Dáil Éireann díospóireacht -
Thursday, 3 Dec 2020

Vol. 1002 No. 1

Saincheisteanna Tráthúla - Topical Issue Debate

Covid-19 Pandemic

Deputy Emer Higgins

Participants in sports such as gymnastics, basketball and karate are getting back to training in sports and community halls throughout the country. They need that outlet to keep physically healthy and active and for mental health as a coping mechanism to help them deal with this strange world we live in now. They also need it as a social outlet, even if it means reconnecting with people from a social distance.

None of these benefits is limited to the world of sport and yet it is only sport training that we are allowing under level 3. Dancers throughout this country are dancing in their living rooms instead of preparing for their Christmas shows. Those dancers and performing artists deserve the same treatment as our athletes. They deserve to practise too. Not every child or adult is sporty. People get their kicks in different ways. That is a why kick dance is as important as a karate kick, or why speech and drama is as important as soccer and drills. However, our level 3 guidelines say differently. The Cabinet at which the Minister sits is telling children who dance and their parents that they are not as important as children who do sport. That could not be further from the truth or from the values that I know this Government holds dear.

I ask the Minister to correct this anomaly, to give those kids equality and fairness, and to give them something to look forward to and a light at the end of the level 5 tunnel. Let them get back to feeling the rhythm of our national Irish dance in their feet, the buzz of modern dance through groups such as Dancity Ireland in their bones, and the elegance of ballet in their spirit.

When I raised this issue in the Chamber last month, the Ceann Comhairle told me he felt like tripping the light fantastic after I spoke. Today, however, silent protesters are lining Kildare Street, asking why no lights are tripping for them. I met and chatted with them. I promised to continue to advocate for them and to bring what they said outside the Dáil into the Chamber where decisions are made in order that I can help effect change and deliver equality of opportunity for them. This is a major issue for dancers. We are talking about denying them their passion after they have already endured months upon months of lockdown. They need that outlet now more than ever and it is especially unfair on those who study for dance, drama and music exams.

I asked the Minister for Health, Deputy Stephen Donnelly, if any additional risk was posed by dancing. I thought perhaps that was the reason dancing was not included in the level guidelines. Just yesterday, he told me clearly it was not about that but about the indoor aspect. That is the nub of this and that is why I do not understand why dance practice is not allowed when Sport Ireland issued guidelines to allow for sport practice in what they are terming "pods of one".

Like Sport Ireland organisations, dancers will make sure their premises are safe and clean and that physical distancing is in place. They will jump through any hoop as long as they can start pulling their moves again because they love to dance. They understand that they cannot dance at level 5. However, at level 3 when indoor sports training is allowed, once participants maintain social distancing, then it is nothing short of discrimination not to let our dancers practise their passion. I ask the Minister to give our dancers their rhythm back

Minister for Tourism, Culture, Arts, Gaeltacht, Sport and Media (Deputy Catherine Martin)

I thank the Deputy. I am acutely aware of the significant impact that the Covid-19 crisis continues to have on the sectors my Department supports. The framework of restrictive measures is a risk management strategy designed to allow individuals, families, businesses and services to better understand, anticipate and prepare for the measures Government might introduce in response to the escalation of transmission of Covid-19.

The priority in level 3 is to keep health services, schools and early learning and childcare services open and to minimise disruption in the workforce. To keep people safe, the public are asked to reduce the number of people they meet to a minimum and stay in their own county until 18 December. Tourism, culture, arts, Gaeltacht, sports and media activities usually involve audiences and people congregating. This is the very thing that health experts advise that we try to minimise. We need to reduce the number of people congregating across a range of settings to reduce the spread of the virus.

As the Deputy will be aware, from 1 December the country has moved to a modified version of level 3 of the Government's plan for living with Covid-19. Under these restrictions, all dance and exercise classes remain suspended. However, there is provision for individual and one-to-one instruction at this level and, to clarify, this guidance applies to sport, exercise and dance. While dance studios are closed at level 3, they can provide facilities for use in individual dance practice or training.

