Leaders' Questions

As elected representatives, we have the honour in the House of having been given the responsibility to debate issues and introduce legislation to improve the country and the lives of our citizens. There will always be political differences; it is a political job. There will be heated debates and slagging matches. Overall, however, all Members are committed to making a positive difference for their communities. We will always have to take into consideration how the public who elect us and whom we serve believe an issue should be dealt with. Over the past two weeks, there have been heated exchanges on the chaotic, irresponsible way CervicalCheck has handled its audit of cervical smears. This was brought to public light by Vicky Phelan who was forced to take her case and tell her story to the High Court. The bravery she showed has led to many developments, including scoping inquiries, processes, data collection and inquiries into laboratories here and in the USA but there has been very little discussion of the impact on women. Of these women, 17 are already dead. The courage of Stephen Teap in telling the story of his late wife, Irene, is amazing. He and 17 families are now digesting the fact that their wives and mothers could have had a better prognosis and chance in life had their smears been read properly.

If any of us was in any doubt about the impact of these mistakes, this morning's interview with Emma Mhic Mhathúna on "Morning Ireland" by Audrey Carville will have blown such complacency away. It is an interview which will stay with anyone who heard it. It seared the soul of our country. It is hard not to be completely distraught at the devastating heartbreak Emma and her family face and there are no words anyone can say to console her, her five children, her family or her friends. She articulated her story in an unbelievably brave way. She was told in 2013 that her smear test was normal but she was diagnosed with cervical cancer in 2016. Yesterday, she met her own GP who told her she had terminal cancer which had spread to her bones. She waited until her child's confirmation, held on Tuesday, was over to get that news. Her GP told her and her gynaecologist confirmed that if her smear test had been read accurately, she would not be facing this diagnosis now. She said that is where it is so much more heartbreaking. She said "I am dying when I don't need to die". She is 37 and has five children, one of whom is a baby. She said "I don’t even know if my ... baby is going to remember me".

The time for defiant defence is over. It is not a time to defend the Government or the HSE. Please stop. Please stop as a Government and listen, but more importantly, hear the story of Emma, of Vicky Phelan, Irene Teap, the deceased women and all those women who are currently going through this journey. Emma's is only one story in an ocean of anguish. I ask the Minister to provide the House with his thoughts as to whether all these women have been failed by the State. Does he believe there should be immediate accountability?

I heard the interview this morning to which the Deputy refers. It was a bright morning and I heard Emma speak about her family, her community and how she feels about all of the normal things in life one sometimes takes for granted until they are taken away. The tragedy, anguish, anger and fear of which she spoke regarding her life, the consultation she has to have tomorrow and what that means for her and her family were harrowing to hear. As such, there are few words I can offer which recognise the scale of the tragedy and the vast difficulty Emma and her family are grappling with.

As Deputy Calleary acknowledged, there has been much debate in the House over the last number of weeks on this tragedy and the cases of the other women who have been affected. No one here has a monopoly on compassion or anguish and what we heard this morning reminded us of that. To answer the Deputy's questions, it is, of course, the case that the Taoiseach, the Minister for Health and the entire Government are completely committed to doing two things. First, we are committed to ensuring we establish why this happened, who is accountable and how it can be prevented in future. That is why the Government has put in place a scoping inquiry on the issue which will provide an interim report in the next number of weeks and a final report shortly thereafter. This is independent and is not being carried out by Government. Rather, it has been facilitated by the Government to get to the bottom of what happened quickly. Thereafter, we will move to a full commission of investigation on the issue. As to immediate accountability, there are two individuals who are no longer in post and performing their previous duties on foot of a recognition of the scale of difficulty and tragedy that has been created.

The second priority of the Government is to put in place all of the supports we can for women to offer comfort to them at a time of great vulnerability. That is why we have put in place the independent review of all audits which have taken place. That is why we moved quickly to make available consultations and further smear tests if needed. That is why a helpline was so quickly set up to provide consultations to women who clearly need and deserve this. Juxtaposing my words and the actions we are taking against the anguish on our airwaves this morning, it is clearly action that is needed. The Government has taken action and is committed for the sake of Emma and everyone else to seeing this through, establishing what has happened and providing all the support that can be provided to women at a time of such great anguish and need.

