Ceisteanna ó Cheannairí - Leaders' Questions

On 3 September during Leaders' Questions, I raised the findings of the review into the provisions of gynaecology services in Letterkenny University Hospital with the Minister for the Environment, Climate and Communications, Deputy Eamon Ryan. The report was commissioned after a hard-fought battle by patients and by their families. These were patients who had suffered delays in diagnosis and treatment with devastating consequences for them and for their families. This included family members such as Dr. Margaret MacMahon who lost her sister.

As I said in September, campaigners such as Margaret deserve praise and recognition for their tenacity and determination. The review found that of the 123 cases of endometrial cancer over a ten-year period in Letterkenny University Hospital, one in three women experienced a delay in diagnosis, one in five women suffered serious consequences as a result, and a number of these women have since passed away, some as a result of the delay in diagnosis.

The review uncovered a litany of failures which had devastating impacts and consequences for these women. In September, I put some of the findings of the review on the Dáil record and I wish to do so again. The review stated:

It is clear that the experience for these women, and the service provided to them, was unsatisfactory. All cases, in one form or another, are typified by delay – delay from an urgent GP referral to a gynaecology outpatient appointment; from gynaecology outpatient appointment to urgent diagnostics ... and-or from diagnostics to intervention.

Today we learned that things have gone from bad to worse. A further three cases of delayed diagnosis have come to light in Letterkenny University Hospital, bringing the total number to 41. This begs the question as to how many more delayed diagnoses are we unaware of. It is simply not acceptable under any circumstances. The families affected are rightly demanding answers.

Tá a fhios againn go bhfuil trí chás úr ina raibh moill leis an diagnosis. Ta triúr mná san iarthuaisceart ag ceistiú an muinín agus an trust atá acu i seirbhísí gnólaíochta agus in Ospidéal na hOllscoile Leitir Ceanainn. Tá eagla ar ár máithreacha agus ar ár ndeirfiúracha. Is léir gur theip ar Shaolta agus ar an Roinn Sláinte ó thaobh na mná seo a chosaint. Níl sé maith go leor agus caithfidh an Rialtas gníomhú air seo láithreach.

It was reported in the Donegal News today that many of the families of those who have passed away as a result of this are disgusted with the individual reports into their care received from Saolta. Several families have come forward - some of them have been in contact with myself - to say that the reports they received are inaccurate and lack accountability.

The Saolta group responsible for these services at Letterkenny University Hospital has a lot to answer for. The review itself criticised the fact that during the very time that Dr. Price was carrying out his review, Saolta management, without his knowledge, decided that they in their wisdom would carry out its own audit of the same files. What does that say to the families? It does not exactly inspire confidence in Saolta's handling of all of this.

This requires Government intervention and action. In September, I raised this issue with the Minister, Deputy Eamon Ryan, and was told that this would be followed up on. I want the Tánaiste to tell me what action, if any, has been taken by the Government over the past two and a half months. I specifically asked at that time that the recommendations of the review be acted on and fully implemented. This has not happened. I asked for a review going wider than endometrial cancer in Letterkenny University Hospital. That has not happened. I asked if the Government would consider the independent panel's recommendation for a full audit to be carried out throughout the State to ensure that Letterkenny is not an outlier. There is no evidence that has happened either.

For the families of those women who have passed away as a result of their failure of their treatment in Letterkenny University Hospital, will the Tánaiste give this the priority it deserves? The women of Donegal and, indeed, their families deserve nothing less.

I thank the Deputy for raising the serious issue of the review of gynaecology services in Letterkenny University Hospital where women experienced delayed diagnosis. Obviously, as a result of that, in some cases they did not get the treatment they should have as soon as possible.

I want to express my deep sorrow to any of the women affected and also to any of their families and friends who have faced an adverse outcome because of this.

I am at a little bit of a disadvantage in answering the question in that I have not been briefed about this recently or in a very long time. I do not want to give an answer on a sensitive matter for it to turn out to be wrong. As the Deputy said, the Saolta group is in charge of the hospitals in the west and Donegal and it carried out individual reports into the different cases. I understand from what the Deputy said that some women and families are unhappy with the individual reports they received.

