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Dáil Éireann debate -
Thursday, 24 May 2018

Vol. 969 No. 6

Leaders' Questions

I ask every Member involved to be conscious of the allocated time.

As we know, BreastCheck, which was introduced 18 years ago, has had a massive impact. It has saved many thousands of women's lives and it has been independently and internationally verified as one of the best screening programmes in the world. In the report for 2015-16, it is stated 198,000 women were offered screening and 146,000 took up the offer. This is an uptake of 74.7%, which is the highest uptake to date. In 2015–16, 986 cancers were detected, thereby giving a better outcome to those who used the service in that year.

BreastCheck costs €30 million per year to run. This is money incredibly well spent. It was described yesterday at a meeting of the Oireachtas Joint Committee on Health as one of the best parts of our health service. At the hearing yesterday, however, doubt was cast on its future. The national clinical director of BreastCheck, Professor O'Doherty, said that since the CervicalCheck scandal broke in the media, BreastCheck has received 15 solicitors' letters. This is extraordinary for a service that, until a fortnight ago, used to receive one or two per year. Professor O'Doherty is genuinely worried that if these cases are successful, it could absorb all the money from the programme and may end up jeopardising it altogether. She mentioned legal costs of tens of millions of euro. She said the taxpayer will require the stopping of the screening programme, which would mean women would die unnecessarily from breast cancer. As I stated, in one year 986 cancers were detected.

Is the Tánaiste aware of Professor O'Doherty's comments yesterday? Has the Government a plan to deal with this challenge to BreastCheck? Can the Tánaiste state today that the Government is fully supportive of the BreastCheck programme and that it will give its full support to the management of the programme to ensure its continued success, particularly in the face of this challenge?

I thank the Deputy for raising this issue in such a positive way. I reassure the House that the Government recognises the value of BreastCheck and the importance for Irish women of its continued success. BreastCheck is the national breast screening programme and it offers screening mammograms every two years to eligible women. It has been running since 2000 and since then has performed more than 1.5 million mammograms and has diagnosed more than 11,500 cancers. It has saved thousands of lives and continues to do so. Therefore, the issues raised yesterday must be noted by the Government. We need to remind people, however, just how important BreastCheck and other screening programmes are. Screening is not diagnosis but it is certainly a way of finding and exposing early signs of the onset of cancer, thereby allowing for early treatment that can save lives.

It is important to reinforce the point that BreastCheck statistics are impressive by international standards. The programme is working. We need to learn lessons from recent weeks regarding the obligation of the State to ensure that information flow is appropriate and proper and that women can gain access to information when they want it. I understand that the comments made on BreastCheck have been reassuring in terms of the commitments made and the lessons learned.

On the legal issues that are of concern, the Taoiseach has set up a working group to examine tort law in respect of medical litigation. We will, of course, await the outcome of the review. We have asked Dr. Scally to examine our screening programmes generally, in addition to CervicalCheck, in his work to ensure we correct the wrongs of the past in regard to CervicalCheck and the information flow that should have happened but did not.

I wish to provide reassurance that, as far as we can see, BreastCheck is performing really well and saving lives, and it will continue to do so. The reviews of disclosure that are taking place will, of course, ensure we learn lessons from the past and that women have information available to them to which they are entitled.

As I stated, BreastCheck has been independently and internationally verified as one of the two best screening programmes in the world. Everyone can have full confidence in it as a screening programme, as the Tánaiste said, but information needs to be given to the public generally on what screening programmes are and do and their limitations. That information may help to avoid some of the legal confusion.

The Tánaiste referred to open disclosure. It has been the informal policy of the HSE since 2013 to have open disclosure. It will be 2019, however, before it is rolled out in BreastCheck. Could the Tánaiste comment on that? Could he guarantee that there are no other underlying issues concerning any of the other screening programmes? Could he confirm that the Government is on top of this issue and not addressing it in the way it addressed the CervicalCheck issue when it first broke? Could he confirm that the Government will not be caught blind once again because being caught blind would undermine the confidence in the delivery of the programme?

