Seanad Éireann debate -
Thursday, 7 Mar 2019

Vol. 264 No. 5

Nithe i dtosach suíonna - Commencement Matters

Abortion Services Provision

Senator Colette Kelleher

I welcome the Minister of State. Since the passing of legislation to regulate termination of pregnancy, early medical abortion has, for the most part, been provided to women by general practitioners and community providers. Clinical guidelines allow for the provision of early medical abortion in the community where gestation is less than ten weeks. These cases are being dealt with quietly and efficiently within the community. However, whereas the legislation permits provision of abortion where the gestation has not exceeded 12 weeks, pregnancies that are ten weeks or more are to be provided for in a hospital setting for clinical reasons.

Where gestation is between ten and 12 weeks, clinical guidelines advise GPs to refer women to hospital, where the abortion can be provided. It appears the method of abortion in the vast majority of these cases is medical. This method is safe and effective. However, it carries a small risk - less than 1% - of ongoing pregnancy following the process. If the pregnancy is ongoing following early medical abortion where it is nearing the 12-week gestation limit, the most effective way to complete the process is by surgical abortion. The availability of surgical abortion in Ireland is not clear to the community providers.

The Southern Taskgroup on Abortion and Reproductive Topics, START, in Cork and the surrounding region, which provides an abortion service in the community, has found that despite initial difficulties, pathways for women seeking abortion are relatively straightforward where gestation is between ten and 11 weeks. That said, there is a concern on the part of this group of GPs that pathways for gestation over 11 weeks are less than clear. Many GPs across the country have found that pathways for the referral to a hospital were created locally as the need arose after the beginning of the provision of services from 1 January last year. Nonetheless, GPs in several parts of the country are concerned that there are no actual pathways for women seeking termination where gestation is between 11 and 12 weeks. It is deeply concerning that should such a case arise, time will be of the essence and it is important that GPs and community providers would be given clear and reliable information about referral pathways for all patients coming under the provisions of the Act, regardless of how close to the 12-week limit they may be.

Will the Minister of State confirm that the State is providing abortion services for all women where their circumstances meet the criteria set out in legislation, regardless of how close to the 12-week limit they may be? If that is so, how many hospitals are participating in this and which ones are they? Will the Minister of State seek to have clear and public published referral pathways for these cases so the community providers can refer women to a hospital that can provide these services in a seamless, established and agreed process?

Minister of State at the Department of Health (Deputy Catherine Byrne)

I am taking this matter on behalf of the Minister for Health, Deputy Harris. I thank Senator Kelleher for her insight and for giving me the opportunity to provide clarification.

On Friday, 25 May 2018, the Government held a referendum arising from the Thirty-sixth Amendment of the Constitution Act 2018. The people of Ireland voted overwhelmingly in favour of deleting Article 40.3.3° in its entirety and substituting an article in the Constitution, the object and effect of which is to articulate clearly the principle that laws may be enacted by the Oireachtas to provide for the regulation of termination of pregnancy. The Health (Regulation of Termination of Pregnancy) Act 2018 was passed by the Houses of the Oireachtas on 13 December 2018 and signed into law by the President on 20 December 2018. The legislation provides for a termination to be carried out in cases where there is a risk to the life or of serious harm to the health of the pregnant woman, where there is a risk to the life or of serious harm to the health of the pregnant woman in an emergency, where there is a condition present that is likely to lead to the death of the foetus either before or within 28 days of birth and without restriction up to 12 weeks of pregnancy.

A public information campaign, My Options, commenced upon the enactment of the legislation. Services for termination of pregnancy have been offered from 1 January 2019 and there is regular ongoing engagement between the Department of Health and the Health Service Executive, HSE, to facilitate the smooth running of the service and to resolve any issues that may arise.

As of 1 March 2019, 290 GPs nationally had signed contracts to provide termination of pregnancy services in the community and terminations up to 12 weeks of pregnancy are being provided in ten maternity hospitals or units in the following hospital groups: Ireland East hospital group - National Maternity Hospital, Holles Street and Midland Regional Hospital Mullingar; RSI hospital group - Rotunda Hospital and Our Lady of Lourdes Hospital, Drogheda; Dublin Midlands hospital group - Coombe Women and Infants University Hospital; Saolta hospital group - University Hospital Galway and Mayo University Hospital; University of Limerick Hospitals - University Maternity Hospital Limerick; and South/South West hospital group - Cork University Maternity Hospital and University Hospital Waterford. A woman requiring a termination at one of these maternity hospitals or units must be referred by a GP.

While most terminations up to nine weeks of pregnancy will take place in the community, some may need to take place in a maternity hospital or unit for medical reasons. However, all terminations between nine and 12 weeks of pregnancy must take place in a maternity hospital or unit. When the service for termination of pregnancy was first introduced, an issue arose whereby some maternity hospitals or units were operating an 11-week cut-off for terminations in early pregnancy. However, this issue has been resolved. Terminations of pregnancy carried out in maternity hospitals or units can be either medical or surgical. The type of termination carried out is a matter for the relevant medical practitioner and the woman concerned.

