end_of_the_skype_highlighting
Area: Lungarno
Closed Wed and then 15 days in Aug and 15 days between Dec – Jan.
This multi-room trattoria is crammed with tables and the atmosphere could well be described as lively. The restaurant has been going since 1945 and the family who own it supply all the olive oil and wines for the restaurant, which go nicely with the wide-ranging list of Tuscan specialties. Booking is reccommended though.
Chiavi: Florence, typical tuscan foodCommenti (0) | March 4, 2010


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The Oxford branch of Friends of the Earth (FoE) organised the Oxford Bee Summit on Friday 7th Feb 2014 in the spectacular setting of Oxford's Natural History Museum.
The purpose of the summit was to inform us about the National Pollinator Strategy, and discuss and brainstorm this and local initiatives with councillors and other local environmental groups. Oxford's Green Party was heavily represented and someone represented our European MP, who couldn't make it. Also attending were people from OBKA, local schools, Berks, Bucks & Oxon Wildlife Trust, Oxford and Oxford Brookes Universities, Cultivate Oxford, and a dozen or more other local organisations.
Below I cover the main points I took from each speaker in the morning session, and also the key points from my workgroup in the afternoon session.
Morning session
The morning consisted of a series of short talks and Q&A with the following speakers. I have summarised the points that made the most impact on me and also linked to the videos of the speeches, where available:
Professor Charles Godfray, Hope Professor of Zoology, University of Oxford and Chair of the Pollinators Expert Advisory Group convened by DEFRA – VIDEO
- Scientists have two duties when advising government: evaluating data and then advocating a strategy.
- There is surprisingly little hard data to go on for many pollinators on which to base strategy. (A later speaker made the point that this is because people tend not to bother recording things until they start going awry.)
- He stressed how important Citizen Science is going to be. I.e. normal citizens reporting observations via the internet.
- With the ban on neonics he hopes farmers will switch to IPM (i.e. only use pesticides when an outbreak occurs), which he considers a good solution, but he fears they will just switch to blanket sprays of some other insecticide.
- DEFRA evaluate a wide swathe of pollinator issues such as bumblebee imports, the Common Agricultural Policy, and environmental interventions such as wild flower borders for fields.
- In his opinion the evidence for the effects on pollinators of the low levels of neonicotinoids found in nectar & pollen is unclear so far.
Ivan Wright, Local bee expert and Chairman of Shotover Wildlife – VIDEO
- Expert on solitary bees. Showed us how these bees don't use pollen baskets, so they spread their pollen around much more effectively for pollination (see picture)
- Oxfordshire has ~150 species of bee (there are ~250 in the UK). A good garden has over 40 species.
- He showed us maps of honeybee distribution in Oxfordshire. This showed big gaps between towns where something is pollinating the crops. He thinks wild pollinators. I think he may be unaware that Oxfordshire has perhaps 200 beekeepers and many keep bees in out-apiaries.
- The smallest bees can only fly ~0.5km from their nest (honeybees are more like 3km)
- He is very, very worried about neonics affecting insects' ability to navigate back to their nests and thinks if they continue to be used, we will be reduced to shrinking islands of pollinators which will eventually dwindle away.
Colin Tudge, co founder of Oxfordshire Campaign for Real Farming – VIDEO
- I have little to say about this presentation as the views on reduced pesticide use in farming and small vs large scale agricultural practices are eerily similar to the values espoused elsewhere on this blogsite
- Studies from Brazil, Italy et alia show that if you withdraw neonicotinoids there isn't a massive increase in pests
- IPM is much cheaper than blanket use of pesticides
Paul de Zylva, Senior Nature Campaigner, Friends of the Earth – VIDEO
- The guy behind the National Bee Action Plan.
- FoE got some academics to work out how much UK farmers would have to spend if they had to resort to hand pollination, as has happened in parts of China where all pollinators died. Answer: £1.8 billion.
- 20 species of British bee have gone extinct since 1900
- There are now 200 cross party MP's supporting the Bee Cause
- Little things add up!
Eleanor Lischka, Plant Health, Bees and Seeds Policy, DEFRA – VIDEO
- As the sole representative of the body responsible for UK farming policy, she needed thick skin as everyone seemed to hold her personally responsible for, well, everything.
- A strategy document is being issued by DEFRA for public consultation this month and the final pollinator strategy document will come out later in the year
- Need sound evidence base but only really have decent data for honeybees, butterflies & moths; the Bumblebee Trust also gives DEFRA good data, as does BWARS (wasps eat pollinators so this is useful indirect data). Flies and solitary pollinators are a blind spot as so few people are interested in them.
- Launching 12 projects to gather evidence base (the phrase Citizen Science popped up again – this will require training people in species identification)
- An independent report, the Status and Value of Pollinators is about to be published
- DEFRA reckons neonics are not the only pesticides with the potential to damage pollinators
- One of the next steps they plan is gathering examples of local best practice to share – could we provide any examples?
Steven Falk, Entomologist from Bug Life – VIDEO
- This was a fascinating and inspiring talk largely about Bug Life's B-Line project, connecting areas of the country with avenues of pollinator friendly plants.
- There was so much great info in this dense presentation that I stopped taking notes and watched in awe, so I had best refer you to the video of his talk and Bug Life's website.
- Everyone else is talking about doing stuff; these guys are actually doing it – and on a significant scale.
- Later on, a speaker referred us to Steven Falk's Flickr collections as a splendid tool for identifying odd creatures in your garden.
Afternoon session
The 50 or so delegates were split into five groups and brainstormed what we could do next for pollinators with FoE co-ordinators guiding the discussions and recording our ideas on flip charts.
I didn't make comprehensive notes on all that was said, but I noted some points which particularly struck me:
- There are lots of biodiversity groups round Oxford but they're all doing their own thing.
- Six, or perhaps just three, people control perhaps 60% of the public land round the city; could they be contacted? As the parks & gardens department is already on a green and blue scheme, and the Green party comprises 10% of the council, they may well be very open to more pollinator-friendly ideas. (Also, what about the Church of England as a major landowner?)
- The colleges own a lot of land round here. Every month there is a Conference of Colleges, could pollinator friendly policies be put on the agenda there?
- These days, high end lawns are treated with neonics to kill cockchafers; this turns them into a bug free sterile zone. A student remarked that for several months of the year, students are warned not to touch the grass at Magdelene College to avoid burns from lawn treatments. This seems excessive.
- The public perception of bees and wasps is focused on their stings; there is a worrying disconnect from nature among segments of society
- B&Q are no longer selling neonic pesticides, and are labelling plants they sell as bee-friendly where appropriate. (B&Q had two representatives at this summit. They seem serious about community responsibilities.)
- Britain in Bloom and Best Kept Village should de-emphasize simply showy flowers and award more credit for pollinator-friendly displays and more permanent planting for all seasons.
Overall I found the Oxford Bee Summit very interesting, especially in how it brought together people with similar interests who perhaps don't usually network together.
