Ceisteanna ó Cheannairí - Leaders' Questions

I have asked specific questions for some time about the Minister for Health's decision last April to offer a free out-of-cycle smear test to every woman in the country who wanted one and about who advised him on the decision. I have been subject to obfuscation since I first began asking these questions in January. As a result of that decision, CervicalCheck has an enormous backlog of up to 80,000 people waiting up to 27 weeks to receive reports on their tests, while thousands of women have received letters to tell them to come back in because the tests had expired and proved to be invalid. We have moved from a situation where tests were provided within four to six weeks to one in which they take between four and six months. The Minister's decision was the major contributing factor to this unacceptable situation. Last week, the Joint Committee on Health revealed that the new HPV test has been indefinitely delayed because of the backlog. We learned from the The Lancet Oncology journal today that the new HPV test, combined with an uptake in the vaccine, would have a dramatic impact on the reduction of cervical cancer in this country and beyond, but its introduction has been delayed because of the backlog caused primarily by the Minister's decision last April.

Susan Mitchell wrote in last Sunday's edition of The Sunday Business Post that it was her understanding that the CervicalCheck team communicated its opposition to the provision of an additional smear test directly to the Department at a high level in advance of the offer being made. We now know that Professor Gráinne Flannelly, former clinical adviser at CervicalCheck, warned publicly of the inadvisability of this particular move during an interview. I listened to the Minister's interview last Saturday morning with Brendan O'Connor. I was taken aback when the Minister chose to launch an attack on the CervicalCheck team, stating that he had lost confidence in the people running CervicalCheck because of decisions on managing the audit, in response to a basic question of whether he had checked with CervicalCheck before making his decision. The Minister replied that he had not because he had lost confidence in the team over the audit and the communication of the audit.

We now know, however, that the audit decision was shared with the Department of Health. The CervicalCheck team did not make the decision on its own but rather in conjunction with the Department of Health officials and the chief medical officer. They were all part of the decision on how to communicate the audit. Irrespective of one's views on the terms of the decision on the audit, the CervicalCheck team did exceptional work over a decade in building up its programme and saving thousands of lives. The degree to which the Minister dumped on the team last Saturday morning and attempted to destroy its reputation is unacceptable and mean spirited. One cannot destroy the reputation and work of people who have committed to the programme for more than a decade. Many people in the medical world are dismayed at the cavalier dismissal of people who have worked in the field for a considerable time.

Did the CervicalCheck team communicate its opposition to the Minister's decision to someone at a senior level in the Department of Health? Does the Taoiseach now accept that the decision last May was a wrong decision without any clinical mandate? When can we expect the new HPV test to be introduced?

All of us in the House will acknowledge and know that cervical cancer is a terrible disease that causes the death of many women and results in life-changing surgery for many others. We also know that cervical screening works and that the number of women who have cervical cancer has fallen for many years as a result of a successful screening programme and the introduction of the HPV vaccine by the previous Government, of which I was a member. Our objective over the next couple of years is to make cervical cancer a rare disease and virtually eliminate it in the period ahead.

We will do so in three ways, namely, promoting the uptake of the HPV vaccine by girls; extending the HPV vaccine to boys, as we intend to do this year; and improving cervical screening by moving from the current test to the primary HPV test, which we will do as soon as possible, and we will be among the first countries to do it. I cannot provide a date for the Deputy and I acknowledge that he has asked the question previously. The dates I was given in the past by the Department of Health and CervicalCheck were not deliverable and, therefore, I will not commit to a date until I have confidence again that it can be delivered.