As the Deputy noted, BreastCheck is currently working on an open disclosure policy, to be introduced next year. BreastCheck advised that the NHS breast screening programme introduced open disclosure on a formal basis in the spring of last year. We are learning lessons from that. I believe England is the only country in the world providing open disclosure at that level on the back of all its systems linked to screening. I am open to correction on that but it is my understanding.

BreastCheck will be examined as part of the Scally inquiry, which is expected to report by the end of next month. As we have said, BreastCheck indicated yesterday that it has received 15 solicitors' letters in the past fortnight and is concerned about the impact of legal action on the future of the programme. Let us not forget, however, that a breast cancer diagnosis is the most common cancer diagnosis for women in Ireland. Therefore, the screening programme is very valuable and needs to be protected. If necessary, we need to continue to improve it as we learn lessons.

It is now less than 24 hours before people go to the polls across the State and have their say on the continued presence of the eighth amendment in our Constitution. We are mindful that voting is already under way on our offshore islands. Many will have engaged with the arguments and propositions made during the referendum campaign and have now made up their minds on how they intend to vote.

I commend and thank all those who were involved in the "Yes" campaign for the job they have done. In the face of dishonest claims peddled by some on the "No" side, they have remained grounded in facts in making their case. They have illustrated accurately and honestly the pain and trauma that the eighth amendment has visited on women for many decades. They have articulated in a very caring and compassionate way the circumstances in which women should be allowed to end their pregnancies. That has not been easy in the face of some of the tactics of the "No" campaign. More than that, however, they have made this campaign about those we love: our wives, daughters, sisters, mothers, colleagues and friends. They need and deserve our compassion. They also deserve our trust, our trust in them to make medical decisions about their own bodies in their own interest. Tomorrow they need our vote. We all know that women in crisis situations, including victims of rape, those whose health is at serious risk, and those who receive the awful diagnosis that their baby has no chance of survival, are already travelling week in, week out to have an abortion in another country, or are taking abortion pills in this country without medical supervision. A "No" vote tomorrow will not stop that but a "Yes" vote can.

Tomorrow's vote is about people, families, a woman's access to proper healthcare and an outdated, ill-fated constitutional provision that criminalises tragedy. That is the sum of it. The eighth amendment must go. The women of this State deserve to live in a compassionate and caring country that does not turn its back on them at a time when they need our care and support the most. Will the Tánaiste agree with me that voting "Yes" tomorrow is the right thing to do for women and girls in this country? Will he join me in making a particular appeal to men to go out and vote "Yes" tomorrow? As men and by dint of birth, we will never become pregnant but our loved ones - our wives, daughters, sisters and mothers - deserve our trust, our compassion and our support. Tomorrow, we cannot let them down.

I want to endorse everything the Deputy said. I believe that, tomorrow, Ireland will make a decision that will have real consequences in terms of how Irish society moves forward. We have an opportunity to address the secrecy, the stigma and, in many ways, the hypocrisy of the way Ireland has dealt with the issue of abortion for most of my lifetime. We have effectively allowed a situation where it is okay to give somebody an address in Manchester or Birmingham and send them on their way on their own but it is not okay to look after them here. We hear arguments to the effect that the Constitution requires us to maintain certain laws that criminalise women for ending pregnancies but perhaps the answer is not to enforce that law because it would be too cruel and not appropriate.

We face a choice tomorrow, and I have to say I have been hugely impressed by the way the Irish people have responded to this challenge. This has been a two year discussion, not a month long one. It started with a Citizens' Assembly that made recommendations that forced me to think about my own views on this issue and confront my own views on the issue that were somehow settled before those arguments were made. I believe I represent a lot of men and many people in this country who for many years have tried to crystallise this debate into pro-life versus pro-choice, believing that by maintaining the current constitutional wording we were somehow protecting unborn children.

