CervicalCheck Tribunal (Amendment) Bill 2021: Second Stage

I move: "That the Bill be now read a Second Time."

We are here today to introduce the CervicalCheck Tribunal (Amendment) Bill 2021 to Dáil Éireann. I begin by thanking my colleagues, the other Deputies, for facilitating the Second Stage debate at this early date. While this is a technical amendment, I acknowledge the profound impact the CervicalCheck debacle has had on women and families who have been affected. It will take some time to restore the loss of trust but I am very confident in the management team at CervicalCheck and I know there is some great work being done by the CervicalCheck steering committee.

The purpose of this amendment to the CervicalCheck Tribunal Act 2019 is to extend the period for receipt of claims by the CervicalCheck tribunal and to provide that I, as Minister for Health, may by order extend that period further. The tribunal was established under the CervicalCheck Tribunal Act 2019 which implements the recommendations of Mr. Justice Charles Meenan by providing the CervicalCheck tribunal as an alternative to the courts for eligible claims. Mr. Justice Meenan was asked by the then Government to review, in the case of women affected by CervicalCheck issues, mechanisms which would avoid, wherever possible, women and their families having to give evidence in the courts. Mr. Justice Meenan proposed that claims arising out of CervicalCheck could be resolved outside the court process and that a tribunal should be established under statute for the purpose of hearing and determining these claims.

In December 2018 the then Government agreed to establish the CervicalCheck tribunal. The legislation necessary to establish the tribunal, the CervicalCheck Tribunal Act 2019, passed through the Oireachtas and was signed into law by the President on 23 July 2019. The tribunal was established in October 2020. Following a pause in the steps towards full establishment to allow for discussions with the 221+ patient representative group about the tribunal and CervicalCheck cases more generally, establishment of the tribunal was completed with the appointment of the nominated members to the tribunal on 1 December 2020. At that time I gave a commitment to 221+ group that their members would not be disadvantaged by the five-week pause in establishment during which claims could not be made.

As we all know too well, the past 15 months have been a challenging time for everyone. Covid-19 has affected every aspect of life and the CervicalCheck tribunal has been no different. The tribunal experienced delays in the development of its premises, which are a welcoming, modern and purpose-built space, and have been designed with the specific sensitivity to the needs of claimants. Unfortunately, as we now know, after the appointment of the members on 1 December, the epidemiological situation in Ireland worsened considerably and the necessary restrictions imposed on movement and working practices caused significant disruption to all legal proceedings, particularly those where claimants had to attend medical practitioners to secure reports on their conditions.

It was only in March of this year when restrictions had eased somewhat that the tribunal received its first claims. The tribunal suffered a further blow in May of this year when it too was impacted by the criminal cyberattack which resulted in the tribunal’s email and databases being taken offline.

This measure was purely precautionary, and there is no evidence that any information was accessed or compromised in any way, but it was only at the end of June that the tribunal was again fully connected. This combination of circumstances has had the effect of substantially reducing the timeframe during which eligible women and families can access the tribunal. This amendment ensures they will be given as much time as possible to consider the options available and to make the choice they believe is right for them.

The 221+ support group made a number of requests in advance of the setting up of the tribunal. We would very much have liked to accommodate all these requests. Unfortunately, some of them were not possible to deliver because of clear legal advice laid out by the Attorney General. I acknowledge the group's disappointment that we were not able to allow for recurrence, for example. It was, thankfully, possible to accommodate many of the requests made for ongoing support for the 221+ group, supports for women and families affected and other assurances relating specifically to the tribunal itself.

The tribunal has received five claims to date. The State Claims Agency has advised that additional plaintiffs have made formal requests to transfer their claims to the tribunal from the courts and that more claimants have expressed interest. I am advised that the tribunal and the 221+ support group are getting queries also, so it is expected that the tribunal will ultimately deal with more claims.

I can also inform colleagues in the House that I have requested, and the tribunal has agreed, that the tribunal premises will be made available to women who are eligible for the tribunal for the hearing of their claims even if they choose to remain in the High Court. As Mr. Justice Meenan recommended, the tribunal's premises have been designed with privacy in mind, so they are not suitable for public hearings. It is also true that women who choose to keep their claims before the High Court will not be able to take advantage of the streamlined procedures available to them in the tribunal. Nevertheless, women should not feel pressured to take a claim to the tribunal solely because of the superior facilities available. As many women as possible should have the benefit of these. The tribunal has similarly agreed to make its facilities available for the mediation of CervicalCheck claims, which is very welcome.

The current time limits for making a claim to the tribunal are set out in section 12(1) of the 2019 Act. The current relevant time limit for all eligible women is nine months from the date of establishment, which is 26 July of this year. The Bill proposes to extend the final date for receipt of claims to the tribunal by way of an initial six-month extension and allows for one further extension of six months.

As well as the tribunal's function in hearing and determining claims, the CervicalCheck Tribunal Act 2019 provides for restoration of trust meetings. The intention behind a restoration of trust meeting is to document experiences, facilitate discussion and provide information to women affected by the issues relating to CervicalCheck, or to her family if it is the case that the woman has died. The meeting process is open to all women who are eligible for the tribunal, regardless of whether they make a claim to the tribunal. A facilitator of the meetings has recently been identified and preparatory work necessary to offer the service is ongoing. I am advised that the facilitator intends to carry out a wide-ranging stakeholder consultation process while the moderator recruitment campaign is being conducted.

The amendments to the CervicalCheck Tribunal Act 2019 will ensure that any woman who is eligible for the tribunal will have ample time to consider whether they will make a claim to the tribunal. I commend the Bill to the House.

I will start by setting out a number of points I made when the tribunal was first established. Obviously, I will support what is a technical Bill to extend the period during which women may make claims to the end of July. It is welcome that this period is being extended. The fundamental question, though, is why it is being extended. I have spoken to members of the 221+ group and their legal representatives, and their view as to why it is being extended is that very few women have lodged claims. Rather than deal with the substantive and genuine reasons most of these women have not made claims, we will simply extend the period during which they may make a claim. Their view is that, without dealing with the very real issues that were not dealt with and their concerns leading up to the establishment of the tribunal, we are not really making any changes at all.

I have said from the outset that the CervicalCheck survivors deserve compassionate treatment. They have asked from the outset for this process to be non-adversarial, and I think we would all accept that was a very reasonable ask, as were their requests that the State should be prepared to settle rather than contest claims where they are clear-cut and that, where possible, the labs should be pursued separately and the State should not use the survivors to do its work for it.

I also asked at the time of the establishment of the tribunal that no woman or her family be statute-barred from making a claim due to the delays in setting up the tribunal. The Minister said at the time that the chair of the tribunal would have discretion and that it was his view that no woman would be prevented from making a claim. Essentially, however, as the women saw it, they were being asked to take a leap of faith, and that was one of the difficulties. We cannot expect women in these circumstances to take a leap of faith because the Minister himself said it will take some time to rebuild trust. There has to be a cast-iron guarantee that no woman in the 221+ group will be statute-barred from making a claim at the tribunal. Every option, including a return to the tribunal where there is a recurrence, should have been fully explored and put in place. It is important that the tribunal has the confidence of the women and their families.

The Minister and the 221+ group published correspondence exchanged between them just prior to the establishment of the tribunal. The Minister stated in a letter on 8 November 2020:

I strongly believe that proceeding with the final steps necessary to commence a tribunal is the right thing to do. Doing so will enable women and families who are seeking access to the tribunal to proceed with their claims without further delay.