I am not able to answer what actions have been taken in the past two months as I am just not up to date on this. There is a meeting of the Cabinet subcommittee on health this afternoon. I will have a chance to see the Minister for Health, Deputy Stephen Donnelly, then and I will let him know the Deputy raised this serious matter. I am sure he will want to respond to the Deputy directly.

I thank the Tánaiste for his response. I appreciate he may not be fully up to speed with the independent review published in August and its recommendation that there should be a statewide review to ensure Letterkenny is not an outlier. Will the Tánaiste, as a GP, read that report because it is absolutely shocking? People lost their lives. The Tánaiste knows that endometrial cancer, if detected and treated in proper time, is not life-threatening or life-ending. In these cases, however, it is clear from the review, which Letterkenny University Hospital and Saolta accept, women lost their lives directly as a consequence of the failure of the treatment in the hospital. Not only that, the numbers are staggering: 41 out of 130 cases were delayed diagnosis while one in five, or 25 or 26, had serious consequences for their health. For some, that consequence was the loss of their life.

What Saolta and the hospital did was flawed from the very start. There was a review in 2018 by the National Treatment Purchase Fund, which made ten recommendations. There was no evidence that any of its recommendations was implemented. There is a lack of confidence in the service. That is why there is a demand for a proper independent review into this and to widen it beyond endometrial cancer.

I am asking the Tánaiste to take a personal interest in this as well as talking to the Minister.

I thank the Deputy. I will do that and I will read the independent review. When we find failings or shortcomings in any particular hospital it is important to apply scrutiny nationwide. If things are going wrong in one hospital it is wrong to assume that everything is okay everywhere else. Too many times we have learned that failings identified in a particular hospital or service are not confined to that service but are a more widespread problem. We have seen that with other reports in the past. I will take it upon myself to read that report and try to understand it better as well as raising it with the Minister for Health this afternoon when I see him at the Cabinet subcommittee.

My party has a proud history of creating social change in this country. We are probably unlike any other party in the degree of change we have stimulated. I refer to our attitudes to divorce, abortion, the rights of the LGBTQ community, women's issues and many other areas. As a party, we are now pursuing a campaign to ensure that every child born in this country has a pathway towards citizenship. We will not stop until it is achieved. The 27th amendment to the Constitution was introduced by Fianna Fáil with the support of Fine Gael in opposition and passed in 2004. It needs to be withdrawn or we must bring in legislation to neutralise it to allow a pathway to citizenship for children whose parents were born outside the State. It is completely wrong that such children cannot get passports, have problems accessing higher education or in some cases are threatened with deportation. It is wrong that children are treated differently from those they sit next to in school and are in some ways discriminated against.

The majority of Members of this House are delighted that change is coming in the United States. US President-elect Joe Biden has said that he wants to support the children of illegal immigrants. They call them "dreamers" in the United States. We have our own dreamers here. There are children in our own country that we need to look after. I am asking for the Tánaiste's support in this. We have 3,000 undocumented children in Ireland. These are our dreamers. We are going through a pandemic. So many of our healthcare workers come from outside this State. I have met some whose children were born in this State but do not have the same rights as the children they sit beside in crèches, primary schools, secondary schools or in some cases third level institutions. The pandemic has created disruption and changed the way we think. It has given us a chance to breathe and think about what is important to us. The children of all of those workers deserve to be treated equally. We all know about the case of Eric Zhi Ying Mei Xue, whose deportation order was opposed by a petition signed by 65,000 people and was then reversed. There are many children like Eric. It is not good enough that if someone has a Minister in his or her constituency he or she can get a deportation order changed for a child while many others face similar orders.

My colleague, Senator Ivana Bacik, has introduced legislation to deal with this issue in the Seanad. Will the Tánaiste support this in order to ensure that these children have a pathway? This is a campaign that the Labour Party has initiated. It is being led by our youth wing, Labour Youth. Will the Tánaiste support this campaign and ensure that our 3,000 dreamers get their rightful place in this country, are respected and are given a pathway to citizenship?