What the discussion in the past two years has shown is that that is simply not true when we look at the facts and the data and hear the stories of many of the women who were brave enough to come out and tell intimate stories about their own trauma, vulnerability and tragedy and having to face that on their own wandering the streets of Birmingham for six hours. The issue around the role of men in this choice tomorrow is to try to see that story through the eyes of somebody close to them. I believe if they do that, the way in which they view this issue will change, as it has for me.

From the conversations I have had, predominantly private ones, we have seen a serious consideration by the Irish people in this time of preparation for the vote tomorrow in terms of the Citizens' Assembly, the all-party Oireachtas committee, a Cabinet decision and now a people's decision.

Thank you, Tánaiste.

I believe the vote tomorrow will be one that has been considered deeply by people and on the basis of that consideration based on facts, I believe they will vote "Yes".

I want to take this chance to thank the Tánaiste personally for his approach to this matter but, more importantly, I want to thank all the women who shared their stories, both publicly and privately, with us and those on the "Yes" campaign and, in doing so, have shifted public opinion on this issue. It is a matter of deep regret that it took personal stories and tragedy to be shared with others in some of the most public ways to ensure that shift of opinion took place.

We know that the "No" side has been using a tactic in the past week in which they are claiming there is a better way to deal with the so-called hard cases, those very real cases where women find themselves pregnant as a result of rape or get a diagnosis of fatal foetal anomaly. They tell us that can be dealt with in the current constitutional context. We know that is patently untrue. We also know that is a tactic to try to sow confusion in the last week of the debate. Will the Tánaiste join me in categorically stating that the only way to show compassion to women in these circumstances is to vote "Yes" on Friday and to repeal the eighth amendment?

Thank you, Deputy.

Is it not time now to say as a nation and as a society that we will no longer tolerate the exiling of women to foreign jurisdictions at a time of crisis?

I am glad the Deputy raised the issue of hard cases because as the Taoiseach said earlier this week, it is hard law that makes these hard cases. It is the fact that we refused to face up to the vulnerability, trauma and appeals for help that many women have asked for and who were sent abroad to deal with that those of us in this House have been thinking about how we can respond to that appropriately. If it was easy to deal with hard cases, I believe we would have had some credible proposals in that regard during the past 35 years. Certainly, the idea that there is any credibility on the part of people who are advocating in the past 24 hours to deal with hard cases on their own and not take the approach that has been the result of two years of consultation and scrutiny is, as the Deputy said, an attempt at distraction and confusion as opposed to a real proposal.

I say to Irish people listening to these proceedings who are trying to make up their mind and are conflicted in terms of the morality of these issues that many of us have been through those thought processes and the conversations that follow. Can I reassure them that from the perspective of the Government and that of the majority in this House, we are proceeding here in the only way that is possible to respond comprehensively in a compassionate way to the challenges that many Irish women will face in the future?

I listened to Saoirse Long last night.

We are out of time, Tánaiste.

In terms of anybody doubting the issues we need to face up to, was that a hard case in the category of the "No" side? Was that a case to which this State does not need to respond in a more comprehensive way than we did?

I am sorry, Tánaiste, but you are way over time.

It is these cases which have crystallised the views of most people in Ireland who want to face up to this issue with more honesty and more compassion in the future. Hopefully, it will allow many of us, a majority, to vote "Yes" tomorrow to allow this House take on our responsibilities to introduce appropriate legislation that can care for women and also take on our responsibilities towards the unborn but, in particular, to care for women in a way that we have not been able to do for the past 34 years.

Tomorrow, the Irish people will have the opportunity to vote either to repeal or retain the eighth amendment. It is essential now to reiterate that no change in our law is possible unless people vote "Yes" tomorrow to repeal the amendment. The last minute scramble by some in the past 48 hours to suggest that it is possible is an attempt at a con job about which we have to be very clear.

