Leaders' Questions

Before taking Leaders’ Questions, I call on Members please to stand as a mark of respect to those who have lost their lives or been seriously injured as a result of the horrendous activities in Gaza.

Members rose.

I appreciate the opportunity to express sympathy and to talk about the issue later.

Last Thursday, at a meeting of the Committee of Public Accounts, three memorandums, dating from March and July 2016, revealed that the CervicalCheck management team, the leadership of the HSE, the acute hospitals division of the Department of Health and the Chief Medical Officer had all shared and discussed memorandums related to the CervicalCheck cancer screening audit, as well as decisions on communicating with treating clinicians and not directly with the women concerned.

What was noticeable in these memorandums was the absence of prioritisation of the needs of the women in question and their families and communicating with them, particularly the families of women who had died from cervical cancer. They reveal a mindset focused on managing the risk to the programme and potential negative repercussions, rather than the needs of the women and their families who are simply not prioritised. They also reveal a policy of containment and concealment.

The Minister for Health, Deputy Simon Harris, has stated he became aware of the Vicky Phelan case on 16 April last via a memorandum. I regret saying this but there has been an absence of political leadership in the Department since then. I cannot understand why the Minister did not summon people to his Department there and then and tell them he wanted all documentation pertaining to this issue produced within 48 hours, after which he would make it public. That did not happen and, as a result, the Minister and Government have been apparently caught unawares by the revelations of the Committee of Public Accounts. This reflects a lack of strong leadership and management of the issue in the Department.

Emma Mhic Mhathúna's public interviews, particularly her interview on "The Late Late Show" last Friday, and interviews with members of other families caught up in this terrible scandal have captured the hearts of Irish people. People are saddened, angry and, in some instances, confused about the entire scandal. They require political leadership on this issue.

The statement by the Department on Health on Thursday night leaves many questions unanswered. We need clarity and I understand further documentation will be published and released today.

I have some basic questions to put to the Taoiseach in order that we can get some answers on the record. Did the chief medical officer or personnel in the acute hospitals division ever discuss these issues with the Secretary General of the Department, the Taoiseach when he was Minister for Health or the current Minister for Health? Did the chief medical officer or personnel in the acute hospitals division ever bring the issue of the audit and communicating the audit to the attention of the management committee of the Department of Health by way of discussion or by alerting people to the issue during management meetings in the presence of the Minister or Secretary General? Was the Taoiseach, in his time as Minister for Health, or the current Minister for Health ever briefed by the CervicalCheck management team on the progress of the screening programme? If such meetings or briefings occurred, were any issues ever raised with the Taoiseach concerning the laboratories or the testing regime or were any other concerns raised?

The Deputy has asked questions of a number of people, among others, the Minister for Health, the chief medical officer and the Secretary General of the Department of Health. I cannot speak for all those people and it would be wrong for me to answer questions on behalf of others.

It is the Taoiseach's responsibility.

In my case, the answer to all of the Deputy's questions is "No" and, to the best of my knowledge, the answer is also "No" with respect to all of the other individuals concerned.

The Department of Health will publish documents today. These follow on from a search of records and documents in the Department which has been ongoing for some time. To give the Deputy a rough idea, 40 million emails and other documents have passed through the Department of Health since 2008. As he can imagine, a document search of that scale, even if targeted, is time consuming.

In the dossier to be produced this afternoon, on which Opposition spokespersons will be briefed in advance and a press conference will be held, roughly a dozen documents will be released. These include memorandums between the Department of Health and Health Service Executive at official level, minutes of meetings of officials of the HSE and Department of Health and emails between various officials. The memos and documents confirm that no concerns were raised about patient safety, the efficacy and accuracy of the programme or the accuracy of any particular laboratories. The only issues dealt with in the documents relate to open disclosure or, rather, the non-open disclosure of information to patients and doctors. The documents confirm that these issues were not escalated to Ministers, advisers or the Secretary General. This follows on a full study of all memorandums, submissions, management board meeting minutes, ministerial management advisory committee, MinMAC meeting minutes and all significant issue papers.

