Seanad Éireann debate -
Monday, 17 May 2021

Vol. 276 No. 3

Nithe i dtosach suíonna - Commencement Matters

Common Agricultural Policy

Senator Maria Byrne

I thank the Minister for being here this morning. The CAP reform negotiations that are currently under way were initiated in 2018 and Ireland had to make a submission by January 2020. I have met many young farmers in my own neck of the woods and have spoken to people from various sectors and there are two main issues at play. Farmers are opposed to any cuts and are concerned about convergence and redistribution. This is particularly the case for active farmers and I engaged with the Minister on this recently. Many different proposals are being brought forward and farmers are fearful. They are afraid that if there are cuts to the CAP budget, it will have a detrimental effect on the farming community in Ireland. Farming is such a difficult business at the moment. We want to encourage young farmers to take over family farms but many farmers are in full-time or part-time off-farm employment. Two important issues have been raised with me, the first being the mental health and well-being of farmers. All of the talk about cutbacks is putting a lot of pressure on their mental health and well-being. Many farmers have young families and are worried about how they can keep their farms going. I would like to see mental health and well-being incorporated into our CAP reform submission. The other important issue is farm safety. Farm Safety Week takes place in July and now is an opportune time to raise the issue.

There have been a huge number of farm accidents, and a lot of them have ended up in tragedy, which is very sad. In 2019, there were 19 fatalities. Up to mid-2020, there had been 14 fatalities, which is tragic. Now is an opportune time, when CAP is being looked at, to give assurance to farmers. They are the lifeblood of our culture in Ireland. There are so many agrifood businesses that have been established from farms. I look forward to hearing the Minister of State's response.

Minister of State at the Department of Agriculture, Food and the Marine (Deputy Martin Heydon)

I thank the Senator for raising this important matter. I congratulate her on her recent re-election to Seanad Éireann. It is great to see her back on the agricultural panel. It is also great that one of the first topics she has raised on her return relates to such an important area of agriculture. I thank the Senator for that.

The Senator is right that it is not just about farm safety, it is also about farmers' mental health and well-being, especially in these Covid times. I am aware that it is hard on all of us and that everybody has suffered isolation. The latter has had a greater impact on farmers, however, particularly those older farmers who live on alone. Their main sources of socialisation outside of their work were, in general, going to the mart or to the pub, both of which were closed due to Covid. Even going to a sporting event, be it a GAA game or a soccer match in the local village, was out, along with mass or services at the weekend. All of these outlets were taken away from them. Farmers spend a lot of time on their own, worrying about the weather, prices, etc., and, during Covid, there has not been a safety valve to relieve the pressure. I am taking a number of initiatives to try to improve the position in this regard, including working with my colleague, the Minister of State at the Department of Health, Deputy Feighan, on the On Firm Ground initiative. This will train advisers to help signpost supports for farmers. I will go into those shortly.

The Senator is right to talk about the impact of farm safety and the overall numbers. Agriculture gives employment to approximately 6% of the State's total workforce but it accounts for almost 50% of workplace-related fatalities. We had a late notification in February for a death that happened last year, so now our numbers for the past year officially stand at 20. Of those 20 people who lost their lives last year, nine were farmers over the age of 65 and three were children under the age of eight. These figures are unacceptably high. This is why the Government is determined to address the issue. In that context, we set out very ambitious targets in the programme for Government.

I am the first Minister of State to be given dedicated responsibility for farm safety. While farm safety is not an issue for the CAP negotiation process - the Council’s agreed general approach to CAP reform does not reference farm safety - this does not mean that we cannot address it in the context of the next CAP. The proposed CAP gives member states much more subsidiarity to design interventions, on the basis of their own needs, through CAP strategic plans. Our strategic plan is being worked on at the moment.

In the context of the flexibility relating to CAP strategic plans and in the context of the programme for Government, which identifies the need to invest in enhanced farm safety and well-being measures under the next CAP, my Department is incorporating farm safety into the next CAP strategic plan for 2023–27, which is currently in development. Putting together the plan will involve a number of stages, including: strengths, weaknesses, opportunities and threats, SWOT, analysis and needs analysis; needs assessment; intervention design; financial allocations; target-setting, including monitoring; and governance systems. The draft CAP strategic plan will also be subject to an ex-ante evaluation, strategic environmental assessment and appropriate assessment including a public consultation on the draft plan and draft environmental report this summer. This will be an opportunity for everybody to have their say.

I have, with my officials, continued to engage extensively with stakeholders on the future of CAP. This process has been ongoing. Further public consultations on the development of the CAP strategic plan are being considered and will happen. I look forward to that engagement with stakeholders as we develop the plan, which as the Senator has said, must be submitted to the Commission by 1 January 2023.

The SWOT analysis and needs assessment process has identified health and safety on farms as an area that requires attention under the next CAP. This is due to Ireland's unacceptably high level of farm fatalities. It is my view is that all measures in the CAP strategic plan should have a health and safety element incorporated as appropriate. I am working with my officials to develop measures in the next CAP to reflect that. We can expect to see health and safety requirements feature strongly in our training programmes for farmers and advisers, as well as through the various measures from on-farm investments to livestock schemes and the rest. I will expand on that further in my supplementary answer.