The Arts Council is in the process of preparing guidance on individual dance practice or training, which will be available early next week. In the meantime, the Sport Ireland guidance the Deputy referred to for individual training may be used. This is available on the Sport Ireland website, and measures to reduce the risk from one-to-one instruction under this guidance include staggered start and finish times, combined with appropriate entry, exit and traffic management protocols to limit the interaction of participants at any one time; pre-booking, which is essential; participants arriving ready to train and leaving immediately; no equipment sharing; and activities taking place in a predefined area that is visually marked out and directionally signed. The space required in this area should reflect the nature and intensity of the activity, and there should be in excess of 2 m social distancing between each of the predefined areas. The cleaning and ventilation of facilities should be conducted in accordance with the Government's most recent Work Safely Protocol, and instructors should refer to HSE guidance on wearing a face mask covering.

While these measures mean that individual activities can take place, individual training and one-to-one instruction should not be viewed as a way of reintroducing organised dance classes, which are specifically precluded under current public health measures. However, as I said, the provision is there for individual one-to-one instruction as I have described at this level. To clarify again, this guidance applies to sport, exercise and dance. While there is understandable frustration in many sectors about the current restrictions, the focus in the run-up to Christmas is on allowing as many activities to proceed as possible while at the same time being mindful of the priority of safeguarding public health. I will continue to engage with all sectors over the coming weeks with a view to working towards the full and safe reopening of society and all individual and group activities as public health allows.

Deputy Emer Higgins

I thank the Minister for her reply. This is the third time I have raised the issue of dancing in the Chamber, and she is the first Minister to take on board what I and the dancing community have said. It is exciting to hear her give us this clarification today. It is a promise to rectify the anomaly and to treat equally children who dance and children who do sport.

The Minister's actions will give dancers back their rhythm. I am excited to welcome the formal guidance. I call on her to publish it as soon as possible to give dance practitioners clarity and direction on being allowed to train in pods of one 2 m apart. The Arts Council is well placed to work with Sport Ireland, which has published guidelines to allow sports to return. Allowing dancers to return to what they love doing will be amazing.

I ask that the guidelines be used to address music tuition. The Minister has outlined that they do. Her response will have a practical and positive impact on the lives of children across the country. It means that dancers and performing artists can practise together, albeit 2 m apart and once they arrive separately, wear face masks and stay safe. That is all they want. Gabhaim buíochas leis an Aire for meeting the passion of dancers with the compassion of the Government.

Deputy Catherine Martin

I thank the Deputy for raising this issue and for the opportunity to provide that clarity. I acknowledge the representatives from the dance and arts community who attended the protest at Leinster House. Unfortunately, I had a scheduled meeting that prevented me from meeting the group today. I assure the Deputy that the Government is committed to reopening society and the economy as soon as it is safe to do so. As I have done since becoming Minister, I will continue my ongoing engagement with the community. I appreciate the benefit that arts have on societal well-being and children's development. The Government will give further consideration to this matter in January. I believe in enabling children to express themselves through dance and other forms of physical activity. Sports are also beneficial and necessary for children's development.

The focus in the run-up to Christmas is on allowing as many activities as possible to proceed while being mindful of the priority of safeguarding public health. If people continue to adhere to public health measures, the opportunities for the transmission of the virus will be minimised. By continuing to adhere to the measures diligently, we hope to be able to open up even more activities in due course.

Nursing and Midwifery Board of Ireland

Deputy Fergus O'Dowd

To clarify, I submitted this Topical Issue matter yesterday before last night's debate. It was not selected for last night's Topical Issue debate, but I wanted to make my views known clearly and emphatically. I know I represent the whole country, including every Deputy, regardless of political party, when I say that we greatly appreciate the almost 40,000 committed and dedicated nurses and midwives working in our hospitals, nursing homes and other healthcare facilities. Along with all other healthcare staff, they have done fantastic work in this most dreadful battle with the coronavirus, particularly in our hospitals.

Included among the 40,000 are student nurses who went into the bearna bhaoil and worked nights and all sorts of hours to ensure that our hospitals stayed open. During the crisis, thousands of health staff were sick with Covid or had to cocoon because they had underlying health issues or for family reasons. There was a large demand for nurses, including students, to work with might and main to protect the lives of our most vulnerable and ill.