I thank the Deputy. I support the thrust of the campaign and the intentions behind it. The matter of how this can be achieved requires a bit more discussion. There is always the law of unintended consequences. We all know of children, young people and teenagers who were born in Ireland, who know no other home and who speak with Dublin, Wicklow or Kerry accents - not that someone's accent really matters. Many were born here, some were brought here at a very young age. To me it would be wrong to deport them to countries they never called home and expect them to start their lives there. We need a change in this area to provide a better legal mechanism for "dreamers", as the Deputy describes them, young people born in Ireland who are not citizens but who know no other home and were schooled here. They need a pathway to regularisation and then to citizenship, which is a slightly different thing.

Reversing the 27th amendment is a different issue. Unusually for a European country, our previous regime allowed anyone born in the State to be an Irish citizen automatically. Unfortunately that can be open to abuse. It could confer rights on a parent who arrived here illegally, which would not be the right thing to do. It could also represent a pull factor, causing people to come here from England to avail of that right. That is what happens in America, as the Deputy knows. We want to avoid replicating that. These are complicated issues, but the principle of providing a pathway to residency and citizenship for children who have only known Ireland as home is a desirable one. We will be happy to work with the Labour Party on that.

I thank the Tánaiste. This is a very important issue for us. Last December we lost the chairperson of our youth wing, Mr. Cormac Ó Braonáin. He was an amazing young man whose many talents had a huge impact on all of us in the Labour Party and further afield. His number one political objective was to ensure that children born to people not from this State or without citizenship would have this pathway. We all know the way our country has dealt with direct provision. We all know that there are children in direct provision whose home is Ireland. We all know that the longer this goes on, the more cases we will have.

Given our experience with Covid-19 and the time we have been given to breathe and to analyse, now is the time to deal with this issue. In light of the Tánaiste's very welcome comments about working with the Labour Party, I ask him to look at the legislation we have introduced to the Seanad and support it. Senator Ivana Bacik is very well versed in this area. We would really welcome that so that we could bring it forward to the Dáil. I am sure my colleagues in the Dáil would support it too.

I cannot say whether we can support it at this time, but I will take a look at it. I will speak to the Minister for Justice, Deputy Helen McEntee, who I expect to be the Minister addressing it in the Seanad, to see what we can do. Perhaps we will not oppose it and attempt to find a solution on Committee Stage. Senator Bacik is one of the best legislators in these Houses so we would always take a serious look at any legislation she puts forward, or at any legislation put forward by any Member. We have found solutions to these issues in the past. Only last year we brought in a scheme to regularise people who came here on a student visa, whose student visa lapsed and who ended up in the workforce. Many have been here for years. This is pretty much what happens to the undocumented Irish in America, who often arrive with a student visa and overstay. We found a solution to that. We never use the term "amnesty" because we have signed a European agreement not to implement amnesties, but we arrived at a system allowing such people to apply for a regularised status. Perhaps we can come up with a scheme to facilitate these young people as well. As I say, I agree with the point the Deputy is making. I would not like to see too many more cases like this arise without a solution in place.

I want to raise the question of international travel and some recent developments in that regard, and hopefully get some clarification from the Tánaiste.

Last week, the Chief Medical Officer, CMO, when he appeared before the Joint Committee on Transport and Communications Networks, was asked about the possibility of restrictions on air travel being eased in order to facilitate people to travel here at Christmas. His response was that international travel is not safe and movement of people around areas with high incidence of this disease, particularly Europe and North America, is not safe. He went on to make the point that it is impossible to gauge what the situation in regard to the virus might be in six weeks' time, which is fair enough. In recent days, the Government announced new proposals in respect of travel and change in the regime in this regard. A number of those proposals require clarification.

It goes without saying that I fully appreciate the importance of Christmas for people, especially families. Many people, including me, have family members living abroad who have not been able to come home for the past year. We would all really love to have some kind of normal Christmas and to spend time with our families. I also fully appreciate the importance of Christmas for the business community in terms of the amount of trade done in the weeks coming up to Christmas and at Christmas in general. However, it is really important that we do not engage in short-term thinking. We need to consider the time horizon relating to the taking of some of these decisions and prioritise keeping the downward pressure on the number of virus cases. The last thing anybody wants, either the public or the business community, is that we would go into a third lockdown in January. It is important to bear in mind that public health considerations and business and economic considerations are two sides of the same coin.