The free out-of-cycle smear tests were offered because a large number of women were concerned that their smear tests were wrong. They sought reassurance from their GPs and the helpline, and a decision was made to offer a repeat smear test out of cycle to give tens of thousands of women who were concerned about the accuracy of their smear tests the reassurance they sought. It was called for by a number of Opposition Deputies, as the record shows. When it was decided upon, it was welcomed by some medical bodies, including the National Association of General Practitioners and the Irish Medical Organisation, although it is true that some opposed it and warned of consequences. I understand from the Minister for Health that the chief medical officer supported the decision to extend the offer. While it has caused some problems and there is a backlog of slides awaiting analysis, that is due not only to the free tests but also to an increase in attendance for screening, which has continued even though the free out-of-cycle smear tests are no longer on offer and have not been for nearly two months. While the increased uptake in screening by women is to be welcomed, those two factors have led to a backlog and the HSE is working hard to clear it to return to the previous turnaround time of between four and six weeks.

I asked the Taoiseach whether the CervicalCheck team communicated its opposition to someone at a senior level in the Department of Health in advance of the decision. Will he answer that question?

The reason the new HPV test is not deliverable is the backlog created by the Minister's decision. Is the Taoiseach comfortable with the Minister's comments in that radio interview? The Taoiseach has stated he understands that the Minister was supported by the chief medical officer. We can find no written advice from the chief medical officer, however, and none has been offered. I tabled a parliamentary question and consulted the Office of the Ceann Comhairle. There was a consultation with the Department of Health, which replied to me. Yesterday, I was told that the chief medical officer's advice was reflected in the press release issued by the Minister. What kind of gobbledegook is that? Did the chief medical officer recommend the decision or not? I do not believe that he did; I believe that tracks are being covered.

We need to learn from the issue. The spending of €10 million of taxpayers' money, which could be used elsewhere in the health service, on a decision that has damaged the CervicalCheck programme and delayed the introduction of a much-valued, new and better test is something from which we need to learn lessons and which needs to be revealed in its full truth. There should not be this studied obfuscation. Will the Taoiseach ask the Minister to retract the commentary he made last Saturday in which he attacked an entire team of people who did much good work for the country in saving the lives of many women?

I acknowledge that the people who built and ran CervicalCheck for a period did a good job. I remember the time before CervicalCheck, when women would present much later with a much more advanced disease than they currently do, and how different it was from the UK at the time. CervicalCheck is a good programme. Those who built it, managed it and worked there for a long time did a good job, saved many lives and made sure that many women had interventions much earlier than would otherwise have been the case. They also made many mistakes, which Deputy Micheál Martin did not say. Among the mistakes they made were a botched audit-----

The Department was part of it.

-----that had significant retrospection bias, and they did not share the information about the audit with the women who were affected.

The chief medical officer and the Department were involved too.

I regret that Deputy Martin did not acknowledge that in his comments because, while they did a good job, they did something very wrong in not disclosing that information to patients. I understand that there were different views about whether the out of cycle test should be offered. Some doctors thought it was a good idea. Others called for it. The Chief Medical Officer, who advises the Minister, supported it.

Did the CervicalCheck team communicate with the officials?

I understood they did after the event.

This morning it was revealed, through the excellent work of "RTÉ Investigates", that nearly 60 families in the west have been issued apologies by the HSE as a result of failings in audiology services provided or not provided to their children. This is not the first time this issue has arisen. Last year, the HSE issued apologies to 49 children in the same region as a result of failings related to paediatric audiology services. At that time, and now, some of the children affected were left with lifelong impairments as a result of the failings of our health service.

The Taoiseach may have heard the story on "Morning Ireland" this morning of 11 year old James from Mayo. His parents were entirely unaware of his hearing impairment until they received a letter from the HSE in recent weeks apologising for the lack of care. Six years ago, James was in junior infants and his parents were reassured that his hearing was fine. He is now in fifth class and in the intervening period, he has had no treatment for his hearing impairment. We can only begin to imagine the impact that that has had on the child, socially, developmentally and educationally. It is shocking. I understand that there is now a look-back review into paediatric audiology services. This is the second such look-back review. At this stage, the parents and families in question have received no indication of how long this process will take to complete and, in any event, they have lost faith in it. They now require an independent inquiry and investigation into this mess. Will the Taoiseach agree to that? It is clear that our health services are failing all of us and our children.