I'd like to thank FoE, and particularly local organisers Fiona Tavner and the other hardworking staff of Oxford FoE, for this extremely well run event; and look forward to hearing more on the ideas the FoE collated and what might be taken forwards, both by them but also by some of the other groups represented, while personally following up some of the ideas myself!
FYI, there is also a short write-up of the event in the Oxford Mail
I hope the above is an accurate representation.- please contact me/comment here if you were a speaker and would like to amend or add anything.


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Harding Safety has redesigned its supply chain by centralising smaller warehouse locations to seven central warehouse locations globally. These warehouses are located in Seimsfoss (Norway), Rotterdam (The Netherlands), Dubai (UAE), Shanghai (China), Singapore, New Iberia (USA) and Macaé (Brazil). TNT will execute Harding Safety's worldwide inbound and outbound transport of spares for lifesaving equipment to merchant-, cruise-, offshore and Navy customers.
Wijnand Koningstein (Global Spares Director) of Harding Safety stated: "The worldwide network and expertise are the main reasons we have chosen TNT. The selection of one carrier increases the control and visibility and further enhances cost efficiency. In TNT we see a professional and ambitious partner to facilitate our growth and support us in offering the best services to our customers."
Erik Uljee, Managing Director TNT Benelux: "We are extremely proud to have been awarded such a long contract with Harding Safety, a leader in the lifesaving industry. We are committed to support their global growth strategy by providing a one stop shop for all required express delivery services and thus contribute to the satisfaction of Harding's goals."


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8 Reasons Why Being Pregnant at Christmas is the Best!
If you're a regular reader, or my mum, then you'll know that I'm pregnant with our second baby. I'm due early Feb which means I'll be in the full throes of third trimester fun this Christmas. I'm not a huge fan of pregnancy. You can read more about how I've been getting on in this pregnancy update, as well as one of the main reasons I find pregnancy tough –emetophobia.
Today though I'm sharing some of the reasons why its fab to be pregnant over Christmas. And this is coming from someone at 30 weeks. I was pregnant with B at Christmas and was just 12 weeks last time. That was less fun with feeling sick and exhausted.
There are a few reasons to be cheerful though so let's get started.
No Hangovers
It has to be up there at number one really doesn't it. The perks of no drinking ey. You can start each day fresh eyed and bushy tailed.
No Taxis
Pregnancy also means you'll be driver. Which means no expense on taxis. Winner.
An Excuse to get out of Anything
With pregnancy comes a free ticket to pretty much give zero f*cks and get out of whatever you want to.
Leave Parties Early
If you do fancy venturing out, you have a great excuse to leave early if you're just not feeling it.
Comfy Clothes
Pregnancy means you can wear whatever you like. Comfort wins for me right now. PJs into joggers? Sure.
Eat What You Want
Pregnancy is great because it means you really don't need to worry too much about eating a few extra treats this year. You're pregnant after all!
Put your Feet Up
Well to some extent but with a five year old that isn't always possible. If you can though, be sure to cash in your pregnancy tokens for chores, washing up and anything else you can think of!
January Sales Shopping
You have the perfect excuse to go shopping in the sales – bargain baby bits!
Can you think of anymore positives to being pregnant at Christmas? These are a just a few that spring to mind. I can think of a lot of negatives! More on that later in the week! Follow us on social for pregnancy updates and fun over Christmas: Facebook, Instagram, Pinterest and Twitter!


text:
Unimont Empire1 & 2 BHK Apartments at Khopoli, Next to Panvel, Mumbai
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Property ID
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- Property ID 5284
- Price Price on call
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- Property status For Sale
- Label Sale


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Deputy Jim O'Callaghan was in possession.
Civil Liability (Amendment) Bill 2017: Second Stage (Resumed)
One of the most tragic events that can happen to a child is that it sustains catastrophic injuries at its birth that will dominate the rest of his or her life. Unfortunately, although these events are infrequent in Ireland, they do occur. The parents of that child are then also placed in a life altering position. They were expecting to take home a healthy child who would grow up to enjoy all the great pleasures and challenges of life but instead they take home a child who will no doubt provide them with joy but who will require enormous care throughout his or her life. Overnight, the parents of that child have their lives changed and, for their remaining days, their primary and never ending responsibility will be to ensure the care of the child. Many parents in Ireland today are in such a position in that they are the parents of children who sustained catastrophic injuries at birth. Those parents need to be commended and acknowledged. Being responsible for a child with catastrophic injuries is not only emotionally draining, it is also financially impossible for most ordinary people. When one thinks of the costs that need to be incurred to accommodate the care necessary for the child, one can recognise the enormous cost involved. Houses need to be restructured - on occasion, they need to be rebuilt - and facilities need to be provided while constant nursing and medical care are required.
In many instances, when parents ask what caused their child to sustain these injuries, the hospital is guarded in giving a response. Unquestionably, there is a fear on the part of the hospital that litigation may ensue but, notwithstanding that, parents are entitled to be told what happened to their child if he or she sustained catastrophic injuries during birth. If there is negligence on the part of the hospital, court action will follow. Professional negligence in all walks of life is an occupational hazard. It applies in every profession. If there is negligence, it would be preferable if parents of children who suffered catastrophic injuries at birth could be told that from an early stage and if hospitals and the HSE could own up at an early stage to the fact that there was negligence leading to catastrophic injuries rather than dragging parents through the arduous and emotionally draining process of going to court.
The cost of looking after a child with catastrophic injuries is enormous. All parents, however, who have such a child will do their best to ensure he or she is cared for throughout his or her life. The greatest fear that the parents of a child with significant disabilities have is that once they die, there will be no resources in place for the child to be cared for. That is why parents go through the process of trying to get compensation for their child if they believe there has been negligence during child birth. It is not just children at birth who can sustain catastrophic injuries. People can also sustain serious injuries during childhood and adulthood, which alter their lives permanently. The injuries mean that they need constant care throughout their lives. If that is the fault of others, individuals are entitled to seek to hold those responsible for the life changing injuries they have sustained to account.
The only method our legal system has to try to rectify damage done to individuals who have sustained such catastrophic personal injuries is that the courts will award them damages for the negligence of others. In our system, people can only get damages as a method of recompensing them for those injuries. They can seek general damages or special damages. General damages are intended to compensate the person for the pain, suffering, distress and loss of amenity of life. However, it is in the areas of special damages that matters become more complicated. Special damages include loss of earnings. That obviously does not apply in the case of a child who sustains catastrophic injuries at birth but it would apply to somebody in middle age who sustains a catastrophic injury. Special damages also include the cost of care, medication, treatment and medical aids required to carry somebody through his or her life. When it comes to the assessment of special damages, the courts make assumptions in respect of relevant factors and contingencies. They are based on factors such as the life expectancy of the person taking the case, the prospect of deterioration, the cost over time of medical care, inflation rates and the rate of return on the compensation for the category of loss concerned when invested. When this matter comes before a court, it can be complicated for the court to calculate how much is required for an individual who sustains catastrophic injuries at birth, assuming that he or she will live to the age of 65 or 70. In many respects, the court is making a guess as to how much money is necessary. To do so, the court will calculate the capital value of future care by multiplying the annual net cost by a multiplier, which is actuarially calculated based on life expectancy. The resultant capital sum is awarded to the plaintiff as damages to enable him or her to pay for a lifetime of future care.