This Topical Issue matter addresses an issue on which I received a number of requests from nurses in my constituency. They felt that a waiver or credit should be given to the nursing profession in respect of the Nursing and Midwifery Board of Ireland, NMBI's, registration fees. It might not seem like much money, but it would make a significant difference in principle and would recognise in a small way the work they have done. The credit would be provided to the NMBI by the State to pay for at least this year. Public opinion is strongly of the view that we should do much more. Many Deputies feel the same. We must find a way of doing this that is acceptable to the Government and the nursing unions.

Deputy Peadar Tóibín

Deputy O'Dowd voted against paying student nurses last night.

Deputy Fergus O'Dowd

Am I being interrupted?

Deputy Peadar Tóibín

The Deputy who is speaking voted against paying student nurses last night.

Deputy Fergus O'Dowd

No. I-----

Acting Chairman (Deputy Bernard J. Durkan)

That is not-----

(Interruptions).

Acting Chairman (Deputy Bernard J. Durkan)

I am sorry, but everyone has the right to raise a Topical Issue-----

(Interruptions).

Acting Chairman (Deputy Bernard J. Durkan)

-----without interruption.

Deputy Mattie McGrath

He is riding two horses.

(Interruptions).

Acting Chairman (Deputy Bernard J. Durkan)

Deputy O'Dowd to continue, please.

Deputy Fergus O'Dowd

Deputy Tóibín is right, in that I voted last night. He knows from his time as a party member that, when we are whipped to vote in a particular way, we have to do so or we can start up-----

(Interruptions).

Deputy Fergus O'Dowd

I am speaking as a backbencher. I tabled this matter before last night's vote. I want to put on the record what I believe.

Deputy Peadar Tóibín

I stood up for what I believed in.

Deputy Fergus O'Dowd

The majority of Deputies, including most members of the Government to whom I have spoken, believe that this should be the case.

Deputy Peadar Tóibín

That is meaningless.

Deputy Fergus O'Dowd

All healthcare staff, including student nurses, have given their all during this period.

Deputy Mattie McGrath

Pay them, then.

(Interruptions).

Deputy Fergus O'Dowd

I am glad we live in a democracy where the moans and groans I hear from the left are-----

Deputy Mattie McGrath

The double talk is amazing.

Deputy Thomas Gould

You voted against it.

Deputy Peadar Tóibín

You voted against it.

Acting Chairman (Deputy Bernard J. Durkan)

Deputies, please observe the usual courtesy when someone else is in possession. Allow Deputy O'Dowd to continue. Time is running out rapidly.

Deputy Fergus O'Dowd

There were some undemocratic interruptions. The point I wanted to make-----

Deputy Mattie McGrath

Is called "hypocrisy".

Deputy Fergus O'Dowd

I am entitled to free speech as an elected Member, just like every other Deputy. As a Government backbencher, every effort must be made to find the extra funding that is needed to reward these workers in a special way for the sacrifices they have made.

Minister of State at the Department of Health (Deputy Frankie Feighan)

I thank the Deputy for raising this important issue. The NMBI is the regulatory body for the nursing and midwifery professions. Its role in setting standards and providing guidance for approximately 79,000 registered nurses and midwives focuses on public safety. The board is an independent body answerable to the Oireachtas with responsibility for ensuring that it has the financial capacity to fulfil all of its legal obligations.

The NMBI has a number of statutory obligations: to protect the integrity of the practice of the professions of nursing and midwifery, to protect the public, and to ensure public safety. It performs important functions in setting education standards, approving training programmes, and investigating complaints against registrants.

My Department is responsible for the oversight and governance of the NMBI, but it has no role in setting or approving fees. The board has a statutory responsibility to ensure it discharges its legal obligations within the financial resources available to it while maximising efficiencies and income generation in keeping with best financial governance practice.

Under the Nurses and Midwives Act 2011, the NMBI is required to be self-financing. This is primarily achieved through the annual retention fee paid by each registrant, which was set at €100 in 2014 and has not been increased since. The income from this fee and other sources provides the funding required by the board to carry out its statutory obligations to protect the integrity of the practice of the professions of nursing and midwifery and to protect the public. Like every other healthcare regulator, the board continues to face considerable costs arising from the way the laws regulating the professions operate and from handling fitness-to-practise complaints. The annual retention fee was set by the board.