The campaign is drawing to a close but whatever the result, the focus will remain on women's health. The scandal that has engulfed CervicalCheck shows a need for the Government to go back to basics on public health information. Through this scandal we have learned more about the science of screening and the limits of that science.

We have also seen the human side and how false negative results have led to terrible family tragedies. It would be an appalling outcome if people stopped believing in the efficacy of screening and stopped attending for screening. Screening and vaccination programmes have been incredibly important in reducing serious illness and premature death. They are imperfect tools but if done properly and properly funded, they are tools that undoubtedly save many lives. Scandals such as that involving CervicalCheck do not just affect a small number of women. They affect all women and men because they undermine public confidence in screening in general. They naturally cause concern. Sadly, cervical cancer claims around 90 women's lives every year in Ireland.

It is heartening to think that if the right public health policies are pursued, the potential is there to eradicate most cases of that disease. A report from the co-creator of the HPV vaccine, Dr. Ian Frazer, argues that most cases of cervical cancer could be eliminated over a period of time if a thorough vaccination programme was implemented. I am glad the Minister for Health agreed a Labour Party motion earlier this year to extend the HPV vaccine to boys as well as girls, which was one of the recommendations made by Dr. Frazer. It is a positive take up of that vaccine that could make an extraordinary difference yet rolling out the vaccine is not enough. We know that the national uptake of vaccines fell by 3% last year. This involves vaccines such as the ones that prevent tetanus and diphtheria and puts children's lives at risk. Common childhood diseases such as measles are coming back. These are not minor diseases. Before vaccination, 2.5 million people died from measles annually worldwide. We saw an outbreak of 1,600 cases of measles last year in Dublin resulting in three deaths.

There is a pressing need to restore public confidence and full participation across all our screening and vaccination programmes. Does the Government accept that this is the case? Specifically, what will the Government do? Does the Tánaiste agree that a co-ordinated and clear campaign of action to restore confidence in both our screening systems and increase the uptake of vaccination is now urgently required?

The Deputy is right. If the people decide to vote "No" tomorrow, what they are essentially saying is that we can change nothing, that Ireland is frozen in time on this issue. We heard stories such as that from Saoirse last night and many others who in an effort to change things, have told their own stories, often in very painful circumstances. We will hear more of those stories in two, five and ten years time. That is not okay for me. I do not believe it is okay for most people in this country any longer, which is why I believe people will vote "Yes" tomorrow but nobody can take that for granted. We will continue to campaign right the way through the day and into tomorrow. To be clear because some people seem to be suggesting again, and in my view spreading untruths, that somehow we can change things and change the law in terms of penalties and so on without changing the Constitution: that is not the advice of the Attorney General or the previous one so we must be honest and up-front with people that if they vote "No" tomorrow, no further change is possible to help and support women who find themselves in awful, difficult and vulnerable situations in a compassionate way and we will continue to send them on a flight to Birmingham and Manchester. People should think about that before they vote tomorrow. As the Taoiseach also said, regardless of the outcome tomorrow, if people vote "Yes", we will still have a country that is compassionate and that cares about family and children in the same way we did before-----

Is it compassionate?

But we will simply be recognising a reality that for the past 35 years has been in the shadows whereby many women have to keep their stories secret and we send them abroad to get basic healthcare needs.

In terms of confidence in both screening systems and vaccinations, it is important to say that if one looks at CervicalCheck and BreastCheck, by international standards we have very high uptakes. A total of 80% of Irish women have used CervicalCheck while about 74% of Irish women participate in BreastCheck. Those figures are high by international standards and we need to maintain that. This is why in the response to the CervicalCheck scandal, we have prioritised looking after victims of that scandal first and foremost. We are absolutely committed to exposing what happened fully, who made the decisions and when so that we learn lessons in terms of full accountability. On the back of that, we want to ensure that we build confidence in this system in the future so that we can ensure that Irish people get the full benefit of screening programmes as indeed they should from vaccination programmes where people should listen to their doctor rather than what they might read on social media on the impact of vaccinations.