Many legitimate criticisms can be made of a process that requires a court when a child is aged ten to award him or her a lump sum to compensate him or her for life. The process can be seriously undermined by the assumptions that are taken into account by the court such as the life expectancy of the person taking the case. The child may live much longer, or not as long, as has been assumed by the court. The court also estimates future investment returns and inflation rates as best it can when awarding a lump sum. The court cases become lengthy hearings because of a conflict of evidence between the two sides as they both try to advance the best outcome from their point of view. They will have different actuarial reports and different assessments based on the child living to a particular age and the court will then have to determine which is correct and resolve the conflicting expert medical and other evidence. This is a difficult task for the court because it has to do what is fair and just in all circumstances. The reason it may be unfair is many catastrophically injured persons have spent their final years without the appropriate compensation. If a court could make periodic payments on an ongoing basis, it would not have to guess as to what is the appropriate amount. Currently, certain individuals who have sustained catastrophic injuries at birth can be left without sufficient compensation in the latter part of their lives to pay for the care required. That is an unfairness to them. A shortfall arises because the lump sum awarded many years previously has proved to be insufficient.
Similarly, there can be a situation where a defendant will have to pay a lump sum on the basis that the child will live to 65 years of age. It may be the case that the person concerned will die in his or her 20s or early 30s. In that instance, it is unfair on the defendant to have to pay the money; the defendant is paying a lump sum to compensate a person who was to live to the age of 65 years.
There are strong arguments in favour of what is contained within this legislation, which is why Fianna Fáil will be supporting it. The arguments in favour are that there will not be a situation where there will be an unfairness whereby somebody could be awarded too much or too little. By far the preferable position is for the court to be able to make periodic payments, to assess the needs of the child or the person at a particular stage and then to come back and assess it at a later stage to see whether a top-up is required and how much further compensation is necessary.
We are behind the curve compared to other countries on this issue. If one looks at other civil law or common law jurisdictions, one will see that many of them have periodic payment structures in place. Periodic payments were introduced in Germany in the late 19th century as the appropriate means of compensating for pecuniary loss. In Belgium damages for future loss may be awarded as a lump sum or by way of periodic payments. The court has discretion to decide the method of compensation to be employed. Initially, there is a mechanism whereby periodic payments are permitted. Periodic payments are still the norm in Sweden in cases involving serious loss of earnings.
When one looks at the common law world, one will see that periodic payments are also made. They were introduced in Australia in the 1960s. In the United States and Canada there has been a recognition from as far back as the 1980s that partial and periodic payments are the most appropriate mechanism. Legislation was introduced in the United Kingdom in 2003 to enable a court awarding damages for future pecuniary loss to order that damages take the form of periodic payments. It required the court to consider whether it should make such an order.
This matter was also considered by an expert group in Ireland in 2010. It was chaired by the High Court judge Mr. Justice John Quirke. It produced a report in October 2010 which concluded that the existing method of awarding damages for future pecuniary loss in Ireland, namely, the single lump sum award, was inadequate and inappropriate in cases where a plaintiff had been catastrophically incapacitated in the long term or permanently. The group noted that these views had been expressed in this jurisdiction previously and that they had also operated in other jurisdictions at the time. It recommended that the court be empowered by legislation to make periodic payment orders in catastrophic cases where long-term or permanent care would be required, subject to its satisfaction that the continuity of the periodic payments would be secured.
The report and its recommendations were produced in late 2010. It is unsatisfactory that the legislation is only now going through the Oireachtas in 2017. It is not just me who is saying it is unsatisfactory; it is apparent to anyone who has knowledge of the courts that it is unsatisfactory for parents to be put in a very difficult position when they have a child with catastrophic injuries and to have to go through this process involving a lump sum payment rather than have the option available under the legislation going through the House. It is instructive to note that the President of the High Court, on 22 March this year, referred to the fact that it was shameful that legislation to allow periodic payments in such cases had still not been enacted. He was saying it was shameful not as a judicial criticism of the Oireachtas because the judges wanted the option but because in the case of a young boy from Killorglin a settlement of €15 million had been approved because of brain injuries he had sustained at birth. The court, when making the comments, stated it had seen many families worn down by the legal process who were opting for lump sum payments instead of coming back to the court for interim payments.
It is important to note that there is urgency attached to this legislation. It is not to facilitate judges or lawyers but families, in particular parents who find themselves in the most appalling position of having to go to court to gain compensation for a child who sustained catastrophic injuries at birth. It is important to note that sometimes when people hear that families have been awarded millions of euro as a result of their children sustaining injuries at birth, they think that in some respects it is a windfall for the family, but it is nothing of the sort. The money is kept under the control of the wards of court system. The parents do not receive the money. It is to be used for the child and his or her essential care throughout his or her life for as long as he or she is a ward of court. That is why we welcome the legislation.
There is another part to the legislation which was introduced when it was brought to the Dáil. It is contained in Part 4 which deals with open disclosures of patient safety incidents. It is a proposal within the legislation which we also support. It seeks to cut down the barriers that prevent medical practitioners or hospitals or other individuals from apprising a patient of the fact that he or she sustained an injury of which he or she should be informed. The hospital may or may not have liability, but that is not the issue. In section 9 of the Bill there is a reference to the open disclosure of patient safety incidents. I believe this will have a positive effect on the way medicine is practised in Ireland. I also believe it will have a positive effect on the rights of individuals who are in hospital and receiving treatment.
As I said, professional negligence is an occupational hazard. There is no professional in this country who has never made a mistake. Unfortunately, if one is a doctor and makes a mistake, it can lead to catastrophic injuries. In general, however, when doctors or medics make mistakes, it does not lead to catastrophic injuries, but it can lead to injuries to a patient in a hospital. The benefit of this legislation is that it will enable the hospital to make an open disclosure. There may be concerns on the part of insurance companies or the hospital about whether this will lead to liability being imposed on the hospital or the doctor concerned. I am pleased to say section 10 of the Bill recognises that any such disclosure will not constitute an admission of liability or fault on the part of the person or hospital making the disclosure.
A novel proposal is contained within the legislation which we welcome and can consider further on Committee Stage, but the legislation should be expedited as much as possible through the House in order that the parents of children with catastrophic injuries will not be forced to go through the very difficult process outlined by the President of the High Court two months ago.
I will be brief in my contribution because we will also be supporting the legislation and look forward to its speedy passage through the Dáil.
