CervicalCheck Tribunal (Amendment) Bill 2021: Second Stage

Question proposed: "That the Bill be now read a Second Time."

I am pleased to introduce the CervicalCheck Tribunal (Amendment) Bill 2021 to Seanad Éireann. The purpose of this amendment to the CervicalCheck Tribunal Act 2019 is to extend the period for receipt of claims by the CervicalCheck Tribunal. 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 2021. This Bill proposes extending 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.

While this is a technical amendment, I once again acknowledge the profound impact the CervicalCheck debacle has had on the women and families affected. The tribunal was established in October 2020 under the CervicalCheck Tribunal Act 2019, which implements the recommendations of Mr. Justice Charles Meenan by providing for the tribunal as a more sensitive and timelier alternative to the courts for eligible claims. Following a pause in the steps towards full establishment to allow for discussions with the 221+ patient representative group, the establishment of the tribunal was completed with the appointment of the nominated members to the tribunal in December 2020. At that time, I gave a commitment to patient advocates that their members would not be disadvantaged by the five-week pause in establishment during which claims could not be made. Unfortunately, as we now know, after the appointment of the members on 1 December, the epidemiological situation in Ireland worsened considerably. Public health restrictions imposed to protect health and save lives caused significant disruption to all legal proceedings, and particularly those proceedings where claimants had to attend medical practitioners to secure reports on their conditions.

It was only in March 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 affected by the cyberattack. That resulted in the tribunal’s email and databases being taken offline. This measure was purely precautionary, but it was only at the end of June that the tribunal was again fully connected. All of this has been deeply frustrating, not least for those directly impacted, and has had the effect of substantially reducing the timeframe during which eligible women can access the tribunal. This amendment ensures they will be given as much time as possible to consider the options available and make the choice they believe is right for them.

It is important to state that the 221+ support group made several requests in advance of the setting up of the tribunal. We were able to accommodate many of those requests, but not all. I acknowledge the group's disappointment that it was not possible to allow for recurrence as a mechanism in the tribunal, for example. Unfortunately, while the Government very much wanted to accommodate all those requests that were made, we were precluded by the clear legal advice received from the Attorney General in this regard.

The tribunal has received seven claims to date. The State Claims Agency, SCA, has advised that additional plaintiffs have made formal requests to transfer their claims to the tribunal from the courts and, in addition, more claimants have expressed an interest. I am advised that the tribunal and the 221+ support group are also receiving queries, so it is expected that the tribunal will, ultimately, deal with more claims. The tribunal has agreed to my request to make its premises available to women eligible for the tribunal regarding the hearing of their claims, even if they choose to remain in the High Court. The tribunal's premises have been designed with privacy in mind and it has similarly agreed to make its facilities available at no cost for the mediation of CervicalCheck claims.

Before concluding, I mention that the CervicalCheck Tribunal Act 2019 provides for restoration of trust meetings. The intention behind such a meeting is to document experiences, facilitate discussion and provide information to those affected by issues concerning CervicalCheck, or to the family if it is the case that a woman has sadly died. This option is open to all women eligible for the tribunal, irrespective of whether they make a claim to the tribunal. A recruitment campaign is now being conducted for moderators. Amendments to the CervicalCheck Tribunal Act 2019 will ensure that those eligible for the tribunal will have ample time to consider whether they will make a claim to it. I thank the House for taking the Bill as speedily as it has.

I thank the Minister for his contribution. It is worth pointing out at the start we are here because of the very brave women who brought this to our attention. I am talking about Vicky Phelan, Emma Mhic Mhathúna, Lynsey Bennett, Irene Teap and all the other women who have put their own horror to one side and spoken and fought so bravely for redress and recognition. They have highlighted the very deep failure of this State to provide healthcare for women. We must recognise those women and the sacrifice they have made for all of the rest of us, in order to ensure the system is corrected and that we invest in women's healthcare. There has been a historic lack of investment in women's healthcare in this country, and the Minister has been working to redress that, along with other many areas.

None of us will ever forget the horror of the CervicalCheck scandal. CervicalCheck impacted on women of every age across every part of the country. It was horrifying when Vicky Phelan's story broke and she was followed by more and more women. There are many women suffering whose names we do not know. They have not spoken publicly because they are suffering and they are dying, and they should not be. Their families are bereft.

I welcome that we are dealing with this Bill. There is obviously a need to extend it. I am aware the Minister has engaged extensively with the 221+ group and am glad to hear the restoration of trust element is contained within the Bill because most women caught up in this absolutely outrageous scandal want the cervical screening programme to continue. It is a good programme. A very early diagnosis is achieved for thousands of women and all of these women have been encouraging others to go ahead. The trust in the system must be restored and the families who unfortunately have been deeply impacted and affected for ever more need to regain trust in the system.

I look forward to hearing the contributions from everybody else in the House. It is such an emotional topic for women. We have all gone for our smears, got our results and trusted what came in the post. To think that might not have been the case for a large swathe of women is absolutely horrifying. There is enough dedication to women's healthcare, particularly here in the Seanad, that we can ensure this Bill is the best it can be, and keep on top of the issue to deliver some justice for the women.

I welcome the Minister to the House once more. It is important to begin by briefly explaining what this Bill sets out to do. The Bill primarily sets out to amend the CervicalCheck Tribunal Act 2019 to extend the period for receipt of claims for compensation to the CervicalCheck tribunal until January 2022. Section 1 of the Bill amends section 12 of the 2019 Act to extend the current period. This Bill seeks to extend the above nine months by a further six months or more, per the subsection, at the discretion of the Minister.