There are no words and I accept that, but the actions of which the Minister speaks are not meeting the challenge. Emma was hugely complimentary about her own GP and her gynaecologist this morning, but that GP, like all others, received a proper information pack only last night on how to deal with the avalanche of concerned inquiries in their surgeries. That took two weeks. The professionalism of Emma's team will not make it any easier for her at 37 years of age. She said this morning that the State had failed her and let her down and she said the Government was not capable of minding us. When the director general of the HSE was challenged about this interview this morning against the background of everything that has been caused by this controversy, he accused Deputy MacSharry of causing and spreading hysteria. He takes no accountability, however, for his own role in this.

We do not need words and promises or shouting or roaring in the Chamber, we need action which shows Emma, Vicky, Stephen and all of the affected women that this Legislature and each and every Member who has the honour to be here understands where they are. We will never be able to walk that journey with them, but do we understand as politicians where they are and get why they need accountability? They may not see the end of an inquiry and the report which is produced. For the sake of our country, I ask the Minister please to demonstrate that the Government is capable of dealing with this.

I am pointing to actions that have been taken and that are under way in recognition of the grief, tragedy and great uncertainty that too many women and citizens face at present. They were let down and we need to understand how this happened and what support can be given. I have outlined the actions the Government has taken. I pointed to an independent inquiry which is already under way and which will report as soon as possible in order to establish why this happened and who bears responsibility for it. The words I am offering here today seek to do two things. First, they seek to offer, in whatever limited way any of us can, a recognition of the scale of the tragedy about which we heard this morning on the airwaves. In conjunction with that, I am also pointing to the actions that have already been taken by the Government in the days since this tragedy became apparent to it and the House. Actions have been taken and will continue to be taken.

In tandem with this, as is correct and proper, many of the individuals and organisations referred to by the Deputy have been before Oireachtas committees almost all week, demonstrating that accountability is happening now. In addition, the Government is giving, and will continue to give, support in respect of the review of audits, making sure that support is available to GPs and women who want and need further smear tests and the helpline. All of that is action that has been taken. More action will be taken as we deepen our understanding of, and our inquiry into, what happened to these women.

Like many others, I sat in my car earlier listening to "Morning Ireland". Unlike other mornings, however, I sat there frozen, shocked, angry and upset as I listened to Emma Mhic Mhathúna speak about her diagnosis of cervical cancer, her misdiagnosed smear tests and how her full medical history was kept from her until last week. Emma told us that her cervical cancer is terminal. She spoke about having to tell her five young children that she is dying. Her youngest is the same age as my grandson and I cannot comprehend having to try to share that news with a two year old. She said, "I'm dying while I don't need to die". Not only does Emma feel that she has been let down by the Government and the HSE, she knows it. Emma said, "the Government isn't doing anything about it. ... surely the Taoiseach is going to do something, and he just seems to be sticking up for them." That is how it appears to the victims - that the Government is sticking up for those who were in charge when the decision to withhold information from women and their families was made. It appears that the wagons have been circled and that those at the top are protecting each other. What about the victims? Who will protect them?

Stephen Teap lost his wife to cervical cancer. He found out last week that she was one of the 209. She was given two false negative results. Speaking on "The Ray D'Arcy Show" he said that the head of the HSE was not accepting accountability for this and that until the Government sends him out the door, it cannot be seen to have control of the situation. The Tánaiste and Minister for Foreign Affairs and Trade has met Mr. Teap and I am sure Mr. Teap told him the same thing he told Ray D'Arcy. This morning, not long after listening to Emma's interview, I took a telephone call from Lynn who lives in Carrick-on-Shannon. She is a mother of two and had to undergo a radical hysterectomy at the age of 39. She was diagnosed with cervical cancer and she was one of the women who was given a false negative. In fact, she was given three negatives in a row. Lynn contacted me because she wants accountability. She has added her voice to the calls for Mr. Tony O'Brien to stand aside. It is not good enough that Mr. O'Brien is shielded or that the Government simply says that he will be gone soon in any event.