As Deputy Jim O'Callaghan outlined, this legislation stemmed from the recommendations of a working group on medical and periodic payments in 2010, under the leadership of Mr. Justice John Quirke who was then in the High Court. He had been asked to examine the system of claims for damages arising from alleged medical malpractice and to identify shortcomings in the system. The group concluded that the system was inadequate and inappropriate and that it should be replaced by periodic payments. We welcome this recommendation. I know that in my constituency in Cork we had a situation where one family had to go to court on three separate occasions to try to secure a settlement. That was a very difficult process for them, They spoke about it in public, but I will not name them here.
It was a much publicised case in national media at the time. Their son had a brain operation and, as a result of that, was left with a catastrophic injuries. The family found itself in a very difficult position in which it ended up having to make numerous High Court appearances on the matter. One of the other reasons that the periodic payments should be looked at, which was touched on by the working group, was that in cases in which somebody who is receiving this compensation exceeds the life expectancy, there can then be additional costs in care for that individual. It should be up to the court to periodically review that. It is very unlikely in the types of scenarios we are talking about that one would see an improvement in a person's condition, but one could very easily see a worsening of that condition. That may be reflected in the periodic payments. It is something that we will be supporting.
We have one concern in the proposed new section 51L in the 1961 Act, which deals with the indexation of payments and would allow for the adjustment of the PPO in line with the cost of living. We would like to discuss that further on Committee Stage. Not only should it relate to the cost of living, but one of the biggest costs in terms of care is the cost of labour. That is something that we could discuss further on Committee Stage. We will support the legislation and want to facilitate its speedy passage through the Chamber.
I feel like I am out of sync with everybody else on this, because while I am obviously very glad the Bill is before us today - there is no doubt about it, it is incredibly long-awaited - the biggest problem I have with it is that there are two key areas it was specifically teed up to address but, as far as I can see on both scores, it is deficient and will need radical overhaul if it is to achieve what all of us hoped it might. The two areas relate to periodic payment orders, which other Deputies have addressed, and open disclosures. In the manner in which both are dealt with in the Bill and in the way they have made it into the final stages of the Bill, they nearly end up thwarting the very objective that was there in the first place.
There are two problems with the open disclosures provision. The first problem is that in its current form, the Bill essentially provides that any open disclosure made and any information gathered as a result of the open disclosure process cannot be relied upon as evidence in any subsequent civil actions. As far as I am concerned, this conflicts with long-established principles of national justice and is likely to adversely impact on the trust between the patient and the health service, which is what the Bill is designed to enhance. In other jurisdictions, like the UK, for example, no such restriction is placed on this information. The other key problem with open disclosure is that, in our legislation, it is voluntary and not statutory. That is a massive failing as far as I am concerned.
The periodic payment orders are obviously long-awaited. Other Deputies who spoke have addressed that. The Bill could have represented an excellent opportunity to address the deficiencies in the existing lump sum model for compensation by replacing it with periodic payment orders, but in order for such a system to work, the periodic payments have to be linked to the right index. It will not work otherwise. It must ensure that annual payments remain pegged as closely as possible to the future cost of medical care and treatment. That is what we should be striving to get to. The original recommendation unanimously endorsed by the judicial working group on medical negligence was that an earnings and cost-related index would be introduced. Perhaps for budgetary reasons, although I do not know, the Bill before us has actually gone for a completely different model and recommends a harmonised index of consumer prices as published by the CSO, which is, as I said, the opposite of what the judicial working group recommended. It completely ignores the group's unanimous recommendation. Linking payments to the consumer price index actually ignores the difference between the general increase in consumer prices compared to the much greater increase in medical wages and treatment costs. Therefore, as it currently stands in the Bill, there is a very real danger that the Government is putting people who have been catastrophically injured in our health service at risk of running out of the money they need to live and maintain an adequate quality of life.
I know, and the Minister of State will undoubtedly say, that there is a review built into the Bill to examine the operation of the index every five years. However, that is a bit half-baked. It is the worst of all worlds. It is as if we know it is limited and we are just throwing something in there. I do not think it is adequate. This must be addressed when the Bill goes to a later Stage. I compliment the work done by the Medical Injuries Alliance in its address to the health committee on these issues.
I would like to develop the points about open disclosure a little bit. In the Bill in its present form, they are totally inadequate and contrary to the principles of natural justice. Again, the Bill states that any disclosure and associated information provided as part of the open disclosure in accordance with the legislation is not admissible as evidence in any court proceedings in connection with any injury or death caused by the health service provider. This is an absolute missed opportunity as far as I am concerned. The system we have at present is clearly not working. All the Deputies have articulated that position. People who are injured by our health service are at present forced into litigation to find out what happened and to try to get justice. Yet, we have had a national open disclosure policy since 2013. The policy has not changed the fact that expensive and antagonistic litigation is the only way ordinary citizens have to get anywhere near the truth. That is a fact.
It is interesting that back in February 2015, the then Minister for Health, Deputy Leo Varadkar, described doctors who failed to be fully open about incidents as the medical equivalent of a hit and run. He is right about that. He said at that time that if more doctors were open about making mistakes, there would be fewer lawsuits. That is true, and I think it has been verified in other jurisdictions. He promised to make it mandatory for medical and nursing staff to admit errors that have caused harm to patients. That promise has not been delivered in the legislation before us. When people make open disclosures, is it more about protecting the system rather than giving patients and families the right to full and open disclosure? Preventing evidence gathered through open disclosure from being used in subsequent court cases is ludicrous and I think it would be constitutionally suspect. I believe the Medical Injuries Alliance made good points in regard to this. It states that it would be abhorrent to the administration of justice that a court might be precluded from considering all existing information necessary to establish relevant facts before making a decision on questions of liability.
I have less difficulty with the proposition in the Bill allowing that admissions made pursuant to the legislation cannot be deemed to be an admission of liability. That is fair enough. However, when there is a dispute on liability, it is essential that the court has the right to consider all relevant factual information gathered on foot of the legislation. That has to include any open disclosure and all records created for the purpose of making that disclosure.
Let us be clear about this. Patients are at a massive disadvantage compared to the health service provider in terms of knowledge when it comes to establishing how an adverse incident came about. Let us be clear that it is the service provider that is in control of the information.
Sadly, unless we change this legislation on Committee Stage, it will not change. Patients might get some more information but will not be able to do anything with that information which is totally wrong and makes the legislation somewhat redundant. Allowing information and records given over as part of an open disclosure process to be entered into evidence in court proceedings does not mean the court proceedings will proceed. That is fair enough. The legal safeguards are still there because the patient would still be required to establish liability when there was not an admission of same. That would provide ample protection for the service provider, in particular when one considers the burden of proof the patient has to reach in any civil action is very high because it has to be proven the doctor is guilty of a failing which no other reasonable doctor of like skill or experience would be guilty of.