I welcome this Bill. It is the absolute minimum that should be done to compensate the hundreds of women who have been affected. These women have been failed not once but twice by this Government. The second failure stems from the subsequent treatment of these women, which has been nothing short of appalling. That only 90 minutes have been allocated for this debate is also disappointing. That is 90 minutes given to the women failed by this Government and then dragged through incessant and unrelenting legal battles, even though in 2018 the then Taoiseach, and current Tánaiste, falsely promised no woman would be made go to court and even referred to being aware of the further trauma a court battle would cause. It is important to remember these women were made to endure these lengthy, stressful and tenuous court battles. These legal battles were made necessary to secure any level of justice. They were then left to suffer not only the physical effects of this failure but also mental and emotional anguish.

Cervical cancer is the second most common cancer in women. In Ireland, approximately 270 women are diagnosed with cervical cancer per year and just under 100 deaths occur from it annually. However, with proper screening and early detection the disease is preventable. In Ireland this screening was and is outsourced to US laboratories, a move on the part of a Fianna Fáil Government, undoubtedly to cut costs, while having little regard to the difference in screening standards between Irish and US laboratories. If Fianna Fáil had had more regard for the lives of these women, rather than cutting back on costs, the outcome for them may have been different. However, the Government is still not prepared to accept any fault and shifted, and continues to shift, the blame to the US laboratories to which it willingly outsourced the responsibility for screening. It must be remembered that Fine Gael is not entirely blameless either. It has, even now, retained the privatisation of cervical screening in Ireland.

Not only did the Government fail in its duty to protect these women from this absolutely preventable disease, it also failed to show compassion, empathy or indeed any proper accountability in its subsequent treatment of these women. There is a continuing lack of dignity and respect shown to these women, particularly regarding the lack of accountability. It is suitable to reference the actions, or should I say the lack thereof, of the Chief Medical Officer, Dr. Tony Holohan. Dr. Holohan echoed the attitude of this Government with regard to these women when he was seen to offer his deepest sympathies but after several chances refused to make an apology or take any accountability over his failure. However, what is perhaps the most abhorrent of Dr. Holohan's actions was his strongly advising against conducting of a much called for CervicalCheck review. This is the man who went on, to the absolute outrage of the public, to be awarded the freedom of the city of Dublin in January. What message does that send to the women affected by the cervical cancer scandal and their families? I have no doubt a similar attitude will arise on the part of Dr. Holohan and his merry National Public Health Emergency Team when a Covid-19 tribunal of inquiry is conducted.

On a point of order, the Senator is talking about the Chief Medical Officer, who reports to me. She is making a lot of allegations under privilege.

What have I-----

I am not as familiar with the rules of the Seanad but in the Dáil I do not believe this contribution would be in order.

I apologise. I retract-----

Dr. Holohan has successfully-----

I am sorry Senators-----

The Senator should withdraw that. The remarks should be withdrawn.

Through the Chair, if I have said something-----

Before the Senator continues, the Senator is aware of the issue of privilege in this House and the new rules we have brought in have been circulated to everybody and I ask you to be mindful of those. Comments that are in the public domain are of course eligible to be discussed in the House. However, I ask you to be mindful regarding issues of a private or personal nature to someone who, though he is in the public domain, is still entitled to his good name. I thank the Senator.

All right. I apologise. "20 Irish women so far dead due to cervical cancer screening errors"; "...130 sick women battling in court over CervicalCheck scandal"; "Husband’s agony as Cervical Check letter reveals devoted mum could have been saved"; and "I don’t want my children to watch me dying in pain, all I want is a choice". These are some of the headlines that relate to a web search of Ireland's cervical cancer screening programme. This is simply not good enough. The State cannot be said to have taken the rights, well-being or put simply, the lives, of these women seriously.

The Minister is as always very welcome to the House. I begin by saying Dr. Tony Holohan, our Chief Medical Officer, retains the confidence of this House, the respect of this House and indeed that of the Irish people for the extraordinary manner in which he has led this country through the worst pandemic in living memory. It is extremely important that is reiterated. The work Dr. Holohan has done, coupled with the work of Dr. Ronan Glynn and indeed all of NPHET, the Department, the HSE and frontline workers throughout the country has saved thousands of lives.

In terms of what is going on in the UK and in other countries we should be proud of the work of our Chief Medical Officer and his team.

I echo the sentiment of Senator Clifford-Lee and others that we should always remember the reason this legislation is necessary in the first instance. It is a response to the awful scandal of what happened over the past three or four years. Our respect for the people who stood up and called it out is enormous. The introduction of this legislation to extend the timeline by another six months is appropriate, particularly as a pandemic has existed here for the past 18 months and it has affected everyone, including people who wanted to use this vehicle to seek redress. This particular manner of seeking redress is far more preferable than people having to go to court. Anything that we can do to facilitate this extension of the timeline will be done. If a further extension is needed in 2022, we should not be shy in introducing further amending legislation to do that. We have passed many technical Bills in this House down through the years, many of which have been of little importance in that they sought only to tidy up or close off loopholes. While that work has to be done and it is what a good Legislature will do, sometimes legislation is introduced that has unintended consequences and technical amending legislation is required to address those unintended consequences. Rarely has a technical Bill of such importance as this Bill come before this House.

We will do what we can. I agree that the 90 minutes is appropriate because we do not want to delay the passage of this legislation. We do not need a two or three-day debate on this Bill. That is not what the women who have been affected by this scandal want; they want this Bill passed as quickly as possible so that the tribunal can get on with its work and redress can be achieved. It is important that this legislation is passed and it will be passed. I sincerely hope it will be passed unanimously without any objections. It appears that that will happen. As I said, if further amending legislation is required in 2022 Members of this House will not be found wanting.

It is important that I and others articulate the fantastic work that has been done by Dr. Tony Holohan, Dr. Ronan Glynn and others. Everyone makes mistakes, but the mistakes have been few and far between.

I am sharing time with Senator Pauline O'Reilly.

