Ceisteanna ó Cheannairí - Leaders' Questions

On Monday, in the Mansion House, the leaders were great at adhering to time limits. I ask everyone to be similarly attentive to time allocations today.

That was a once in a century event.

I would not like for us to wait another 100 years to see the limits adhered to again.

The scandal surrounding the CervicalCheck programme and the withholding of information from women in relation to their false-negative test results last year has caused much trauma, anxiety and hurt. Unfortunately, women have died of cervical cancer. Over the weekend, I was sad to hear of the passing of Orla Church, a campaigner and cervical cancer victim.

The CervicalCheck programme has been in place for a long time and has saved many lives, however I understand that it is now in crisis mode. To work effectively it must work within certain parameters and timelines. The capacity must match the volume of tests per annum. When the scandal was exposed last year by Vicky Phelan, Emma Mhic Mhathúna and others, the Minister immediately announced that he had decided to provide free smears to every woman in the country who had concerns. On 9 January we learned from TheJournal.ie, through freedom of information, that the Minister took this decision against official and expert advice, that the decision would damage the efficacy of the programme, would delay and cause backlogs and was not clinically warranted. On average, CervicalCheck tests about 230,000 smears annually. The Minister's decision last April added an extra 90,000 to 100,000 to that volume. The Minister was warned repeatedly over a long period that this was wrong yet he proceeded without any additional resources being provided. The additional volume of tests as a result of the decision has created an unacceptable and enormous backlogs and women have been waiting for up to six months for the results of their tests.

There is a further problem. I understand that the delay has impacted on the quality and efficacy of the tests and has rendered a significant number invalid. There are two elements to the test. Cells are put on the slide and there is also viral loading which, in the detection of low-grade cell abnormalities, indicate whether colposcopy or further referral is required. Because of the backlog and time delays this part of the test in many cases, I understand, has been rendered invalid, null and void. Normally they would be done within ten days but because of the Minister's decision the resulting backlog has compromised the quality and efficacy of the tests.

This has serious and obvious consequences. I asked the Minister, Deputy Harris, a specific question on this issue on 15 January. I asked for the rationale of announcing the repeat cervical smears against expert advice and why he did not make that public at the time. He avoided answering that part of the question and I have officially complained about this under Standing Orders. The Minister has withheld information from the Dáil and the public on developments in the CervicalCheck programme that are clearly in the public interest. Is the Taoiseach aware of this development and the serious implications that arise from it? Was he informed by the Minister? Why did the Minister ignore expert advice and why did it take until December to discontinue the free smear tests? Why again the secrecy and the withholding of information?

Before I reply, I want to recognise, on my behalf and on behalf of the Government and my party, the Ceann Comhairle and his staff for organising what was a really appropriate and successful commemoration on Monday.

I also join Deputy Micheál Martin in expressing my condolences to the family and friends of Orla Church. I was filled with sorrow over the weekend when I heard of her untimely passing. I also pay tribute to her and thank her for her contribution to helping the health service to update its guidelines for GPs and others in relation to cervical screening. I recognise that it was a very important contribution which will help women in future.

I have always said, as have others, that we want some good to come from this terrible tragedy and the controversy around CervicalCheck. Some good has come from it. The Scally report was undertaken and is being implemented. We put in place a package of supports for the women affected by the audit including medical cards, experimental medicines and other supports. We have taken the decision to extend the HPV vaccine to boys this year and to introduce a new, more modern smear test - one of the first countries to do so - which is more accurate. That will be done this year. Important progress is being made.

We all know that cervical screening works. It has helped reduce the instance of cervical cancer in Ireland in recent years and has reduced the number of deaths. I am pleased that, notwithstanding the controversy around CervicalCheck, that women are still attending for smears and the programme is still working well.