The question is this: has it worked? Have women lodged claims? How many claims have been lodged? How many have been heard? We know how much the tribunal has cost. That should not be the issue, but it has cost more than €2.5 million. It was set up to give women an alternative to the courts system and a less adversarial approach. Hundreds of women had access to the tribunal. As the Minister knows, we cannot get information now - or at least were not able to do so up to last week - because of the cyberattack, but the most recent information I have is that five claims were lodged. Maybe that number has gone up slightly. I do not know. That number suggests that women are voting with their feet and saying to the Minister loudly and clearly that there are problems with this tribunal and that there were problems from the get-go with recurrence, the statute of limitations and whether their legal advisers sought an alternative to the courts system. There is little point in establishing a tribunal for a section of society and for those women who were so badly wronged by the State and so badly let down and who feel genuinely so hurt if it does not have the confidence of the women. That was a problem.

I extend my best wishes to Vicky Phelan. We all know she is in a battle and we all wish her the very best. I also extend my solidarity to all the women affected, as I am sure the Minister and everybody else in the Chamber would. It is our job to make sure we do right by them and that we stand by them and stand with the families. By standing with those families, the Government would set up a tribunal that works for them. Quite clearly, with the figures we have, that does not seem to be the case. While I will support this Bill to extend the deadline for women to make more claims, I am really concerned that so few women have stepped forward.

While this Bill seeks a necessary extension to the duration of the CervicalCheck tribunal, we have to face the fact that, with only a single-figure number of claims, it is not working and is not fit for purpose. The Minister has heard that loud and clear. I welcome what he has said today about the consultations that will take place. He says women will have more time. Well, unfortunately, in the CervicalCheck scandal, many women did not have more time, and that was the issue.

This needs to be addressed once and for all. Trust needs to be earned. The Minister needs to fix this and do so now.

I have spoken about trust. I raised the affordability of the HPV vaccine on 15 December, 13 January, 26 April and 6 May. I ask the Minister to listen to me again today. There are women who cannot afford this. Some have been medically advised by their consultants and doctors. They do not have medical cards. The €600 being demanded for the HPV vaccine is not right. Can the Minister include it in the drugs payment scheme, at a minimum? It should be free. I am not asking for it for everybody. I know the programme is there but I keep getting back benign answers to my questions. There are women who cannot afford this €600 who do not have medical cards. I know that the Minister will say this is NIAC advice and so on but he is the Minister and the buck stops with him. Will he give the HPV vaccine to those who are medically deemed to need it by the medical practitioners?

This Bill, which proposes to amend the CervicalCheck Tribunal Act 2019 to allow for more time to make a claim, will ring hollow with many of the women most affected by the failings of that programme because it does nothing to address the reasons the extension is needed. The Minister mentioned Covid and the cyberattack on the HSE but it is 19 days away from the deadline and here we are. The fact remains that driving licences were extended for longer as a result of Covid than the plans for an extension in this Bill. If a fraction more care and attention had gone into the administration and logistical oversight earlier, we might not be here today, these women might not be sick today and these women might not be dying today. I ask the Minister not to add to that failure. It is not only the decent and humane thing to do but it is the responsible course of action to accept that if a person is entitled to institute proceedings, the limitation period should not be applied to them - they should not be excluded from doing so because time is not on their side. There is no closing date for sickness and there is no closing date for the worry that the women, their families and children are experiencing. Why should there be such a tight closing date on their right to justice and recompense?

There is a growing perception that the Minister is wedded to getting this tribunal done and dusted so that it can be brushed under the same carpet as many other failings in women's healthcare, such as the mesh implants or the hepatitis C scandal. I ask the Minister not to add to that. This Bill does nothing to address the concerns of the women most affected. With only five claims to date, instead of apologising, compensating and rectifying, there is now a pattern of aggressive confrontation, of clouding central issues and of victim blaming. Let us not add insult to injury. Let us stop injury being compounded on injury. The Minister has an opportunity to show further commitment to these women by accepting that the limitation barrier should not be applied.

I want to begin by welcoming Vicky Phelan home. I am delighted that she is on her way home to her family. I hope she gets to spend a lot of quality time with them in the coming days and weeks. Without her, I do not think we would be here today discussing all the issues, failings and positive aspects. I was in touch with her last night and she is looking forward to coming home.

We will support the Bill. I do not know if anyone would oppose it because it is purely a technical Bill to extend the tribunal which was established by these Houses. I accept that. We all know it is limited. Five women are using the tribunal. That says it all for me. I have had many discussions with the Minister on this and also with the Taoiseach. While we will vote the Bill through tonight, unfortunately I do not think it will have much impact, to be honest. It is unfortunate because that is not the way it was meant to be.

Last October, the Minister signed a statutory instrument to commence the tribunal even though he had made pledges about consultation and what he would do to try to make the tribunal better, but it just did not work out. I felt the way that was done was so haphazard and wrong. I told the Minister that at the time and that is on the record.

Good faith was lost around then. I know because I was dealing with the 221+ group. I dealt with Lorraine Walsh, Stephen Teap, Vicky Phelan and many others. That was when good faith was lost and when they said they would not advocate for any woman or family to go through this process. Now €2.5 million has been spent for five cases and I do not believe there will be many more. It is overstating it to say that there will.

When we gathered in Leinster House on 22 October 2019, the then Taoiseach said:

We have found the truth and the facts and are making changes to put things right. We need to restore trust and rebuild relationships that have been severely damaged.

On 2 September 2020, the Minister for Health met online with the 221+ group. The meeting went through all the group's concerns. Where the Taoiseach spoke of restoring trust, the issues were never dealt with. One issue was that the tribunal would be non-adversarial. That has not been the case. Lorraine Walsh, in particular, highlighted the need to allow women whose cancer recurred to be able to go back to the tribunal. She put a great deal of effort into trying to sort that out but it has not been dealt with. The question of why laboratories have to be brought into it has not been fully addressed. The HSE is primarily liable, and that is something I will return to in a minute. They sought a guarantee that the HSE would not object. There was the issue of the statue of limitations, which has already been raised. All five of those issues were sincerely raised but were not dealt with. There is a lack of respect for the Chief Justice's decision following the Ruth Morrissey judgment. I have spoken of this often in the House. It is a stain on us as a Legislature that we have not dealt with what the Chief Justice asked us to do in relation to the Ruth Morrissey judgment which was appealed by the last Government. I stood almost alone - there may have been one or two with me - in saying that was wrong. The judgment was held up by the Supreme Court. It changed everything. Ruth Morrissey was an amazing woman and because of her case and the way she stood up, she will have changed Ireland for so many in this area.

The HSE is now primarily liable for these cases where negligence is found so why are these cases not being dealt with beforehand? Why are they not being dealt with far more quickly? Following the recommendation made by the Chief Justice to us as legislators, why is it not a requirement in the Government's legislative programme to change the Civil Liability (Amendment) Act to ensure that women are not faced with having to choose between taking cases or allowing their families to do so after they pass away? That is scandalous. These are not equal options. It is neither tolerable nor fair. I have told the Taoiseach and the Minister that I have drafted a Bill to deal with this so that women do not have to face the choice of taking cases or allowing their families to do so after they pass away. I have never received a response of any substance. I am not saying that the Bill I produced is perfect - in fact, it probably is not - but it is a start and one that was made a year and a half or two years ago.