It is important to examine the legislation that exists in other jurisdictions. A statutory duty of candour has existed in the UK since 2014. Following an adverse incident there, health service organisations must give a patient a full explanation of what is known at the time, including what further inquiries will be carried out. Organisations must provide an apology and they must keep a written record of the notification to the patient. On top of that there is a statutory duty to provide reasonable support for the patient, such as emotional support or an interpreter, to ensure the discussions are understood by the patient or his or her family. The UK's guidance note on implementing the duty of candour states: "A public authority's objective must not be to win the litigation at all costs but to assist the court in reaching the correct result and thereby to improve standards in public administration." That is what we should be trying to achieve by this legislation.
The UK's statutory duty of candour came about as a result of the Francis report which investigated catastrophic failings of the NHS in Staffordshire. We are devastatingly familiar with catastrophic failures here in Ireland. Deputies should think of Portlaoise or Portiuncula. The HIQA report into the deaths of babies in Portlaoise was hailed at the time by the then Minister, Deputy Varadkar, as a watershed in terms of maternity services in Ireland. It was published years after some of the incidents occurred. The report made sweeping criticisms of the HSE and its staff for repeated failures in the care in the units and, critically, the failure to learn from those mistakes over the years. Who is to say that, had they learned from those mistakes, some of the tragedies would not have occurred. A statutory duty of candour is one of the ways to address this.
Despite having Portlaoise in our recent history, the Government has shied away from this in the legislation. I cannot understand it. Let us look back. The HSE director general, Tony O'Brien, threatened to injunct HIQA when he saw its first draft report on Portlaoise and its criticisms of senior management. All this happened at a time when the HSE had a voluntary open disclosure policy similar to the one we are debating here. It has not done much good for the families in Portlaoise who spent ten years trying to highlight what went on at the hospital. I find it a bit bizarre that the Department's briefing note states there is no question that the protections in section 10 provide a hiding place for "incompetent, negligent or other unprofessional patient care" and that "organisations and health professionals continue to have accountability mechanisms." Having spent a lot of time working with families and the campaign to ensure mandatory inquests in cases of maternal deaths, I can tell the Minister of State the accountability mechanisms that are there now are not fit for purpose.
There were eight inquests into maternal deaths in Ireland between 2007 and 2015. All of them had to be fought for tooth and nail by the families involved in the face of intense HSE stonewalling. All eight were marked by consistent under-co-operation or non-co-operation by the hospitals involved. Families need to know when tragedies happen. Sadly, tragedies will happen and it is not necessarily anybody's fault. It is life. We need to be open when they happen. Our hospitals are chronically understaffed and underfunded which means accidents are probably guaranteed. The full scale of the crisis has to be known by the public and a statutory duty of candour is the key way of providing an impetus for change. There is a huge issue here because the proposal to prevent a patient from being able to rely in any way on the open disclosure process is likely to breed a lot more distrust. What will it do to public confidence in our health service if a patient is provided with clear and frank information about how an adverse incident happened but later in court the very same facts and version of events are denied by the service provider? The reality is the Bill, as structured at present, will lead to increased legal costs. The State already spends tens of millions in fighting damages claims as do the families who have to put up the money in fighting for it. If one party to a civil case has access to relevant factual information and the other party is denied access to the same information, the only consequence will be much more hard-fought, lengthy and costly civil actions. Patients will be forced into a situation of instructing a bunch of independent medical experts to give expert evidence needed to establish sub-standard care or causation, something which had potentially already been established under the open disclosure process but which they could not use in court. It is bizarre and will need to be changed. If the open disclosure is legislated for properly, it will lead to an improvement in the level of trust patients have in our health service, which is supposed to be one of the objectives. I genuinely believe, as the then Minister, Deputy Varadkar, said two years ago, it would lead to fewer civil actions, less trauma for injured patients and families and less money wasted on litigation. It will not happen as the Bill is now. In some ways the Department of Health agrees because the report of the commission on patient safety and quality assurance, published almost a decade ago in 2008, said:
Over the last two decades there has been growing support in the international literature for the concept that doctors should make full disclosure of medical errors to their patients. As well as enhancing patient safety by the acknowledgement that an error occurred, it is also in keeping with the ethical commitment of honesty to patients. Failure to communicate effectively with patients following errors therefore damages the integrity of the profession. Studies show that openness can decrease the trauma felt by patients following an adverse event and that patients often forgive the medical error when it is disclosed promptly, fully and compassionately and action is taken to make sure it does not happen to another patient.
That is the battle the spouses and partners of the women who lost their lives in maternal deaths in our hospitals over the last number of years engaged in when they launched their campaign to secure mandatory inquests in cases of maternal deaths. It cannot bring their wives back but it can stop it happening to somebody else. That has to be the objective of this litigation. Last week, I again met in my office an incredible man, Micheál Grealy, who is 84 years of age and whose wife, Kathy, went into hospital on Christmas Day 1972 to have their first baby. The baby was born on Christmas Day and died because the Coombe did not realise the mother was rhesus negative and the baby was rhesus positive and it did not correct it. Even worse than that, Kathy was given an anaesthetic when she should have been given an epidural. She vomited, which resulted in Mendelson's syndrome, and died seven weeks later in 1972. Her husband, at 84 years of age, is still carrying on the fight to find out what happened in that case.
He has seen documents which state his wife's death was avoidable, but he has had no explanation of why it happened. The names of the medical personnel involved in the case, the anaesthetist in particular, were withheld from him for decades. He eventually found out the correct name, following which medical personnel involved in his wife's care gave him information which led him to believe the anaesthetist had had a drug problem and probably should not have been working on that tragic day. He has still not received proper answers. These are things that follow people for a lifetime and the damage and trauma caused are reprehensible.
We have nothing to fear from a proper duty of candour which can actually also protect doctors and nurses in terms of personal liability for accidents. In the final Francis report which led to the statutory duty of candour in the United Kingdom Mr. Robert Francis, QC, very reasonably made the point about professional misconduct proceedings that professional regulators would be far more lenient on those who owned up to errors that had a serious effect on patient safety than they would on those who denied or sought to cover up their lapses. He said, "We need a situation where the legal advice is going to be, 'I know this is unfortunate, but you are going to be better off by telling them about it and by being honest and open about it than not'." Sadly, this Bill, as structured, will not do that. We owe it to people who will fall foul or be the victims of adverse incidents in the health service to deliver a proper Bill. I hope we can work together on Committee Stage to ensure the Bill will deliver on open disclosure and periodic payment orders in a way in which all of us believe citizens should be treated.
I welcome the opportunity to contribute to the debate on the long-awaited and long overdue Civil Liability (Amendment) Bill 2017. I am broadly in agreement with the points so cogently made by Deputy Clare Daly on open disclosure which were closely modelled on the well researched points made by the Medical Injuries Alliance. Open disclosure is an important concept. Very often a full and frank disclosure could prevent the initiation of a personal injuries claim and would most likely lead to a reduction in same. In that context, it is important for people to know the sequence of events. There is a duty of candour in other jurisdictions and the proffering of a full explanation of the sequence and precise nature of events is an act of civility founded on common sense and decency. An immediate apology should likewise be forthcoming contemporaneously. As Deputy Clare Daly said, this has clearly applied in the United Kingdom since 2014, particularly in the context of catastrophic events. I am of the opinion that it could be helpful to the professionals involved, doctors and others, to give their views and opinions and articulate precisely what happened in various situations. We have had a significant number of events in this country involving hospital treatments which would warrant a statutorily enforced open disclosure policy. As a midlands Deputy, I am familiar with some of the cases alluded to by Deputy Clare Daly.