As Deputy Martin said, in May the Minister for Health decided to offer free out-of-cycle smear tests to any woman who was concerned about her health and about the accuracy of previous smear tests in relation to the CervicalCheck screening programme. The Minister made the decision in good faith to answer the considerable fears and anxieties of many women in Ireland who were worried that their recent smear tests may have been misread or inaccurate. In the months after that, there was a significant increase in the volume of women presenting for smear tests. This not only included the women attending for the out-of-cycle tests but an increased uptake in testing in general by women. That increased demand put immense pressure on laboratory capacity. The HSE has worked actively with the laboratories to manage this and to improve turnaround times for smear tests. The HSE tells us that the laboratories have agreed to undertake additional recruitment, to provide overtime and to manage annual leave in an effort to minimise and reduce the backlog. In addition, the HSE is trying to source additional screening and laboratory capacity which would improve turnaround times for results. The HSE advises us that sourcing capacity and resources is a serious challenge as countries start to move to primary HPV screening to the new test, there is a shortage of capacity, not only in Ireland but also internationally. However, they are undertaking to provide that additional capacity and get on top of the backlog. Now that the out-of-cycle free smear tests have stopped, we expect that it will be possible to reduce the backlog over the next couple of weeks.

That is not true and the Taoiseach did not answer my question.

Was the Taoiseach made aware of the serious developments by the Minister, particularly regarding the validity of a significant number of tests that had been rendered null and void because of the delay? Normally, the virus would be tested for within ten days, yet people are facing six-month delays. This was discovered last year but not revealed by the Minister or anyone. In essence, that information has been withheld. That is why the service was discontinued. The Minister's decision went against expert advice that warned him repeatedly that this would damage the entire programme. It is my understanding and information that the programme is in jeopardy because of this and that further significant decisions and communications will have to occur.

I asked the Taoiseach whether he had been made aware of this by the Minister. Will he please answer that question? I asked him about the rationale behind the Minister's decision, which went against repeated expert advice that this was not clinically warranted and would damage the efficacy of the entire programme.

Have we learned any lesson? The withholding of information and the secrecy and denial that were part of the first phase of this scandal are being repeated yet again in the lack of upfront honest responses to parliamentary questions, the ducking and diving, the papering over of cracks and the subsequent covering up. We are now being led to believe that the decision to close down just evolved in December.

Time is up, Deputy, please.

It did not just evolve. A discovery was made that tests were invalid because the expiry date was passed due to the backlog and delay. That has consequences for the many women involved. Will the Taoiseach ensure that the Minister appears before the House and makes a comprehensive and transparent statement on what I have asked about today?

I thank the Deputy. The rationale behind the decision by the Minister, Deputy Harris, to offer a free out-of-cycle smear test back in May or June was to respond to the anxiety of many women that their smear tests may have been misread. It was done in good faith and for good reasons. It was never intended to be a permanent offering - it was only ever intended to last for a few months. Those free tests ceased to be available at the end of December last year.

I was made aware of a backlog a few weeks ago. The Minister informed me a few weeks ago-----

I do not mean the backlog. I mean the invalid tests.

I will answer the Deputy's question if he allows me to. I was made aware by the Minister, Deputy Harris, a few weeks ago that there was a backlog, that this was creating problems and, as a result of that, some tests had expired and would have to be repeated.

The Minister, for that reason, is working with the HSE to deal with that and to make sure that additional capacity is found in order to catch up on the backlog.

Why was this not made public? Why did the Government not reveal this to anyone so that-----

No. Please, Deputy.

I am sure the Minister will be happy to come before the House-----

When did the Taoiseach find out?

-----and make a statement on it.

When did the Taoiseach find out?

I would have to check my diary. A couple of weeks ago. I do not remember the exact date.

This is a very serious issue, Taoiseach.

Deputies, please.

I do not want to mislead the Dáil. I cannot remember the exact date.

Why did the Minister, given all that has happened, not comprehensively present this to the House? This is very serious. It is unbelievable that-----

The matter is inordinately serious, Deputy, but your time has elapsed.

We will get to it again.

The projected cost overrun in respect of the national children's hospital is, at best, a fiasco and, at worst, an example of gross incompetence on the part of the Government and those overseeing the project. What is most worrying is that, despite the fact that this overrun is set to blow a hole in the capital budget for years to come, no one seems willing to take responsibility for it. The Department of Public Expenditure and Reform, whose function is to supervise Government procurement and public expenditure, has gone into hiding. Its Secretary General has refused to appear before the Oireachtas Joint Committee on Health to account for the Department's role in this process.