We must deal with what the Chief Justice, Mr. Clarke said, but we have had radio silence on it. The draft Bill I prepared permits both legal actions to be taken, while prohibiting double recovery. The draft amends section 48 of the 1961 Act to provide that, where:

– a person before their death has brought an action and recovered damages in respect of a wrongful act that caused their death, and

- a court, if it was awarding damages in an action under section 48 for the benefit of the dependents, would be entitled to take account of heads of damage additional to those in respect of which damages would have been awardable in an action brought by the person before their death,

At times, the Minister and the Taoiseach justifiably castigate some in the Opposition for not having alternatives and bringing forward solutions. I have brought forward a solution to that has been identified by the Chief Justice as a massive issue. It is unfair on so many people to be left in this position. Will the Minister please engage with me? My party has made the first steps in this regard.

My good friend, Vicky Phelan, when speaking about the establishment of the tribunal, asked why was it so hard for the Government to do right by the women of Ireland? She is right. Everything that has been done in the aftermath of the CervicalCheck scandal has been done through a paternalistic lens, in particular in how we ploughed on with the tribunal. We now have a situation where many women are being advised not to participate in the tribunal. The cost is €2.5 million. We have five cases and an empty building that has been fitted out for the purpose at a cost to the State of €600,000 a year. It is not good.

This legislation is required because the term of the tribunal must be extended given the circumstances in which we have found ourselves in the past year, but it does not deal with the fundamentals of how we ended up here. This is flawed. I have probably met more of the women and their families than anyone else in this House, but I would not advise any of them to go through this tribunal. As somebody who had to vote on it, that is not good.

Women and their families want to have confidence not just in the tribunal but also in the screening programme. We all know that screening is not diagnostic but bringing screening home would go a long way to help build up confidence in the system. Knowing that their smears are not being sent off to different corners of the world would give women peace of mind. That must be a big priority for the Minister.

I welcome the changes in the appointments to various roles across the screening programme. However, I want to sound a word of advice: the paternalistic attitude in any form must go. What Vicky Phelan exposed was how a minority in the medical profession spoke to their patients and looked down on them. That must stop. Patients are entitled to ask questions about their own health. I would be worried if a little bit of that paternalistic "I know better" attitude from some people were to creep back in. I am flagging that for the Minister because I am seeing some stuff that I am not very happy about.

I want to end with the words of the great woman that is Vicky Phelan. She said:

Confidence comes from actions not words. If an absence of trust continues it is in the absence of action by the State to deal fully with the past. The change that is needed must come from within the system. It is never too late to do the right thing. The discourse will follow.

I join the previous speaker in paying a short tribute to Vicky Phelan. I was pleased to hear earlier this week that she is on her way home. She has had six rough months in the United States. She was on "The Late Late Show" with Ryan Tubridy last summer, a day or two before her departure. She was filled with hope but also trepidation and fear. She has embraced the science of this from the get-go and is clinging to every tree that she can. I wish her every success going forward.

It is important in the same breath to also mention a woman from my own county, Laura Brennan, who was also an ardent campaigner on the CervicalCheck fiasco. She was a young lady who lost her life in March 2019.

I hope the Bill will enjoy the support of all Deputies. It is essential that we extend the period within which claims can be made by the CervicalCheck tribunal. An initial six-month extension is proposed right up to 26 January 2022. If we enact the Bill, it also entitles the Minister for Health to extend the period further for another six months up to 26 July 2022.

Each year 6,000 women attend CervicalCheck. With or without tribunals, it is a functioning mechanism in the healthcare system. We must do everything we can to ensure it functions well. There have been very few claims going to the tribunal. I heard what previous speakers have said. We must look at some of the reasons for that and address them. Moreover, in the spirit of both Vicky Phelan and Laura Brennan, we must fully resource CervicalCheck to ensure that it functions, regardless of Covid, detects cervical cancer early and allows women to get proper and effective treatment so that they are not left in a battle for their life. Sin é.

It is no accident that we are here today discussing an extension of time for anyone making claims to the CervicalCheck tribunal. The families have no confidence in the process and are not engaging with it for good reason. The Government must talk to them and address their concerns.

I pay tribute to the members of the 221+ patient support group, and their families, for their bravery in coming together to support each other. I remember in particular those who have died. As one member of the group said:

The day I found out I had cancer was what I thought was the worst day of my life! I was wrong; the day I found out that I shouldn't have got cancer had my smear been read properly was the worst day of my life!

We must prevent a repeat of scandals like this. We must spare any other family the torture of having to go through anything like this in the future. This must start with the repatriation of CervicalCheck screening services to Ireland.

As others have stated, this is a technical Bill and I am happy to provide support for it. The Bill provides for amendments to the CervicalCheck Tribunal Act 2019 to extend the period for receipt of claims by the tribunal and provides that the Minister, by order, can extend it on one further occasion, giving a total extension of one year. There is no issue with that as far as I am concerned. I will support the Bill.

It is important though that we pay tribute to the women and families who were so tragically impacted by this failure of the system, and the many women who died as a result of the errors that were made. I also pay tribute to the leadership of the 221+ patient advocacy group, which has done the State and women so much service. The group continues to do the State service in improving the health system. In that regard, I identify Vicky Phelan, Lorraine Walsh and Stephen Teap for the outstanding work that they have done.

I join others in welcoming back Vicky Phelan after her period of treatment in the US. I was delighted to hear her in such good voice and in such good form on Sunday talking to Miriam O'Callaghan. I wish her the very best for her time with her family before she returns for further treatment. I hope everything works out well for her in that regard, as I do for all of the women involved in this issue.

I acknowledge what the Minister said about his meeting with the 221+ group. My concern is that further work could have been done to reach an understanding with them. The decision to go ahead and establish the tribunal probably should have been given further consideration and thought to see if there was a way of addressing the very real and genuine concerns that the 221+ group had in terms of trying to find a non-adversarial route for the tribunal which would not oblige the women to fight the labs. I fully recognise the legal difficulties involved in that, but I think it might have helped if more time had been taken to see if another route was possible.

The Government's position is clearly that the labs may need to be present in proceedings as a third party because they have indemnified the State and will need to take their responsibility and be part of any settlement agreement for compensation. This eliminates the possibility of the State in turn suing the labs and dragging out the number of hearings. While I accept that, I would also say a mistake was made in proceeding to the tribunal without teasing out the full implications of that for women who are to attend the tribunal and be part of what is inevitably an adversarial route, and maybe more time should have been taken in that regard.

Obviously, the 221+ group also wanted applicants to the tribunal who receive an award to be eligible to return to the tribunal if they suffer a recurrence of cancer. I am not sure why that could not have been addressed satisfactorily. I do not believe the Minister responded to that issue in his opening statement and maybe he will in his wrap-up. However, that is a very reasonable request to have made and I feel it should be accommodated.

The 221+ group also has concerns about the statute of limitations, given that a large group may not be in a position to partake because of how long it took to set up the tribunal. It would have been good if there had been a more positive response to that request to extend the statute of limitations. I am not sure why that could not have been done.

All of the concerns that have been expressed by the 221+ group in regard to the tribunal, and all of the issues which gave rise to the need for this tribunal, are issues that have not yet been dealt with. There are two elements that Dr. Gabriel Scally found in his examination of the whole issue. First, there was the fact of the original decision that was taken by the State some years ago to outsource the processing of smears in labs that were outside this jurisdiction, and to effectively move to the private sector to do that. Most of us would accept now that this was a serious mistake. It has given rise to problems, obviously, and it is the reason we are in the situation we are in now, but there are also issues in regard to how the concerns raised by the women can be addressed. There was a recognition of that at the time this issue came to light but we have not yet got to a position where there is full capacity within this country to do the processing of the smears in Ireland and through a State system. We absolutely have to get back to that and we have to be in a position to provide our own service.