It is the practice in the Department of Health that for every ministerial management board meeting a document called a significant issues paper is prepared so that the Secretary General, the management board, the Ministers and advisers can be made aware of those significant issues. The documents released today will show that none of this was escalated beyond the office of the CMO and the office of acute hospital services and that the concerns the Department was dealing with were concerns about open disclosure and about CervicalCheck passing on information about the audit to clinicians. There is nothing about concerns around laboratories, the efficacy, the accuracy of the programme or patient safety, but that will all become apparent today.

When the Taoiseach said no and no, do I take it then that CervicalCheck, as an organisation, never met either him or the Minister for Health, Deputy Harris, in four years? The Taoiseach might just clarify. That is the question I am asking. It would be normal for a significant screening programme to brief the Minister annually on the progress of the programme. The Taoiseach seems to be saying that did not happen and there was never a meeting between CervicalCheck and the Minister.

The reason I ask these questions is I find it difficult to comprehend why the acute hospitals division, a big division within the Department to assistant secretary level, or the CMO did not discuss this issue, as opposed to sharing documents on it, with the Secretary General or with anyone else in the Department. Given the reference in the three memos to adverse publicity of the kind that the "screening [programme] did not diagnose my cancer", one would expect such matters would be alerted to a Secretary General in a Department and to the Minister in the understandable expectation that the Minister might some day have to respond to a public debate around that very issue. It is extraordinary, in my view. I am not casting aspersions anywhere here. I am simply stating the obvious. It is quite extraordinary that the acute hospital division-----

The time is up.

-----did not alert the Secretary General or the Minister or it was never discussed at a management meeting of the Department given the clear implications, as we now know, about the revelations of this kind of thing and the absence of non-disclosure.

My understanding, having spoken to the officials concerned since, is that they did not escalate it because they believed that CervicalCheck and the HSE had the matter in hand. Letters were paused for a reason in the spring but the letters flowed freely through the summer of 2016 and all clinicians-----

Not to the women.

Not to the women, yes. However, all clinicians - all doctors, rather - received those letters through the course of 2016. Therefore, there was a delay. The delay was at the request of one or two of the laboratories which expressed concerns. The HSE sought legal advice and was advised that it was free to continue with open disclosure. It sent the letters out about all 209 women to all the consultants over the summer. The HSE and departmental officials wrongly assumed that the information had been passed on to the women. We now know it was only passed on to a quarter of the women. That is the explanation that I am being given but those officials will be before the Joint Committee on Health tomorrow and before the Committee of Public Accounts and will give explanations for themselves.

As far as the Government is concerned, one point on which I agree with Deputy Micheál Martin is that when I look at those documents, I see the absence of concern for patients. I can understand why CervicalCheck, officials of a previous Department of mine or anyone would be concerned about damage to the programme because that is what has happened. We have a big concern that women may not go for smears now because of the damage that has been done to confidence in screenings. I can understand why they had a concern for reputational damage to CervicalCheck because CervicalCheck saves lives, but what I do not understand is the absence of any concern or care for the women and their families who were going to find out about this in the way they have.

Did the Taoiseach meet them?

Did the Taoiseach meet CervicalCheck?

Did the Taoiseach ever meet them?

This is why the decision we took as a Government and which has been our first priority was care for women and the families concerned. Our second is getting truth and getting to all the facts. Our third is accountability and our fourth is confidence.

Did the Taoiseach meet them?

That is why, on Friday, we announced our package of measures.

Answer the question. Did the Taoiseach meet them?

Did the Taoiseach meet them?

The time is up. I call Deputy Pearse Doherty.

Not about the audit. I would have to check.

No. Did the Taoiseach meet them?

Answer the question.

I can answer that if the Deputy wants.

Did the Taoiseach ask?

It is a sub-organisation of the National Screening Service which is a sub-organisation of health and well-being, which is a sub-organisation of the HSE.