On "The Week in Politics" at the weekend, the Chief Whip and Minister of State, Teachta Kyne, said that the position of the Secretary General was not sustainable. He was right. He offered up the view that the Comptroller and Auditor General could review the spiralling cost of the children's hospital. We in Sinn Féin welcomed that suggestion and were hopeful that such an investigation would be forthcoming, but lo and behold, a few hours after the suggestion was made, it was rebuffed by a Government spokesperson. It would seem that the Minister of State either misspoke or was slapped down. Which was it?

There are serious issues to be examined. The original tender from BAM was €131 million lower than the next bid. Did anyone in government raise questions as to how the accepted tender could be delivered when others were indicating clearly that it would cost over €100 million more to deliver? Surely the Taoiseach will agree when I suggest that someone or a group of people have messed up seriously. Will he now act without hesitation and agree to a full public investigation into what has happened and who is responsible? This is serious stuff.

The Government has committed to capital spending of €3 billion over the next four years. An overrun of more than €450 million will reduce that amount by up to 15% and will stop projects that have been provided for going ahead. That is the reality. There is significant concern in communities across the State about how the overspend will impact on them and on commitments made to fund badly needed projects. For example, what of the commitment for a new MRI scanner at the Midland Regional Hospital, Mullingar? What about the second cath lab at University Hospital Waterford? What about the Drimnagh primary care centre? I could go on.

What projects will be cut because of this scandalous cost overrun? People want an answer to that question. Will the Taoiseach clarify whether he agrees with the Minister of State that the position of the Secretary General of the Department of Public Expenditure and Reform is not sustainable and that he should make himself available to answer questions?

Thanks very much, Deputy. First of all, it is not €3 billion. No projects will be stopped and no projects will be cut but some projects may have to be-----

----deferred. It requires a reprofiling of about €100 million worth of capital expenditure this year out of a total capital budget of €7 billion. It requires a reprofiling of the budget of somewhere between 1% and 2%, half of that coming from the Department of Health and the other half coming from other Departments. Where there are overruns in expenditure, there are consequences, but it is not true to say that any project will be stopped or cut or cancelled. Some may well be deferred.

When we talk about the children's hospital, I really think we need to understand the value of this project as well as the cost. This is going to be a state-of-the-art children's hospital, a revolution in healthcare for our children - a hospital attached to a major adult hospital, a maternity hospital and an academic centre, with 450 single beds, with rooms for parents to stay beside their sick kids at night-----

Expensive bread and board.

-----with 15 theatres, five MRI machines, parent accommodation, and outpatient and-----

-----urgent care centres in Blanchardstown and in Tallaght-----

Not a single extra place.

-----allowing a whole new model of paediatric care to happen in this country, the kind of which we have never seen and a hospital that will be born digital with an electronic health record. That is the value of it. Like many of these big, expensive, important projects, whether it is the port tunnel or terminal 2 at the airport or the Luas, when it is built, everyone will be glad that it was built and will want to be associated with it and not the criticisms thereof.

No maternity services.

An investigation will be carried out into the reasons for the overruns. PwC, the major accounting and consultancy firm, has been retained by the Department of Health to carry out that investigation. I am always afraid to put a timeline on investigations or inquiries, as they always seem to take longer than we expect-----

How much will it cost?

-----but as soon as it is done, that report will be furnished to the Government and published thereafter. If people wish to make further inquiries on foot of that, having all the facts, that would be very welcome.

Mr. Robert Watt is the Secretary General of the Department of Public Expenditure and Reform. He regularly accounts to committees - the finance committee and the Committee of Public Accounts - and he will do that on any aspect of expenditure. However, the Accounting Officer for the Department of Health and for this project is Mr. Jim Breslin, and he will make himself available to account for any health expenditure to the health committee. I understand a date has been set for that.