The other issue which is at the heart of all of this is the question of mandatory open disclosure. In May 2019, in a review of HSE practices after the CervicalCheck controversy, Dr. Scally found that the deeply flawed policy of open disclosure was still in place at that stage. I know there is legislation on Committee Stage at the moment and it is making its way through very slowly, but that legislation does not go far enough. We know from looking back that when the whole CervicalCheck debacle came to light, many promises had been made and the Government of the day had backed down, finally, before the legislation was due to be introduced to provide for mandatory open disclosure. We also know that the Crowe consultancy team submitted a report on the evidence to support the Independent Patient Safety Council for the development of recommendations on a national policy framework for open disclosure in healthcare in Ireland, and that report was provided in January of this year to the Department.

We need to make amends to the women and families who were so tragically impacted by this incredible failure of our health service to provide basic services and to meet the needs of this group of women. We need to make proper amends to those women and to their families, if that can even be done, but there has to be a significant element of compensation, at a very minimum. The best tribute we can pay to those women is to take the steps that were so clearly recommended by Scally, first, in terms of the processing of smears and doing that within our own public health care system, but also by ensuring there is full mandatory open disclosure, as recommended by the Crowe report. It is regrettable that the Minister did not reference those two fundamental issues which go to the very heart of this debacle, and it would been helpful if he could have provided an update on where we are and what his current thinking is in that regard.

I will leave it at that. Again, I pay tribute to all of the extraordinary women and their families who have been so tragically impacted by this failure of our system and the failure of leadership within the healthcare system which led to this appalling situation. I will be happy to support this legislation going through this evening but so much more needs to be done.

Sadly, we have learned that time is not on the side of women impacted by the CervicalCheck scandal but time is something we must give now to those we can give it to. Women have felt betrayed and, let us be honest, we have a storied history with tribunals. To extend this timeframe is the only thing we can do, but we must also look at what is wrong.

The three-member tribunal, which was established in December 2020, has received only five of 221 claims transferred from the courts or lodged, and to have the clock run down at the end of this month would be a travesty. It has been well reported that there were many issues around the setting up of this tribunal and, of course, we have had Covid to contend with. However, there is something wrong when women are choosing the courts over this tribunal. My understanding is that its purpose is to deal with these claims quickly, and the Minister knows how important that is. It is vital that the timeframe is extended and that we try to fix the issues raised. It is, of course, entirely up to these women as to whether they use the tribunal, but for it to be a valuable alternative, it has to be used. We must do all we can to ensure we repair what trust was broken and to make sure it does not happen again.

Here, on the floor of this House, is the place to have a proper debate on making the tribunal better for these women, removing any barriers to them using the system and giving them the time to come forward in some way, now or in the future. We absolutely must listen to the voices of women affected by the CervicalCheck scandal and ensure we do no more damage by pushing a system that is adversarial or that does not put them at the centre of the process. We cannot force them to use a broken system but we could fix what is broken, and if that means a live review, then so be it.

There has not been a balance for far too long and many who have used such processes report not being heard, not feeling believed or being undermined and being treated poorly. These women have fought too much to have to fight the system again so we must do all in our power to get it right this time. The Minister has given a commitment on this and will follow through. He is listening to these women. It is important that we listen to them and do all that we can to recognise what has happened.

I do not agree with the previous speaker that extending the time limit is the only thing that we can do. We could scrap the current tribunal structure and listen to the 221+ patient support group, which pulled out of talks with the Minister because the group was not being listened to. The fact that this Bill exists at all is an admission by the Government and Minister that the original Act has failed. If the Act had succeeded in its aims, it should not be necessary to extend the deadline. The extension is an admission of failure and an extension in time will not address that failure. It has not failed because of Covid, time delays or any other external event. It failed because the Act and the tribunal itself failed the women affected, just as the State has largely, since the start of this scandal, failed those women.

It is astonishing that this House passed the original Act in July 2019 and two years later, just five women have applied to the tribunal. When this Act was introduced, the Opposition, including the current Minister, warned Deputy Simon Harris, the then Minister for Health, that it was seriously flawed, exclusive to some victims, risked being overly adversarial, excluded victims' families and did not offer the supports needed to them, and did not allow for subsequent claims for compensation in the case of recurrence of cancer. The Act has spectacularly failed in its stated aim to provide a fast, cheaper, less adversarial route for the women affected, and the Minister's insistence on proceeding with it, despite the concerns of the 221+ group, is an example of how the State has failed yet again to listen to the women affected. If Vicky Phelan's case was just starting today, she would not be eligible to apply to this tribunal. Most of the household names that we are now familiar with would not be eligible to go before this tribunal.

It is clear that the laboratories involved have actively resisted progressing cases in the courts and have tried to delay them. Unfortunately, there is nothing to suggest that this tribunal will be any different or less adversarial and this is just one reason many women have failed to seek to have their cases heard there. It is bitterly ironic that with the current trends, the tribunal is more likely to spend more State funds on itself than on the women affected by the screening failures.

Unless the tribunal is reformed in line with what the 221+ group quite reasonably asked for, it will continue to be a failure. The fears of many of us about this tribunal have been proven correct. It is not about the State making amends to woman affected or following through on its apology; it is about the State circling the wagons and ensuring secrecy about its failures. Two of my amendments have been ruled out of order on grounds of costs. Ironically, the purpose of the amendments was to make the tribunal more open to women affected who are not included in the 221+ or Royal College of Obstetricians and Gynaecologists groups. I ask the Minister how he intends to address the issue, given that when he was in opposition, he seemed to agree with and share these concerns when we discussed the original Act.

I will make some general comments on the CervicalCheck scandal. Women affected by this scandal, and some of us who have raised it here, have had to listen continually to an avalanche of commentators and experts explaining to us that screening programmes are not diagnostic, they are not perfect and it is perfectly natural to miss some discordant slides. Women have been talked down to and told that them raising concerns is threatening the screening programmes that have saved thousands of lives. We are warned that if the legal claims continue, the poor laboratories will have to withdraw from providing the vital service. The hidden and not-so-hidden message has been to shut up and move on.

The women affected know exactly what the natural limitations of screening are and so do I. We do not need that to be repeated. Screening is not a diagnostic check. There will be natural and unavoidable errors in screening. False negatives can mean different things depending on the actual smear. Some false negatives are not negligent. There are different grades of errors in each individual test. I and other women understand that but we also know what negligence is. The CervicalCheck scandal is about negligence. Multinational corporations have paid out millions of euro and the HSE and State have apologised because negligence has cost lives.

The question of how this happened remains unanswered. From the start, I believed that contracting out the screening service to private for-profit laboratories in the USA, competitive tendering for such a vital service, and closing down domestic and publicly controlled laboratories that did the screening were mistakes. Since the scandal broke, we have been repeatedly told that there is nothing to see, to move on, and that the privatisation of the screening programme was not an issue. Ministers and HSE officials have become angry with me at committee hearings for suggesting that there were any connections.

At no stage has the State seemed interested in why catastrophic errors have been made by private laboratories while conducting a service on the behalf of the State. That is astonishing. What we know about the US laboratories as a result of the past three years is that laboratory screeners could examine 100 slides a day, whereas when we had Irish laboratories, an individual screened between 30 and 60. Screening is laborious, difficult work. That is why the NHS and the HSE insist on a high level of qualifications and put limits on how long examiners can screen in one day. Some US laboratories did not have ISO accreditation. Some US laboratories subcontracted cervical check screening to other laboratories. There were only two site checks of the US laboratories in ten years by the HSE.