Taoiseach, please do not encourage them to be unruly.

Ar dtús báire ba mhaith liom mo chomhbhrón féin agus comhbhrón Shinn Féin a chur in iúl do mhuintir na Palaistíne i ndiaidh an tslada uafásach a rinneadh orthu inné. Caithfidh an Rialtas gníomhú agus ba chóir dó ambasadóir Iosrael a dhíbirt ón tír agus aitheantas a thabhairt do stát na Palaistíne.

What happened in Gaza yesterday was a massacre. There is no other way to describe it. Anybody who witnessed the scenes on television or read of the terrible atrocity that happened there will agree. Live ammunition and tear gas were used against unarmed Palestinians who were demanding their right to return to the homes and villages they were expelled from in 1948. We now know that 58 people have been killed as a result of the actions of the Israeli forces, including six children, and 2,700 have been injured. It is shameful. On behalf of Sinn Féin, I wholeheartedly condemn the brutal and violent actions of the Israeli forces and I extend our solidarity to the Palestinian people at this time. Tá siad inár smaointe agus inár bpaidreacha ag an am seo.

The actions of Israel are undermining efforts to secure a sustainable and peaceful two-state solution and must be urgently challenged by the international community. Without sanction and without adequate diplomatic response, I fear more innocent civilians will be killed in the coming days. It is long past time that the international community, including the European Union, acted in this case. We see the ongoing Israeli aggression against and oppression of people who are defending their rights, the people of Palestine. The onus is not just on the international community but also on the Government to respond robustly. I understand the Tánaiste met with the Israeli ambassador this morning and urged restraint. Words are not enough. We need action and the Tánaiste should have told the Israeli ambassador it was time to pack his bags because there can be no impunity for Israeli's mass killings of Palestinian civilians and its continued illegal occupation of their territory.

In response to a British security assessment delivered to the Government by Boris Johnson that Russia was involved in the Salisbury attack in March, the Government acted quickly and expelled a Russian diplomat. We need an even more robust response in this scenario. Will the Government move to expel the Israeli ambassador to Ireland in response to these murders and the flagrant disregard of international law or will it turn a blind eye? Will the Taoiseach also recall the Irish ambassador to Israel in protest?

The Palestinian people need our solidarity now more than ever. This could be one of the bloodiest episodes we have ever witnessed if we continue to stand idly by. The Government must take action. It must also recognise the state of Palestine. A motion tabled by this party in 2014 received unanimous support. It similarly happened in the Seanad. Despite a commitment in the programme for Government, the Government has dragged its heels on the issue. I urge the Government at this critical time to make a stand for peace and progress in the Middle East, recognise the state of Palestine and expel the Israeli ambassador.

I will touch briefly on the previous question because it is pertinent and deserves an answer. The HSE is an enormous organisation with a €16 billion budget, 110,000 employees and 2 million patients. It is too big and it needs to be slimmed down and broken up and that is what the Government will do now following on from the recommendations of the Sláintecare report. It will slim down the HSE, put in place a board and establish local and regional autonomy around the CHOs.

To explain it to people interested in knowing answers to the questions they ask, CervicalCheck is-----

With respect, Ceann Comhairle, there has been an absolute onslaught against the people of Palestine.

I will answer both questions.

I expect a response to the question.

If I am not interrupted I can answer both questions.

It is completely disrespectful.

It shows his attitude to the Palestinian people.

CervicalCheck is a subdivision of the National Cancer Screening Service-----

It is not acceptable.

-----which is a subdivision of the National Cancer Control Programme which is a subdivision of the health and well-being section-----

This is simply not acceptable.

He cannot ignore a question.

-----of the HSE. I met the head of the health and well-being section of the HSE every two months.

This is a disgrace.

It is disrespectful.

The rules are that we deal with each question and conclude it and move on to the next question.

Will the Ceann Comhairle reset the clock?