Figures provided to my colleague, Teachta Louise O'Reilly, show the disgraceful delays for children in accessing speech and language therapy and occupational therapy. These waiting lists not only impact on children's lives in the here and now, but they have future implications too. Some of the worst delays for occupational therapy are in Mayo, where there are 138 children under five who have been waiting for more than a year for basic treatment. In Cavan-Monaghan, 523 children are on a waiting list. In Cork, 679 kids over five face delays for care. The window of opportunity for these therapies is short and the significant delays cause additional problems for children in the future and as adults. Will the Taoiseach agree to the inquiry as called for by the parents of James and others? Who is accountable for these waiting lists and delays for our children? Who is answerable? Is anybody answerable for this?

The HSE finalised the report of a look-back paediatric audiology services review for the Mayo-Roscommon area for 2011 to 2012 in June last year. It was shared with all 49 affected families in accordance with open disclosure principles. The report and accompanying documentation sent to families from the HSE included an apology for the failures identified and for the anxiety caused to families and those who may have been affected. All 49 children who needed a follow-up as a result of the look-back are either receiving or have already received appropriate necessary care. The HSE has been assisting parents in accessing the necessary health, educational and social protection services, and there has been significant cross-departmental co-operation in that regard.

In December last year, the HSE recalled a further 57 who were identified during the look-back process. The HSE has indicated that this group had an appropriate audiology assessment and the hearing loss was correctly diagnosed. However, they were discharged without appropriate follow-up treatment and a management plan. This group of 57 was not followed up at an earlier stage, as the preliminary risk assessment did not flag them as an area of concern. The group of 49 was seen as the at-risk group and was recalled as a priority. The HSE has advised the Department that of those in the additional group of 57, 35 are under 18 and 22 are over 18, and all 57 have been contacted. To date, 26 have taken up the offer of an appointment. Some 31 did not attend but are being followed up. The priority is open disclosure, which is taking place, and making sure that those who need medical care, educational and social protection supports receive them. We will give an independent inquiry consideration but the priority has to be making sure that affected patients are told and that they receive the medical care and any additional educational and social supports they need.

With regard to other community healthcare areas, only CHO 2 and CHO 5 have had clinical risks identified, requiring a formal look-back review into paediatric cases. The HSE is proceeding with a precautionary recall of children and young adults in CHO 5, the south east area, as part of the quality assurance process. The audits in CHOs 1, 3, 6, 7, 8 and 9 have been completed and were found acceptable. An audit of paediatric cases in the south west, in Cork and Kerry, is also planned.

I could have added failures relating to autism services to the list that I presented. Cases have come before the courts because of the HSE's consistent failure to comply with the law. The Disability Act provides for children to be assessed within a tight timeframe so that tailored treatment can be identified and started but, yet again, there is delay after delay. Parents are now moved to go to the courts to seek some level of accountability. Open disclosure is very necessary and welcome but there has to be accountability too. Who is responsible for this mess?

Every day, it becomes more and more apparent that the health services are in a crisis and there is a lack of leadership and direction. Deputy Micheál Martin himself spoke this morning about obfuscation. He has raised questions over the truthfulness of accounts given by the Minister for Health on CervicalCheck and the additional smear. Fianna Fáil is nonetheless happy to allow a Minister and Government to evade accountability for the many failures in our services. I have raised specific services where children are being let down today and will be let down tomorrow. Their parents are being misled and fear that their children will be affected now and in the future. I asked the Taoiseach who is responsible for this and I want an answer. Who will be held accountable?

Who is responsible for it? Obviously it is the clinician who made the mistake, carried out the hearing tests and either failed to diagnose or ensure the children and people affected had the proper follow-up. It is not about Fianna Fáil or Fine Gael or Micheál Martin or Simon Harris. I know that the Deputy tries to turn everything into a political attack, but, of course, accountability lies with the person who actually made the mistake - the clinician who did not do their job properly and did not carry out the test correctly-----

Who employed them?

It is about the lack of services.