Is that agreed? Agreed.

I welcome the Minister, Deputy Stephen Donnelly, to the House. This is a very sad issue for me, or any woman, to have to speak about. Over the past few years, I have often sat at home and cried while watching and listening to various people on television and on radio speak about this horrendously bad hand that people were dealt through no fault of their own. I have regular cervical smear checks. During one check irregular cells were detected, but in time to enable them to be removed. Lucky me. Unfortunately, that was not the case for many women. It is important that this amending legislation is enacted as soon as possible to provide for more time for the women who were not as fortunate as me to go forward with the tribunal if they deem it suitable for them. The restoration of trust meeting is important but care needs to be taken in regard to the gender balance in that regard. I am not a feminist or anti-man but this matter raises again the issue of the latent patriarchy within which we live. We, men and women, do not value women and their bodies in the same way that men have not been oppressed in that way. This is the reason we had to take to the streets in regard to other rights such as the repeal of the eighth amendment. We have to take time to consider if there are too many men in charge of the healthcare system and if we are doing our best to represent all genders by ensuring there is gender equality.

This is a good amendment. It gives people more time. One wonders if this was men's services would this have happened. We have to think about that. There has never been any issue with prostate cancer checks. It is important that we think about that. I am not suggesting I am perfect. I might be a little sexist. We have the patriarchy in us; we were raised in it, but women are 51% of the population. It is time to get things right on every level. The gender pay gap legislation is very helpful in that regard. I do not believe the Minister is sexist. We should all be more aware of that go-to of making preconceptions about people. We need to value women's bodies much more. The Government has more to do to reassure women to have cervical smear checks because that service is still in doubt. Each time we discuss the cervical smear scandal and the tribunal it causes further doubt about the service. We will need reassurance in that regard.

Today, we are thinking of Emma Mhic Mhathúna and her family. It is appropriate that we put those who were impacted at the centre of this debate. Nothing we do can bring back the women who lost their lives. This tribunal can bring about some justice but it cannot do all that those impacted want it to do. The Minister recognises that and it is the advice that we have before us. It also does not change the fact that women are entitled to go to the High Court. Time and again there are scandals related to women's healthcare. It is ten years since Vicky Phelan's smear test and we are still discussing the issue. It is absolutely right that we extend the timeline. I am happy to note that more people have come forward since this legislation was first debated in the Dáil. The Minister also said that more people are indicating their intention to come forward. That is welcome.

There needs to be a proper investigation by the State in regard to what happened around justice and healthcare during the pandemic that has impacted women more than men. The cyberattack and the pandemic have influenced this amendment. We know that women and children have been impacted more by the pandemic than men. We need to have a proper investigation in that regard.

Time and again, we talk about putting something on the table that will restore trust in the Irish State. It is right that we would do that, but we have a long way to go. The restoration of trust meeting is welcome but unless we have a broader conversation around the role and place of women in this State and the support that Departments give to women it will not do what we need it to do.

I welcome the Minister. I will begin by extending my best wishes to Vicky Phelan. We all know she is in a battle and we wish her the very best. I also extend my solidarity to all of the women affected, as I am sure the Minister and all Senators here do. It is our job to make sure we do right by them and that we stand by them and their families. I take this opportunity to encourage women to continue to go for their cervical smear tests and those eligible to get their HPV vaccination.

Sinn Féin will support this technical Bill to extend the period during which women may make claims. It is welcome that this period is being extended. However, the fundamental question is why it is being extended. This Bill fails to address that question.

The Sinn Féin health spokesperson, Deputy Cullinane, has spoken to members of the 221+ group and their legal representatives.

Their view as to why it is being extended is that very few women have lodged claims. Despite hundreds of women being affected and hundreds of claims being made in the courts, only a handful of women's claims have been received by the tribunal. Rather than deal with the substantial and genuine reasons most of the women have not made claims, we are simply extending the period during which they can make a claim. The view of the 221+ group is that without dealing with the very real issues and concerns, which were not dealt with leading up to the establishment of the tribunal, we are not really making any changes at all.

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

The Minister and the 221+ group published correspondence exchanged between them prior to the establishment of the tribunal. The Minister stated in a letter of 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.

We must ask ourselves if this has worked. Have women lodged claims? How many claims have been lodged? How many have been heard? Only a handful of people have opted in. That low number suggests that women are voting with their feet. They are saying loudly and clearly to the Minister that there are problems with this tribunal and there were problems from the get-go with reoccurrence, the Statute of Limitations and whether their legal advisers sought an alternative to the courts system.

There is, therefore, little point in establishing a tribunal for a section of society and for those women who were so badly wronged and let down by the State and who feel genuinely so hurt. If it does not have the confidence of the women, that is a problem. By standing with those families, I believe 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.

As I said, I will support this Bill, as will my party, to extend the deadline for women to make more claims. Our real concern, however, is why so few women have stepped forward to use this mechanism.

Cuirim fáilte roimh an Aire. The Labour Party will be supporting this legislation, as we did in the Dáil. It is a technical amendment to the 2019 Bill to extend the existence of the tribunal. This in itself is unobjectionable. We will not be found wanting in ensuring those who want to go through the tribunal can do so.

I must express frustration, however, as have others, that this Bill contains no attempt and makes no effort to resolve the reasons so few women have come forward. It almost seeks to extend in the hope that more claims will arise. As my colleague, Deputy Alan Kelly, has repeatedly said, as we understand it at this point, only five women are currently making claims. This small number should surely be ringing an alarm bell when we contrast that with the 160 active cases that were going through the courts as of May of this year.

There is, therefore, a very real question as to why the Government has not engaged with or listened to the very real concerns of those women who have decided not to go down the tribunal route, and why the 221+ group could not advise its members to make claims through the tribunal.