I am seeking clarification from the Tánaiste. Last year, approximately 1.2 million people passed through Dublin Airport. What kind of modelling has been done in respect of the potential for a spike in the virus figures? Specifically, was the CMO consulted about these proposed new arrangements? What are the proposals for oversight of the testing arrangements that the Government suggests would apply to people coming from red zones and orange zones? As far as I know, the public health advice is that there is a need for a double test to ensure that a person is negative. For people who do have a test when they arrive here and it proves positive, is the Government satisfied that there is sufficient capacity in the tracing system to be able to respond to what will inevitably be a spike in positive results?

I thank the Deputy for the questions. The CMO was consulted. The matter was discussed at the Cabinet sub-committee on Covid. We were both present and we discussed it. I recall that at the time the CMO said he was not particularly concerned about international travel. As we get the numbers down, it becomes a greater concern for reasons which the Deputy will understand. I do not know exactly what type of formal oversight mechanism will exist. I will come back to the Deputy on that.

We are confident that we will have the 800 contact tracers in place and that will give us sufficient capacity to carry out whatever tracing is necessary. There are 650 in place already. In a situation where there are approximately 1,000 cases per day, tracing becomes really difficult. If we can keep the number of cases low, in the ballpark of 100 or 200, we will have more than enough tracers to do the job that needs to be done.

International travel is a risk. We need to be upfront and honest about that. We need to get the virus down to very low levels again. We are doing really well in that regard. We are ahead of the projects at the moment in terms of getting the virus under control. The average number of weekly cases is one quarter of what it was only a few weeks ago and the positive rate has fallen from 7% to 3.5%. The numbers are very much going in the right direction. There is a risk, however, that as we get down to very low levels again, the country could be reseeded with the virus by people travelling in from overseas. There is an even higher risk that if people engage in North-South travel - because a different approach is being taken in Northern Ireland - we could be reseeded as a result, This type of travel probably poses a much higher than people travelling here from Qatar, Miami or wherever. We need to bear in mind that Ireland is an island but it is not an island state. There are two jurisdictions on this island. We are never going to close the border between North and South so we have to bear in mind that we are not in the same boat as other island nations might be.

We can limit risk but we cannot eliminate it entirely. That is why we have opted into the European system for international travel. It is advocated by the EU Commissioner for Health and backed by European Centre for Disease Prevention and Control's data and so it is science-based. This creates regions that are green, amber and red. There will be no restrictions in respect of travel here from a green region but a person travelling from an amber region will need a negative test before arriving in order to avoid having to restrict his or her movements. A person travelling here from a red region will have to his or her restrict movements and undergo a test after five days. He or she will not have to restrict his or her movements if that test proves negative. We are considering what kind of legal mechanism we need to put around that because it is not mandatory or enforceable, and penalties do not apply. Perhaps, we need to do that. This is one of the issues we are discussing at the moment. There are also a series of exemptions for healthcare workers, diplomats and people engaged in imperative family travel and imperative business because those things have to go on.

In terms of people booking flights to come home for Christmas, I would advise them not to do so at the moment. I know that is difficult and I know it is tough. Christmas is six weeks away and it is too soon for people to be booking flights to come home. I was watching "Reeling in the Years" the other day. In 1967, there was an outbreak of foot and mouth disease in England and people were asked not to come home. They did not come home and foot and mouth disease did not spread to Ireland. I am not saying that it is the same now but we are not in a position at this point to advise people that it is safe to come home for Christmas. I know that is a tough message to hear but that is the case at the moment.

I thank the Tánaiste. On my question about the requirement for a double test, my understanding is the medical advice is that a double test would be required at the moment. I ask the Tánaiste to clarify that.

My question in regard to capacity for tracing does not relate to the current numbers, it relates to the potential for large numbers of people coming here for Christmas. That is why it is really important that there are not mixed messages in this regard. I note what the Tánaiste said about the current advice. In the event of large numbers of people coming here and needing to take tests after five days, I presume that a significant number of them will test positive. Is the Government satisfied that there is capacity in the tracing system to deal with that potential large influx at Christmas, when people will be looking for leave and so on. Can the Tánaiste tell us what modelling has been done in this regard? The last thing we want is a third lockdown. It is in nobody interest that we would face that. Has modelling been done on the potential for a spike?