Senator Maria Byrne

It is good to hear that farm safety is being taken seriously and is included in the CAP. I was delighted to hear the Minister of State's acknowledgment that he is working with the Minister of State at the Department of Health, Deputy Feighan, on the issue of mental health. Stress has presented many mental health issues for farmers and I am glad the Minister of State acknowledged that. Falling incomes, higher costs, which affect every industry, and increased regulations are a cause of stress, and I welcome the fact he acknowledged that. I thank him for his commitment and look forward to hearing in the future his plans as they unfold.

Deputy Martin Heydon

The Senator is dead right. I am delighted to hear her equate farm safety, well-being and mental health because there is no doubt they are deeply interconnected. The agrifood strategy for 2030, which is currently out for public consultation, reflects that. We talk about a food systems approach to agriculture in the future and the sustainability of all the systems, that is, not just environmental sustainability, which is crucial, but also economic and societal sustainability in order to allow farmers to continue to do what they are doing, make an economic return on which they can raise families, as generations before them did, and be able to do that without additional pressure.

I am also taking other measures in the Department. I secured €1 million in the most recent budget in the context of the EIP on farm safety and the second phase of those initiatives is being worked through. The accelerated capital allowance, approved by the Minister for Finance, Deputy Donohoe, in the Finance Act has also helped.

I am determined to see farm safety feature prominently in all aspects of CAP, where possible. Any engagement with farmers from the Department and the arms of the State will continue to drive home the message in order that we can change the culture and significantly reduce the level of farm fatalities and serious incidents on farms.

Cancer Services

Senator Victor Boyhan

I welcome the Minister of State at the Department of Health, Deputy Butler, to the House. As always, it is good to see her. She always gives a very comprehensive response to Commencement matters or any other matter that might come before the House. I raise issues with BreastCheck, CervicalCheck and bowel screening. I am a former director of the National Treatment Purchase Fund - I do not know whether the Minister of State knew that - so I am very aware of the importance of waiting lists, how they are managed and the significance of screening for cancer. Early detection means better outcomes for people struggling with the terrible disease of cancer. There is also anxiety arising from having to wait for screening, which is not good for patients or anybody else. I accept that Covid-19 has had a significant impact on waiting lists and our health services. These three issues were covered in the Sunday newspapers yesterday, strangely enough, although I had tabled this Commencement matter a few days ago.

There are substantial waiting lists and backlogs for BreastCheck, CervicalCheck and bowel screening. The number of women who had a complete mammogram last year was just over 56,000, which was behind target by 128,730 patients. The number of women who had one or more cervical smear test in primary care cases was 143,000, behind target by 111,000 patients. As for bowel screening, there were 50,000 tests, yet this was behind target by 75,000. Bowel cancer that is detected early can be treated very successfully.

Doctors and patients have called for a strategy to tackle these backlogs in respect of cancer diagnosis and that is important.

The National Screening Service also says it is under pressure in terms of capacity and wishes to come back on target in respect of the stated objectives regarding issues surrounding analysis and diagnostics. As the Minister of State is aware, there were over 5,600 GP referrals for cancer in March 2021 alone, compared with 2,234 in 2020 so the figure has gone from over 2,500 to over 5,500 in one year for one month. Alarm bells must be ringing in respect of these issues. Diagnostic services such as colonoscopies are critically important. We know colonoscopy is the most accurate test for cancer of the colon and rectum and is proven to detect disease early so that the disease is treatable and curable and people can get on with their lives. Diagnostics is really important.

I am conscious that the three biggest challenges for the Government are health, housing and jobs. The Government and all politicians on all sides of the Houses will be judged on how they perform. I believe that without one's health, one does not need a house or a job. Health is primary. It is at the top of the matrix in terms of how we can deliver for our people. I accept, understand and acknowledge the enormous pressures faced by the Government. I am not here to blame anybody. Like the Minister of State, I am here to get us back on track and I would like to hear what the Government has in mind in terms of getting these three critical cancer screening services back on track for the well-being of our people and our health service.

Minister of State at the Department of Health (Deputy Mary Butler)

I thank Senator Boyhan for giving me the opportunity to update the House on this important matter. There is probably not a house in Ireland that has not been affected by cancer. I did not realise the Senator was a former director of the National Treatment Purchase Fund so he has a very good understanding of how it actually works.

I am pleased to say that our three cancer screening programmes - BreastCheck, CervicalCheck and BowelScreen - are operating. All programmes were paused for a time in 2020 due to Covid-19. While screening services resumed throughout last year, it was at reduced capacity. BreastCheck was paused again in January and February of this year due to the Covid-19 situation and resumed screening on 8 March 2021.