In fairness to Deputy Doherty, he is entitled to-----

Reset the clock.

We will reset the clock.

Reset the clock.

Deputy Doherty is entitled to the same time.

The Taoiseach should let his spin doctors out.

On behalf of the Government, I want to say we are profoundly shocked at the death toll and scale of injuries that have been inflicted by Israeli forces on Palestinian demonstrators in Gaza.

This morning the Tánaiste summoned the Israeli ambassador to Iveagh House to express the Government's and the people's outrage and dismay at these events, including the number of people who have been killed and injured, and directly request that there be an independent international investigation into what happened, as called for by the UN Secretary General. Any country is entitled to defend its borders, but the use of force must be proportionate to the real threat posed. The protests may not have been 100% peaceful, but there is no indication that the scale of the threat could have justified such violence and so many deaths. In our view, live ammunition is not a tool to be used for crowd control; therefore, Ireland fully supports the UN Secretary General's call for an independent international investigation. It must examine the fatal decision to use live ammunition which led to so many deaths and injuries, including the deaths of children.

The blockade of Gaza which has gone on for over a decade is inhumane, a recipe for disaster and must end. Young people in Gaza have no prospect of ever leaving the tiny strip of land on which they are imprisoned and cannot even travel to the West Bank to study, visit relatives, work or engage in any normal activity. Ireland is very conscious of the difficulties faced by the people of Gaza. For this reason, the Tánaiste has made engagement with the Middle East process a priority. He will travel to Jerusalem in the coming months.

As the Tánaiste said, we profoundly disagree with the United States' decision to move its embassy to Jerusalem. Jerusalem is a city shared by two communities and is important to many faiths. No decisions on where embassies should be located should be made until there is a peaceful resolution of the conflict there. As a result, Ireland's embassy will remain in Tel Aviv, in line with international law and compliance with UN Security Council resolutions on the issue, in particular Resolution 478, by which we call on others to abide.

The Government will not be expelling the ambassador at this time. Ireland has not expelled an ambassador in recent decades, if ever. That is not the way we believe we should engage with other states.

What would it take?

If we were to expel Israel's ambassador, Israel would expel ours. As far as Israel is concerned, Ireland would be taken off the map and as far as Ireland is concerned, Israel would be taken off the map.

We should withdraw our ambassador.

There would be no engagement. The Tánaiste and Minister for Foreign Affairs and Trade called in the ambassador of Israel this morning and told him exactly what the Government and the people thought about what was happening in Gaza. He told him about our objections to it and where we stood. If we had expelled him, that would not have been possible.

He would have got the message.

The Taoiseach's response was very disrespectful to my question and the topic, which concerns the onslaught the Palestinian people are going through and what happened yesterday. The Taoiseach mentioned the UN resolution and referred to an independent investigation, but the United States has already vetoed it. It has made it very clear that it is in support of Israel in this case. None of the actions I have asked the Taoiseach to take would be for the sake of it. If Israel continues to act with impunity, we will continue in the weeks ahead to see carnage as we witnessed on our television screens yesterday. It is time for countries to make a stand. As the Government made a stand in the case of a Russian diplomat, what will it take for it to state "No more"? What will it take for this proud country to take a stand, as an independent country, by telling the Israeli ambassador that it is time to pack his bags?

This did not just happen yesterday. Israel enforces apartheid in the state of Palestine.

The Deputy's time is up.

I will finish on this point. For the past seven weeks soldiers have been killing innocent civilians with impunity. Since 30 March, Israeli forces have killed at least 109 Palestinian civilians in Gaza and injured 12,000 people. The time for talking is over.

It is. The Deputy's time is up.

The stock response from the Taoiseach, to the effect that the Tánaiste had called in the Israeli ambassador, does not meet the scale of what happened in Palestine yesterday.

Deputies

Hear, hear.