A number of key issues remain unresolved in this Bill. We have heard assurances so many times that this process would be non-adversarial. Of course, that has not come to pass. Ms Lorraine Walsh has repeatedly been seeking assurances with regard to those who suffer recurrence of their cancer, which the Minister mentioned in his contribution. It is my understanding that in the hepatitis C tribunal, in the event of recurrences of hepatitis C people could go back and had a right to return to the tribunal if their health deteriorated. That avenue has not been opened up to women in the context of the CervicalCheck tribunal, however.

Women wanted reassurances that they would not be statute barred. They were asked to have faith in the system. It is very hard to have faith in a system that let them down in the first instance. Of course, we have a very real failure to take on board and respond to the Chief Justice's decision following the Ruth Morrissey judgment. There was a failure to amend the Civil Liability (Amendment) Act so that no woman has to choose between taking a case herself or waiting until after she passes away.

I wish to pay tribute, as have others, to the enormous courage and fearlessness of the women and men behind the 221+ group and the others who have stepped forward. Behind those faces, obviously, are enormous personal challenges, while they are sick and having to fight this campaign to get the recognition and justice they deserve.

I really believe it is incumbent on the Government now to respond the Chief Justice's comments and that decision to amend the Civil Liability (Amendment) Act so that no woman has to choose. We need the Minister to come back in the next term and remedy these issues so many of us have spoken about today. We are happy to support this Bill to extend the tribunal but ultimately, the tribunal will fail if it does not address the issues that have been set out.

I welcome the Minister to the House today. I can only imagine how hectic it has been for him and how busy he is in these really crazy times. I fully support this Bill to extend the period for receipt of claims by the CervicalCheck tribunal. As we all know, the past 16 months have been seriously challenging for everyone. Covid-19 has affected the pace of everyday life and the CervicalCheck tribunal has been affected the same way; there is no doubt about it. Naturally, therefore, an extension is essential, especially given that it was only in March of this year, when the restrictions eased slightly, that the tribunal received its first claims.

While this Bill is a technical one, it is imperative to acknowledge the immense pain and suffering of the women and families who were tragically impacted by the CervicalCheck failure and the many women who died as a result of the errors that were made.

I thank the inspiring leadership of the 221+ patient advocacy group. This group continues to do so much for the State in improving the health service. It is also essential to acknowledge the brave women who have been cervical cancer campaigners like the incredible Vicky Phelan, who we all know is an absolute inspiration. I wish her well going forward. She is a powerful advocate for Irish women. I also pay tribute to the voices of Lorraine Walsh and Stephen Teap.

It is important to remember the CervicalCheck contract was awarded by the State based on the lowest price procurement process rather than price and quality. The failure to give proper consideration to quality was one of the main issues raised by the Scally report. This is why the Quality in Public Procurement (Contract Preparation and Award Criteria) Bill 2021, introduced by my colleague, Senator Higgins, is so important in preventing this horrific part of Irish history, which has not only darkened our past but also the present lives of so many women, from ever happening again.

I also want to bring awareness to the fact that I have been hearing reports about many women who are currently undergoing cervical smear tests and who have not been receiving results. Many of these women have been given different excuses as to why they should wait another three months before resubmitting the test. Some say they are being told of the backlog that is preventing their access to results. As the Minister can imagine, it is very frightening for many women to receive news that their results are not being processed, particularly after Covid-19. Many women have not had screenings for a long time and that will unfortunately affect fertility for some women. We need, therefore, to ensure that the backlog is being tended to and make sure that all cervical smear tests are being processed. I believe it is an urgent priority.

We have a long and tragic history in this State when it comes to women's healthcare but the shocking reality is that this is not just something that happened in the past. This reality still adversely affects women today.

It is a problem that perpetuates itself and it must be solved.

I pay tribute to all the inspiring women and their families who have been so tragically impacted by this failure of our system and by the failure of leadership in the healthcare service that led to this appalling situation. I also pay tribute to those who continue to champion their cause. I am happy to support this legislation, but much more must be done to ensure that cervical health is a priority and the hideous past never repeats itself.

I welcome the Minister to the House to address this important issue. I note that the House is exclusively occupied by women here to speak on this issue. It shows the importance of this subject to female legislators, policymakers and Members of this House. It also demonstrates the importance of showing our solidarity with the women and families affected by the terrible tragedy that is the CervicalCheck scandal. I am sure all of us have been through the CervicalCheck system in the normal way. It saves lives and it is fantastic to have a screening programme, but it is important that the screening programme is fit for purpose. The bravery of women who spoke out, like Vicky Phelan and the members of the 221+ support group and their families, means we will now have a better system than before. It is something positive to take away from what is an awful blight on our State’s history of providing women’s healthcare.

One important thing to emerge from this tragedy is that before this CervicalCheck scandal broke many people, including me, misunderstood what the screening programme was there to do. Sometimes we went away with a false sense of security that getting a negative result meant the all clear. We might not have taken symptoms we then experienced as seriously as we would have otherwise. I feel like I have been educated by the whole process. If you get a screening test appointment now you will take it and if you get a negative result, that is fantastic and you get a sense of relief from it. You are still more vigilant, though, because you know that it does not mean you are 100% clear all of the time and that you do not ignore symptoms. That was not made clear previously. I did not understand that as a young girl going to get my first smear test. I did not understand that a number of cases would not get picked up. The real failing of the system was that we did not properly educate young girls and women about what the screening programme did and was intended to do. It is definitely important to get screened, but it is also important to not ignore symptoms thereafter. It is still important that we get that message out to young girls and women who will be going through this system. We must encourage as many as possible to go through the system.