Among the NMBI's core functions are maintaining the register of nurses and midwives and a candidate register for student nurses and midwives; setting the standards for the education and training of nurses and midwives; approving the programmes of education necessary for registration and monitoring these programmes on an ongoing basis; supporting registrants by providing appropriate guidance on professional conduct and ethics for registered nurses and midwives; and holding inquiries into complaints about registrants.

The NMBI makes decisions relating to the imposition of sanctions on registered nurses and midwives who have findings made against them, and advises the Minister and the public on all matters of relevance relating to NMBI functions.

It is vital that the NMBI remains independent to allow it to regulate the professions of nursing and midwifery, as defined by the 2011 Act. The work of the NMBI over the next two months will concentrate on collecting the registration data of all nurses and midwives, and that is important for our entire health service. The registration process is open until 31 January 2021.

As the Deputy said, during the current Covid-19 pandemic, it has been important that we carry out our duties in a well-regulated and timely manner. Staff in the NMBI have worked throughout the pandemic to ensure we satisfy our statutory requirements to ensure nurses and midwives can be registered throughout this time.

Again, I pay tribute and thank the nurses and, indeed, student nurses for the work they have done through this pandemic. The Minister, Deputy Stephen Donnelly, has confirmed to me that he is looking into the request that nursing home registration fees paid to the NMBI by nurses can be repaid in another way. We are looking into it and seeing what can be done. We are looking for €7 million per year to get this resolved. We need to find it somewhere but we are looking at that fund so those payments can be reimbursed or repaid by Government in some other way. We hope to have a decision in the coming weeks.

Deputy Fergus O'Dowd

The Minister of State has iterated the importance of the registration process and the importance of the independence of the board. I acknowledge that and everybody acknowledges that. On the request made to me to put this before the Houses, which I did yesterday and which has been taken today, I am fulfilling my commitment to speak in support of this motion.

I welcome the fact that progress is being made and, in particular, the comments today by the Tánaiste, Deputy Varadkar, when he said that, in fact, negotiations are ongoing with the nurses' unions and at the Department of Health with a view to improving pay and to regulate the income student nurses get in a way that is more attractive to them. That is an important point.

Part of the problem and what really happened here is that when we entered the pandemic, nobody knew what was ahead. All those people on the front line, and I am talking about people in the National Ambulance Service, all the healthcare assistants, cleaners, people who work in nursing homes and all those, took huge risks with their health to stay the course and help us through this pandemic, which is not over yet.

It is important that we go ahead and provide significant increased support at this time, particularly to nurses, and acknowledge the work they have done in a special way. I believe that is the will of the people. From the debate last night and the views we are getting today, the fact is that student nurses were not acting as student nurses when they went in but were acting in their full capacity to protect, help and support people who had Covid-19. I believe that is what we should do.

Deputy Frankie Feighan

It has long been the practice, both in this country and internationally, that registered health professions pay an annual registration fee to their respective regulator allowing it to perform its functions independently of State support. The regulation of the healthcare sector and its professionals has become increasingly important over recent decades to ensure the compliance of set standards of healthcare and administration.

As I said, the NMBI has a number of statutory obligations to fulfil to protect the integrity of the practice of the professions of nursing and midwifery, to protect the public and to ensure patient safety. The NMBI performs important functions in setting education standards, approving training programmes and investigating complaints against registrants. The annual retention fee is the single most important item of income for the NMBI in order for the board to progress these statutory duties.

My Department, as part of its oversight and monitoring role regarding regulators within the health sector, including the NMBI, will continue to engage with it as appropriate. This engagement will include guidance and support but will fully respect its independence, as required by the legislation.

Regarding the professions of nursing and midwifery, there are many recent positive developments for these careers in recent years. For example, the creation of the enhanced nurse-midwife role allows today's graduate nursing and midwifery students to apply, after one year and 16 weeks' suitable experience, for these enhanced nurse-midwife roles, with a starting salary of €37,161. That does not include those allowances or premium pay that are also available.

Additional promotion opportunities are available under advanced and specialist practice where the policy of the development of the graduate to advance nursing and midwifery practice provides a framework for graduate nurses to draw upon their undergraduate programme and translate their broad-based experience and knowledge into action.