As I listened to Emma's interview I, like others, fought back tears. This woman and the victims of this scandal need and deserve accountability. Does the Minister have confidence in Mr. Tony O'Brien? Emma said this morning, "They're all hiding there in the Dáil and they don't see what I see." Is the Minister going to stop hiding?

When I heard the interview this morning, my world began to slow down and then stop at the scale of the anguish and tragedy that Emma and her young family are dealing with today and have been dealing with for the past number of days. The feelings Deputies O'Reilly and Calleary have articulated are the same feelings I had this morning. They are the same feelings my colleagues in the Government have. To hear this mother speak of having to sit down and talk to her young children and her family about what does not lie ahead is something that slows all of us down and makes us reflect on the obligations we have as members of the Government and Members of the House.

To be clear, the only agenda the Government has is to establish fully what happened. That is why we moved so quickly to put the inquiry I referred to in place and why a number of individuals who were involved in this work are no longer in post. Second, it is to put in place the further help that is needed to provide support to the health and lives of women. Our only agenda is to do the right thing and establish what happened. No wagons are being circled, and no circle is being created. The only obligations this Government is aware of are those it has in respect of the health and lives of women. That will be the guiding approach we will use in continuing to deal with this tragedy and the great uncertainty that exists over the coming days.

My question was a simple one that required a "Yes" or "No" answer. Does the Minister have confidence in Mr. O'Brien? I ask that question as a user of the CervicalCheck service and as somebody who supports that service and knows how important it is. However, it is also important that there be accountability so women can trust the service. Somebody should be paying a huge price for this scandal but it certainly should not be women such as Emma and their families. I will put my question again. Does the Minister have confidence in Mr. Tony O'Brien?

I believe Mr. O'Brien should continue in his post. The reason, to address the question the Deputy posed, is the concept of confidence. The greatest duty we have at present is to restore confidence in programmes that have saved lives and helped the health of women. As a result, I am of the view that Mr. O'Brien should continue his work over the next number of weeks. He has appeared before Oireachtas committees in recent days in order to be accountable in his role as director general of the HSE. I understand that this afternoon he will be working with the team that is dealing with responding to the questions and the great uncertainty that exists at present. If our prerogative is - and I believe it is shared across the House - to examine how we can restore confidence in programmes that have saved lives, helped health and mean that men and women are alive today who otherwise would not be with us, that is best served by Mr. O'Brien completing his time in office and ensuring that he answers the questions to which he has to reply now.

The personal testimony of Emma Mhic Mhathúna was quite devastating, as everybody has said. I listened to it in my office. I will never forget it. The impact of this scandal on families across this country is causing enormous public distress.

As a father and husband, I can only think of my own wife and children. I ask Members to put themselves in a similar situation. Many of us in this House are, I presume, thinking the same thing and considering the distress being caused. I say to Members of all parties and none that, politically, this scandal is a stain on all of us and on our health service.

This morning, at a meeting of the Committee of Public Accounts that I chaired, the chief executive of the HSE revealed that he had a memo on this matter dating from early 2016 and that it was possibly sent on to the Department of Health. We will receive the memo in the next hour and it will add to the issue of accountability, which, as we all know, it is necessary to deal with.

There is another and greater priority here, namely, what we will do immediately for these women. It may take time, but there will be accountability in the health service and politically. The State has committed to providing assistance to Vicky Phelan. Will the Minister make a commitment that all women, including Vicky and Emma, who have received terminal diagnoses will have absolutely all possible treatments and supports paid for by the State? This is one occasion on which we actually need to provide a blank cheque to people in light of the circumstances in which they find themselves. We are aware of the issues of public confidence, the phone lines and the very large number of calls that many people are trying to deal with. I put this to the Minister for Health, Deputy Harris, previously. He has taken on board many of my suggestions over the past week. I want the Minister, Deputy Donohoe, to take on board this as well in order to address these immediate concerns. To restore public confidence, the Government should authorise a random sampling of smear tests carried out in the past three years. It should commit to this so that we can get the statistics and results in order to give public confidence a boost and ensure that women can at least know that the sampling showed statistically what has happened in the past.