I welcome that the Bill proposes an extension to the final date for the receipt of claims. It is important that we give more people time and that we do not rush through this process. Time is always welcome. It is good to have this legislation coming through the House in that regard. The Bill also allows us to discuss other issues. More than 6,000 women every year get early detection and treatment. Those are lives saved every year and that is something for us to be proud of as a State. We are doing something right in this area of women’s healthcare. I also welcome the introduction of the human papilloma virus, HPV, test last year. That is a positive step. The old test, if I am correct, caught seven out of ten cases, whereas the new test detects nine out of ten cases. We have greater detection rates now and a more robust and safer screening programme in which we can have greater confidence. That is very important.

While we are making great headway in this area, I acknowledge that there are still women and their families dealing with the fallout from the CervicalCheck scandal and they will be dealing with it for the rest of their lives. I think of the children left behind and the husbands and partners who have been bereaved. It is a very sad situation. While discussing this issue today, we must bear in mind that many of those women are still trying to fight their cases or have fought their cases. I commend the 221+ support group that has undertaken amazing advocacy for women in this country. It has kept this CervicalCheck issue live, to the fore and as a priority. I say that because things in this job move at a great pace and we must deal with many issues as legislators and policymakers. The Minister for Health also has to deal with many other issues going on in the State. However, the 221+ group has been fantastic in ensuring that this issue stays to the fore.

I ask for one reassurance from the Minister today. On foot of everything the country and the women of Ireland have been through, it has been really upsetting for women to listen to all of this. It was especially difficult when this CervicalCheck issue first arose. You could have been sitting in the car, listening to reports on the radio and then wondering if your test was okay and if you needed to go and get rechecked. That whole issue was there. Every woman across the country felt that anxiety and was wondering if she was okay and if she needed to get rechecked. Therefore, there is a healing process here for us to go through as a State. If we can take one thing away from this whole matter, it will be to ensure that we educate and better inform young girls and women about the screening programme, what it does, its benefits and also its flaws. It is a flawed system and no system is perfect. If we can do that, then we will protect and save the lives of more girls and women in the future. It is a positive takeaway from this whole situation. If it is possible to find one positive aspect of this situation, that is it.

It is good to be here on the floor of the House with so many other female legislators and policymakers, colleagues in the Seanad, to discuss this important issue. It is also important that we have a female Acting Chair. I commend the Bill to the House.

Senator Chambers is right. The House is full of female legislators. Senator Martin Conway contributed as well.

Senator Chambers is entirely right that the experience of going for a smear test overshadows what it actually does. Much of the focus is devoted to preparing to go for the test and to encouraging people to do it. The same focus is not necessarily placed on what the smear test does.

That was well said and it summed up all our fears. I also commend this Bill to the House and I support it 100%. I am glad to see that the numbers who have registered have improved even this week since the debate in the Dáil. It is regrettable that we have only seven women involved from those more than 221 potential applicants. I heard the Minister’s reassurance that it looks like participation will improve and the number will increase. I read the transcript of the Minister’s speech in the Dáil and I listened to him today. I note that some of the requests of the 221+ group could not be accommodated due to the clear legal opinion of the Attorney General.

I want to dwell on this aspect for a moment and consider it. The Attorney General’s role as defined in Article 30 of the Constitution enshrines it as an adviser to the Government. The Attorney General is obliged to advise on all potential Government policy. It is then our job as politicians to find a way forward, to surmount issues and to try to maximise meeting needs when we craft legislation. We must keep the idea that politics is the art of the possible front and centre when we legislate. Even when the Attorney General puts up roadblocks and states something cannot be done for this, that and the other reason, it is important for us to revisit an issue and state how it can be addressed while bearing in mind the advice from the Attorney General.

The 221+ group has undertaken fantastic advocacy in respect of a shocking and horrific experience for those women. It is one which resonates with us all as women. The treatment they received in being obliged to go through the courts was horrendous. I congratulate Vicky Phelan for her courage in being the first woman to stand up and speak out. I welcome her home after treatment in the United States. I am sure it was very difficult to be away from her family. Treatment for many of these women, and for others diagnosed with cancer, particularly when it involves any sort of cervical cancer, involves hysterectomies. Part of the standard treatment in our State in this regard is for women to be referred to the Rotunda Hospital where their eggs are taken and frozen, even when there is knowledge that they are going to have a hysterectomy.

This leads me on to what is probably a predictable subject. In light of that practice, we need laws on surrogacy and we need international surrogacy laws. We cannot yield to impediments being raised in this regard. We must find a political solution, enter into discussions and engage with the advocacy groups. I state that because some of the women who are members of the 221+ group need surrogacy and will need international surrogacy. Others are women with cystic fibrosis. The Irish Families Through Surrogacy group has really highlighted these stories. People have shared their personal experiences regarding why they have needed international surrogacy. Therefore, if we have a medical programme which anticipates the need for eggs post hysterectomy, then there is no reason we cannot find pathways to both domestic and international surrogacy.

The statement that went to the "Today with Claire Byrne" show last week from the Department of Health has had a chilling effect on people throughout the country who are waiting for the Government and the Legislature's response to the report from Professor Conor O'Mahony that finds a pathway to international surrogacy. This is not about morality. It is about an ethical pathway to a treatment that is available. Some of the language around the discussion is appalling in terms of how women are being categorised. It is really important that we engage with this issue. Women are accessing a service and we, as legislators, must have courage in embracing what is and will continue to be a reality. Surrogacy is now a pathway to parenthood and we need to find a way to legislate for it. We cannot rush the legislation and publish it without proper engagement. Parents and their children need a response on surrogacy and it must be included from the outset in any Bill that comes to the floor of the Houses. Let us not rush it. Women and families deserve better than that.

On a point of order, Senator Seery Kearney said that the end result for women with cervical cancer is a hysterectomy. Even after they have had that procedure, however, the Department of Health continues to send them cervical screening reminders for years.