We often hear the State Claims Agency referring to the significant costs associated with medical negligence claims. A lot of these costs would be eliminated at the outset by an early admission of failure, if there was fault. This could be facilitated by a statutory duty of candour. Very often plaintiffs are put through the legal wringer, with costs incurred at every step. Even when it is abundantly clear that liability should be admitted, there are still motions for discovery and so forth. Everyone is entitled to defend a case and I strongly argue that point because it is important to ensure all matters are properly tested. However, where it is abundantly clear that liability should be admitted, it should be so done. There is no point in bemoaning the cost of civil actions in the context of significant events where the opportunity to reduce such costs is not taken. This would be greatly facilitated by an open disclosure policy.
I now turn to the issue of periodic payment orders, the central core of the Bill. In December 2012, during the term of the previous Dáil, I brought this issue to the attention of the House. I am, therefore, no latecomer to it. As a barrister, it is an issue that has exercised my mind for some time. As the House will be aware, where a person is injured in an accident as an employee, or in a road traffic accident or under the auspices of the occupier's liability principles and the injured party establishes liability against a particular person or company, that party is entitled to recover compensation by way of damages. In deciding the amount of compensation to be awarded to a civil claimant the courts resort to two headings of damages - general and special damages. General damages are that part of an award which compensates a person for the injury up to the day of the court hearing and also into the future which at best is a guesstimate since the effects of the injury can be borne by the injured party throughout his or her life until he or she dies. One will often hear people belittling those who have been injured; for example, one will regularly hear people pour scorn on whiplash injuries. However, I know people who are still suffering ten or 15 years after suffering a whiplash injury and still receiving physiotherapy. People say this does not happen in England and so forth, but I take issue with those who belittle individuals who suffer such injuries. I am not talking about low-velocity accidents but those in which significant injuries occur.
General damages are encompassed by a lump sum award which, despite public perception to the contrary, is not unlimited as there is a court defined cap on general damages in civil claims. The second heading is special damages which include various items which can be calculated with reasonable accuracy with the aid of expert evidence provided by an actuary. Consultants and other experts are often also involved. Such items include loss of earnings, both past and future. In the context of likely future earnings, the possibility of not always being in employment must be factored into the estimate. Special damages also include future medical expenses and in the case of very serious physical injuries can include the cost of equipment, the modification of a dwelling house, the requirement for an automatic car, the requirement for home care and the cost of specific medical aids. Under the system as constituted in this jurisdiction, awards in these cases consist of a lump sum which is a once off payment. In terms of the amount awarded in special damages, it is especially problematic because the amount is intended to be a capital sum which, if invested wisely, will yield enough annual income for the person injured to pay his or her medical and other expenses and live comfortably with the injury.
The Judiciary has been very active in this area for the past six or seven years. Mr. Justice Kearns, then President of the High Court, established a working group on medical negligence and periodic payments under the chairmanship of Mr. Justice John Quirke and the first module of a report on periodic payment orders was presented in October 2010. The report has been available for more than six years. Several members of the Judiciary, most notably Ms Justice Mary Irvine and Mr. Justice Kevin Cross who have taken a number of these cases for ruling, have been urging the bringing forward of appropriate legislation to implement the recommendations made in the aforementioned report but nothing happened in this regard until recent times. In that context, I compliment the Minister of State on bringing forward the Bill.
The House will be aware that since 2005 in England and Wales personal injury awards in catastrophic injury claims may be based on structured settlements or periodic payments. A structured settlement is, in effect, an annual payment or an annuity purchased from an insurance company to meet the obligations in an agreement to provide periodic payments. Periodic payments are the payments made as a result of personal injury claims and to be made by way of a future stream of payments.
The executive summary of the working group's report contained 13 specific recommendations. The group was unequivocally clear that the single lump sum award was inadequate and inappropriate in cases where the plaintiff had been catastrophically injured either in the long term or permanently or where the person would require ongoing care and medical treatment into the future. As an alternative to a lump sum award of damages, the court can make consensual or non-consensual periodic payment orders to compensate injured victims in cases involving catastrophic injury where long-term or permanent care will be required for the cost of future treatment and care and the future provision of medical and assistive aids and appliances. The order should apply to the whole or part of an award in any case where, having regard to the nature of the injuries for which the award is being made and the circumstances of the person to whom the award is being made, the court considers it is appropriate and in the best interests of that person that such orders should be made, provided that the parties have been given an opportunity by the court to make submissions and be heard in full on the relevant issues. The court should be empowered to make periodic payment orders to compensate for future loss of earnings only with the consent of all parties to the relevant claim.
That is important because we do not want a broad brush. We want to give people an opportunity to be able to make their points in court. I wonder whether the Bill will facilitate this. The Minister of State might refer to this in his response because it is important that people have that opportunity. The legislation should facilitate rather than impose.
The 2011 programme for Government, to which the Minister of State, Deputy Eoghan Murphy, subscribed, as did I as part of the Labour Party's participation in government, included a strong commitment to the introduction of legislative reform in this area. It stated legislation would be introduced to enable the courts to make "provision for structured settlements in circumstances where lump sums are currently awarded as a consequence of individuals suffering catastrophic injury because of the negligence of another". The main purpose of an award of damages is to restore people, as far as is possible by way of pecuniary compensation, to the position that prevailed for them before they were wrongly injured. The provision of such awards is clearly inadequate for people with catastrophic injuries, but its objective is restitutory in nature. Such an attempt at restitution by way of monetary compensation is, of course, totally and absolutely inadequate.
I take grave issue with the fact that it has been determined by the courts that the maximum claim in general damages that somebody who has been catastrophically injured can receive is €450,000. The big awards are made when special damages are being claimed in respect of medical assistance, aids and equipment, the modification of houses, the provision of automatic cars and the loss of earnings. A recently qualified plumber aged 25 years should have 40 years of paid work in front of him or her, given that he or she could work until he or she is 65 years of age. When the loss of these earnings is actuarially evaluated, the amount of the compensation could come to several million euro. However, it is lost in the discussions on this issue that the maximum one can receive in court for the injury is €450,000, which is totally on the lower side. Special damages constitute a significant element of any award in catastrophic injury cases. I reiterate that the current ceiling on awards of €450,000 in general damages for catastrophic injuries is totally inadequate when considered against the pain and suffering, the loss of amenities and the loss of expectation of life.