Again, the Minister has confirmed that he is trying to resolve this issue and I hope we will have some positive outcome in the coming weeks.

Industrial Relations

Deputy Jennifer Murnane O'Connor

I appreciate the Minister of State taking the time today to discuss this important issue. I have had numerous inquiries over recent weeks from the Psychiatric Nurses Association ambulance drivers, who are the National Ambulance Service Representative Association union members, asking if there has been any contact or dialogue between the Minister of State's Department and the HSE regarding the union's aim to gain official union recognition.

Before Covid-19, we all stood in solidarity with these ambulance drivers. We all promised outside the Dáil that we would listen, engage and seek to help these ambulance workers in NASRA fighting for trade union recognition and fighting to be heard. There has been a refusal by the HSE to afford these hard-working ambulance personnel, many of whom we have relied on heavily over recent months, the right to be members of, and represented by, the union of their choice. The HSE has been invited on three occasions to the Workplace Relations Commission, WRC, but this step in the HSE framework on dispute resolutions has, to my knowledge, not happened. Will the Minister of State's Department confirm that the HSE wishes to resolve this dispute and has agreed to engage with these members?

More than 500 PNA ambulance members wish to be represented by the recognised trade union of their choice. It is not good enough just to keep ploughing money into private operators to avoid the conversation. In my home of Carlow-Kilkenny, we have an excellent hospital which does an excellent job. All the staff and all the members are paramedics. Today, we have 34 cases of Covid-19. The hospital has been forced to close the outpatient clinic and has asked patients to stay away from the accident and emergency department.

I ask that the Minister of State do whatever he can because we realise how important lives are, and 34 cases is quite a lot. I know everybody is doing their best but these paramedics have come to me for months now and I have brought this up, first in the Seanad and now in the Dáil. I believe they should be allowed to have the union of their choice. These paramedics work hard and have worked hard during Covid-19. They have been exceptional and we can be proud of them. I would like to have the Minister of State's answer.

Deputy Frankie Feighan

I thank the Deputy for raising this issue today. I again take the opportunity on behalf of the Minister, Deputy Donnelly, to recognise the outstanding contribution our front-line workers make every day to enable the country to respond in the way it does to the Covid-19 pandemic. No profession is more front line than our paramedics.

To move on to the particular issue raised, we are talking about a branch of the Psychiatric Nurses Association called the National Ambulance Service Representative Association or NASRA. This group has engaged in industrial action on eight occasions since January 2019. By way of background, members of NASRA represent a minority number of front-line ambulance personnel out of a total National Ambulance Service work force of 1,800. I understand they are mostly based in Cork, the south east and Tullamore.

The PNA states that its industrial action is in connection with two main issues.

The first is a dispute over the automated deduction of union subscriptions from members' pay. The HSE is refusing to facilitate payroll deductions at source of union subscriptions to NASRA as it does not recognise the association. The second issue relates to a refusal by the HSE to engage in negotiations with the PNA or to recognise the PNA as union representatives when representing its ambulance personnel members. It is regrettable that this group has taken the industrial action that it has. On each occasion, the HSE and the National Ambulance Service confirmed that a robust contingency has been in place to ensure there was no risk to the health and safety of health service users. The HSE confirmed that full emergency cover was provided during the action, which means there were no adverse incidents.

NASRA, which is affiliated to the PNA, is not recognised by the HSE and, therefore, does not have negotiating rights. Furthermore, the PNA does not have negotiating rights for ambulance personnel. The legal position is very clear. The HSE and the National Ambulance Service have no obligation to recognise NASRA or the PNA in respect of ambulance personnel. The PNA, which is not affiliated to the Irish Congress of Trade Unions, ICTU, does not have negotiating rights for nurses working in the psychiatric and intellectual disability sectors. The main union that is recognised by the HSE for ambulance front-line grades is SIPTU. Fórsa and Unite also represent ambulance grades. The HSE deducts subscriptions at source for ambulance staff who are members of SIPTU, Fórsa and Unite. This is consistent with the fact that these unions are recognised as representing ambulance grades. Again, the HSE does not carry out deductions of subscriptions for NASRA because it is not recognised. It should be noted that facilitating deductions at source is not a legal right but rather a concession granted to recognised unions.