We would appreciate it if the Minister could stop that happening. It can be very distressing for women who have had hysterectomies to get continued reminders to go for cervical screening.

Senator Keogan has already contributed to the debate. I call Senator Ardagh.

I support the points raised by Senator Seery Kearney, who is a great advocate for families going through surrogacy. It is important that the Minister listens to her point that there must be a pathway found between his Department and the Department of Justice in regard to international surrogacy. I have heard anecdotally that there is an impasse on the issue. The Minister needs to find the political will to address it.

We are here to discuss the cervical screening programme and, as I speak, there are only women in the Chamber discussing it. Ultimately, we have a role to ensure that trust is put back into the programme. Extending the date by which people can submit claims goes some way to instilling trust in the CervicalCheck tribunal. However, there is clearly still something wrong. It is very easy to blame the lawyers for being greedy in wanting to go to the courts because they will not get huge fees if they go to the tribunal, but that is unfair. No solicitor could advise his or her client to go to the tribunal when there are clear or perceived limitations to that forum. We need to find a political way, as other speakers have said, to address the issues of recurrence and the statute. If the hepatitis C tribunal was able to address the issue of recurrence, why can the CervicalCheck tribunal not do the same? The changes set out in this Bill go some way to encouraging people to avail of the tribunal but the reality is that the system is not perfect. Legal advisers are not going to advise their clients to go the tribunal route when they perceive limitations and consider it to be wrong to do so. That needs to be addressed.

We are here today because of the work of the many advocates involved in the 221+ group. I do not like listing names because there are so many brave women, but I will mention Vicky Phelan, Emma Mhic Mhathúna, Irene Teap, Ruth Morrissey and Lorraine Walsh, all of whom have been in the public eye. All the members of the 221+ group have kept this issue alive, as my colleague said, through huge adversity and pain for their families. My father had cancer for a long time before he passed away. I do not know how these women had the energy, going through this, to keep their fight alive. It is commendable. People are watching Vicky Phelan's journey as she goes to the United States, gets an apartment and goes through therapy. Her experience gives hope not only to cervical cancer patients but also to many patients across the board. It gives them courage to face their treatment and keep going. Ms Phelan has been very generous in sharing the detail of her treatment and life.

As other speakers noted, we have moved to the HPV first screening method for cervical cancer. Screening has its limits and is not perfect. As Senator Chambers said, the HPV procedure has a success rate of nine out of ten, but there are still 10% of samples that will get through the hoop. We need to make people aware of the symptoms of cervical cancer, which include bleeding between periods and perhaps after intercourse. Some women do not know about that and the message must be put out there. As public representatives, we must use our platform to let women know what the symptoms are and that while screening is not perfect, it is vital that they attend their appointment because it may catch early abnormal cervical cells. They also need to be alert to other symptoms that may present.

This Bill is a first step towards improving the CervicalCheck tribunal but, as other speakers said, much more needs to be done. The figures alone speak volumes and what they indicate cannot be denied. The fact there have been only seven applicants makes clear that the system is not working and more must be done to improve the legislation. We would all be delighted to come back to the House to see improvements in it. Through the Leader's office and with the assistance of the Fianna Fáil leader in the House, we would be very happy to schedule time to consider improvements to the CervicalCheck Tribunal Act.

I take this opportunity to thank the Minister for sanctioning the drug patisiran last weekend. It was wonderful news for the cohort of 35 patients who have amyloidosis. I am delighted for Pat Tinsley, about whom I have spoken to the Minister and whose situation I have raised several times in the House. This is a life-changing drug. While I appreciate that the access programme has to be put in place, this news is a lifeline for many. I thank the Minister for it.

I also thank him for all the work he has done in the area of women's health since he came into office. Within a relatively short period, he has put in place funding for more gynaecology services, enhanced endometriosis services and fertility clinics. He has appointed a clinical lead for women's health and accepted the Free Provision of Period Products Bill 2021 that was tabled by our colleague, Senator Clifford-Lee. The Bill the Minister is working on at the moment to do with assisted human reproduction is very important. Senator Ardagh and I have been working closely with his officials on the issue of IVF. There is also the matter of the issues that have arisen during the Covid period and the health challenges they present.

Turning to the Bill that is before us, I want to express my compassion and understanding for, and solidarity with, all the women and their families who have been impacted by cervical cancer. There are children, sadly, who have lost their mums. This is a moment to reflect on what the women affected have gone through and the challenges ahead of them. I welcome the extension that is proposed in the Bill for receipt of claims by the tribunal. There will be an initial six-month extension, to 26 January next year, and a further extension to 6 July 2022. Reference was made to the smaller than anticipated number of women taking up the tribunal process. It is important for us to outline why this option is a good one. Women eligible to present to the tribunal under the Royal College of Obstetricians and Gynaecologists review are currently at a disadvantage in terms of time limits. That is why this provision is particularly important. It gives an opportunity for potential claimants to consider how effectively the tribunal deals with claims it has received to date. The dedicated case management process operated by the tribunal means claims can be brought to a stage where mediation may take place much faster than is the case for a new claim lodged with the High Court.

It is important that those who have already started court proceedings have the option to come back to the tribunal. As Senator Chambers has outlined, it is also an opportunity to talk again about the importance of the screening process. Over 6,000 women are referred for early treatment every year. Cervical screening continues to have a highly significant value for population health in our country. The introduction last year of the human papillomavirus screening test is a significant milestone for the screening programme.

It is my view and that of my party that the tribunal offers a more suitable and less adversarial alternative to the courts for dealing with eligible claims. We know it may be several years before all claims are dealt with in the courts. This is beyond the control of the Government. By establishing the tribunal, the Government and Minister have provided an alternative forum with the exclusive purpose of dealing with the claims promptly. The outreach programme put in place is to be commended. The tribunal has a number of significant advantages and it is the best possible forum. I wish the Minister well in his continued work.