It is time to expel the ambassador and recall ours and do what the people of Ireland are asking the Taoiseach to do. It is what the programme for Government states the Government would do and what all-party motions, in this House and the Seanad, stated the Taoiseach should do - to get to his feet and recognise the state of Palestine in order to express solidarity with the people who are facing an onslaught by Israeli forces at this time.

Deputies

Hear, hear.

The Deputy accused the Taoiseach at the start of disrespect. He is disrespecting the House by ignoring the time provided for these questions.

Deputies

Hear, hear.

They are all doing it.

I am afraid he is doing it far more so.

My first bit was trying to-----

Respect works both ways Deputy.

I was forced to spend the first part of my contribution dealing with the issue.

Our view as a Government is that we solve conflict through dialogue. Dialogue requires engagement and requires an interlocutor. In this country, just over 20 years ago, it was necessary to engage in dialogue with terrorists in order to bring about peace on this island. That had to be done and it was the right thing to do. We believe, and I think Sinn Féin would understand this, that sometimes you need to engage with violent people to bring about peace.

Sometimes you needs to expel diplomats.

You had your own way of doing that.

For these reasons, we will not be recalling the Irish ambassador or expelling the Israeli ambassador. We will continue to engage with Israel and Palestine and try to be part of a future peace process. We will also act through the United Nations. We have given our support to the UN Secretary General in his call for an independent investigation into this matter. I will attend the EU Council in Sophia tomorrow and the next day, and I am absolutely sure it will be a topic of discussion among the Heads of Government and State.

Recognition of the state of Palestine.

I will be putting across the views of the Irish Government and Irish people very strongly at the summit over the next two days.

The programme for Government commits the Government to recognising Palestine as a state as part of a two-state peace solution, and we stand over that Government commitment, but we do not yet have a peaceful solution.

The motion of the House did not qualify it.

I also condemn the genocide perpetuated by the sectarian apartheid Israeli state against innocent Palestinians and I support the BDS campaign against that nation.

I want to return to the cervical smear issue. The way in which this issue is being handled is an absolute disservice to the women at the heart of it and it is perpetuating a situation whereby we will not change things if we do not cop on. That there are people who are surprised about a memo which stated to leave a decision on telling people until the legality is sorted out shocks me. Where have those people been? Do they not know there are people who have seen their babies die or be gravely injured in our hospitals who have not been given answers? Do they not know there are men who have held their wives' hands as they were robbed of their lives as a result of clinical negligence in our hospitals and they cannot get answers? Have people in here forgotten Portlaoise and Portiuncula, and it taking ten years or three and a half years for reports to be published, and that today five bereaved families are still before the courts? Do people not know this is what happens in our health service, that maybe five or ten years after people suffer a devastating loss they might settle with the HSE and they might get an apology or a few answers, but they might not? That is our health service.

We might need a commission to find out how the latest scandal happened, but we do not need a commission to tell us why. It is happening because of the actions of everybody in this House and frankly I am sick of it. I could not care less if the Taoiseach was the health Minister or if Deputy Micheál Martin was the health Minister because it goes on. Governments are too busy staying in power to actually govern, the Opposition is too busy scoring cheap political points to actually hold the Government to account, and the media are too bloody lazy to analyse what goes on in here so the Civil Service rules, unelected and unaccountable.

We do not need a new oversight governance body here. There is a suite of measures which has long been flagged that could alter and transform the situation now. It is in the programme for Government. There is mandatory open disclosure, which the Government baulked from and which Fianna Fáil was knobbled on and on which it voted against us last year. Last year, Deputy Frances Fitzgerald promised us that mandatory inquests into maternal deaths would be delivered before the summer. The Taoiseach told me in February the legislation would be published. It has still not been published. We passed pre-action protocols but they have not been enacted.

A huge amount of what has gone on in our health service is because of litigation in the backdrop. It is a requirement to notify the State Claims Agency 48 hours after a serious adverse incident but not to tell the patient.