Individuals have a right to membership of any trade union, but they do not have a right that such a membership must be facilitated or recognised by their employer. Industrial relations policy has a long-standing objective of avoiding fragmentation in workers' representation in public sector employment and the trade union movement generally. This is to facilitate the orderly conduct of bargaining and other aspects of industrial relations. I can confirm that Department of Health officials engaged with HSE management to explore ways forward by which this dispute could be progressed, but a resolution could not be identified. The position remains, therefore, that the PNA does not have negotiating rights in respect of ambulance grades.

Deputy Jennifer Murnane O'Connor

SIPTU, Fórsa and Unite are excellent unions and they are not the problem, because they do great work. The paramedics who have contacted me want to stay in NASRA. My understanding is there are approximately 500 members in NASRA. Paramedics or everyone else in this line of work do an excellent job and have been fighting for well over a year for NASRA, yet the HSE keeps saying "No". We need to have proper engagement and to come to some solution for these paramedics who want to stay in the union. It is important that the Department and the Minister for health examine how they can address the issue for the paramedics. They contacted me a few weeks ago and deserve an answer. They do great work. The other unions are excellent too; that is not in question. Paramedics have been fighting for this for so long. I do not know whether the Minister of State is aware that they have protested outside Leinster House on a number of occasions. We need to talk to them and to find a solution, as does the HSE. I will seek one and I hope we can find it.

Deputy Frankie Feighan

It is important to reiterate the position in respect of this dispute. NASRA, which is affiliated to the PNA, is not recognised by the HSE and, therefore, does not have negotiating rights. Furthermore, the PNA does not have negotiating rights for ambulance personnel. The legal position is very clear. The HSE and the National Ambulance Service have no obligation to recognise NASRA or the PNA in the context of representing ambulance personnel. The National Ambulance Service is committed to maintaining positive industrial relations with all staff and is fully satisfied that ambulance personnel are adequately represented through the agreed and recognised industrial relations process that exists within the health sector.

I will convey the Deputy's concerns to the Minister. I hope that, within the Department and the HSE, we might be able to find some way around this complex and difficult issue. I thank her for raising it and hope that, when we go back to the table, we may able to get some resolution.

Abortion Services Provision

Acting Chairman (Deputy Bernard J. Durkan)

The next matter was tabled in the names of Deputy Mattie McGrath, Nolan, Michael Healy-Rae, Canney, Grealish, Michael Collins, O'Donoghue, Tóibín and Fitzpatrick. As far as I can ascertain, only five of those Deputies are in the Chamber. With their co-operation, I will try to accommodate each of them.

Deputy Mattie McGrath

I thank the Ceann Comhairle for allowing this very important issue to be raised and I apologise on behalf of the Deputies who are not present . Some, including Deputy Fitzpatrick, pulled out to give us more time.

The reactions of doctors who carry out late-term abortions in Ireland make for grim reading. One doctor described the carrying out of foeticide as "stabbing the baby in the heart". Others said it is brutal and awful, while one revealed: "I remember getting sick out in the corridors afterwards because I thought it [foeticide] was such an awful procedure and so dreadful." Many of us Deputies on the pro-life side tried hard at meetings of the Joint Committee on the Eighth Amendment of the Constitution in 2018. We put forward amendments to ensure that pain relief would be administered. The then Minister for Health, Deputy Harris, was dismissive and ignored all our appeals. He told us it could not happen but we knew from international experience that it would happen, and it is happening. It is a shocking situation in our country and something has to be done about it. It is just not acceptable. It is unspeakable.

Deputy Carol Nolan

We were all given assurances that there would not be an issue with aborted babies being born alive. We raised that issue in the Chamber and asked what would be done in that instance. We were dismissed, yet evidence and facts are now coming to light from GPs and other types of doctors. What is the Government going to do about this? It is shameful that the Minister for Health is not present.

There is conflict among doctors regarding the diagnosis of fatal foetal abnormality and in respect of palliative care for aborted babies born alive. What action is the Government going to take? We will not allow this to be swept under the carpet. It is barbaric and shameful.