The National Screening Service has done a significant amount of work to mitigate against Covid-19 risks and support the safe resumption of services. This has included the vaccination of front-line staff in screening services. The latest data show a good increase in numbers screened during March and April. In March, CervicalCheck screened over 45,000 women and the provisional data for April indicates that over 28,000 women were screened. This is significantly above the target of 24,000 and I acknowledge the huge effort by CervicalCheck, primary care services and GPs and the laboratory services in achieving this level of activity. The provisional April data for BreastCheck show that over 12,000 women were screened and in BowelScreen, over 24,000 invitations were issued. Again, I acknowledge all the teams in screening services and clinical pathways for their ongoing work to get screening back to full capacity.

The focus of the resumption of cancer screening services includes the management of capacity across the whole of the screening pathway, which includes follow-up assessment and treatments so while invitations for screening were paused, it is important to note that follow-up assessments and treatment continued throughout the pandemic with a particular focus on urgent and time-sensitive cases.

In resuming screening, those who may be at highest risk of disease are being prioritised. The Senator was quite right when he said that early detection is vital. It is also important to emphasise that screening is a population-based measure aimed at healthy people who do not have symptoms. People who may be between screening appointments or who are waiting for rescheduled appointments should contact their GP if they are concerned about any possible symptoms.

In terms of funding, an additional €10 million was allocated for cancer screening services to the HSE for 2021. Many of the new developments being funded in 2021 will enable the management of screening service users with deferred appointments due to Covid-19. One important initiative prioritised for 2021 is the development and opening of semi-permanent BreastCheck units in two locations in Donegal and Dublin later this year.

In light of all of this, I trust the public can be assured of the ongoing commitment to our national cancer screening programmes and to getting services back to full capacity as safely and as quickly as possible.

Senator Victor Boyhan

I note the additional funds and resources that have been allocated to address this issue. I thank the Minister of State for that. I am particularly pleased about the confirmation of the services for Donegal today because there is a substantial level of concern about the issue in the county. That is good news for the people of Donegal, for the people who represent them and for the people of Dublin. This goes back to the fact that the delayed detection of late-stage cancers will mean fewer treatment options and not very successful outcomes. This is the impact on people, in terms of their survival, and their families to which the Minister of State referred.

I ask the Government, the Department of Health and the Minister of State's officials to keep this as an issue a priority, to review the national cancer strategy, to address any further shortcomings and to monitor developments on a month-by-month basis. We must remain on the case and keep monitoring. In another few months, if there is a reduction in the figures, we need to examine that. Ultimately, I would like the Minister of State to publish a comprehensive capacity and workforce plan. It is important that we stay focused on this issue and continue to publish the figures. I thank the Minister of State for her comprehensive reply.

Deputy Mary Butler

As the Senator said, every area of the health services has been affected by Covid-19 and our national screening cancer services are no exception. The HSE and the National Screening Service are working hard to provide cancer screening in a safe environment and to get screening back to full capacity. I take the Deputy's point and I agree with him wholeheartedly that we have to ensure that this matter remains a priority. It is essential that we do so.

As I outlined, the data for March and April show a significant improvement. The National Screening Service continues to provide up-to-date information for the public on its programme websites, including regular updates with respect to Covid-19. Due to the difficulties we are encountering in the Department of Health and the HSE because of the cyberattack, I encourage anyone who has an appointment this week to check the website, if possible, before attending because, unfortunately, many appointments have been affected. It is awful when we are finally getting back on our feet that people who have been waiting for an appointment for quite a while might have it cancelled.

Health Services

Senator Fiona O'Loughlin

I thank the Minister of State for being here. I also thank her for the work she does on behalf of older people and in the area of mental health. It is fitting that she is here to discuss the menopause. This matter relates to older women and those who are suffering from mental health issues because of a lack of understanding and awareness and many have either been misdiagnosed or have not had the proper diagnosis. I know the Minister of State will be bring compassion and understanding to the matter. I have not previously sensed or felt as much frustration, liberation or emotion as I have in recent weeks in the context of the discussions we are starting to have with regard to the menopause.

We have had not only decades but centuries of not discussing something that 51% of our population experiences. We know that women generally live one third of their lives post menopause. The quality of that third of their lives very much depends on the support and treatments they receive during the menopause. Some 80% of women have a difficult menopause. I have read and listened to accounts of what large numbers of women have gone through, many of whom have opened up and told their stories and outlined their journeys. That has been cathartic for these women in many ways. I want to listen to all the recordings from Joe Duffy's radio show of the women telling their stories, outlining their journeys and expressing their sadness, anger and frustration at not being believed about what they were going through.

There were stories of women who were put on anti-depression medication or being diagnosed with different conditions and referred to consultants and of people not understanding. It is shocking that we are having these conversations at this stage.

We want to encourage and support women and, of course, men to lead healthy and fulfilling lives at every stage of their lives. We need to support women and we need to support men to understand what the women in their lives are going through. We need to support our health professionals because far too many GPs and physiotherapists do not have the proper supports or training on what they need to do to support their patients.

It has been a breath of fresh air in many ways, even when looking at some of the Facebook groups such as The Irish Menopause and My Second Spring groups. Reading and listening to these stories, I felt I had found my tribe. I could identify with and relate to all of it. The floodgates have opened in terms of the menopause and I thank all the women who have been brave enough to share their stories.