Primary human papillomavirus, HPV, testing will be introduced later this year in respect of CervicalCheck. There have been calls by experts - I have spoken to a number of them - for this to be fast-forwarded. From these consultations, I know that this will not happen this year unless money is put aside for labs and IT systems. The Minister is the man with the chequebook. Will he ensure that the money in this case is ring-fenced in order that the HPV version of the testing can be brought forward as quickly as possible this year?

Finally, Vicky Phelan has requested that a commission should consider in public the issues about which we all know. Section 11 of the 2004 Act provides that a commission shall conduct some of its investigations in public. It is clear that the law for commissions of investigation provides for public hearings under this section of the Act, whereby victims such as Vicky Phelan, Emma Ní Mhathúna and anyone else would be able to speak. Can we stop beating around the bush on this? Will the Minister confirm that the Government will allow this to happen?

The Deputy made the point that he found it difficult, or even impossible, to imagine what it would be like to walk the journey Emma is walking this morning and how we would deal with and what we would say to those whom we love and to our own families. We often come across tragic situations, but our ability to understand them or to walk in the shoes of those affected is so constrained because the hurt and tragedy are so great. What we heard about this morning is one such tragedy. I agree with what the Deputy said about imagining what it would be like for those conversations to take place and how that family feels today. I am aware that this private anguish has now become a matter of such public interest and is so visible, and we must respect the family at all points as they grapple with what their mother and Emma herself are dealing with.

I know Deputy Kelly is engaged with the Minister for Health on matters other than those he has put to me, and I thank him for the way in which he has done that. Regarding the three points Deputy Kelly put to me, first, of course, any support we can offer to women dealing with what this means for their lives and their health we will make available. We know how they feel at present, we know the questions that must be answered, we know that women who had information about their health that was not shared with them were let down, and we must respond to that, as this Government will.

Regarding the Deputy's second question about the timing for the roll-out of HPV testing and when it will happen, any help I can give to the Minister for Health and the HSE in making this happen, of course, I and the rest of the Government will give.

On the commission of inquiry and how much of it should be held in public, this will be a matter for when we set up such a commission and for the person who will run it. I do not need to tell the Deputy - he will be aware of this - that there may well be citizens who will participate in this commission who do not want their participation to be public, particularly in light of the scale of private anguish with which they are dealing. I would have no objection to any dimension of that being made public if the judge or person leading the commission of inquiry decides to do so and, of course, if the citizen, the person participating in it, gives his or her consent for that to happen. We all need to be mindful of the scale of private tragedy faced by a number of families at present.

I thank the Minister for answering the questions for once. There is another aspect to this: the Labour Party has been pushing for a long time for the health technology assessment, HTA, to be brought forward in respect of HPV screening of boys. HIQA must do this. This needs to be brought forward in order that we can have herd immunity and protect the population into the future. I ask the Minister, through Government, to push to ensure this.

This morning, Emma said, "The Government are not actually capable of minding us." We want confirmation that all payments and costs associated with treatment of these women will be covered and that the random sampling will happen. The Minister for Health has come a long way in agreeing to this today and in the past. The HPV funding which is required in respect of the labs and the IT systems should be brought upfront in the next few months and not the next few years. This will cost millions and human resources will have to be allocated. Such resources must be provided. Furthermore, I accept and agree that some people may not want to be out there in the public when it comes to the commission, but some definitely will. If they are speaking on national radio and television, they certainly want to speak in the commission of inquiry in public, so we must allow that to happen.

Finally, there was a real issue regarding the fact that, on Tuesday of last week, the Minister for Health had to walk into this Chamber and say he had been misinformed about the number of women affected. We discovered subsequently, through the National Cancer Registry, that 1,620 women came from a different cache and had cancers and were not part of the audit. It is also important, from a public confidence point of view, that we know that this is the only case in which this has happened, that it is not the case in any of the other screening programmes - for example, in bowel screening. I have had confirmation of that this morning, so that needs to be brought out on the public record.