Clinical claims against the State have an estimated cost of €1.98 billion, an increase of €1 billion in five years. Families are being dragged through the courts. If a family do not have the funds required, they cannot do this because they have to pay for their own expert reports. We know of the case of one family with a child with cerebral palsy in whcih 46 expert reports were commissioned over six years before the family received damages. Of the 244 cases that were settled in 2016, only five went to court. There are measures in the programme for Government which, if they were enacted, would transform the situation. Will the Taoiseach look at them, including having a no fault compensation system to deal with this issue once and for all to take the lawyers out of hospitals?

The Deputy makes some very valid points. There has been too much political point scoring on this issue and a degree of political opportunism. If we genuinely want to put women and patients in general first, we should look for solutions and ask what we can actually do to improve the situation that has gone on for decades. A suite of measures is required. I argue that we are making good progress in implementing it. The Government of Fine Gael, the Independent Alliance and Independents has brought about significant legal reforms in the past two years. For example, we have the Mediation Act 2017 and have seen cases in recent weeks that were settled by mediation to the satisfaction of both sides. We have brought forward the legislation on periodic payment orders to move away from massive settlements of €10 million or €13 million in order that a person's needs can be assessed along the way and that he or she can be given additional compensation if he or she requires it. We also have the Legal Services Regulation Act 2015 which provides in law for pre-action protocols. I am aware that it has not yet been commenced, but we have the legislation which we will commence as soon as possible.

We have the Civil Liability (Amendment) Act 2017 which provides for voluntary open disclosure. That legislation is very important. I know that some people have dismissed it, but it is important because it removes the excuses. It tries to create a culture of truth rather than one of secrecy in which doctors, nurses, midwives and managers will not be afraid that an apology will be used against them in a court and that admitting to a mistake could be used against them as an admission of liability. That is why we brought forward and passed the Civil Liability (Amendment) Act 2017. That is why it will be commenced by June, once we have the guidelines in place. In addition, the Patient Safety Office has been established within the Department of Health. It is a very important measure.

The Deputy is correct - there are two major outstanding issues in the programme for Government which is a five-year programme and we are only entering year three. There are two outstanding issues in the programme for Government that need to be dealt with, the first of which is mandatory reporting of serious reportable incidents. We will do this. The heads of the patient safety Bill have been through the Cabinet and we will get it done in the next couple of months.

I have also initiated the establishment of a working group to look at alternative means of settling medical negligence cases, including a no fault system. Such a system operates in New Zealand and some other countries. There are pluses and minuses and it must be borne in mind that some people do want to ascribe fault and find out who was to blame. Where there is a no fault system in place, it can work quite well and should be considered as an option. We shall establish the working group, as committed to in the programme for Government, under an independent chairperson, which will involve my Department, the Office of the Attorney General, the Department of Justice and Equality, the Department of Health and the Department of Public Expenditure and Reform.

I do not believe the Taoiseach listened to what I said. I genuinely do not blame him for anything that has happened before now. I am, however, going to blame him for what will happen next. On the day he announced that the Attorney General was being instructed to cease litigation in cervical cancer cases, a Kilkenny family who had appeared before the High Court went to the courts for the ninth time to seek discovery in a case involving Pandemrix. We know that in September 2009, before any child or any person was given Pandemrix, the Chief Medical Officer of the HSE received a letter from the chief executive of the Irish Medicines Board, now the Health Products Regulatory Authority, expressing the board's concerns about the impact of the absence of data on information on the product and the dangers with reference to the dosage for children and pregnant women. One month later, in October 2009, the HSE issued a glowing report that stated Pandemrix was safe for use as the seasonal flu vaccine. This was in direct contradiction with the letter the HSE had received from the Irish Medicines Board just days before. There are dozens of families before the courts who have been waiting eight years to get answers.

If the Taoiseach is serious about there being a change in culture, the first step must be a moratorium in respect of these cases, which have put families through years of devastation, litigation and cost. The Government should call a halt first and then embark on having a proper redress scheme in advance of a no-fault compensation scheme.