Women are being misdiagnosed. They have been denied treatment and given incorrect treatment. We need to change that for women who will go through the menopause in future. We need to ensure they get proper treatment and we have awareness programmes in place in health and education.

Deputy Mary Butler

I thank Senator O'Loughlin for raising this important issue, which was also discussed in the Dáil during the Topical Issues debate on Thursday last. Sometimes Ministers can be asked to respond to questions in an area with which they are not especially familiar, but when it came to talking about the menopause, I was well qualified to answer.

It is great to hear what has happened on the airwaves over the last couple of weeks. Women have been given a voice and somebody to listen to them. That was a huge part of it. It was therapeutic that someone was there to listen. It was also great for men to be given an understanding of how difficult it can be for women going through the menopause.

The Government recognises that menopause is a key health issue for women in Ireland today. Stigma and uncertainty persist for many women on an issue which will impact over half of the population and this has to change. Work is under way to drive progress in this area. This has been driven by the women's health task force, which was convened in September 2019 to improve health outcomes and experiences for women and girls.

The menopause has been identified as a priority under the women's health task force. A number of initial priority areas for action were determined by the task force in 2020, with the issue of menopause recognised and included as one of these priority areas. This is welcome.

In terms of treatment, most women will experience some symptoms around the menopause. The duration and severity of these symptoms vary from woman to woman. It is recommended that women who experience menopausal symptoms which they find difficult to deal with see their GP. GPs can offer treatment and suggest lifestyle changes if a woman has severe menopausal symptoms that have a significant impact on her everyday activities.

Discussion is under way between the Department and the HSE on the provision of potential additional support to this area and I will be happy to update the House on the matter once it has been approved and finalised.

An important aspect to mention is that increased information and awareness has been a key ask heard from women on this issue. This has been heard by the women's health task force, both through direct engagement with stakeholders and the national radical listening consultation exercise under way to capture women's voices and views of health in Ireland. This has also been reiterated in recent media conversations. I am happy to share details of activity, both under way and planned, which will address this ask specifically such as the inclusion of menopause as a topic within the new HSE online citizen health guides currently under development.

Menopause will be included within a women's health information repository site of trusted sources, to be developed over the coming months. It will also be included as a topic in an education and communication campaign on specific women's health issues that is intended to be held later this year. Women's health will be represented on the healthy workplace framework implementation committee that will be convened later this year. This will help ensure women's health needs are addressed in this forum with particular reference to increased awareness of menopause within the workplace, which can be very difficult for some ladies. I was listening one day to a woman who felt there was no understanding in the workplace of what she was going through.

I hope this has given the Senator some assurance that the Department and the HSE are fully aware of the importance of this issue for the women of Ireland, and that we are actively engaged to deliver positive change in this area. I know the Senator will drive this issue in the Seanad.

Senator Fiona O'Loughlin

I acknowledge the work that is being done to include the menopause as a priority under the women's health task force. I also thank the Minister for Health, Deputy Stephen Donnelly, because he has already done quite a bit of work in the area of women's health and that must be recognised. Education and research are central to removing the taboos and stigma around the menopause and supporting women going through their journey. The Minister of State mentioned that the menopause will be included as a topic within the new HSE online citizen health guides that are currently being developed, and the women's health information repository site is important. We have to keep talking about this. That is key. The women who are tuning in to this debate should keep talking, listening and sharing and we will keep talking here. As chair of the women's caucus, this is something we will continue bringing up with the Minister.

Deputy Mary Butler

As outlined, menopause has been recognised by the women's health task force as a priority healthcare issue impacting women. Significant activity is planned for this year to increase awareness and access to information, which was a key ask from the women of Ireland. As the Senator has said, it is only right and fitting to acknowledge the work of the Minister for Health, who is progressing these new initiatives. While GPs can advise women who experience difficult menopausal symptoms on potential treatments and lifestyle changes that may benefit them, discussion has also taken place on the provision of potential additional supports in this area. I will be happy to speak further on those once they are finalised. Both the Department and the HSE are very much engaged and committed to driving progress in this important area. I again thank the Senator for inviting me in today to speak on this very important issue. I have no doubt that the voice of the women's caucus will be very loud in progressing this matter.

Acting Chairperson (Senator Sharon Keogan)

Having 40% women Senators has driven women's health into the limelight. I am very thankful that we are doing that, for once.

Primary Care Centres

Senator Garret Ahearn

I welcome the Minister of State and thank her for the work she has done with nursing homes in her portfolio of older people. It is such a relief for people at the moment to be able to visit friends and neighbours in nursing homes. I know that from my own experience. I thank the Minister of State and all the people working in that sector.

My question relates to the proposed primary care centre in Fethard, County Tipperary. Fethard has been identified by the HSE as the preferred location for the development of a primary care centre. A site directly adjacent to Fethard town park has been scoped and approved by the proposed primary care centre developer. This development is greatly welcomed as it will allow for increased economies of scale and the creation of a co-located campus with mutual health and well-being benefits for all. However, there seems to be a lack of progress lately. The HSE has been quite slow in progressing primary care centres in the south east, which includes Fethard. I understand that all works have been slowed and bogged down because of Covid but can the Minister of State give assurances that this is still a priority for the Department, and for her in particular?