I agree with the Tánaiste. I think the most impactive thing for me in the campaign over the past number of months was the personal stories that complete strangers would tell you on the doorstep much less in public fora. People, I could name them, came to meetings around the country and in my constituency of Wexford to talk and share their experiences for the first time. Those stories cannot be untold. They cannot be unsaid. They cannot be hidden again and they cannot be ignored again. The only way to address them properly is, obviously, a "Yes" vote.

A campaign on vaccination and screening is required. It is good to say there is strong uptake but it will be undermined if people's concerns are not addressed. The Government needs to step up and understand that and promote and explain screening. That can only be done by complete transparency and open disclosure and by addressing the issue of anybody who actually has been wronged by a system through a non-adversarial system of redress.

The truth is that this is already underway. If the Deputy talks to the Minister for Health about this issue, he will learn that there is effectively already a campaign advocating the use of vaccines like the HPV vaccine. We have seen a significant increase in the uptake from girls. Indeed we have been looking at ways in which we can extend that and add to and reinforce that message. In terms of the follow on from the CervicalCheck scandal in particular, we know there is a big obligation on the Government and Department on the back of full accountability and transparency in terms of what went wrong and that there is a need for a campaign to reassure and educate people about why screening is such an advance in terms of a medical response to early diagnosis of cancer and early treatment that can save lives. We are very much aware of that and I agree with everything the Deputy said about it.

I thank the people of Dublin South-Central for their courteous and respectful response on the doorstep, regardless of whether they favour "Yes" or "No". There is a very strong indication that there will be a "Yes" vote from Dublin South-Central. While people have indicated a "Yes" vote, it is really important that people go down tomorrow between 7 a.m. and 10 p.m. and plan their day to do that.

I wish to raise the regeneration of St. Michael's Estate in Inchicore. St. Michael's Estate Regeneration Team called a public meeting on 15 May 2017 saying that there is another way. One of the speakers was Tom Healy, author of a report entitled Ireland's Housing Emergency - Time for a Game Changer. I also wish to put on the record the fact that the Government programme embraces the concept of cost rental. I welcome the fact that the Minister met with St. Michael's Estate Regeneration Team from St. Michael's Estate this morning. This is a 12-acre site owned by Dublin City Council. St. Michael's Estate Regeneration Team, which is a local campaign, has put forward a very sound proposal, namely, for the State to use this site as a pilot project for the development of publicly owned land throughout the State. On 26 April, St. Michael's Estate Regeneration Team launched a plan entitled Inchicore for Quality: Fair Rents Homes, which is based on the fair rent model, which is a proven European model that delivers a secure tenure home at an affordable rent which remains a public asset.

It is proposing the site be used to build affordable energy-smart homes, half of which would be local authority housing and half on the cost-recovery rental model. This would make housing affordable for those whose income is above the limit for local authority housing and would never be able to afford a €350,000 mortgage and who are being screwed with exorbitant rents in the private rental sector, facing constant insecurity in short-term leases. This morning, I checked daft.ie and the rent for a two-bedroom apartment was between €1,900 and €2,600 in our area.

Such a scheme would achieve a good social mix; the Tánaiste previously said he did not want to see social housing ghettoes. This is precisely the type of affordable rental accommodation with security of tenure required for people on moderate incomes such as nurses, teachers, construction workers, transport workers and all sorts of people who get up early in the morning but cannot afford the unaffordable house prices or rents in the private sector.

A recent report by housing expert, Mel Reynolds, estimates that 114,000 homes could be built on existing zoned land held by local authorities. Some 70,000 of these could be built in the four local authority areas in Dublin if this land was used as proposed by the St. Michael's estate regeneration team, with 50% local authority housing and 50% cost-rental.