I do not know anything about the details of that specific case, so it would be improper for me to comment on it. It relates, obviously, to a vaccine rather than the issue of cervical cancer screening, but I appreciate it is part of the bigger issue of how we deal with medical harm and medical negligence.

The last time I studied that topic and got a briefing on it, my understanding was that there was not sufficient epidemiological evidence - or scientific evidence, to make a long word sensible - to show that that vaccine caused the harms that were claimed, but I will take a look at that again because it is not something I have had an engagement on in at least two years.

In recent weeks, the world-class reputation of the Irish medical and maternal health care system has been subjected to a national campaign of dangerous and reckless misinformation. The situation has got so bad that no fewer than four former heads of the Institute of Obstetricians and Gynaecologists and the current chair of the joint HSE working group on maternal mortality, Dr. Michael O'Hare, have called on two of the "Yes" campaign's leading medical spokespersons to withdraw statements they have made about how the eighth amendment impacts on medical care. Just last night, 15 members of the consultant body of the maternity directorate of the South/South West hospital group, which covers my area, called on Dr. Peter Boylan to step aside from his role.

Has the Minister for Health, Deputy Harris, supported these calls for balanced and accurate information? Of course he has not. In order to get this referendum over the line, the Government has essentially given free rein to anyone who wants to paint the worst possible picture of the Irish maternity system and services. As if that was not a bad enough judgment of the kind of campaign that the Government is supporting, there was a statement last week from almost 200 judges, solicitors and barristers, including a former judge of the European Court of Justice and the High Court, Mr. Justice Aindrias Ó Caoimh, and a former judge of the High Court and chairman of a referendum commission, Mr. Justice Iarfhlaith O'Neill. Mr. Justice O'Neill and his colleagues have described the Taoiseach's view and that of the Minister for Health that abortion up to six months will not become freely available as having "no rational basis". Today, a former Taoiseach and leader of the Fine Gael Party, Mr. John Bruton, wrote to the current Taoiseach again about how the Government's proposal to remove every last shred of constitutional protection for the unborn child was a human rights travesty. Those are the former Deputy's words.

Whenever others or I have raised these matters with the Taoiseach, he has trotted out the grossly offensive and deeply personalised remarks that those who oppose the repeal of the eighth amendment are turning a cold shoulder to the victims of sexual violence. That is unfair. Is Mr. Justice O'Neill turning a cold shoulder? Is the former leader of the Taoiseach's party, Mr. Bruton, turning a cold shoulder? Of course they are not.

Will the Taoiseach join me in defending the world-class nature - those are the World Health Organization's words, not mine - of our maternal health system? Will he call on those who are recklessly damaging our international reputation and creating unnecessary fear to refrain from making such remarks? Will he finally accept that the law the Government is proposing will allow for the majority of abortions to be carried out on the perfectly healthy unborn children of healthy mothers? As we know, these constitute 97% of the abortions that take place in the UK.

Before I call on the Taoiseach to respond, it is a long-standing precedent of the House not to mention people outside it by name or in such a way as to make them identifiable.

When this referendum campaign started, or certainly the day that the Government confirmed that we would hold a referendum, I said that I hoped that the campaign would always be respectful and never become personalised. I think that, by and large, that has been the case. We are only a week and a half away from polling day and, by and large, this has been a much more respectful campaign than people perhaps anticipated and, by and large, has not been personalised.

That is why I deeply regret that some people have now chosen to try to personalise the campaign in regard to Dr. Peter Boylan. Dr. Boylan has the right to his view, just as doctors or former judges on the "No" side have the right to their view. Nobody should be individually targeted because they hold a particular opinion on this issue and I regret that in the final days of this campaign people have started going for the man or woman rather than talking about the issue. Whether that is done by the "Yes" side or the "No" side, it is very wrong.