I am sharing time with Senator Maria Byrne. I thank the Minister for attending. This really is tough because the CervicalCheck tribunal is such a mark on our history. There have been terrible outcomes, including loss of life. It is important to recognise the women affected and their families.

The cervical screening tribunal is examining the State cervical screening programme, including inaccurate diagnosis and lack of treatment. As previous speakers have done, I encourage women to ensure they get regular checks. With the lockdown and pandemic, we have prioritised other things and we sometimes forget about our own health. I encourage women to log on to cervicalcheck.ie and book an appointment. I acknowledge the general practitioner services in our towns and villages, many of which provide this service so it is not difficult to get this done. I appeal to the Minister to introduce measures to support our GP services and primary care services to ensure more specialties for women's health in our local GP and family practices.

As has been mentioned, we should encourage parents of young girls to consider the importance of the HPV vaccine. Imagine not having to go for smear tests. Having access to the HPV vaccine is crucial.

The investment in the clinical lead for women's health is wonderful. Senator O'Loughlin mentioned this as well. Has that appointment been made appointed yet? I will speak to the investment in healthcare infrastructure, resources and laboratories as well as the training of medical scientists. All of these things will prevent anything like this recurring. What infrastructure do we need to have in place?

I welcome the Bill to extend the period for compensation claims. I acknowledge the bravery and strength of women who are suffering the impact of this. I acknowledge the 221+ group, the CervicalCheck patient support organisation, which supports women taking the first step to go into this process.

We should acknowledge that this is an extremely onerous process. It is such a demand on a woman who is going through this to have to deal with the potential tribunal or the legal side. I acknowledge the strength and bravery of women who are doing that, as well as managing outcomes relating to their health.

My thanks to the Minister for attending for this important debate. I begin by welcoming Vicky Phelan home after six long months in the United States where she received treatment arising from her misdiagnosis under the CervicalCheck programme. No individual should be required to leave her family, as Vicky did so bravely and amid a pandemic. She had to go through this experience alone and that was genuinely awful. The late Ruth Morrissey was another Limerick woman who was affected by CervicalCheck. I recognise the courage of both women and how they prevailed through the most difficult of challenges. It should never have happened. I also recognise the work carried out by the 221+ group and other organisations, as many Senators have done today. We need to ensure something of this nature never happens again.

I welcome the amendments. While I recognise that they are mainly technical, they are important. We all recognise the importance of the Bill. The extension of time is welcome, especially in light of the delays caused by the Covid-19 pandemic and the recent cyberattack. Can the time be further extended or should there be an overarching time limit? The experiences of all women should not be disregarded. They should be allowed access to the tribunal at a time suitable to them. For many of the women in question, their health is very important and they are, unfortunately, going through a great deal. Having spoken to some of them, it seems they are fighting for their lives in terms of their treatment and what they are going through with their families. It is not always an appropriate time to apply for compensation. Perhaps that is why there has been such low uptake to date. Would it be feasible to investigate why the tribunals have seen such a low uptake? Can we work with these women? There are more than 200 of them. Can we try to encourage more of them to apply and work with them on this?

I thank everyone for their contributions. I have a wrap-up speech but I am not going use it. Instead, I will try to respond to the questions and points raised because this has been a useful debate.

I echo the sentiments expressed by Senators from across the Chamber that we have to get women's healthcare right. We have never got women's healthcare right. I have no doubt that if men had babies, Holles Street would look like the deck of the Starship Enterprise or the Blackrock Clinic or some other gorgeous place. There is no question about it. The maternity hospitals are not fit for purpose. We have extraordinary clinicians throughout the country in obstetrics, gynaecology, midwifery and so many other areas. We have not given women's healthcare the investment and focus it needs.

Unfortunately, we have a deeply dark past and history when it comes to women's sexual and reproductive health in this country. We know that and we all know the reasons for that. What I want, and I think all of us want, is a revolution in women's healthcare. We do not want marginal change or for things to get a little better. We need to do women's healthcare fundamentally differently. That means large amounts of money and cross-party political agreement in the Oireachtas to enable our phenomenal clinicians to do the jobs they know how to do and to do them better and better. We need this in women's health.

The women's health task force is amazing. It has already identified many areas. For younger women, it identified areas such as mental health, especially around eating disorders, wellness, sports and activity. There is a great deal of focus on team sports and sports that have been more traditionally played by boys rather than girls and we need to rebalance that. Sexual and reproductive health is essential in many different ways. Obstetrics and gynaecology are important. Menopause is now being flagged. There was considerable focus on it publicly recently but the Department and the women's health task force were already examining the issue.

I acknowledge the role played by Deputies and, in particular, Senators given that we are in the Seanad today. I have been working on many of these issues with many of the Senators who contributed to the debate this morning. When Senator Chambers and I were in opposition, she raised with me the issue of endometriosis. We have set up the first specialist clinic in Tallaght and we are going to do much more. Various Senators spoke about domestic surrogacy, international surrogacy, donor-assisted human reproduction and IVF. We are moving on all these matters. I will soon introduce legislation on surrogacy. Three Departments are working on that.

The maternity strategy from 2016 is very good and everyone bought into it but it never got any money, until this year.