The rate of false negatives from Ireland that were subsequently judged to contain high grade abnormalities was astonishing. Quest Illinois had an incidence rate five times that of the Coombe, while Quest New Jersey had an incidence rate four times higher and CPL Texas had an incidence rate seven times higher. I did not believe the previous Minister, Deputy Harris, then and I do not believe the current Minister now. The scandal has shown the devastating effects of contracting out vital public services. I thank the 221+ group, which has fought to show this up. Despite their courage, tenacity and dignity, they have failed to get justice. The extension of this tribunal by one day or even by the months that the Minister is proposing will not bring that justice any closer. The State has created an impression that this is a compensation tribunal; it is not. It is just as adversarial as the courts.

The Minister needs to listen and take on board the concerns of women and those of the 221+ group. They want a non-adversarial approach in this tribunal and a tribunal that will not oblige women to fight the laboratories. They want they right for a woman to return to the tribunal if her cancer recurs. They want the Statute of Limitations to be extended as well as other reasonable, modest demands. They feel that the tribunal is not working for them. It is meant to be the Minister's job to ensure that the tribunal works for them. I support the extension of the deadline but it is not the key issue. The key issue is that the way in which the tribunal works needs to change and the Minister needs to listen to the concerns and to the women in the 221+ group.

I will make some other, more general points that were raised in this debate. On the issue of HPV screening, not having specialised capacity to examine slides in public laboratories in this State is no longer a relevant issue with the new techniques that are available. Has the State ended the contracts with the private laboratories or are tests still being outsourced to for-profit agencies? I would like an answer to that question. The scandal raises broader points about women's healthcare in the State and the treatment of women as second-class citizens by the health system. That has undeniably been the case as shown by this and other cases. The average wait for a woman or a girl who wants to get checked for endometriosis, while going through extreme pain in some circumstances, is nine years.

That is not acceptable. Many GP practices deal with the menopause as though we were in the 20th century. Medicine and techniques have moved on. Why do only 10% of women presenting with menopause have hormone replacement therapy, HRT, treatment? There are three beds in the entire State, in one public hospital, for the 200,000 people affected by eating disorders. Many people are forced abroad for treatment. Second-class citizenship for women in the healthcare system must be ended. There should be justice for women in relation to cervical cancer. We can start by extending the deadline for compensation but that is not the key issue. The key issue is the way in which this tribunal works has to change.

We have a long, dark history in this State when it comes to the treatment of women, especially when it comes to our healthcare. However, the devastating reality is that this is not just something that happened in the past; this reality still hurts women today. While we regularly hear Government politicians lament the treatment of women in the past, those words ring hollow when we consider the CervicalCheck scandal.

The fact that women with cervical cancer were told that smear results, which showed them to be clear, were in fact inaccurate, is nightmarish. Not only this, the revised test results were also kept from them for years. Let us be clear that the reason this came to light, and we are even having this discussion, is the tireless work of campaigners, who are people affected by this issue and people whose families have, sadly, passed away as a result.

This Bill seeks to extend the period of the CervicalCheck tribunal but we need to listen to campaigners and their concerns about this. Of course, nothing will ever give them justice but we need to listen to them now. This must be the end of this State’s systemic mistreatment of women, once and for all. I urge the Minister to listen to the campaigners and to those affected.

This Bill appears to be simple. I will support it. What does not seem to be so simple is the process these women have to go through. The purpose of the Bill is to extend the period for making claims for compensation to the CervicalCheck tribunal from January 2022 to July 2022. In line with Deputies from the Regional Group, I urge the Minister to take that time to review the situation and engage with claimants.

Everybody seems to be affected in some way by Covid. The extra time available to make a claim goes some way towards allowing for delays during lockdowns, which were inevitable when it came to many services. People working from home or not working with their usual colleagues, and a variety of other issues, make the preparation of claims, such as the ones related to CervicalCheck, a little more time-consuming and slow than might otherwise be the case. From that point of view, the extra time being made available in this Bill should be welcomed.

I hope that once the deadline for claims has been reached, the tribunal will progress at relative speed given the nature of the topic and the health status of the victims involved. We have seen some examples of tribunals lasting for way too long in the past, but it is important that progress is made swiftly on this one. It took 14 years to publish the Moriarty tribunal report and 15 years to publish the Mahon tribunal report. I hope for the sake of these women and their families that the CervicalCheck tribunal will produce a published report and compensation arrangement far more quickly than that.

The CervicalCheck scandal continues to have a major daily impact on the victims still lucky enough to be alive. Vicky Phelan is perhaps the most well-known of those involved because it was her original court case that brought this scandal to light. Some 208 women were falsely given the all-clear. It was subsequently discovered that 162 women were not informed of their false results when they were discovered. One of the most shocking elements of all is that one of the main reasons for the delay in informing the women was a difference of opinion as to who should tell them. I understand it was not until six years after Vicky Phelan's test, and three years after the error was discovered, that she was informed of the mistake in her test result. No doubt, many others were left in the dark for similarly unacceptable lengths of time.

The Chief Medical Officer, Dr. Tony Holohan, was quite determined in his attempts to avoid an independent review of this scandal. He warned the then Minister that to announce a review would unnecessarily undermine public confidence in CervicalCheck when there was no evidence, at that stage, of quality or patient safety concerns about the programme. Surely, it was outrageous for Dr. Holohan to claim there was no evidence of patient safety concerns about the CervicalCheck programme. There were more than 200 false results, a three-year delay in identifying the mistake and a further three-year delay in informing patients of the mistake. I cannot understand how Dr. Holohan was of the view that those matters did not fall into the category of quality or patient safety concerns.

I have a major fear of history repeating itself. There will be a need for a Covid-19 tribunal. Many things have happened in the past 14 months that will require investigation by a tribunal. While Dr. Holohan's every word with regard to Covid is venerated by the Government, we saw a scandalous neglect of our cancer patients in the early stages of the Covid-19 response. Cancer screenings were shut down, treatments were disrupted and there were, no doubt, countless missed or delayed diagnoses, which will, unfortunately, have devastating effects on many people and families. As I have said previously, it seems the authorities did not mind what you died from as long as it was not Covid.

I do not know if all these things were recommended by the National Public Health Emergency Team, NPHET, or if they were part of a Government solo run, but judging by how little Government has been willing to deviate from the advice of NPHET, I would be surprised if the closure of services was not done at its behest. There is no doubt of the need for a tribunal of inquiry into all the Covid-related decisions, that the citizens of Ireland have been subjected to for the past 18 months. Dr. Holohan suggested he should have been the one to conduct the inquiry into the CervicalCheck scandal. I sincerely hope that any suggestion that he, or NPHET, conduct the inquiry into the various Covid-19 scandals will be met with short shrift by the Minister of the day.

I welcome the extension of the time available to make a compensation claim under the tribunal examining the CervicalCheck scandal. I hope that those who apply for compensation are justly compensated for the pain and suffering inflicted on them and are given a fair hearing. I also hope those who are requested to appear before the tribunal do so and that they provide open and honest evidence to the patients affected by the scandal, who are still putting up a good fight. I wish those patients all the best. I hope they will receive the answers and compensation they deserve in a timely fashion and that their families will know they fought for them so that a broken system would be called out, giving us all hope for the future.