Senator Colette Kelleher

I thank the Minister of State. She stated, "Terminations of pregnancy carried out in maternity hospitals or units can be either medical or surgical." Can she confirm that they are both - as is the right pathway for the woman - because medical can be the right way to go or surgical can be the right way to go? I refer to the particularity of the pathway for a woman who is in her 11th week. There seems to be some doubt in the minds of GPs about the clarity of that pathway. The Minister of State offered me some clarity but she did not offer me the clarity that I am seeking on the issue of the clinical pathway for a woman presenting at 11 weeks and the access to both surgical and medical in the hospital groups. The Minister of State did not answer that question but I would like if she could do so.

Deputy Catherine Byrne

As already stated, terminations of pregnancy carried out in maternity hospitals or units can be either medical or surgical. The type of termination carried out is a matter for the relevant medical practitioner and the woman concerned. It is clear from this that they can be either. This comes down to the decision of the medical practitioner.

I am not sure to what the Senator is referring in the context of pathways. Perhaps I can get the Minister to revert to her on the exact pathways that are being taken. From reading the script I was given, it is clear that there is a pathway through the GPs to the effect that, up to nine weeks, it can happen in the community. Thereafter, however, it is essential that women have their procedures in a hospital environment. That is what is happening. However, if the Senator persists, I will seek a reply from the Minister for her on the pathways and on the concerns raised by some of the GPs she mentioned.

Senator Colette Kelleher

I would welcome that.

Transport Costs

An Leas-Chathaoirleach

As ever, I welcome the Minister, Deputy Ross.

Senator Kevin Humphreys

I thank the Minister for attending. He always makes himself available to take transport issues in the Seanad and I thank him for that.

I tabled this matter because of a concern about overruns. In the case of the national children's hospital, which was originally budgeted at €650 million, for example, we are looking at a cost of possibly €1.7 billion or more, an increase of 260%. Hopefully, this will not happen. If overruns of the same scale were to occur elsewhere, the cost of BusConnects would increase from €2 billion to €5.2 billion and that relating to MetroLink would increase from €3.8 billion to a possible €8 billion. There have been significant increases in construction costs and increases of between 12% and 20% in labour costs. Previously, there were substantial overruns when the ticketing system was realigned with the Leap card. The latter is a cashless payment system.

In the context of the core bus corridor project, the National Transport Authority, NTA, originally estimated that the cost of compulsory purchase orders, CPOs, would be between €22 million and €24. That appears to have been a gross underestimate and the new cost is estimated at approximately €32.5 million. In some areas of the Dublin Bay South constituency, the devaluation figure relating to properties is approximately 25%. Without legal fees, valuation and reinstatements, we are looking at approximate devaluation of €500,000 per unit. On the basis of a conservative estimate per unit, the land take could cost up to €500,000.

I am concerned that the Minister should ensure that there are adequate checks and balances in respect of the budgets for BusConnects and MetroLink. We have not seen the estimates relating to the change in the line for the MetroLink on the northside and the impact the latter will have on the overall budget. What I do not want to see is that we go so far and the overruns are so extensive that this project is dropped like a donkey. I certainly do not want to see it dropped like a dead donkey. I am anxious to hear what adequate checks and balances are included to monitor both the budget and to what is happening in the context of overruns.

Minister for Transport, Tourism and Sport (Deputy Shane Ross)

I thank Senator Humphreys for raising this issue. I understand his concerns. I hope I will be able to reassure him. I ask the Senator's indulgence for a moment. I will give him my script afterwards. I brought some copies along and I think I left them in the anteroom. I will give the Senator my script afterwards and I will try and answer his questions off-script as well.

I agree completely with the Senator that we need to ensure rigorous and appropriate monitoring of mega-projects, such as BusConnects, the DART expansion and MetroLink. The Government plans to invest billions of euro of taxpayers' money in public transport over the next ten years. Recent events have obviously made us even more conscious of the need to be forensic in our examinations. I know that the investment to which I refer is welcomed by all sides of this House. While we can all have opinions about particular issues within these mega-projects, I would hope we could all agree on their absolute necessity. However, we need to ensure that the funding involved is spent wisely and well and that, ultimately, the taxpayer gets value for his or her hard-earned money.

Delivery of these projects and programmes is led by the State agencies responsible, primarily the NTA in these cases, but with funding provided by my Department. That funding is subject to the public spending code, which sets out the appropriate structures for monitoring and management of publicly-funded capital expenditure programmes. My Department has long had responsibility for significant capital expenditure programmes and, obviously, we have well developed monitoring and oversight systems in place already. We absolutely recognise that these mega-projects bring unique challenges and we need to keep our governance arrangements for the years ahead refreshed and effective. I assure the Senator that my Department is keenly aware of the need to maintain appropriate oversight as these projects really take shape over the course of this year and beyond. We can all recognise that this governance will need to be flexible and will take different forms at different stages - just like the projects themselves.