Deputy Seán Canney

I add my support in respect of this matter. The report is very frightening. The onus is on the Government and the Minister for Health to ensure that this report is examined. It is an independent report and it has not been commissioned by any particular group. The findings are horrific. I will not spell out the wording but there seem to be a significant number of anomalies in respect of the provision of pain relief and palliative care for aborted babies who are born alive. We really need to examine the matter and to ensure that our children are treated with dignity.

Deputy Peadar Tóibín

An unborn child is a living individual human being. He or she is as human as the Minister of State, as alive as him and as individual as him, and that is according to science. Under the Government, however, late-term abortions are being carried out on unborn children and pain relief is not being used.

On any level, humanitarian basis and understanding of society, how can the Minister of State stand by this? When we put amendments to the Bill when it was rushed through in 2018, Fianna Fáil, Fine Gael, the Labour Party and Sinn Féin voted against amendments to ensure that pain relief was included in this regime. I put a question to the Fianna Fáil Minister, Deputy Stephen Donnelly, only a week ago asking him to ensure that pain relief would be afforded to children when they are being aborted in this country. Deputy Stephen Donnelly, the Fianna Fáil Minister for Health, refused.

Deputy Michael Collins

The people of Ireland voted for abortion a couple of years ago but no one ever thought that there would be 6,666 abortions in 12 months. I met so many people who voted for it who are stunned by this. It is what it is.

The discussion today is about late-term abortions. It is about what a new study tells us about late-term abortions and babies born alive after abortion in Ireland.

A study, from UCC, recording the experience of ten foetal medicine specialists providing abortions for foetal anomalies in Irish maternity hospitals was published in the British Journal of Obstetrics and Gynaecology. The reaction of the doctors who are carrying out these late-term abortions in Ireland make for grim reading. One doctor described carrying out infanticide as "stabbing the baby in the heart". Others said it was "brutal" and "awful", and one revealed that "I remember getting sick out in the corridors afterwards because I thought it [the foeticide] was such an awful procedure and so dreadful".

We were assured that this would never happen and it is happening. It is wrong. It is a terrible, terrible wrong. We would like complete clarity on this from the Minister of State.

Deputy Frankie Feighan

The Minister, Deputy Stephen Donnelly, is aware of the research article to which the Deputies refer on foetal medicine specialists' experience in providing a new service of termination of pregnancy for fatal foetal anomaly. The research article to which the Deputies refer reports on interviews carried out with ten foetal medical specialists in Ireland.

Foetal medicine focuses on the management of high-risk pregnancies and includes the assessment of foetal growth and the diagnosis of foetal illness and abnormality. The Minister is advised that in certain circumstances it may be necessary to perform specialised diagnostic tests on a foetus, for example, amniocentesis to check for certain chromosomal or genetic conditions of the foetus. Such diagnostic tests may be recommended, for example, if an earlier screening test or scan suggested that there may be an anomaly within the foetus.

Regrettably, at times these diagnostic tests identify conditions that have no known cure. Where a test shows that the foetus has a genetic or chromosomal abnormality, the healthcare team provides information to the woman concerned and discusses the options that are available either to continue or end the pregnancy.

The Health (Regulation of Termination of Pregnancy) Act 2018 sets out the parameters in which the termination of pregnancy may be lawfully carried out in this country. The Act permits termination to be carried out in cases where there is a risk to the life or of serious harm to the health of the pregnant woman, where there is a condition present which is likely to lead to the death of the foetus, and without restriction up to 12 weeks of pregnancy.

Section 11 sets out the laws on access of termination of pregnancies in cases where there is a condition present affecting the foetus and that is likely to lead to the death of the foetus before or within 28 days of birth. It requires the involvement of two medical practitioners. One must be an obstetrician and the other a medical practitioner of a specialty relevant to the diagnosis, care or treatment of the condition affecting the foetus. Both medical practitioners must certify their reasonable opinion formed in good faith before the termination of pregnancy can be carried out. It is essential that we are clear on the purpose of the legislation. It is to set out the law governing access to termination of pregnancy in Ireland. It is not to dictate the practice of obstetrics or of medicine more generally.

Medical practitioners are always required to maintain professional standards and to uphold medical ethics. They are bound, through professional regulatory mechanisms, to deliver medical services in accordance with the best medical practice.