Primary care centres play a vital role in rural areas and towns. Fethard is a prime example of an area and hinterland that would benefit greatly from having a primary care centre. The Minister of State is based not far from the area, so she knows Fethard is a small town with a population of approximately 1,500, with a good hinterland. Successful work has been done on a range of issues in the town. A primary school has been extended to add two new classrooms, the secondary school has a large extension of 14 new rooms, so we now have almost a new school beside the existing one, and funding of €2.6 million was secured from the rural regeneration fund for Fethard town park. All of these developments are in the same part of the town. It is in a perfect area, which incorporates education, well-being and sport. The jewel in the crown, the development that would finish the whole project, is the primary care centre.

There is so much work going on in Fethard. I do not know of any other area, in County Tipperary or beyond, where so many community groups have been involved in the projects. They include Holy Trinity National School, the town's secondary school and community playschool, Fethard GAA and rugby clubs, the scout group and the community council. Some 27 groups have come together to work with Tipperary County Council, the Cashel and Emly diocese and Coolmore to build a centre of excellence for well-being, sport, community and education and everything is progressing nicely.

We have had some difficult number for building and progressing projects, which is of course understandable. However, things are starting to move now on the 23-acre site, which includes the secondary school, primary school and town park. As such, some information on progress for the primary care centre would be the icing on the cake for a fantastic community of people who give back an awful lot to their area and, most important, work together for the benefit of the region. Any indication the Minister of State could give in this regard would be greatly appreciated.

Deputy Mary Butler

I thank Senator Ahearn for raising this issue. He described a vibrant community supported by many community groups and also the importance of the new proposed primary care centre for Fethard, County Tipperary. I welcome the opportunity to provide an update to the House.

The ongoing development of both community and primary care is the core of the Sláintecare vision. This Government is committed to ensuring people are provided with the care they need as close to home as possible and have access to the wide possible range of health and social care services within their community. In support of this national goal, south east community healthcare is working to develop primary care centres across the region. In February 2019, a schedule setting out the next stage of primary care development was drafted and priority sites in the south-east were identified.

One of the five priority sites was the area of Slieve Ardagh and west County Tipperary which includes, as the Senator mentioned, Fethard, Killenaule, Gortnahoe and Ballingarry. As the area is rural, with a number of small towns and villages, it was considered from both an operational and HSE estates perspective that the development of the new primary care centre should be located centrally insofar as is possible. Following consultations, Fethard was agreed as the proposed site for the new centre. Expressions of interest were subsequently advertised in November 2019 and the process of engaging with developers commenced. I understand two developers have expressed an interest and that local GPs have also signed up in support of the Fethard centre. It is the intention that some existing GP practices will be aligned with the Fethard primary care centre, while GP practices in other local towns and villages will be maintained.

I am pleased to be able to advise the Senator that HSE estates is reviewing the schedule of accommodation and expects to be in a position to issue relevant documentation to developers before the end of May. This will allow developers to finalise the design and bring the opening of the centre one step closer. This is a very welcome development as the centre will bring vital services to the Slieve Ardagh and west County Tipperary area, providing modern, purpose-built accommodation and acting as a single point of access for health and social care delivery. The primary care team will include GPs working alongside public health nurses and other healthcare professionals, including occupational therapists, physiotherapists and speech and language therapists.

This team will also link in with the wider community network services, including dental care and hearing specialists, among others. The Government is committed to continued investment in the development of primary care centres nationwide, in both urban and rural areas. These facilities have a crucial role to play in enhancing and expanding capacity in the primary care sector to deliver high quality, integrated care to people in their own communities. I am sure the centre in Fethard will come to be seen as a valued community asset.

Senator Garret Ahearn

I thank the Minister of State for her detailed response. I thank her, in particular, for saying that relevant documentation to developers will be issued before the end of May. That takes us one step closer and it is the major step towards getting everything moving. I thank the Minister of State for her engagement and work on this matter, and her help in pushing it along. There are many things going on in the Minister of State's Department, including the cybersecurity issue we heard about last week and, with that in mind, I thank her for prioritising primary care centres. As she said, the Government is committed to prioritising primary care. I can see that in Cahir. A primary care centre opened in Cahir approximately two or three months before the onset of Covid-19. GPs and public health nurses in that primary care centre do not know where they would have been had they been in their old facility, nor how they would have coped. The comparison between the challenges they face and the challenges they would have faced if they were not in a primary care centre is like comparing chalk and cheese. It is massive for Fethard and the surrounding areas that they will have a primary care centre in the future. I thank the Minister of State again for her work and for her commitment that the next stage will happen at the end of May.