-----or, having diagnosed the hearing loss, did not ensure the patients affected had the appropriate follow-up. The problem was identified internally. The HSE assistant clinical lead for audiology services identified the problem and acted on it. I understand the people who made the mistakes are no longer working for the public health service.

The Minister will be.

There are appropriate professional bodies that register people and that can sanction them by striking them off.

The Minister employed them.

Small businesses in towns throughout the country are preparing for the potential disaster of a sudden exit of the United Kingdom from the European Union. It is time for the Government to support small businesses to reinforce the viability of towns for shopping and services. In that context, it seems incredible that the Minister for Finance is sitting on his hands while a Revenue Commissioners' decision threatens the jobs and livelihoods of those involved in the health food store industry. Ireland has a range of value added tax, VAT, rates which include the zero rate applied to food. Historically, Revenue has applied the zero rate of VAT to food supplements, except those associated with sport, slimming and certain cosmetics. However, it has recently announced a new interpretation of the VAT rules applied to food supplements and that it intends to apply the 23% VAT rate to food supplements from 1 March. This will happen just four weeks before Brexit for an industry that is already very exposed to the UK market for imports and its supply chain. How does this represent helping business to prepare for Brexit? There are 3,600 jobs at stake in the industry.

The Minister for Finance has claimed that Revenue only ever allowed basic vitamins, minerals and fish oil products to be subject to the zero VAT rate, but his claim has been contradicted by the previous Minister for Finance, Deputy Noonan, who told the Dáil in June 2014: "A range of food supplements and vitamins that encourage the maintenance of health, through the sustenance derived from a normal, healthy diet, benefit from the zero rate." He then referred to Revenue eBrief 70/2011 which makes it clear that food supplements associated with sustenance are zero rated for VAT purposes but not those associated with increasing muscle mass or weight reduction. The Minister, Deputy Donohoe, has advanced a subtle but important change by referring to basic vitamins, minerals and fish oils. There is a fundamental question of policy. The Minister has insisted that he cannot interfere with an independent decision of Revenue, but that is not true. He is the policy maker. The job of Revenue under law is to implement, not to make, policy. It is certainly not to change it. The industry is asking the Government or the Minister to instruct Revenue to halt this interpretation of the new VAT change until a full review has been completed. That is a very reasonable request to make. There will be a budget in October and that is the time when we debate tax changes, understand their implications and have democratic oversight of them. Will the Government undertake to halt the impending change at a most vulnerable time for the industry until the Oireachtas has had a chance to review the matter?

The Deputy is aware that VAT is quite a complicated tax. It derives not just from the EU VAT directive but also from national legislation. There are different VAT rates for different foods, for example, fresh foods which are, of course, the healthiest to eat. There is also a zero VAT rate for oral medicines, but VAT is applied to injectable medicines because there is value added. VAT is also applied to processed foods. It is a Revenue interpretation in deciding the appropriate rate to be applied in different circumstances. It is not a political decision, or a decision of the Government or the Houses of the Oireachtas. It was not part of the Finance Act 2018 or the budget. It is a Revenue decision and it is for Revenue to interpret the rules and laws appropriately. The Minister for Finance has made contact with Revenue to see what can be done, but it would not be appropriate for him to direct the Revenue Commissioners on the rate they should apply to different products.

Does the Taoiseach accept that this is a policy decision to be determined not by an interpreter of the law but by the makers of it - this House and the Government? We determine the VAT rate to be applied, in accordance with EU rules. This is a change of policy that remained unaltered since 1972 and there is great uncertainty, even in this interpretation. For example, according to the Minister, why are fish oils determined to be basic but not other oils? Fish oils are a source of Omega 3, a basic nutrient, but flax and other oils which are also a source of Omega 3 are not to be treated in the same way. They are the oils preferred by vegetarians. This is causing confusion and, in the teeth of Brexit - at least ten separate businesses have contacted me directly to state they will not survive this change - can we simply not postpone it until there is a proper review and we can make a determination that will be subject to democratic accountability in this House?