I will respond to one of the points the Deputy put to me, which, of course, is prompted by the tragedy that we are all aware of this morning, about what our obligations are to mind our citizens. In the midst of all of us responding in the way we are attempting to, we need to be aware that while we are looking at great private tragedy and anguish today, the programmes that have been in place have worked for many. This is why there is such an imperative on all of us, but particularly those of us in government, that we ensure we restore confidence in respect of the issues and tragedies that are now causing these programmes to be challenged. As a country, as a State, for all of us who have been in the Dáil, for anyone who has served in government, we have seen improved outcomes in respect of invasive cancers because of the long-term commitment that politicians in this House, of all parties and none, have to trying to help our citizens. Only a number of months ago, the Minister for Health published a national cancer strategy that was welcomed by the Dáil. We have seen improvements in the survival rates and treatments of so many different forms of cancer.

This backdrop, however, is what makes the stories we heard this morning so much more acute and more tragic. Inside the figures which I gave the Deputy, we all are aware that this morning, we have heard from a family and from Emma, who may not be part of that. That is what we all seek to respond to.

The Government has sought to respond in a prompt fashion. Deputy Kelly asked a specific question on random sampling that I had not answered in my first response to him. We have brought in two international institutions to put in place the review of audits which we know is vital. We want the review to conclude as quickly as possible. I will put Deputy Kelly's specific point to the bodies that are undertaking that work. We will see if it is possible and either myself or the Minister, Deputy Harris, will respond to the Deputy.

We very much share the anguish that everyone feels in response to hearing the tragic stories this morning of women who feel that the State has left them down.

I want to raise a wider threat to the State and to all our people in respect of what is happening in the Brexit negotiations. The meeting in Dundalk with Michel Barnier and the interested stakeholders was very useful. It presented a very stark picture of where we are in the withdrawal negotiations, where 75% of the text of a putative withdrawal treaty has been agreed but two critical areas remain. One is the Irish issue, which in a sense is a metaphor for the wider issues about the nature of the customs arrangement that will take place between the UK and the rest of the European Union, although Ireland's concerns are very specific. The second, if we can overcome that, is the issue of governance which would effectively be the agreement of the UK Government to accept the European Court of Justice, ECJ, as the arbiter for that initial agreement and any future negotiations. The scale of the challenge in getting those two was remarkable, and then there is the transition arrangement after that where we would have to have 700 deals for a whole range of different sectors and where the EU has to have unanimity. The EU has all the negotiating power because it is staying the same and is not changing how the Union works, whereas in effect the UK must give in every area.

From what happened in London subsequent to our meeting in Dundalk last week, it seems clear that the UK Government seems completely incapable of addressing that challenge. The Tory party is split like a log divided in two by an axe. There seems no way by which the two parts of that party will come together. As there is an opposition there that is not putting forward an alternative, it is hard to see how agreement might come from the UK Parliament.

There seems an increasingly high risk that the UK will crash out of the EU, where there will be no draft treaty withdrawal agreement. Yesterday, the Taoiseach said that he has not spoken to the British Prime Minister in six weeks. However, the Minister, Deputy Donohoe, has met and spoken to the Chancellor of the Exchequer, Philip Hammond. Is the Minister starting to work with the Chancellor of the Exchequer on plans for such an eventuality and how we can avoid the absolute economic carnage that would take place in the event of a crash-out Brexit without any withdrawal or trade deal, where presumably we would revert to World Trade Organization, WTO, rules and where there would be incredible economic dislocation?

We have had a good process with the Tánaiste, Deputy Coveney, on the talks. However, we have not looked at the "emergency, brace yourself, we are about to crash" scenario. It is time that we did that. It is time that the Government and all the parties sat down about this, perhaps in private as some of these matters are difficult to discuss publicly. The responsible thing to do for Irish society, North and South and our relationship with the UK, would be for us to start thinking about what we would do in that scenario because to me, that scenario seems like the most likely. If there is any reason that the Minister can question my logic, I would be glad to hear it. I also would be interested to hear what the Minister and the Chancellor, Philip Hammond, are working on in this incredibly threatening and complex process.