Before Christmas, I held a meeting with the clinical director of CervicalCheck regarding the content of a letter she sent me. In this meeting, and in the letter, CervicalCheck criticised remarks I made in the Dáil on the scandal. I was criticised for suggesting that women had been wronged and for my use of words such as "mistakes" and "misreadings". CervicalCheck stated women had not been wronged; they had just been unfortunate. When probed at a meeting, CervicalCheck clarified its position was in contradiction of court rulings and the position of the Government. It should be remembered that the Government had issued a State apology to the women affected. It is significant that CervicalCheck does not accept that women have been wronged, slides have been misread or mistakes have been made.

Different arms of the State, the Government and the courts are in conflict with another arm of the State, that is, the HSE and CervicalCheck. When I raised this at the time with the Taoiseach he said he would check out this contradiction immediately because, he said, "We all have to uphold the decisions of the courts and the Supreme Court." The Minister for Health, Deputy Donnelly, subsequently wrote to me saying that CervicalCheck had confirmed that its position was not as I had alleged it to be. When I probed as to how he had arrived at his conclusion, the Minister, confirmed to me in a reply to a parliamentary question that he had not met or corresponded with CervicalCheck on this issue but had instead studied the remarks that it had made in the media. That is an incredible situation on an issue of such gravity. A blatant contradiction remains at the heart of the Government approach to CervicalCheck which says to the women who have been wronged, "Sorry, but we're not sorry." This has caused major hurt to the survivors of CervicalCheck.

Responding to the remarks made by the clinical director of CervicalCheck in the health committee, Vicky Phelan said she was shocked to see that such an attitude "is still in place two and a half years after my case broke open the CervicalCheck debacle and an independent review by Dr. Gabriel Scally found that CervicalCheck was doomed to fail, identifying serious gaps in governance structures and misogynistic treatment". The 221+ support group also said that it was deeply concerned by the comments attributed to Dr. Russell. The group immediately wrote to the CervicalCheck steering committee to express concerns that comments betray the commitment of Government and operational agencies to cultural change within CervicalCheck.

Tributes have been made here this evening to many women, such as Vicky Phelan, who have fought for justice. I would dearly like to echo those tributes. The tributes that have been made by the Goverment ring hollow if one arm of the State still maintains that nothing wrong has been done. It is an incredible situation that there still hangs within an arm of Government an attitude that the Government has never done anything wrong. The reason that attitude is maintained by that one arm of Government is that the instinct remains within the HSE to fight every individual, if necessary, through the courts.

The purpose of the CervicalCheck tribunal was to foster and rebuild trust between women and the health services as an alternative option to the courts dealing with claims against the State. It was supposed to be a forum where women affected by the CervicalCheck scandal and their families and survivors could give an account of their experiences and be compensated for the dreadful failings to which they were subjected. Instead, it was a process that was badly put together because it did not meet the wishes of the women concerned and their representative groups.

What is the point in extending the claims period if the concerns about which women have been very vocal are not addressed? Concerns were raised about the adversarial nature of the process. We need to know what other options for mediation have been explored. The State should be prepared to settle rather than contest claims where it is clearcut. Where possible, the laboratories should be pursued separately. The State should not use the survivors to do the work for it. All of this is borne out of fact that as of the end of May only three claims had been made to the tribunal. To put that in relative terms, it equates to 1.2% of the eligible claims which could be transferred from the High Court.

We must ensure that no woman or her family is statute-barred from making a claim due to the delays in setting up the tribunal. My colleague, Deputy Cullinane, has tabled an amendment to permit a claim to be heard where a person may be statute-barred. Sinn Féin is also seeking to permit anyone who may have grounds for a claim, whether or not an award was previously made or where there is recurrence, to be heard by the tribunal and to provide for the tribunal to determine if a future award is warranted. This must be explored by the Minister and his conclusions must be communicated transparently. Ultimately, it is important that the tribunal has the confidence of the women and their families and that the women affected are given answers and justice.

I am sharing time with Deputy Danny Healy-Rae. Although the tribunal was established as an alternative to bringing a compensation claim to court, to date very few claims have been submitted to the tribunal. On 22 March 2021, no claims had been made to the tribunal. On 30 June 2021, the Minister for Health, Deputy Donnelly, stated that five claims had been received. In contrast, to date 199 legal proceedings relating to the CervicalCheck issue have been issued, of which 195 are claims received since 1 January 2018 and 170 relate to the alleged misreading of a smear test of a service user. The 221+ patients support group provides support and advice to women and families directly affected by CervicalCheck failures and it has been critical of some of the processes of the tribunal. For example, the group has proposed that a non-adversarial route be found for the tribunal, one that does not oblige the women and families affected by these incidences of cancer misdiagnosis to fight the multinational laboratories. This approach was rejected by Government. In October 2020, the group stated that it was seeking further engagement for change in the tribunal, as previously requested, or it would recommend that members not engage. I would urge the Government to get this sorted. We have had enough cock-ups on this issue. This is people's lives Government is dealing with. Women and their families have suffered enough.

Many of the Government slots for contributions on this issue have been passed over because none of the Deputies has the guts to stand here before the people in regard to the shocking way Government has treated women's health in terms of this issue. It is easy to understand why they are embarrassed and they have turned their backs on coming here to, maybe, issue an apology. This is an appalling attack on a woman's basic right to know the results of a test. These results, which are a life and death issue for many women, were withheld and nobody has been held accountable. That is the astonishing thing in all of this.

We heard Deputies speak about the Chief Medical Officer at the time, Dr. Holohan, saying that there were no patient concerns. He made many other statements at that time. I want to know from the Minister who was held accountable for this absolute shocking situation whereby women were left without test results that could have helped to save their lives. There are great people in this country, such as Vicky Phelan, who are fighting for their lives and to be with their families, but also fighting to show other people what a great fight they can put up in regard to the awful things that were done to them. In my time here, I have yet to see someone from this Government or the previous Government stand up and say, "We got this terribly wrong, but heads did roll." I think most of the people that were involved in this scandal down through the years have been promoted and given extra pay when instead heads should have rolled and we should have had accountability. People want accountability. The word "sorry" is a small word, but it seems, for politicians, it is a difficult word to say. In my time as a Member of this House I will do everything I can to help smooth out the road for people who are going through such a horrific ordeal in their lives and have had terrible wrongs done to them. We must make sure that wrong is never repeated in this country. The only way that can happen is if we have accountability for those who committed the wrongs and who continue the cover up, which is what it was. That cover-up has led to a lot of suffering for families in this country. It is unfortunate that no matter what advice Government gets on this issue it continues to make people suffer.

As I said earlier, the 221+ group proposed that a non-adversarial route be found for the tribunal, one not obliging the women and the families affected by these incidences of cancer misdiagnosis to fight the multinational laboratories but this approach was rejected by Government, leading to the continued suffering of these women.

It is not good enough for there to be error after error and for their suffering to continue. That must be stopped immediately.

I thank the Acting Chairperson for the opportunity to speak on this very sad saga and on the desperate treatment of so many of our fine women. I think of poor Emma Mhic Mhathúna, who lived in Dingle in our county for a while. My sympathy goes out to her family and to the families of all the other women who lost their lives because of incorrect diagnoses. Emma was a witty and charming woman who fought as hard as she could up to the very end. Our thoughts and prayers are with her family and with the families of all the other women.

The worst part of this whole saga, in addition to the incorrect diagnoses, is the length of time it took for women and their families to be informed that incorrect diagnoses had been made. We all know that time is crucial with regard to cancer diagnoses. Outcomes are very different where there is delay. People should be brought to task. Whether it was Dr. Tony Holohan or someone else who was responsible for the delay, there are certainly questions to be answered because time is so important. More than 200 people got the wrong results and there was a great delay in informing many of them. We applaud Vicky Phelan for the fight she has put up on her own behalf and on behalf of all of the women who were affected.