Deputy Mary Butler

I again thank the Senator for raising this matter I understand the importance of the development of such facilities to local people in communities such as Slieveardagh. As I have said, the development of primary care centres is an important part of the Sláintecare vision. These facilities provide a single point of access to health services and offer a means of supporting people to live independently in their own communities for as long as possible. That is what I aspire to every day - the right care in the right place at the right time, including the correct wrap-around supports for older people so they do not have to go to an acute hospital for support or that their entry into a nursing home may be delayed because they can get the appropriate supports at home.

Good progress continues to be made in the development and roll-out of primary care centres across the country. Some 142 are now operational, with 14 of them opening last year, despite the challenges posed by Covid. A further 15 are at different stages of the construction or equipping process and are expected to open in 2021, with a pipeline of projects to follow in later years. As he said, the Senator is aware that Tipperary has benefited from investment with four primary care centres in Tipperary Town, Carrick-on-Suir, Cashel and Cahir. We can all agree that these facilities have a key role to play. I reiterate that relevant documentation to developers will be issued before the end of May. I thank the Senator for his interest in the matter.

Dublin-Monaghan Bombings

Senator Robbie Gallagher

Cuirim fáilte roimh an Aire Stáit as teacht go dtí an Teach ar maidin. Tá a fhios agam go bhfuil a lán oibre le déanamh aige. Gabhaim buíochas leis as a bheith anseo chun caint linn faoin ábhar iontach tábhachtach seo do na daoine as Contae Mhuineacháin agus Baile Átha Cliath.

I welcome the Minister of State to the House this morning to discuss this important issue. Today, 17 May, marks the 47th anniversary of the Dublin and Monaghan bombings. Each year, we gather here to discuss this issue but, unfortunately, there is little or no progress or forward movement for the victims, survivors and their families. Some 34 people lost their lives in Monaghan and Dublin on that fatal day. It was the greatest loss of life on a single day during the Troubles.

As the anniversary occurs again today, our thoughts and our prayers are with the victims and their families. It is difficult and frustrating to try to understand how, 47 years on, we are no wiser as to the role of the British state or who was responsible for this tragedy in which 33 people lost their lives, seven in County Monaghan and 26 in Dublin. We can only imagine the pain and grief the families continue to endure over this period. That pain is compounded by the absence, for more than four decades, of the truth of what actually happened on 17 May 1974.

I pay tribute to all those who have worked through the years to lift the lid on this mystery. I acknowledge the huge work done by the Justice for the Forgotten group, as well as everything that has been done by Members of the Oireachtas to move this issue forward. Despite all of this, we are no closer to a resolution. The families' quest for truth and justice has been blocked in every quarter and largely ignored.

The British Government must make all documents relating to this atrocity available. It is imperative that both Governments work together to deliver a structure that can manage the legacy of the past in a way that can positively contribute to reconciliation on this island in the future. Unilateral action is unacceptable. I call on the Government to reinvigorate our efforts, on behalf of the people of this country, especially those of Monaghan and Dublin, to request the British Government to release the papers in order that these families can finally bring closure to this and put the memories of their loved ones to rest.

Minister of State at the Department of Foreign Affairs (Deputy Colm Brophy)

The Government stands in solidarity with all those impacted by the Dublin and Monaghan bombings. Some 33 people were murdered and hundreds seriously injured on that awful day in 1974, which was the highest number of casualties in any single day during the Troubles. We will continue to seek the full truth of these appalling attacks, as well as some measure of closure for the victims' families and survivors, in accordance with the three motions passed unanimously by Dáil Éireann to date.

The all-party motion on the 1974 Dublin-Monaghan bombings that was adopted by the Dáil on 25 May 2016, like those adopted in 2008 and 2011, calls on the British Government to allow access by an independent, international judicial figure to all original documents relating to the Dublin and Monaghan bombings. The motions also ask the British Government to provide access to original documents relating to the Dublin bombings of 1972 and 1973, the bombing of Kay’s Tavern in Dundalk, and the murder of Seamus Ludlow.

The Government is committed to actively pursuing the implementation of these all-party Dáil motions. We have consistently raised the issue with the British Government, including at the British-Irish Intergovernmental Conference. We have also raised the Dublin-Monaghan bombings and the need for access to all original documents during regular engagements with the Secretary of State for Northern Ireland and the British Prime Minister. The Government will continue to engage with the British Government on this request, at senior political level and in official level engagement by my Department, to pursue all possible avenues to achieve progress on this issue until a resolution is found.

Importantly, the Government has also welcomed the announcement by the PSNI on 30 November 2019 that former Bedfordshire chief constable, Jon Boutcher, is heading an independent police team to conduct an analytical report on collusion in what has become known as the Glenanne gang series of cases. This is relevant to several cases including the Dublin and Monaghan bombings. The former chief constable has been in regular contact with the Garda Commissioner regarding his investigation, as well as with the Dublin-Monaghan families. This is a potentially significant development and one which I know the families have strongly welcomed.