Given his experience in government, the Deputy will be well aware that very often there are arguments about which VAT rate should be applied to which product or service. The Deputy will recall the debate some years ago on whether a cake was a cake or a biscuit a biscuit, based on the different rates applied. There are often debates about these matters. There has not been a change in the law in this regard. It is an interpretation to be made by the Revenue Commissioners. The Minister is examining the matter and we will see what we can do, but I do not think it would be appropriate for the Minister to direct Revenue to do anything on a tax matter such as this.

It seems to be a day to express no confidence in the Government, given the motion to be debated later on the Minister for Health, but I have absolutely no confidence in the Government to do anything meaningful to deal with the biggest challenge facing humanity - climate change. Yesterday the Minister for Communications, Climate Action and Environment and the Chairman of the climate "inaction" committee yet again held hostage a Bill that was supported overwhelmingly in this House last February. The Petroleum and Other Minerals Development (Amendment) (Climate Emergency Measures) Bill 2018 sets out to ban the issuing of further fossil fuel exploration licences off our shores. It seeks to do so because science has long settled on the understanding that, as people who inhabit the planet, we should leave 80% of known, proven reserves of fossil fuels in the ground. There is a widespread movement screaming at governments globally to leave them in the ground. We have seen evidence of this, with young people outside the gates weekly baying at the Government to do something about climate change. We are to see a global strike of schoolchildren on 15 March. To cite one very inspiring school student from Sweden, Greta Thunberg: "I want you to panic." She wants governments to feel the fear young people feel every day of their lives when they wake up because we are stealing their futures, unless we challenge the fossil fuel industry. The Bill would help to contribute to a global movement, not just in Ireland.

There is no fooling nature. It understands we are overheating the planet and that we are hurtling towards a global rise in temperature of 2°C. That is why the Bill proposes radical measures to deal with the issue and this House overwhelmingly supprted its move to Second Stage. In an act of incredible hypocrisy there is procedural trickery taking place at the climate "inaction" committee.

This trickery is allowing the Minister of State, Deputy Canney, and the Chairman to vote to hold onto that Bill as if it was their little baby, to keep it hostage, and to not allow it to move forward when they already voted for the motion I put yesterday to lay a report before this House and to allow the Bill to proceed to the select committee in order that everybody can come in and amend and change it. The Bill is about doing something meaningful, courageous and even trailblazing. When the Taoiseach himself has accused us of being laggards when it comes to climate change, why does he not now use his power and instruct his Minister and the Chairman to let the Bill go and to release it so that we can become a leader in climate action instead of a laggard?

I thank the Deputy. I believe our duty as a Government and as politicians is to make sure that we pass our planet on to our children and grandchildren in a better state than we found it and that means taking action on climate change and protecting the environment. We have taken a lot of action in recent years. For example, there is legislation working its way through the House at present to outlaw the use of microbeads and certain plastics. We passed legislation last year to prevent the Government and Government investment funds from investing in the hydrocarbon industry. We have taken measures to support renewable energy, to take coal off the grid by the end of the decade and to take peat off the grid. Other actions under way include the fact that from this summer, all new buses bought by Dublin Bus or Bus Éireann in our cities will be low-emission or no-emission vehicles. We are taking climate action both as an Oireachtas and as a Government.

On this particular issue, the Deputy has it wrong in terms of climate action, energy security and the economy. The truth is that we will need natural gas and oil as transition fuels for the foreseeable future, whether to fuel aircraft so that they can fly, to produce plastics necessary for medical devices or to power our towns, cities and industries when the wind is not blowing and the sun is not shining. Most people who are interested in climate science understand that natural gas is a transitional fuel and that we will need it as part of our energy mix for the foreseeable future if not for decades to come. The question is therefore, if we have our own natural gas, should we use it or should we import it? Of course, importing it as opposed to using our own is worse for the environment because the gas we might import from the United States is very often shale gas, which is much more damaging to the environment than our own natural gas from Corrib. Some of the gas we import from Russia or eastern Europe gets lost along the way, so it is actually worse for the environment to import gas from the US, Russia or Venezuela than to use our own gas. From a climate science point of view, the Deputy's proposal is wrong-headed. Second, there is the issue of energy security. Do we want to use the gas we have or would we prefer to import it from Canada, the United States, Venezuela, Russia and the Middle East?