The Taoiseach need not convince anybody on the necessity of having a world-class children's hospital. God knows, people have waited long enough for it, but that is not the source of my questions. I am questioning the efficacy and effectiveness of the procurement procedures of the State. The Taoiseach should bear in mind that in the term of office of the previous Government his party made a virtue of the fact that it had overhauled procurement procedures to avoid precisely this type of scenario of cost inflation and potential wastage of expenditure by the State. It is for that reason that Mr. Watt needs to present himself to the Joint Committee on Health. I am well aware that Mr. Breslin is the Accounting Officer for the Department of Health, but I am with Deputy Kyne, the Government Chief Whip. I do not believe Mr. Watt's position is sustainable and see no good reason he should not present himself to the Joint Committee on Health. A review by PwC is all well and good, but it is not in government and running Departments. Where we need accountability for this cock up is among people in government and the senior civil servants who advise, guide and implement Government decisions. The Taoiseach is dancing on the head of a pin in saying matters are simply being deferred in respect of other spending. Neither people living in Waterford who are waiting for a second catheterisation laboratory, nor people living in the midlands or Drimnagh will welcome or feel in any way reassured by the Taoiseach's distinction between a cut and a deferral. Will he confirm for the House that he will make available a full and comprehensive list of deferred and re-profiled projects in order that people can make a decision for themselves?

We will make it available when we have it. As the Deputy is aware, in the procurement process for any project there are a number of steps along the way. A project must have planning permission; it must then to go to tender and be built. We may find other projects have been delayed for reasons beyond our control. For example, sometimes a project will not receive planning permission, which in itself creates a saving. When we have the list, we will provide it. However, I can assure the Deputy that none of these projects has been cancelled and stopped. The report on the inquiry being carried out by PwC will be made available. The Deputy correctly states PwC is not in government. It is also not in opposition, which means that it will be objective and not political in coming to the facts. When we come to the facts, the report will be furnished to the Government and then published. People can take it from there.

Yesterday the Taoiseach got away with telling us that the mother and baby home commission needed time to finish its work. On the surface, that sounds reasonable enough. The problem is the commission does not deal with the issue of the time it has already had. It was set up to do a job in three years, but what we have after its four years of work is four interim reports, in the first of which it looked for a time extension. In the second it told us why it had asked for a time extension in the first report. Incidentally, its publication was delayed for eight months by the Minister because it also stated Bethany Home survivors should never have been excluded from the redress scheme, which issue has still not been addressed. In the third interim report which devastated the survivor community, the commission looked for an extra year just before it should have concluded. Now, at the eleventh hour, in another report it is looking for another year. Is this a joke? Do Members honestly think it is acceptable that we should wring our hands for a little while, offer a bit of sympathy to the survivors and then move on to the next issue? I am not blaming the Taoiseach for this, but he is the one in power who could sort it out. We need to know why the commission has not completed its work and who will be held to account.

The report talks about there being a considerable workload to cross-reference documents. It also talks about delays in obtaining evidence from the authorities which ran the institutions which could not be examined until the commission had finished the examination of the documents. Why has this not been done? Is it a question of resources? If so, why did it not flag it before now? If it is a question of non-co-operation, why did it not highlight it before now? Why did it only receive the first tranche of documents over two years after it had been set up? Did it not ask for them? Was it obstructed in getting them? Why did a commission set up by the Department of Children and Youth Affairs and reliant on information from that Department and the Department of Health, in its words, to produce a "comprehensive" and "accurate" report only receive information recently, a year after its business should have been concluded?

The commission talks about being dismayed that so little information had been kept by the HSE. It finds it difficult to understand why relatively recent documents are not available. It does not understand why the HSE does not have any system for archiving material. Does the Taoiseach understand it? What has he done about it? Let us remember this is the same HSE which two years before in 2012 had produced a report on the 500 baby deaths at Bessborough. It beggars belief. These are fundamental issues, but there are so many more. How come the commission can come in within budget? How come it is not costing any more money in continuing for two extra years? Will it not pay for remaining an extra two years in its Baggot Street offices? Will it not pay salaries? Did we get it wrong the first time? These are fundamental questions, but there are so many more. The only conclusion one can draw is either the commission is grossly incompetent or it is being deliberately misled. My question to the Taoiseach is which is it. Is allowing the commission to continue without scrutinising these matters in the interests of the people whom on Monday the Taoiseach so accurately and articulately stated had been betrayed by the State?