Advocates of a lump sum award note that it is final and that it allows the injured party, or those acting on his or her behalf in loco parentis or as part of a committee, to deal with his or her needs and wants as they arise. I accept that it is an advantage that a lump sum award of €4 million or €5 million is final. This approach enables people to deal with their circumstances. While there are advantages to this approach, the argument against it centres on the possibility of over or under-compensation. The Minister of State has made this argument, with which I agree. The periodic payments principle is enshrined in the Bill for this reason. The role of the actuary is central to the calculation of awards in cases involving catastrophic injuries. Actuarial assessment plays a pivotal role. The calculation of average life expectancy which a court has to determine might not ultimately bear comparison to the real or actual life expectancy of the person involved. If the injured person dies before the date expected, measured or outlined, there is over-compensation. In such circumstances, the defendant cannot recover or reclaim what is, in effect, an excess of damages. We are talking about special damages in such cases because that is where the huge sum arises. Of course, the converse is also true. It is clear that when an injured party lives for a significantly longer period than expected, anticipated or measured under the Irish population mortality statistics - all of this is done statistically - the damages will not be sufficient to meet his or her needs or requirements during the latter phase of his or her life. Such a person will find himself or herself with insufficient resources to meet his or her needs. That creates a huge issue. Annual periodic payments could deal with this issue on a real and practical level. That is why the Bill is so important.
The rate of return on the investment of lump sums which have to be invested is critical. The other issue that has to be considered when a lump sum is awarded is that it is predicated on the cost of care and various other things I have mentioned. Such costs could escalate significantly as a result of inflation. This might mean that they are well in excess of the rate or value operating at the time of the court proceedings and the awarding of the grant. While lump sum awards have the benefit of being definitive and final, they have presented a significant challenge to the members of the Judiciary who deal with these cases and try to do their level best in a sea of uncertainty. Various judges have consistently championed the development of a system of paying damages by means of periodic payments. As I have said previously, periodic payments facilitate the structuring of awards or settlements in a more realistic way in order that injured parties receive regular annual payments for as long as they live.
The working group under the chairmanship of Mr. Justice John Quirke specifically recommended that a periodic payment order be made only where the court was "satisfied that the continuity of payment under the order is reasonably secure". If that recommendation is to be brought into effect, a form of financial infrastructure will have to be established to guarantee the level of payment. I suggest the Minister of State consider the possibility that the National Treasury Management Agency, NTMA, will have to be involved. It might well seek to be involved. My view is that it could have a significant role to play in that regard. It is a complex area. The Minister of State has a role in the Department of Finance which might well look at the possibility of providing for NTMA involvement in that regard. It has a very high reputation in areas such as this. It would be useful to resort to it in this instance. I have always been concerned about the impact of cases in which plaintiffs live for longer than expected or are imputed in the calculations. It is possible that the awards in such cases will be insufficient to meet the needs of those involved, thereby placing substantial pressure on parents, people acting in loco parentis or others concerned with meeting such needs. We hope those who receive €3.5 million or €4 million will live for ten or 15 years more than we might anticipate, but we must have arrangements in place for such cases. That is why this is an important area.
I have always advocated that provision should be made for the appropriate indexation of periodic payments. I believe they should be index-linked with the earnings of treatment and care personnel and changes in the cost of medical and assistive aids and appliances. The Minister of State deals with the ordinary consumer price index every day of the week. There is a huge difference between medical inflation and ordinary inflation. The Minister of State might say attempts are made to control both, but there is a big difference between them nonetheless. A link with the consumer price index would do a disservice to what we are trying to do. It would actually defeat the purpose of our endeavours. The Minister of State has spoken about the involvement of statistics from the Central Statistics Office and such things, but I argue strongly that there should be a link with the level of earnings of treatment and care personnel who are essential in this context and changes in the cost of medical and assistive aids and appliances. That would ensure plaintiffs would be covered for the cost of treatment and care well into the future.
I certainly welcome the Bill and compliment the Minister of State on reaching this point. I raised this issue with the then Minister, former Deputy Alan Shatter, on 4 December 2012, which is near enough to four and a half years ago.
Is he gone that long?
He assured me that this legislation would be brought forward in 2013. I appreciate that it is a complex area and the Bill is better late than never. I congratulate the Minister of State and the officials in the Departments of Justice and Equality and Finance. There is a lot of work ongoing in these Departments. I do not wish to criticise anybody as people do their best to bring forward proposals and it was not easy to legislate to deal with this issue. People often say flippantly that certain things can be done overnight. There are many flaws in the current arrangements. I have pointed to one or two things, of which I would like the Minister of State to take cognisance. I do not say this for the purposes of blowing a trumpet but to make sure the legislation that will emerge will deal with this issue. It will benefit people who receive catastrophic injuries in the course of medical treatment or road traffic accidents - we would love if nobody suffered such injuries at any stage - and who become plaintiffs in employers' liability or occupational injury claims. We hope no such accidents will occur, but when they do, we must ensure it is possible for those who are unfortunate enough to find themselves in this position to secure the very best result.
The others who will benefit from this legislation are legal people, particularly judges, who have been advocating for it for a long time and will be mightily relieved and grateful to see it at long last being placed on the Statute Book and passed by the Houses of the Oireachtas.
I am pleased to speak to the Bill as it deals with a matter that affected many people when they presented at a hospital and the right result was not achieved for them. This is an issue that does and will continue to affect many.
As the Minister mentioned, open disclosure is about an open, honest and consistent approach to communicating with patients and their families when things go wrong in health care. The open disclosure process should include keeping the patient informed, providing feedback on investigations and the steps taken to prevent a recurrence of the incident. It may also include, depending on the particular circumstances involved, an apology for what happened. I note that the Minister first announced his intention to push forward legislation to enforce a medical negligence open disclosure policy in an address to delegates at the State Claims Agency's first annual quality, patient safety and clinical risk conference at Dublin Castle in September 2016.
It is a fact that many involved in the legal profession make a great deal of money out of cases where people make a claim to obtain redress because things had gone wrong in hospital, something should not have happened to them and, in some cases, lives were lost or people were hurt and the right result was not achieved. The Minister also said at the event that the establishment of a new national patient safety office would "lead a programme of significant patient safety measures" that would include a review of how adverse medical events were disclosed to patients and their families and the process for claiming medical negligence compensation. I would be worried if this were to be another governance arm set up in the HSE where we would have to depend on the HSE to tell the patients about their rights. An independent body should be monitoring this area. It should not be another job handed to the HSE to correct itself or check what happened. I would not trust it in that scenario. It must be an independent body to monitor this area.
I note that A Programme for a Partnership Government also makes it clear that open disclosure is an essential component of patient safety and commits to measures to support it. The programme also states it will be made mandatory to report specified patient safety incidents or serious reportable events to the authorities and the patient harmed. That is certainly necessary.