It is correct that I met the Chancellor of the Exchequer, Philip Hammond, some weeks ago while I was in Bulgaria at a meeting of European finance ministers. The Tánaiste is in the UK today and will also meet the Chancellor and the Minister for the Cabinet Office, David Lidington, to review where negotiations stand and once again articulate the Irish national interest in the negotiations. The Government and this House need a clear pathway and framework to ensure that in the case of any eventuality that could occur when the United Kingdom leaves the European Union, our interests in respect of Northern Ireland, specifically in ensuring that there is no return to a hard border, are delivered. That is the Government's public position and what all our efforts, privately and otherwise, seek to secure.

The Government has done a significant amount of contingency planning to look at the different scenarios that could develop. I will speak to the Tánaiste about seeing how that could be shared. I understand that some of it may already have taken place and that there have been stakeholder fora where political parties, politicians and stakeholders are present. As we approach June and beyond, we are entering a period where it is crucial for Ireland to secure its objectives for the island and its stability. We have the support of the European Union in so doing and will work very hard to ensure it happens.

Regarding the Deputy's analysis of what is under way in the UK, it is not appropriate for me to comment on the internal workings of another government. I will leave that to the Deputy. I would say it is interesting that in the votes which are taking place in the British Parliament, in the House of Lords and others that could occur in the future in the House of Commons, views are beginning to crystalise on what form of Brexit could happen. That could yet have an effect on issues that the Government and the Dáil will need to respond to later in the year.

I agree with the strategy of holding to no hard border but I am concerned that we are putting ourselves at the epicentre of a bigger problem, namely, that the Tory Government cannot agree anything about the future relationship between the UK and Europe. It is putting Ireland at the central point of what is the bigger problem, which is that the Tories want to have their cake and eat it but will now not be able to get it. We must be careful that we see the bigger picture.

The stakeholders forum has been very useful but we have not looked in detail about what will happen in a crash-out scenario where there is no withdrawal deal. As I understand it, in those circumstances there would not be a backstop arrangement then because that is part of the deal. Our discussion on this in Dundalk was interesting. The impact it would have on the beef and cheese sector, for instance, is that overnight there would be tariffs of 50% or 60%. However, it is not just those sectors. How would the financial services sector manage in those circumstances? What would happen to all the digital services companies or flights between the various jurisdictions? In every one of those 700 areas where we have to seek agreement, if we do not have a transition arrangement, there will be an economic crash and we will be stuck in the middle.

I ask a question of the Minister and he can respond through the Tánaiste and it could be in private rather than public, because the issues are sensitive and difficult, but we need to start preparing for that now. We need to start being honest and upfront with the UK Government about where we are at. It is not merely an Irish Border problem now, the whole arrangement is in deep trouble and we must start getting ready for that.

Many of the issues at the epicentre - to use the Deputy's phrase - of how the United Kingdom will leave the European Union are crystalised in the very issues with which the Government and Dáil are dealing.

Many of the issues that are at the heart of Britain's future relationship with the European Union in respect of customs policy, access to the Single Market and the role of the European Court of Justice could have their most tangible manifestation in the issues with which we are now dealing on our island. That is why we have been working so closely with the European Union task force led by Michel Barnier and why Mr. Barnier was in Dundalk last week. I was there myself for most of the day. Both he and the task force have a very clear understanding of the issues that Ireland faces because they are at the heart of the issues which will define the relationship between the UK and the EU.

I will answer the two questions the Deputy put to me. The first was whether we are being direct with the British Government regarding the challenges and our national interests in this regard. The answer to that question is yes, but we are doing this primarily through the EU task force led by Michel Barnier. The second question had regard to the degree of contingency planning that is under way. Again I can tell the Deputy that planning is very advanced. It is dealing with many different possible outcomes. I have direct responsibilities for areas relating to banking and financial services and for what it would mean if we were met with the vista the Deputy described. We have much work done and more under way in that regard.