Some modelling has been done on the possibility of a third wave in January and February, which has been published by NPHET or Professor Nolan. I do not know to what extent international travel feeds into that modelling. I will have to check that. In terms of the European regulation that we have adopted and signed up to, that does not require a double test. It falls within the discretion of member states to decide how to proceed in this regard. NPHET's advice to us is that a double test would be better which, of course, is the case because any laboratory test creates false negatives. If there is a double test, it is less likely there will be two false negatives. This is the Swiss cheese analogy that people tend to use.

In terms of capacity, the position is that people coming in from the green regions will not have to undergo tests so their travelling here should not have any implications for contact tracing. People coming in from amber regions should have a negative test before getting on the plane and this, too, should not have any implications for contact tracing. Where implications might arise is people coming in from red-----

What is the situation where a person tests positive?

A person who tests positive is not supposed to travel.

Is there any oversight of that?

That is what we have to work on.

I want to raise with the Tánaiste the issue of the different approaches being taken on both sides of the Border on the island of Ireland in regard to Covid.

It has been reported in the media today that the Government is considering relaxing the lockdown restrictions after the current period ends and limiting the public to seeing only family members in terms of close contacts over the Christmas period. As the Tánaiste will be aware, the Northern Assembly is deadlocked and playing petty political games in its approach to coping with this deadly virus. My main issue is the fact that a different approach being taken to the virus on each side of the Border. The effects of this are clear to see.

The infection rate soared in Border counties from Louth to Donegal. In my county of Louth, at one time the rate in the northern part of the county was one of the highest in the country, yet less than 10 km away in the mid-Louth region there were practically no infections, and likewise in the south of the county. That is not a coincidence. The reasons are simple. The fact is that the authorities in the North have taken a different approach and that is causing severe problems for Border counties such as Louth, Monaghan, Cavan and Donegal. During the week a doctor in Donegal stated that the rates along the Border in Donegal, which are the highest in the country, are a direct result of the different approaches taken North and South of the Border.

We in the South have been placed under the most restrictive lockdown in Europe. People have accepted that because they want to get rid of this terrible virus and get their lives back to normal. Many businesspeople have sacrificed their businesses to help in this national effort. The Tánaiste knows as well as I do that many of those businesses will not be in a position to reopen once they are permitted to so do. These people will have effectively sacrificed their livelihoods for the sake of the health of the country. That is why, when I see the North taking a different approach on this issue, I feel for the people and businesses who have made great sacrifices.

How is it that the State has forced certain types of shops and businesses to close but similar shops across the Border remain open? How is it that shops and businesses in Dundalk have been forced to close, yet only 10 km up the road similar shops and businesses can continue to trade? How is it that under the current lockdown restrictions people are not allowed to travel outside their own county or more than 5 km from their home, yet people can travel from the North across the Border with apparent ease and face no fines or penalties? The North still has one of the highest rates of infection in Europe, yet we have no restrictions on travel.

It is plain to see that two different approaches are being taken and we in the South are paying a price for that. The Government has to get real and get a handle on this situation. Action, not words, is needed now. If the Northern Assembly is not capable of working together and taking an approach that keeps not only its citizens, but also people south of the Border, safe then the Government of which the Tánaiste is part needs to act strongly. Surely we cannot expect people and businesses in the South to continue suffering and making significant sacrifices while in the North the Assembly is playing petty political games and is unable to reach an agreement that would make our island a safer place for all citizens. Will the Government consider restricting cross-Border travel on the island of Ireland should the Northern Assembly fail to reach agreement or, indeed, decide to take a different approach from us in the South?

We are making enormous progress here south of the Border. As I stated earlier, the percentage positivity rate was approximately 7% but is now under 4%. The average number of weekly cases is down approximately 1,200 to approximately 400. The numbers in hospital and ICU are a fraction of what they were in the spring and are now stabilising or falling.

The picture in the Border counties is variable. We are concerned about the situation in Donegal. We have not seen a significant fall in the incidence of the virus there, particularly in east Donegal. In the other Border counties, namely, Louth, Cavan and Monaghan, the numbers are good. We need to bear in mind that all Border counties are not the same. However, we need to keep at it and we need to drive the virus down further.