The Government will be supportive of facilitating this investigation subject to the requirements of the law as there are other investigative processes in Northern Ireland. The families, like so many across this island who have suffered great loss during the Troubles, have been waiting far too long. It is appropriate to recall the powerful findings of the inquest last week into the deaths of ten people in Ballymurphy in 1971. It shows that truth can still be brought to light, even decades later. Some injustices can be corrected for the world to see. We look forward to the day when the families of the Dublin and Monaghan bombings, and other terrible days, will see days like last Tuesday in the Coroner's Court in Belfast.

Senator Robbie Gallagher

I thank the Minister of State for his comprehensive response. The events last week in regard to Ballymurphy give us all hope. I am sure the people of Monaghan and Dublin who were following the developments last week in regard to Ballymurphy, which occurred in 1971, are, perhaps, hopeful that their day too might be coming. I urge the Minister of State and the Government to do all they can, as I know they will, to ensure these families can finally get closure. Forty-seven years have passed and a lot of these people are not getting any younger and they would like closure while they are still here to witness it.

Deputy Colm Brophy

I have taken note of the Senator's remarks, particularly in regard to the passage of time. The Government will continue to engage with the British Government to secure the implementation of the all-party Oireachtas motions on the Dublin-Monaghan bombings. Our position on the Dublin-Monaghan bombings is consistent with our approach to the legacy of the Troubles more broadly. Every family bereaved in the conflict should have access to an effective investigation and a process of justice regardless of the perpetrator. To achieve this requires a collective approach. We have set out this approach in the Stormont House Agreement. Progress on implementing a framework that is consistent with the agreement is critical to ensuring that these issues are dealt with comprehensively and fairly, and in a way that meets the needs of the victims and survivors, as well as society as a whole.

I again thank the Senator for raising the matter.

Middle East

Senator Frances Black

We are on the brink of a full-scale war in Israel and Palestine, with Israel bombing Gaza and Hamas firing rockets. The only way to stop this horrific spiral of violence and displacement is to end Israel's illegal occupation of Palestine and its violent oppression of the Palestinian people. The Government should sanction Israel for breaching international law and committing crimes against humanity by way of passage of the Control of Economic Activity (Occupied Territories) Bill 2018.

Human Rights Watch, one of the most respected human rights organisations in the world, and B'Tselem, another respected Israeli human rights organisations, both recently concluded that Israel is committing crimes against humanity, against the Palestinian people. The only way to stop this horrific cycle of Israel's violent displacement of Palestinians from their homes, the daily punishment of innocent families and Israel bombing Gaza is to make the economic cost of this conflict too high to bear. Ireland was at the forefront of the campaign that ended apartheid in South Africa and we can end Israeli apartheid.

Condemnation is not enough. It can be ignored. It is only when there are consequences for Israel that it will end the discrimination and oppression. Most EU states, including Ireland, are rightly calling for an immediate de-escalation of hostilities to save lives, but calls for de-escalation without any meaningful plan for what comes next is gaslighting. Western leaders can call for de-escalation, but when the fighting stops, what happens next? Everything goes back to normal, but normal just means institutionalised discrimination and apartheid, with widespread injustice across the West Bank, Jerusalem and Gaza. Those same Western leaders will accept this return to normal and move on to the next issue, refusing to take any real action or ensure accountability.

Breaking the cycle of violence requires de-escalation, but it also requires political will and action from the international community. Let us not gaslight the many Palestinians and Israelis who want to see a just and lasting peace by calling for de-escalation today when the issue is in the news, but abdicating any responsibility tomorrow.

The Palestinian people have been abandoned by the international community but Ireland can take a stand and progress the occupied territories Bill. The Government has said that it received legal advice from the Attorney General that EU trade agreements prevent Ireland from acting unilaterally on the issue. It also said Ireland could face many millions of euro in EU fines for introducing such a law. The Government’s contention that the Bill would contravene EU law has been challenged by Professor Takis Tridimas, a barrister and one of Europe’s top legal experts on EU law. Professor Tridimas wrote a legal opinion on the Bill, citing previous decisions upholding the right of a member state to unilaterally ban imports from a country. Ireland can unilaterally ban imports from the occupied territories under a provision that allows it to take decisions based on public policy. The Government’s position that we would be breaking EU law can be challenged at the European Court of Justice. We should make the case and then let the court decide. Sometimes laws are there to be changed and the dial is there to be moved. That can only be done by testing the law and that is what we should be doing here.

The Government regularly states that it and our diplomats speak up for the human rights of Palestinians at the EU and the UN Security Council. Will the Minister of State make a statement on what specific actions Ireland will now take at national, EU and UN levels in response to the extensive human rights violations and military assaults on civilian targets being conducted by the Israeli Government? Does the Minister of State accept that statements of condemnation have not been and are not sufficient? Does he acknowledge that a response based on international human rights must demonstrate seriousness about those human rights by following through with appropriate diplomatic and economic action, and what such actions will Ireland take and advocate for others to take?

Virtually every other tactic has been tried for decades to stop Israel's oppression of the Palestinian people. The occupied territories Bill may be the first step in bringing freedom to Palestine and peace to the region.