Perhaps the Deputy would like that, but it is my view that it is wrong-headed. If we have our own natural gas we should use it and should not be dependent on Russia, countries in the Middle East and Venezuela for our energy needs. Third is the issue of imports and exports. Surely it makes more sense to use our taxpayers' money and our people's money on things like public services than on importing oil and gas from other countries.

I would dearly love to have this debate with the Taoiseach's party and with every other Deputy in this Dáil. That is why I want the Taoiseach to tell his Ministers to let go of the Bill and to let it go to the select committee where we can have precisely the type of debate the Taoiseach is trying to engage in with me here. The Taoiseach did not answer the question I asked. I am asking him why procedural trickery is being used by the Minister of State and the Chairman in order to hold the Bill in limbo when there is no justification for doing so under Standing Orders. There is no precedent in Dáil Éireann to carry out such administrative trickery in respect of a Bill which should proceed. I believe the reason the Taoiseach is doing this is that he is wed to fossil fuel industry. Last February, after this Bill passed Second Stage, the chief executive officer of Providence Resources, Tony O'Reilly Jnr., wrote to the then Minister saying he was deeply concerned and that he wanted the Government to deal urgently with the question of this Bill. The Taoiseach is wedded to the fossil fuel industry and he is dancing to its merry tune rather than to the tune of the young people who will go on strike on 15 March and who will be outside the gate of this House consistently to demand that something meaningful happen. Will the Taoiseach tell his Minister of State to get that Bill out of limbo, to stop breaking Standing Orders, to follow procedures correctly and legally, as they should be followed, and to allow the Bill go to the select committee where we can have the debate the Taoiseach wants to have here now?

I note the Deputy did not actually address any of my substantive arguments around climate science, around-----

I want to do that on Committee Stage.

I note the Deputy did not answer any of my substantive arguments around climate science, import substitution-----

The Taoiseach did not address the Deputy's arguments about holding the Bill hostage.

-----and energy security.

I am the one asking the questions of the Taoiseach. He did not answer my questions.

Her question was entirely a procedural question. As the Deputy should be well aware, the procedures of a committee-----

It is the Taoiseach's Minister of State and his Chairman.

-----are a matter for the committee. If the Deputy has a question for the Chairman of the committee-----

It has nothing to do with Members from the Taoiseach's party or with his Ministers. Will the Taoiseach give us a break?

-----that question should surely be addressed to the Chairman.

The Taoiseach's Government and his Ministers are holding this Bill hostage. The Taoiseach can admit it and do something about it or answer to the young people of this country.

Will the Deputy please desist from heckling?

I am not heckling. I am speaking in a loud voice because my microphone was turned off.

The Deputy should try to be constructive around the issue of climate change and climate action. I understand that she offended the Senators at the committee, which is one of the reasons she found it difficult to get support for her Bill. She does not really want it passed.

Those Senators were not even there for the debate.

The Senators did not even bother attending pre-legislative scrutiny to hear the debate.

As is always the case, the far left does not actually want to solve any problems. They want to politicise problems so that they can get airtime, attention, likes, retweets and all of the rest of it.


I advise the Deputy to work harder, to be respectful and polite to colleagues, to try to build support for her Bill, to try to build a coalition for it-----

I will not grovel to people who came in deliberately to stop the Bill proceeding. They are disgraceful.

-----and to work much harder at the Joint Committee on Climate Action on the issue of carbon tax. The truth is that the far left has no interest in climate change. It just wants to do this stuff.

The Taoiseach is using Senators and Deputy Lowry to play the tune of the fossil fuel industry. That is exactly what he is doing. It is disgraceful.

The Deputy does not care about the environment, she should stop pretending.

The Taoiseach certainly does not care about the environment.