Another thing is happening and has happened. More people are dying as a result of another delay, one which has continued since the Covid pandemic began. Many people with other serious issues are affected, including a man I know whose wife told me he has just four months to live. He was supposed to be seen after his first round of treatment in January of this year. This was delayed and put back from month to month. It was only last month, in June, that he was seen. It had spread all over him. He has a young family and a young wife. I know there are miracles but it is unlikely that he will survive. I am very sorry for him. There are many others suffering such delays. We know that Covid is very serious and had to be dealt with but people with other medical problems should not have had their treatment held up as it has been, and is being, held up. I have asked the Government before to ensure that does not happen anymore. It needs to get its house in order because it is not in order. People from Kerry are facing delays in being seen.

I cannot understand why the Government is cutting the time so tight in extending the deadline to, possibly, 26 July 2022. Why can it not be extended to sometime in 2024 or 2025? Some women may live longer and come forward later. I ask the Government to give them more time. Why is it trying to cut the time? It is not a grant for which farmers are applying. It is a serious matter and these women are entitled to get retribution, to be shown respect and to be treated properly in light of the wrongs that have been done to them. I cannot see why it should be limited to July 2022. While I welcome its extension to 26 July 2022, I ask the Government to extend it for a couple of years beyond that to give women a chance to come forward. This is a desperate scenario. People were given the wrong information. We all trust medical advice and are taught to respect it but the wrong advice was given and someone should have to explain why and why it took so long - three or four years - to inform the women involved. That is where the desperate wrong was done. I ask the Government to ensure all of these women are treated fairly because they have not been treated fairly up to this point.

This Bill seeks to extend the operation of the CervicalCheck tribunal until January 2022 and to provide for an additional extension to July 2022, available at the discretion of the Minister for Health. Of course I support this Bill. It makes sense for the period of time in which a compensation claim can be lodged to be extended significantly if we consider the fact that, up to two months after its establishment, the tribunal had not received any claim whatsoever. This clearly demonstrates the job of work to be done on the Government's behalf. This was unusual in and of itself in that, following Vicky Phelan’s journey for accountability, more than 100 women came out and revealed that they were in the same situation. The whole thing reeks of a lack of respect and due diligence for women’s health. We have, lamentably, seen this on countless occasions in the history of this State. Women, their bodies and their reproductive rights have suffered insult after injury, with salt repeatedly rubbed on the wound.

The fact that the consultation between the Minister, Deputy Stephen Donnelly, and representatives of the 221+ support group, which was intended to provide meaningful engagement between the Minister, his Department and the women impacted, broke down and did not conclude in satisfaction for the advocates involved does not bode well for respectful handling of the cervical smear scandal. The least these women deserve is an extension of time and for that reason I support this Bill and the proposed new timeline.

However, it is not as if all is well in the world of women’s health. Due to Covid-19 and limited HSE services, many constituents who have come to me are seriously anxious about the fact that their scans and appointments have essentially disappeared, with appointments for March of this year being rescheduled for May of next year and the likes. As the Minister can imagine, this does not inspire confidence that hard-learned lessons are being heeded.

Cervical cancer is the fourth most common cancer in women worldwide. This was mentioned in Dr. Gabriel Scally's report, which was published in September 2018. It goes on to say, "In Ireland in 2015 (the most recent year for which data is published), there were 241 cases of cervical cancer." It then goes on to talk about the importance of screening and of an effective screening service. We all know about that. I heard Deputy Bríd Smith speak earlier about being patronised with regard to screening. As women, we know how important screening is. That is not what this was about. Before I go into the body of what I am going to say, I will say that when I was on the Committee of Public Accounts, I remember what truly horrified me were the internal memos we eventually elicited. These showed that officials were more worried about publication and screaming headlines than about the failures that had taken place. That stays with me. I will not personalise the matter but the medical people from the Department of Health utterly failed to see the relevance of that for women. Indeed, Dr. Scally did not put much emphasis on it in his very welcome and methodical report. He certainly failed to see that the memos were more concerned with avoiding screaming headlines than with dealing with the issue.

We are here today to extend the time. None of us could disagree with doing so. What are we extending? We are extending the provisions of legislation that allows for women affected by this scandal to come forward and go to a tribunal while we know that nobody has come forward. When we look at the Bill digest, we read:

Although the Tribunal was established as an alternative to bringing a compensation claim to court, very few claims have been submitted to the Tribunal to date. No claims had been made to the Tribunal by 22 March 2021.

This should set alarm bells ringing for any government. There were no claims by March 2021, but the digest continues:

The Minister for Health stated on 30 June 2021 that 5 claims had been received. In contrast, 199 legal proceedings have been issued to date

I looked at why this was brought in. The Minister has quoted repeatedly from the Report on an Alternative System for Dealing with Claims Arising from CervicalCheck.

It is a very succinct report of 32 pages which comes down in favour of a tribunal. That is how the tribunal was set up. That report said many other things. The final chapter stated, "There is a clear urgency that this legislation be passed without delay", and it was duly passed. Many things were said about High Court hearings and the fact Mr. Justice Kevin Cross, the judge in charge of the personal injuries list, with the co-operation of the solicitors and barristers "has ensured that these cases have been dealt with in an efficient and timely way" and so on.

There was provision in the existing court system to deal efficiently with these cases but we went for a tribunal. I had serious reservations about that because language was being misused in relation to it not being adversarial. That was not true. It is a little less formal than a court setting but not less adversarial. The consent of all parties was needed. Surely, if the consent of all parties was got in court and liability was not an issue, it would proceed quickly in the courts system.

We set up the tribunal and nobody availed of it. Some women are availing of it now and I am glad they are, in the sense that that is the decision they have made for many reasons, including speed and illness. Within that Bill, we were to restore confidence but nothing has happened. Over two years later, the Minister tells us in his speech he will set up the process: "A facilitator of the meetings has recently been identified and preparatory work necessary to ...". We say we will restore confidence and bring in legislation. Two years later we have nothing and say again we will restore confidence. My confidence and trust are at an all-time low.

I have a very specific question before I go back to the general. When I sat on the Committee of Public Accounts, we were told by the head of the Department that the audit of cervical test results had stopped temporarily. Was that ever reinstated? If not, why not? That should be part of the Minister's speech today. It is an essential. That is how we learned - we did not, actually, but I will come to that. An audit was carried out and the women affected spoke out, starting with Vicky Phelan, who was extremely courageous and refused to sign a non-disclosure agreement. We learned then an audit had been carried out. We were told repeatedly it was for the purposes of learning, but we did not learn anything until Vicky Phelan had the courage not to sign the non-disclosure agreement and tell us. Then a lot of stuff came out.

Remember the number of women who have died in the meantime. Out of the 208 women whose results might have warranted a different action, 17 have died. A total of 162 women were not told their smears had been audited and that the audit found a different action should have been taken. I will not name out the women but we are deeply indebted to them and their families for their courage in persisting and bringing this matter to attention.

If we look at the speech given today, we get a clear indication of the mountain the women had to climb. I would have expected at this point a detailed speech on all the aspects of the tribunal, the various parts of the legislation I have mentioned, the audit and mandatory disclosure. We have a Bill sitting somewhere on disclosure. Scally had two reports and 52 recommendations. I quote from the digest but I have read the full Scally report, "In the Scally Report, a number of chapters dealt with open disclosure in the context of the HSE, the Medical Council and CervicalCheck." It goes on to refer to leaving a decision to disclose or not to disclose to "the unfettered judgement of the clinicians" as unacceptable and that is what happened. It refers to the "lack of a systematic evaluation of the implementation of the policy". On the following page, it says, quoting the Scally report:

When disclosure in the substantial majority of the cases eventually happened, [this is with the cervical smear cases] it was hurried and took place against a fevered media and political backdrop. The way in which women and families were treated was responsible for substantial hurt and anger.