Deputy Colm Brophy

I acknowledge that the Minister, Deputy Coveney, cannot be here. I know he engaged with Senator Black on this yesterday at some length. I would like to restate the Government’s deep concern at the intensification of violence in Gaza, on the West Bank, and in Israel. Now is the time for de-escalation, as the Senator correctly points out, before further loss of life. We need to encourage all efforts to reach a ceasefire. These events are terrifying for both Palestinian and Israeli civilians. The number of child casualties is particularly shocking. The protection of all civilians is of paramount importance and it is an obligation under international humanitarian law.

Ireland has been vocal, as the Senator will acknowledge, in its condemnation of the escalating situation in the Middle East. Yesterday, the Minister, Deputy Coveney, addressed the UN Security Council, which met in emergency session. He called for the council to condemn the violence and that all parties must adhere to international humanitarian law and respect human rights. Adherence to international law is critical. The Minister has also spoken to his counterparts in the Middle East region to underline the need to protect civilians, bring an end to this violence and move towards political engagement. EU foreign ministers will meet tomorrow in an extraordinary session to discuss the issue.

The overall human rights situation in the occupied Palestinian territory remains a matter of serious concern. The protection and promotion of human rights is an integral part of Ireland’s foreign policy and we consistently seek to raise our concerns on human rights issues through the most appropriate and effective channels. Our active participation at the UN Human Rights Council is particularly important for us in that regard. Ireland is a consistent and strong supporter of interactive dialogues with the UN special rapporteur for human rights in the occupied Palestinian territory at the UN Human Rights Council and the UN General Assembly. At the most recent session of the UN Human Rights Council in March, Ireland made a statement under item 7 during the general debate, which restated our commitment to the principles of accountability and emphasised that Ireland will continue to speak out against unilateral actions which are in breach of international humanitarian law. Ireland regularly conveys our concerns on human rights issues to the Israeli authorities, both directly and through the EU. The Minister raised these concerns with the Israeli ambassador last week. We also provide financial support to Israeli and Palestinian NGOs working on human rights issues.

In respect of the occupied territories Bill, I know from her contributions on the Government's position that the Senator is well aware that the Bill is not and will not be compatible with EU law and will not be implementable. This is the clear legal advice on the matter the Government has received from two Attorneys General. As a Government that is strongly committed to the observance of international law as a solution, if it is not legal it is not something we will take forward.

Ireland has consistently and strongly opposed settlements, and will continue to do so. Ireland is very clear on the illegality of Israel’s settlement policy, which can only be seen as a strategy to take possession of Palestinian lands and is fundamentally undermining the two-state solution and a future Palestinian state. The events of the past few days have not happened in isolation. They come after settlement expansion and threats of violence against Palestinians in particular. Ireland remains firmly committed to a negotiated two-state solution based on international law, the relevant UN Security Council resolutions and the agreed parameters. I thank the Senator for raising the issue.

Senator Frances Black

I thank the Minister of State. I want to put on the record that I thank the Minister for calling me last night. I know he would have been here this morning if he could have been. I suppose the Minister of State has to understand my frustration. It is very difficult to watch what is happening in Gaza and see children and families being killed. Not only this but their homes are being destroyed. They are given 58 seconds to leave their homes. What kind of world are we living in? I acknowledge the Minister is very passionate on this issue. I understand where he is coming from. I ask the Government to be open to looking at the opinion of Professor Tridimas, and those of Senator Michael McDowell and Professor James Crawford. They are all experts on this issue. I also ask that the Government publishes the advice of the Attorney General. It would be very beneficial for the people of the country to see what the Attorney General is saying so we can argue and debate it. This is my ask today. Let us see the advice of the Attorney General. I thank the Minister of State for coming to the House.

Deputy Colm Brophy

I thank the Senator very much. I agree that it is incredibly difficult to see the pictures and the absolute horror of what is taking place, and see people who are effectively trapped in Gaza coming under the most sustained very sophisticated military weaponry with absolutely nowhere to go. We all take on board the horror of what we have seen and, obviously, the impact in Israel of rockets coming in in an uncontrolled way and landing on civilian populations there. What is happening in Gaza, particularly to children, is something that is absolutely awful.

With regard to the occupied territories Bill, as I said in my opening contribution, we are guided by the advice of two Attorneys General. I fully empathise and understand where the Senator is coming from on this and the need and want for people to see something, and the concern they have about the settlements. It is very important, as the Minister has said very clearly, that we want to engage with all of the partners, particularly with our EU partners. We want to act collectively to bring about the solution, as I mentioned, that is desired by everybody, which in this immediate case is a cessation of the current violence. The best way for us to do this is to adhere to law. If we have the advice from two Attorneys General that we cannot progress, I do not think we, in setting out on a course of action, should do something we are told as a Government is not legal and, therefore, we cannot do. Obviously we want to work towards a solution. I thank the Senator very much for the opportunity she has provided by raising this today.

Acting Chairperson (Senator Sharon Keogan)

I thank Senator Black for continuing her work with the people of Israel. I thank the Minister of State and I will use one of his lines. Some injustices can be corrected for the world to see. I hope he does all he can.

Sitting suspended at 11.40 a.m. and resumed at 12 noon.