The operation of section 11 of the Act is supported by clinical guidelines developed by the Institute of Obstetricians and Gynaecologists. The implementation of the Health (Regulation of Termination of Pregnancy) Act 2018 has put in place a comprehensive termination of pregnancy service in Ireland. It allows us to look after women experiencing crisis pregnancies in this country rather than forcing them to travel abroad for care, as we have done in the past.

Deputy Mattie McGrath

I thank the Ceann Comhairle for allowing us this important Topical Issue debate. It is a shame that the Minister, Deputy Stephen Donnelly, is not here. I met the Ministers of State, Deputies Butler and Rabbitte, wandering around downstairs. None of them would come in to answer it.

This is shocking. What we want is a ban on late-term abortions, mandated care for any baby born after an induction, and pain relief for babies being aborted. That is a basic human requirement.

It is barbaric, shocking and unbelievable what is going on. I intend, with my colleagues here, to bring forward an amendment to this barbaric legislation. We warned about it. We railed about it. We were dismissed that we were nobodies. This happened all over the world and now it is happening on our shore. It is hard to believe it. It is barbaric.

Deputy Carol Nolan

It is disappointing to hear, from his scripted response, the Minister of State has not dealt with anything we raised here. We raised issues such as babies being born alive without palliative care, conflict among doctors, and the issue of no pain relief being given even though the Animal Health and Welfare Act 2013 allows veterinaries to prescribe pain relief. This is going unnoticed. The Minister of State is almost justifying it with that sort of response. It is barbaric.

At the end of the day, this Government is responsible. Most of its members are back again. The Government is responsible for this and it needs to deal with this issue because it will not go away.

Deputy Michael Collins

I thank the Ceann Comhairle for allowing this Topical Issue debate. The Minister of State says the Minister, Deputy Stephen Donnelly, is aware. Is the Minister aware of what is happening, because if he is, the Minister of State has not got a proper response here? This is a very important issue.

Babies are being born alive and there is no pain relief being administered to them. The Minister of State did not answer that question here. I would support any amendment that would help babies who are born alive and help them through it.

We warned that this would happen and it is happening. Sadly, no one listened to us at that time and now we have been proven right.

Deputy Seán Canney

The response is an official response but it has dodged the questions. Quite simply, this is not something that should be treated as passing the responsibility to somebody else. We are legislators. We need to look at this.

I would ask the Minister to look at the report that was done. It was nothing other than a report and an interview with the people who were carrying out these procedures. I would ask the Minister of State to bring this back to the Minister for Health. I know well he will. I respect that, but I must say that the answer here is disappointing.

Deputy Peadar Tóibín

The Minister of State is reading a script but he has an individual responsibility over what he says in this Chamber and what is happening. The hundreds of words that he spoke add up to nothing. They mean business as usual. It means that a boy or girl who survives abortion, who is a citizen of this country at this stage, is allowed to expire, potentially, with no palliative care whatsoever or no effort to protect his or her life. For the Minister of State to come in and give that complete non-answer to such a shocking humanitarian situation in this country is so hard to listen to.

Deputy Frankie Feighan

In concluding the debate on the issues raised by the Deputies, I would like to clarify again, on behalf of the Minister, Deputy Stephen Donnelly, that to provide a termination of pregnancy under section 11 of the Health (Regulation of Termination of Pregnancy) Act 2018, two medical practitioners must have previously certified the reasonable opinion formed in good faith that the foetus concerned is likely to die either before or within 28 days. It is essential that we have in place a medically delivered safe and regulated service for the termination of pregnancy for all those who require it if they find themselves in this unimaginably difficult position.

In line with the will of the people, the implementation of the Health (Regulation of Termination of Pregnancy) Act 2018 allows us to provide women experiencing crisis pregnancy with access to a full range of services in this country. However, we must be very clear about the purpose of the legislation, which is to set out the laws governing access to termination of pregnancy in Ireland. Its purpose is not to dictate the practice of obstetrics. It is vital that our healthcare providers are assured that they can be confident in the decisions they are helping their patients to make and in providing the care those patients require.

I listened to the sensitive questions Deputies have raised and, unfortunately, I do not have answers for them. I will take those questions back to the Minister and the Department and try to get a written response in the coming days. I will do whatever I can to get the Minister and the Department to respond to the Deputies on the points raised.