I very much share the distress and disappointment of former residents of the mother and baby homes that we do not yet have a final report from the commission which we should not forget was established by the Oireachtas. None of us believed at the time that it would take as long as it has for the commission to do its work and issue its report. The commission is independent. The whole point in having a commission of investigation is that it is independent of government. It is not a creature of government. Therefore, I cannot answer questions on its behalf. If I was able to interfere in the work of a commission and answer questions on its behalf, it would not be independent and would defeat the purpose in having such a commission of investigation.

The commission has informed us that it has more work to do. So far it has interviewed 519 former residents. It wants to interview more and everyone to have his or her opportunity to be interviewed and his or her story heard. It has received new material which needs to be considered and a mass of documents - I am informed over 100,000 documents - all of which need to be considered properly. It tells us that it has adequate resources and that, notwithstanding the delay, will come in on budget. It has not requested additional resources, but should such a request be brought forward, it will be considered.

It is not the case that we must wait another year before anything happens. We will receive a comprehensive report on the burials. It is scheduled to be presented in March. It will give us more information on the burial grounds.

We have already taken a decision as a Government, a few months ago, that investigations will be carried out at Tuam, with a view to identifying, if possible, the remains of some of the children buried there to give them the appropriate burial they should have had when they died. The Minister for Children and Youth Affairs, Deputy Zappone, working through the consultative forum, is drawing up proposals for how we might do something to assist and support the health and well-being of former residents while we await the final report.

The information the Taoiseach has given the House is inaccurate. How does he know that the commission will carry out its work now? He has referred to other interviews that need to take place and extra documentation received. Does he not know that the report published yesterday referred to the interviews being concluded this month? Can he tell me if they have been concluded? The commission stated it had been expecting 277 files to be delivered in December. Were they delivered? Does the Taoiseach know? If he does not, why does he not? I do not expect him to be on top of every detail, but there is a considerable problem in this House where we set up commissions of investigation in response to appalling scandals and horrific abuses perpetuated on people in that we let them carry on and ask for extra time. The Taoiseach does not pose or answer any of the valid questions I have raised about the reasons for the delay. It is not acceptable. It is a feature of Irish political life, for the Opposition and the media, that nobody follows them through.

Last May, the Taoiseach told me that in response to the CervicalCheck scandal and the lack of action on mandatory disclosure the Government would progress and implement a patient safety Bill. That was not seen through and has been forgotten. In response to the Grace scandal, the Government set up the Farrelly commission. Everybody forgot about it and the time to finalise its report has been extended. The Government must see these issues through. I ask the Taoiseach to answer the questions he was asked about why this commission has not done the job it was supposed to do. Is it being obstructed or is it just incompetent? There is no other explanation, although the Taoiseach may invent one.

The information I have is that the interviews are not yet concluded. There are 26 or more yet to be carried out.

The interim report published in December stated that the interviews would be concluded by now.

My information note is dated 22 January. Although it may be out of date, the information I have is that the interviews have not yet concluded. The information I have is that the discovery of records is complete and the files have been delivered, although that does not preclude the possibility that further records may be found, as happens on occasion, particularly with historical records. The Minister, Deputy Zappone, has met Judge Murphy to raise her concerns and those of the Government regarding the delay.

Carers do a tremendous job day in, day out across the country. According to census figures, there are 195,263 carers, of whom 118,000 are women and 3,800 are under the age of 15. They provide 6,608,515 care hours each week. Women provide more than two thirds of the care and young carers under the age of 15 provide 2.2 million care hours each year. They provide 24-hour care for some of our most vulnerable people and save the State billions of euro each year. The most recent figure of which I am aware indicates an annual saving of approximately €4 billion. They provide care for thousands of people in their own homes, keeping them out of nursing homes and freeing up thousands of hospital beds. I dread to think what our health and hospital services would be like without these carers. The current health crisis would become absolute mayhem without them.