When we ease restrictions, and I think everyone is confident now that we will ease restrictions in December, there will be risks. There will be embers of the virus still out there in the community and, as we gather and meet again, those embers can be fanned. There is the risk of international travel, which was discussed earlier. There is a significant risk associated with cross-Border travel and the virus being brought south by people travelling back and forth across the Border. That is a real risk of which we need to be aware. We need to measure it better. In my view, it is not being measured as well as it ought to be. The 14-day averages in the North show it is at three times our incidence rate and four times our death rate. There is a significant reservoir of infection in Northern Ireland and there is a risk that could spill over into the South. If we ease restrictions in December, it will be a real risk too.

As the Deputy will be aware, Ireland is one country but it is not one state. Obviously, Northern Ireland is a different jurisdiction. That is part of the Good Friday Agreement and we must respect the fact that in Northern Ireland the Executive has decided to adopt a different approach from here and, indeed, from the approaches in England, Wales and Scotland. It is part of the Good Friday Agreement settlement that there is autonomy in Northern Ireland and that the power-sharing Executive there makes decisions for itself as it sees fit. The easing of restrictions in Northern Ireland and how that might impact on the South is something about which the Government is concerned. The fact that things are so much worse in Northern Ireland and the Executive is considering easing restrictions is very much on our risk register. We do have a memorandum of understanding. The CMOs and the health ministers are in contact with each other and the Taoiseach is in contact with the First Minister and Deputy First Minister to express our views. We must respect the right of the authorities in Northern Ireland to make their own decisions for their jurisdiction under the terms of the Good Friday Agreement.

On the question regarding cross-Border travel, the Deputy should bear in mind that the 5 km rule applies. People can cross the Border, but only to go to work, school or college or for necessary reasons such as a medical appointment or to care for a relative or child, for example. There is no other reason for people travelling more than 5 km or across the Border. That is being enforced and I ask people to respect that.

We need to protect our people and businesses. I asked the Taoiseach the exact same question on Tuesday and he basically gave me the same answer, that the Ministers are speaking to each other, as are the chief medical officers. We have a serious issue at the moment. Everything the Tánaiste told me indicates that we need to do something across the Border. I come from Dundalk. What will happen on Friday in the North if they start opening pubs and restaurants? People will travel from the South across the Border and vice versa. That will cause serious problems. We must do something about it.

From Omeath to Cullaville, there are approximately 30 Border crossings. It is impossible to put checkpoints along the Border to stop people crossing it. As an ex-soldier of the 27th Battalion, I think it is about time we started to use the Army. There is a barracks in Dundalk with 450 soldiers. Why not deploy them in Border areas? Donegal is in a serious situation. Louth, Cavan and Monaghan have done a fantastic job over the past three or four weeks. Is that just going to be flushed down the toilet? We have to be realistic. I wish to see a united Ireland, but I do not wish to see a united Ireland right now. At the moment, my first priority is for the citizens of Ireland to be protected. The Government has to protect them.

We are in a second lockdown. The way things are going, there will be a third lockdown. I know and the Tánaiste knows that we do not wish to see a third lockdown. Prevention is the best cure. We have an opportunity to do something. The Government should get the Army out to stop the southerners and the northerners crossing up and down the Border. There is no problem with people who have to travel, but I have seen this situation develop in recent months and I do not like it. The situation is being abused. The freedom to travel is being abused in Border areas such as Omeath and Carlingford by northerners who are coming down to the South.

Thank you, Deputy.

The number of Northern number plates I have seen is unreal. I ask the Tánaiste to do something to protect the citizens of Ireland, please.

The Government is not giving any consideration to putting the Army on the Border between the North and the South. We struggled and fought too hard for too many decades to take all armies off the Border and we certainly do not want to be the jurisdiction that puts uniforms on the Border again. That is not something to which we are giving consideration. The point raised by the Deputy is a serious one. The situation in Northern Ireland is much more serious than the situation here. There is a very significant reservoir of infection in Northern Ireland and people travelling to and from Northern Ireland create a real risk. We need to enforce the 5 km rule, but that is best done by the Garda rather than by military means.