Removing the eighth amendment would remove the equal right to life for a pregnant woman and the unborn from our Constitution. There are other rights in the Constitution such as the right to common good, and that concept will remain in the Constitution. We propose to remove the concept that an unborn child, a foetus of one, two, three or even ten weeks' gestation, has an equal right to life as one's sister, mother, niece or female friend. I do not believe that to be true and that is one of the reasons I am comfortable voting "Yes" in the referendum.

Above all, this is about accepting the reality that abortion exists in Ireland. In 1983, people thought that by putting that amendment into the Constitution, somehow there would be no terminations of pregnancy. We know that nine or ten women every day take the boat or plane to England or other countries to end their pregnancies and that two, three or probably more women every day import a pill over the Internet to be taken unsafely and without medical supervision, counselling, advice or being able to talk about the alternatives. That is what we want to change. Abortion is a reality in Ireland and in many ways we propose to recognise that reality and legislate for, and regulate, it.

The Deputy raised the issue of care and compassion. I have yet to hear from those who argue for a "No" vote, including Deputy Mattie McGrath, how they would care for and what compassion they would show towards the victims of violence he mentioned, such as a 13, 14 or 15 year old girl who may have been raped by her father, grandfather or uncle and is bleeding and in pain. What answer does the Deputy offer her?

For the past two weeks, the Taoiseach has been asking people to stop making comments that might damage the integrity of the Irish health system. I share his view in that regard. However, two of the country's senior medical professionals are endlessly repeating dangerous and reckless comments and the Taoiseach will not stand up to them because they support his view in the upcoming referendum. The Taoiseach can stand up and pontificate and purport to have infinite knowledge of everything. However, I have the heads of the Bill before me. The Taoiseach is aware that head 4 of the general scheme states that the life of an unborn child cannot be ended once it has reached viability. However, there is no reference to where that mark will be set. I suggest that the Taoiseach read that if he wishes to understand it. I suggested that to him last week but it is obvious that he has not yet done so. It is even more disturbing that provision is made in head 5 to nullify or cancel the prohibition in head 4. It is all over the place and that has been proven. I have the Bill in front of me and have studied it, as have legal professionals. We know that over 40% of abortions in England are carried out before the 12 week period. The Government is all over the place on this issue. The Taoiseach has no right to lecture us. We have compassion. Many organisations and agencies, which I support, assist victims of sexual violence on an hourly basis. We want more compassion, not the taking away of the last vestige of support for the unborn child - not a foetus - in the womb. We wish to maintain life from conception to end of life.

We have good maternity services in Ireland but we would be very unwise to think a relatively low maternal mortality rate means that we have the best maternity services in the world. We do not have that and never did.

We are close to the top, according to the World Health Organization.

Unfortunately, there are major shortcomings in our maternity services and that has been laid bare in several hospitals around the country in recent times-----

While the Taoiseach was Minister for Health.

-----and through a number of cases of which many Members are aware. As Minister for Health, I produced the first national maternity strategy, which is a strategy to improve significantly our maternity services.

As Minister for Health I produced the first national maternity strategy, which is a strategy to improve our maternity services significantly, and as Taoiseach I am making sure the funding is in place to implement that over time.

Head 4, to which the Deputy referred, relates to viability, which is an issue of clinical judgment. It may be 23 weeks or it may be 24 weeks. It depends on a few things, namely, the gestation, the weight and the size. That has to be a clinical judgment. Part of the problem that we have in Ireland with our abortion laws is we have tried to define too much in the Constitution and have not allowed for clinical judgment. The term "viability" is there so clinical judgment can apply. We should bear in mind that medical science changes. It may be the case over time that viability comes down in terms of weeks, so we want to provide for that too. We do not want to put in 22 weeks or 23 weeks and then find out in a few years that new technology brings that backwards. That is why we put viability in as a legal concept, so it is based on clinical judgment of gestation, weight, size and modern clinical science.

What about head 5?

Head 5 relates to emergency situations. Supervision exists already in the Protection of Life During Pregnancy Act to allow for one doctor to intervene-----

The time is up.

-----in those emergency situations, and that is what that is for.