I do not think we needed a scoping exercise from Dr. Scally to tell us that but at least it is down in black and white. The digest goes on to quote the Scally report:

A situation where an organisation can be allowed to impede the speaking of truth to patients in relation to their health care is totally unacceptable. Nor should it be acceptable for an organisation to give permission to health professionals, of whatever seniority, to withhold the truth from patients.

There are many other things I could quote from, including the Madden commission, going back to 2008, which set out the necessity for mandatory and open disclosure. It has not happened.

I ask for clarity on the audit. Why, if we want to restore trust, has that part of the Bill never been used? On the outsourcing of tests, what progress have we made? That was a fatal decision made by a Progressive Democrats-led Government. The Government inherited that but now it has the chance to change it. When we outsource something as essential as cervical smear tests, we are in serious trouble as a civilised society. What update has there been on that? Are we on the road to ending the privatisation of our laboratory services? It is extraordinary that the restoration of trust part of the tribunal legislation has never been used. Trust on every level has not been restored. The women are still fighting with the Government - I take back the word "fighting" - they are still struggling to get their voices heard and say this tribunal is not the most suitable mechanism. The High Court would do a more efficient job if it was adequately resourced to hear the cases. There is provision for private hearings and that could have been done.

I thank all colleagues across the House for their contributions on the Bill. It has been a useful and important session so far. I welcome the broad support that has been indicated for the Bill and for the extension of time. I join colleagues across the House in welcoming Vicky Phelan back from the United States. I acknowledge, as I and many of us have before, the huge contribution she has made to this issue from the start.

I have listened carefully to the speakers and will consider the issues raised. I will revert to colleagues on specific issues raised, including the audit raised by Deputy Connolly and other issues. I would be glad to update the House, or the health committee if that is appropriate, on the progress of the tribunal in as much detail as is useful.

The central purpose of the Bill is to extend the period for receipt of claims by the CervicalCheck tribunal. It will ensure women eligible to make a claim to the tribunal have adequate time to consider whether they wish to do so. In my opening remarks, I explained some of the reasons an extension to the deadline is considered necessary. They include the pause in establishment. That was an issue last year. It should not have gone the way it did. There was no bad faith intended. A statutory instrument was lodged which, it turned out, could not be stopped under the law of our land. It started a time period.

The moment I found out it could not be stopped, I personally phoned several of the people who have been referenced in the Chamber today to say that the statutory instrument is what it is but I was giving a commitment that day that nothing would commence in any meaningful way until there was a lot more engagement. Today's Bill is about honouring that commitment. I gave a commitment personally that whatever period we needed, we would extend the time period of the tribunal by that amount. Indeed, the Bill extends it by an amount further than that because there were then other issues, as we discussed, one being the cyberattack and another being the huge disruption that was caused by Covid. We spent approximately two months after that point going through the various issues, many of which were raised again today.

It is important to acknowledge, as Mr. Justice Meenan did in his report, that the tribunal is not a redress scheme. I acknowledge that the tribunal is not exactly what the 221+ group wanted it to be. There was a lot of engagement in October and November with the group and, indeed, here in the Chamber on these issues. I would like to stress again that my only interest was, and is, in establishing a tribunal, within the bounds of the law and what is possible, that does as much as possible for the women and families affected. There is not a single Member of the Oireachtas - in the previous Dáil, where this came to light and where we passed the Bill, in this Dáil, or in the Upper House - who would not want this to be pushed as far as is possible. I want to re-emphasise that.

I looked into the issues at great length, as did the Department, the Attorney General and the Cabinet. This was discussed at several Cabinet meetings and the question was asked again and again as to whether we can do more and push further. Can we do more on recurrence, the statute of limitations and the different asks and guarantees that were very reasonably being asked for by the 221+ group? Where we got to, and I am very happy to go into some of the detail because it is important, was we brought it as far as is possible to bring it, partly because of the Constitution. We cannot constitutionally change the statute of limitations retrospectively. We cannot do it under our Constitution. We found another way, which was the next best way. I personally wrote to all of the women and families eligible to say that if they were in one of the groups that may be statute-barred, there has been engagement, they should lodge their claims and there is a very reasonable argument they can make, because of Covid, as to why they might have missed the High Court deadline.

Another point that was raised again today was one I supported when it came up in the legislation. I remember the debate around recurrence. I still think it is a very reasonable request for everyone, whether in regard to CervicalCheck or any other issue, that if there is recurrence, one could go back and say, "I had a recurrence of whatever this may be and I need more financial support because of this." Every Member of this House is sympathetic to that ask. It is a very reasonable ask. It is not that I, the Government, the Department of Health or anyone else did not want to accede to that. I think we all accept - certainly, most Members of this House would accept it - that, under Mr. Justice Meenan's report, the tribunal is voluntary for the women and for the laboratories. We cannot legally compel them not to avail of the High Court.

A few things would happen if we brought in recurrence. The first is that the representatives of the laboratories would walk out the door and simply go to the High Court. Under the law of the land, the High Court does not do recurrence like that. The way the High Court deals with it, and the way the tribunal would deal with it, is to factor it into the initial settlement amount. Even if people went to the High Court and somehow it was facilitated in this other way, which it cannot be, what would happen? First, the initial amounts would be lower because those initial amounts include the possibility of recurrence. What else would happen? Let us say there was a recurrence three, four or five years later. People would have to go back to court and the laboratories would be allowed to say, "Well, hang on a second, there may be no link between this occurrence and what happened previously." The women and families might be asked to go through it all again.

I promise the House that if we, as a Government, could have done what was asked, we would have done it. It is not that anyone did not want to do this. We pushed and pushed as far as we could. I am the first to acknowledge that we were not able to deliver on everything that was asked, but we delivered on everything we could deliver on and we set up the tribunal. That is where it stands and that is the position the previous Government took. We all, or certainly most of us, voted in support of the legislation, even though we debated exactly these issues in 2019. The advice is still the same. I hope colleagues will accept that these decisions were made in good faith and every effort was undertaken to push each of these issues as far as they could be pushed.

The tribunal has received claims and it is a small number of claims. Obviously, we would like there to be more claims. What is happening is that a lot of people are waiting to see what will happen with these initial claims and reserving judgment. One could not blame anyone for doing that. I know that some of the claims in the courts have been waiting for several years, while the tribunal provides that a new claim will come to hearing in 30 weeks and a claim transferred from the courts can be heard more quickly than that again.

Before we move on to Committee Stage, I thank colleagues again for their contributions. I would like to put on the record that I take issue with comments made by Deputy Verona Murphy with regards to Dr. Holohan and his motivations. They were entirely inaccurate and unfair and he is not in any position to address them. The Scally report deals with those issues and I hope the remarks can be withdrawn. I do not think they were right and I want to take issue with them. I thank colleagues for their contributions. As I said, I am very happy to come back. Colleagues are asking very reasonable questions about the tribunal and details around it. I am very happy, at the health committee or in the Chamber, to have that discussion at a later date.

Question put and agreed to.

In accordance with an order of the House, we must suspend now until 6.30 p.m., when we will take Committee and Remaining Stages.

Sitting suspended at 6.19 p.m. and resumed at 6.30 p.m.