However, carers receive very little financial or other support in return. If they successfully overcome the massive 17-week delay in processing carer's allowance applications, they will receive the princely sum of €1.20 per hour on the full rate or €0.60 per hour on the half rate. There is little or no respite care available to give carers a break. Many have health problems arising from their caring duties. Carers may be housebound due to lack of support, suffer from exhaustion or experience emotional and mental health difficulties. The 17-week wait for decisions on carer's allowance applications is unacceptable. Some 40% of applications are refused but, following a wait of up to 12 months for the review and appeal of applications, more than 60% of the appeals and reviews are granted.

Will the Taoiseach agree to resource and staff the carer's allowance section of the Department of Employment Affairs and Social Protection to enable it to issue a decision on these applications within a reasonable time limit such as six weeks? Will the Government increase the carer's allowance payment in line with the minimum wage and ensure that respite care is available to support the health and welfare needs of carers?

The Government very much values and appreciates the work of carers, family carers in particular, in looking after their loved ones. As a Government, we are determined to support them. Those are not just words, as we have demonstrated in the past couple of years.

We fully restored the carer support grant which was cut by another Government some years ago. The carer's allowance and carer's benefit will increase in late March to a level higher than that in place before the financial crisis. Last year, we extended free GP care to those in receipt of carer's allowance or carer's benefit because carers also need to be cared for. When I was Minister for Social Protection, I brought in a 12-week rule whereby carers continue to receive carer's allowance or carer's benefit for three months after ceasing to be a carer, such as when their loved one passes away or goes into a nursing home, for example, in order to give them time to get back on their feet, readjust and find a new life for themselves. I am very proud to have been part of making some of those changes. Carers are allowed to work part time because some carers who we support financially are not full-time carers and are able to undertake part-time work. The means test is among the most generous internationally and carers are allowed to earn additional income on top of the carer's payments, which are among the highest in the world.

Crucially, last year and this year respite services were and are being extended because carers need time off. The best way we can support them in that regard is to ensure that more respite is available for those for whom they care. That is why an additional respite house is being established in every community care area in the country, a process that is very much driven by the leadership of the Minister of State, Deputy Finian McGrath.

The Minister for Employment Affairs and Social Protection, Deputy Regina Doherty, has apologised already for the delays in processing applications. Work is being done to improve the situation and allocate more staff to the section to ensure that applications are processed far more quickly than is currently the case. The applications are not always straightforward. The process differs from other applications because in addition to a means test, a medical report to verify that the person being cared for needs full-time or close to full-time care is required. That is one of the reasons why they take somewhat longer to process than other applications. However, we accept that the processing times are too long and are resourcing the section and changing procedures to speed them up. Of course, as is the case with many social welfare allowances and benefits, arrears are paid once eligibility has been determined.

I am not sure from what hymn sheet the Taoiseach is singing but his comments are pie in the sky and completely out of touch with reality. If he were to telephone the carer's allowance section of the Department of Employment Affairs and Social Protection, he would be told that the current waiting period is 17 weeks. That is worse than was the case six months ago. In June of last year we were told that the waiting period was 15 weeks, which was also unacceptable. However, the situation has worsened. I and many other Deputies are aware of cases in which those being cared for passed away during the application process.

An urgent and comprehensive review of how we deal with the caring situation, including the role of and support for carers, is needed. One thing the Taoiseach could do today would be to fully resource and staff the carer's allowance section of the Department to ensure a reasonable turnaround time of no more than six weeks for applications. Carers are waiting for that to be done. This is a very significant issue which the Taoiseach and the Government should address immediately.

I am advised that the current average number of weeks to award carer's allowance and carer's benefit currently stand at 17 weeks and 14 weeks, respectively. However, the vast majority of applicants do not wait that long. Some 70% of carer's allowance applications and 90% of carer's benefit applications are decided in less than 12 weeks. However, I fully appreciate that the delay can be very distressing for the 30% and 10% of applicants who must wait more than 12 weeks. The Minister, Deputy Regina Doherty, is working on the issue and I have discussed it with her. I will ask her to furnish the Deputy with more detail on the actions being taken by the Department to reduce the waiting times.