Not only will there be different phases over the life cycle of these projects in respect of which different skills will be required at various times but also the projects differ considerably from each other. BusConnects and the DART expansion, for example, are both programmes of capital expenditure made up of many different projects, each required to give the overall benefits expected of the programme, whereas MetroLink is in some ways unique. MetroLink is the development of a largely underground link from the city centre to Swords and a connected requirement to increase capacity along the Luas green line.

Delivery of these projects and programmes will be led by very experienced State bodies such as the NTA and Transport Infrastructure Ireland, TII. They are widely recognised as having successfully implemented a number of significant public transport projects through the years.

Of course at a departmental level we need to monitor and oversee delivery in line with the public spending code and also advise the Government in its role as the ultimate sanctioning authority at certain key decision points. At the relevant points along the way, we will need to augment our skills with specialised knowledge to ensure we are providing the best advice we can to the Government. We have been discussing what those requirements are with relevant stakeholders in recent months. I assure the Senator, and the House, that the good governance of these, and indeed all projects and programmes in my Department, are of the utmost importance and we will strive to ensure the taxpayers' interests are protected at all times.

I will add to that because I want to give more specific information to Senator Humphreys in response to what he said. When we get a business case in such situations, we normally tear it apart and then we go to the Government with the budget. If one takes, for example, the Irish Rail situation at the moment where there is €480 million budgeted for it for the coming year, the independent Commission for Railway Regulation, CRR, meets with my Department every quarter. The National Transport Authority, NTA, on the other hand, on projects like the ones mentioned by the Senator, namely, the metro and BusConnects, meets on a monthly basis to discuss the budgets. It looks at all the expenditure, tracks it and it reports to the Department of Public Expenditure and Reform if there is any diversion beyond a margin which I think is about €100,000. The Senator should not quote me on that but it is something of that order and that is reported to the Department of Public Expenditure and Reform if there is any diversion or wavering outside the set parameters. Expenditure is monitored strictly, on a monthly basis in the case of the NTA, while Irish Rail monitors its projects on a quarterly basis. Senator Humphreys can be absolutely certain that we are looking out for any kind of diversions from the original budgets and they will go straight back to the Department of Finance-Department of Public Expenditure and Reform.

Senator Kevin Humphreys

As the Minister mentioned Irish Rail, I compliment it as it has brought a number of significant projects in on time and within budget. Irish Rail's record in that regard may be a good example for the rest of the public sector.

I am a little cautious in response to the Minister saying it is the responsibility of the NTA to report to the Department of Public Expenditure and Reform. It must be the responsibility of the Minister. It is a significant investment in public transport, which is badly needed, and we must monitor the budget extremely carefully. I believe there have already been significant overruns. Could the Minister refer in his response to the significant overruns that have already been indicated in relation to the core bus corridors? I imagine the overruns have already exceeded €100,000.

An amount of money has already been spent on those projects and concern has been expressed in regard to that. I understand they relate to Government policy in terms of the 2040 plan. I am also concerned by the fact that some Fine Gael Ministers and backbenchers have said they have no confidence in BusConnects and that they will resist any further progress on it. If Fine Gael is saying it no longer has confidence in BusConnects then let us stop spending further money on it. I have extensive quotes from various Fine Gael Ministers and Deputies saying BusConnects is not going ahead. If the project is not going to proceed because the Minister's partners in government no longer have any faith in it then for heaven's sake let us not spend taxpayers' money and flush it down the drain. If the project is to proceed, let us make sure that there is support for it from the Government parties.

An Leas-Chathaoirleach

The Senator has had an extra minute.

Deputy Shane Ross

I will respond to that extra minute. You are very indulgent, a Leas-Chathaoirligh.

An Leas-Chathaoirleach

I assure the Minister that I will be equally indulgent with him.

Deputy Shane Ross

I know that. Of course you will. In fact, I would rather you would cut me off very quickly given what Senator Humphreys said.

An Leas-Chathaoirleach

I will oblige the Minister if he wishes.

Deputy Shane Ross

BusConnects is going ahead. Let there be no doubt about that. The Senator should be aware that a consultation process is going on. Many people, including Ministers, are not terribly comfortable with what is happening in their constituencies, which is inevitable in a project of this sort. I have said to my colleagues, I have even said it at the Cabinet meeting, and I say it openly here, that it is open to them to go to the public consultations and I hope they will. They can suggest improvements to some quite radical steps which are being taken in their area, which are not universally popular. It will be difficult in certain circumstances for a project of this sort to go ahead and there will be resistance in certain places, but for the greater good BusConnects will go ahead. It will reduce the commuting times for getting people to work and it will hopefully get more people not just into buses but also on their bicycles. In the meantime, the public consultation on BusConnects is going ahead on both the network and on the corridors and there will be continuous consultations. We will not have the last ones-----

Senator Kevin Humphreys

What about the overruns?

Deputy Shane Ross

I cannot comment on the initial cost overruns.

An Leas-Chathaoirleach

I thank the Minister and Senator Humphreys. I was equally indulgent to both of them. That concludes the debate on Commencement matters.