A number of Deputies from various parties attended the launch on 26 April and all gave a commitment to support the St. Michael's estate regeneration team pilot. We have not got an indication from the Government as to whether that would be the case. However, if the Government is not prepared to do it, it will be in the minority. I urge the Tánaiste to come back with a positive response.

I thank the Deputy for raising the issue. I was on the site with the Minister of State, Deputy Catherine Byrne, when I held the housing brief. This represents a huge opportunity to develop something significant in the area.

This morning, the Minister, Deputy Eoghan Murphy, met the St. Michael's estate regeneration team. He also met other residents last week along with the Minister of State, Deputy Catherine Byrne. The St. Michael's estate regeneration team proposal, "Our Community a better way: campaign for fair rental homes", was launched on 26 April in Buswell's Hotel. It comprised 300 homes, 150 of which were social and 150 were cost-rental. The State would fund the capital cost of all units at a cost of €56 million. There would be a mix of one, two and three-bedroom apartments costing on average €175,000, €183,000 and €200,000, respectively. Average monthly rent on a cost-rental basis would be €900.

Dublin City Council is proposing a minimum of 420 units on the site, which is significantly more than the fair rent homes proposal has envisaged. It is important on key pieces of land such as the St. Michael's estate site that we make optimum use of the land assets available. Aside from the construction costs of whatever development takes place, it is critical we do not have a loss of opportunity because of density that is too low. Dublin City Council proposed 30% social housing, 126 units; 20% affordable housing, 84 units; and 50% private homes, 210 units. The first phase of the social housing element, which is 52 living-with-care homes, has housing with the support of the pilot project under Rebuilding Ireland. It has been approved by the capital assistance scheme, a funding of €15 million plus a contribution of €450,000 from the Department of Health towards additional communal facilities.

Dublin City Council intends to develop the lands primarily for residential development with commercial, retail, enterprise and community uses as outlined in the Dublin City Council city development plan. Proposals for interested parties can be assessed as part of the public procurement process to develop the land.

This is a really significant site. We need to proceed with the construction project as soon as we can. Dublin City Council has a view on the way to move forward. I know there are varying views among many people living in the community in the area. The Government intends to prioritise the best approach here that can deliver housing units to ensure we have a mixed-tenure community with social, affordable and private housing to create the right communal environment on the site.

The programme for Government states:

To this end the new Government will introduce a new model of affordable rental by working with housing associations and local authorities to develop a “cost rental” option for low-income families, as recommended by the NESC. The new Minister for Housing will provide leadership, work with all relevant stakeholders, and will set out in the Action Plan for Housing, a roadmap to implement the cost rental model.

The existing Government policy is not working. Only 2,378 houses were built by local authorities and housing bodies in 2016 and 2017, which is 4% of what could be built on State-owned lands. Apart from the fact that it is a giveaway of State lands, the housing land initiative will not work. Even if developers take up the offer from local authorities, the housing built will not be affordable.

We are pushing an open door here. Many people in the community support the concept of the pilot scheme proposed by the St. Michael's estate regeneration team. Councillors also support the concept in general. People on this side of the House support the concept and have committed to work together in solidarity to implement this pilot model. I ask the Tánaiste to sit down with the relevant parties, including the councillors, the housing manager in Dublin City Council and Government representatives, to implement a cost-effective rental model that will be a game changer in our community.

I assure the Deputy that the Government is committed to the cost-rental model.

Some 55% in NAMA.

Dún Laoghaire-Rathdown County Council has a pilot project in co-operation with the Housing Agency and approved housing bodies at Enniskerry Road, Dundrum. While it is relatively small scale with 50 cost-rental units, it will be a proof of concept. We are absolutely committed to affordable rental and cost rental as well as using land banks the State owns strategically today to ensure we can deliver on the potential of that model.

The Government also insists that we want to create mixed-tenure communities where social housing is next-door to affordable rental, next-door to privately owned property.

At the cost of rent they cannot afford it.

That is how we create the advantages of mixed-tenure communities, which in our view is a more sustainable way to develop many of these sites.

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