This year, I allocated five times more money to the maternity strategy than it got last year, so it is happening now. They are hiring midwives and creating more choice for women around midwifery-led care, home births, community-based care and so forth. We funded an extra 24 lactation consultants recently and we will keep going. We have one of the lowest breastfeeding rates of anywhere in Europe; that has to stop. It must change and we are going to change it. We are setting up new fertility clinics and hubs. There are new "see and treat" gynaecology centres that are very important. There are some great ones already in existence, but we are expanding on them. For the first time, we have funded a clinical lead out of the Irish College of General Practitioners, ICGP, for women's healthcare and primary care. This has been mentioned by various Senators this morning. That has to be just the beginning. I have met with the cross-party women's caucus of the Oireachtas and we must keep meeting up. We have an opportunity here - I am acutely aware that I am a male health Minister saying this, but so be it, there is nothing I can do about that - if we work together on this. There is strong cross-party support in both Houses to start doing women's healthcare differently and make it something we can be immensely proud of. There is no reason we cannot do this. Other countries can and so can we.

I echo the importance of cervical screening. I was taken by the many Senators who got that message out there, notwithstanding what was an horrific and unacceptable situation for the women involved in the 221+ group, which is what today is about. It is wonderful to hear so many Senators echo the point that our cervical screening programme is one of the most advanced in the world. We have some of the highest participation rates and most advanced technologies in the world. I may have my numbers slightly wrong but, from recollection, deaths from cervical cancer were falling by 7% a year, from the year CervicalCheck was set up. I remember the graph. The rates were going up and up, but the year CervicalCheck came into being, they started going down. Clinicians from around the world come here to understand how we have such a high participation rate. It is partly because of the advocacy of political leaders like Members of this House and encouraging people. We have the same thing with vaccines generally. It is wonderful to hear the call being pushed again and again.

Not everything has been possible to deliver on, and the issue of recurrence was raised here this morning, but a lot has been done. Dr. Scally's very good report came up with 170 recommendations. Some 155 of those have been fully implemented and progress is being made on the last 15, so that is pretty good. There were a lot of recommendations that involved a lot of work, and credit goes to our clinicians working in the HSE and officials in the Department for helping to make that happen. There was an ex gratia payment of €25,000 to recognise the trauma of the non-disclosure aspect of what happened. Some 170 women applied for this and all 170 women received it. I appointed a new independent chair to the steering group which the 221+ group had asked for. There was progress made on medical cards, and other issues, as well. However, not everything was possible. The issue of recurrence is one of the big ones and I believe it is one of the reasons not as many women or families have applied. The 221+ group decided not to support the tribunal, which was entirely its right to do. We know the legal advice to some women and families is not to support the tribunal. Can I take another minute, nóiméad amháin?

That advice, as far as I can see, was partly because of this issue of recurrence. All I can say is that I wanted to do it. Every Member of the Cabinet and the Oireachtas wanted to do it. If it could have been done, we would have done it. There were numerous conversations at the Cabinet about this. Every time we brought it back, my Cabinet colleagues and I asked whether we could go further and do more. We pushed and pushed for this. It has never been out of a lack of willingness or due to not listening. We have listened and we have got most of the requests over the line. Some of them are just not possible because you hit up against the Constitution. On the issue of recurrence, for example, if we did it and changed the Act, a few things would happen. First of all, the laboratories would walk. Under the Constitution, we cannot compel them to be involved in the tribunal. Therefore, they would walk and go straight to the High Court. The tribunal would shut down. Even if the laboratories did not walk, which they would do, the initial awards would be lower because in the High Court, as in the tribunal, awards are given for the future possibility of recurrence. It is already brought into the first award. What would happen is that the first award would be reduced. The legal advice I got was that if there was recurrence three or five years later, constitutionally, the laboratories would be allowed to ask that it be proven that it is a recurrence and that it is linked to what happened several years earlier. Women could be potentially asked to go through a process again. All I can say is that everything that was possible to do was done. I am acutely aware of this. There is nothing I would have liked more than to have got everything over the line. We are all on the same team on this. That is as far as it was able to go.

In terms of the tribunal versus the High Court, it is up to every woman and family to do what they think is right. It is up to me to lay out the case for the tribunal. During the debate, I made a few notes on the advantages of the tribunal that we have tried to create over the High Court. One is that it is much quicker. It is months versus years, and, as colleagues have said, time matters. Months versus years is really important. The hearings are in private. The whole thing has been set up differently from the courts to address the process women have had to go through. The hearings are in private. There are pre-hearing steps that reduce the adversarial nature of it. There are, for example, written statements rather than verbal testimony. The hearings are less formal. I remind the House that this is a specialist tribunal just for CervicalCheck cases. Like a commercial court or a specialist court, the tribunal does not have to go through and re-establish facts of law or science. That gets incorporated in it. The legal fees are lower in the tribunal than in the High Court. The facilities are specially designed. There are bespoke facilities, including private rooms, specifically for CervicalCheck hearings. Any woman, at any time, can immediately go to the High Court if she is not happy with how things are going in the tribunal. We have given tight assurances that there would be no penalties in terms of cost or anything else. The State has underwritten any potential liabilities for additional legal fees or else anything like that. The justice, the chair of the tribunal, has agreed that the tribunal will fully support and encourage mediation, which many of these cases will hopefully end up in.

Those are some of the advantages of the tribunal. In contrast to that, there is no advantage of the High Court over the tribunal - there is not one. That is why we introduced this legislation and set up the tribunal. In so many ways, we tried to set it up to be better than the High Court process. There is not a single criterion that I can find where the High Court is a better option than the tribunal. The debate has been that unless we get everything over the line, the tribunal is not what we wanted it to be - I accept that. There is nothing we would have wanted more. Part of my job is to lay out why the tribunal is a better option for the women and families because they are all who matter here. Let us remember, there is a default that at any given hour of any given day when a case is in the tribunal, a woman can say that it is not working for her and she can go back to the High Court. She can do that, and the State will cover any costs or issues there. I will finish with that. I thank the Chair for the extra time and colleagues for what has been an important debate this morning.

Thank you, Minister. I think it was important to get that extra clarification.

Question put and agreed to.

When is it proposed to take Committee Stage?