The general scheme of the Health Information and Patient Safety Bill also has provisions on voluntary external reporting of non-serious incidents to the States Claims Agency, supporting and complementing the current reporting process to the agency. However, it is not proposed to legislate for mandatory open disclosure to patients. That is wrong. That is what we should be hoping to achieve in the Bill, that there would be mandatory open disclosure and that doctors, nurses, matrons or whoever makes a mistake or an error would come clean and tell patients or their families what had happened. That is what this is about. It appears that doctors and others involved in the medical profession are prevented by the HSE from disclosing to patients what happened in different cases. That is wrong. This measure should legislate for mandatory open disclosure to patients. We are told the reason it is not proposed to legislate for this is related to creating the positive voluntary climate for open disclosure laid out in the Madden report and which will be reviewed in line with experience to see whether it needs to be strengthened and how, if necessary, that could best be done. I do not trust that aspect of the Bill
In Australia one of the central principles of open disclosure policies involves the presence of good governance and the insistence that quality assurance requires organisations to be able to demonstrate that they learn and improve their performance through continuous monitoring and by reviewing the systems and processes in place for meeting their objectives and delivering appropriate outcomes. Can we hold out any great hope the HSE will be capable of demonstrating that approach? As the Australian model of open disclosure also notes, health care organisations need to ensure appropriate direction and internal control through a system of governance. It is imperative that each facility and its management show the capacity and a willingness to learn from adverse events. As noble as the aim is and as good as the principle is, do we really need to go about creating an additional level of governance within the HSE? How can we prevent the difficulties that will go along with it?
I welcome the principle of the Bill, but I have serious concerns about the capacity of the HSE to carry it through. There is a need for a radical change in its culture first. We all know about the serious events where the lives of family members have been lost, where family members have been left with serious disabilities, where babies have been left with serious disabilities caused by negligence during childbirth and where mothers, likewise, have suffered during childbirth. Doctors and nurses know at that point that they have slipped up and it would be much easier if they were allowed to come clean. I know that most of them would, but they are prevented from doing so by their organisation, the HSE. I refer to people who have lost a family member, a father or a mother, the breadwinner in the family, because cancer was not diagnosed in time. Men and women have lost their lives because a heart complaint was not diagnosed. Sadly, after spending days in hospital, when it should have been detected, they died. Someone has to be held to account. Someone must be accountable when something dreadful like that happens and family life as they knew it is finished forever. In cases where the breadwinner dies the wife and children will suffer for years and never recover following their loss. I know of one hospital which I will not name where six lives were lost in the space of two months. They lost their lives because they had developed clots as their complaints were not addressed when they presented at the hospital. I know about these incidents because I was very close to one of the people concerned. That is not right. I know that the doctors and nurses involved knew that things were not right and that they would have come clean, but the system in place does not allow them to do so. A lot of money has been lost in the courts with mounting legal costs. When an award is made, a percentage of it goes directly to the legal profession, including barristers and solicitors; that money could be used to pay damages to many people to give them some retribution, while freeing the courts to deal with other business.


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Penrith City
Is a Power Partner
council facilities have solar PV
Local government has a strong history of working together on energy and climate-related projects, and this partnership gives us an opportunity to continue and strengthen that work by sharing knowledge, experience and resources, to achieve positive outcomes for all
Partnership Action Pledge
Our power partners are committed to switching to non-polluting energy and reducing emissions in their communities.
Install renewable energy (solar PV and battery storage) on council buildings for example childcare facilities, libraries, street lighting, recreation centres, sporting grounds and council offices.
Power council operations by renewables, directly (with solar PV or wind), or by purchasing Greenpower (from electricity retailers). Set targets to increase the level of renewable power for council operations over time.
Adopt best practice energy efficiency measures across all council buildings, and support community facilities to adopt these measures.
Public lighting can use a large proportion of a city's energy budget – roll out energy efficient lighting (particularly street lighting) across the municipality.
Set city-level renewable energy or emissions reduction targets and sustainable energy policies to provide a common goal and shared expectations for local residents and businesses.
Penrith City
What council has achieved in the past in energy efficiency, renewable energy or broader sustainability:
Since commencing our Sustainable Penrith program in 1999, we have undertaken a number of key actions including the establishment of our Sustainability Revolving Fund in 2003, a financial mechanism that provides ongoing funding for sustainability projects with savings re-invested back into the fund for additional projects. More recently, we've adopted our Cooling the City Strategy which provides strategic actions to adapt to climate change; retrofitted our most inefficient street lights with new efficient LED fittings, and completed the installation of solar PV systems on more than 25 Council facilities.
What council hopes to achieve in the future in energy efficiency, renewable energy or broader sustainability:
In 2015, Council adopted a Sustainability Policy and Strategy to provide clear direction to the organisation to ensure that sustainability remains a key consideration and is effectively built into our operations, activities and decision making processes. At the same time we also adopted corporate emissions reduction and renewable energy targets:
- 10% of council's electricity supplied from low carbon sources by 2030
- 40% reduction in greenhouse gas emissions by 2030 based on 2010-11 levels.
These targets are an important way of continuing to encourage resource efficiency within the organisation and the transition to more sustainable energy efficiency.
Why council joined the Cities Power Partnership:
Participation in the Cities for Power Partnership provides significant opportunities for Penrith Council to gain ideas on how to tackle issues we face in Penrith from other cities that are in a similar position. The Partnership also aligns closely with several focus areas and actions identified within our recently adopted 'Sustainability Strategy 2015'. The Partnership will provide major benefits to Council, complementing our participation in the Global Covenant of Mayors for Climate and Energy, which focuses on climate change mitigation and adaptation, and our participation in the Resilient Sydney Program.


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Pleasant Ridge Physical Therapy Services
HealthQuest Physical Therapy in Pleasant Ridge is conveniently located in Pulse Fitness, which is located inside the Iron Ridge Complex on East 10 Mile (696 service drive and Bermuda). The Iron Ridge Complex is a short drive from Royal Oak, Ferndale, Hazel Park, and Madison Heights. Pulse Fitness offers over 10,000 square feet of a unique design that combines industrial and modern elements along with state-of-the-art equipment. We are excited to partner with an organization and facility that shares similar beliefs and missions. Pulse memberships are separate from Physical Therapy but are similarly created and centered around the individual and you only pay for what you'll use: independent gym use, personal training, group training or fitness classes. Our talented Physical Therapist team has years of experience in treating patients with orthopedic problems, injury prevention, and pre/post surgical treatments. Bringing these services into Pulse Fitness allows us to offer the full continuum of consistent, high-quality care that is specific to each patient's condition.
HealthQuest Physical Therapy centers lead in musculoskeletal healthcare by serving, rehabilitating, and caring for the total patient and athlete. Our commitment is demonstrated by engaging in education, advancing our profession, and acting as a resource to our community. Whether your goal is to get back on the golf course or bounce back from surgery, we have the experience and know-how to create the most effective rehabilitation program for you. When seen at HealthQuest Physical Therapy Centers you can expect friendly, professional, one-on-one attention from our knowledgeable board certified physical therapists and physical therapist assistants.
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