Nithe i dtosach suíonna - Commencement Matters

National Risk Assessment

I welcome the Minister of State, Deputy Halligan. He is on parade.

I thank the Minister of State for attending in place of the Minister for Foreign Affairs and Trade to answer this particular question, which we have raised with the Minister previously and are now raising again. It is partly on the issue of the risk register, but also on the issue of uniting Ireland.

Before I begin, I welcome to the Chamber Ms Caroline Mulvaney, who has been working in my office on a number of research reports. I hope that she found some benefit and insight into politics in Ireland as opposed to how it works in the United States of America.

In recent days, we have had everyone from the head of the Orange Order to, in an interview with Simon Carswell in today's The Irish Times, members of the UVF discussing the issue of a united Ireland. The concern is that, in the 2019 national risk assessment, which was undertaken by the Department of the Taoiseach and fed into by all Departments and Government agencies, there is no mention of the possibility or probability of there ever being a united Ireland. Bear in mind that the national risk assessment started in 2014 and literally covers every topic under the sun, including global warming, global terrorism, cybersecurity, the healthcare crisis and the housing crisis.

Under the issue of instability in Northern Ireland, it includes Stormont not being in session. It also discusses the possibility of another referendum in Scotland on Scottish independence. However, there is no mention anywhere in the national risk assessment of the possibility or probability of there being a referendum on a united Ireland.

When I and Deputy Fleming asked the Taoiseach and Tánaiste why uniting the people of Ireland, the main aim of the State under Articles 2 and 3 of the Constitution, is not in our national risk assessment the Taoiseach replied that he did not see it as a risk, and that it was too important and sensitive to be in the national risk assessment. The reply of the Tánaiste and Minister for Foreign Affairs and Trade on the issue of a referendum, the preparation required for a referendum, which would come under the remit of both his Department and the Government, and what was being done on that was that it would be dealt with when the Secretary of State for Northern Ireland called the referendum.

As we know from Brexit, long-term planning and engagement are required well in advance of holding a referendum. The lesson from Brexit in Ireland's case is that one should not call a referendum and then try to figure out the future. The Department of Foreign Affairs and Trade is saying in its response to Deputy Fleming and me that it will do the preparation when the Secretary of State for Northern Ireland calls the referendum. There was a court case in Belfast taken by a unionist against the Secretary of State to force her to come up with a policy on how she would determine that the majority of people are in favour of a united Ireland, as provided for in the Good Friday Agreement. She refused to come up with a policy. However, under the Northern Ireland Act, the Secretary of State alone decides who gets to vote in that referendum. That has potential for chaos and for all elements of risk.

That is why Deputy Fleming and I made a submission to the national risk assessment. We asked that the Government include the issue of a referendum on a new agreed Ireland in the 2019 national risk assessment. It has not been mentioned in any national risk assessment since 2014, but the Government again refused to include it in the draft risk assessment even though we highlighted the issue to the Taoiseach's office. I am interested to hear the response from the Department of Foreign Affairs and Trade as to why the main aim of this State is not included anywhere in our national planning.

On behalf of the Tánaiste and Minister for Foreign Affairs and Trade, I thank the Senator for raising this matter.

First, it is important to point out that the issue of Brexit is separate and distinct from a Border poll. I believe that to be the case. The full implementation of the Good Friday Agreement and subsequent agreements is a priority for the Government. The approach of the Government to Irish unity is guided by Article 3 of the Constitution, as amended by the people in 1998. The principle of consent and the possibility of change in the constitutional status of Northern Ireland are fundamental elements of the Good Friday Agreement, endorsed by the people of this island, North and South.

It is worth recalling the precise wording and provisions of the Good Friday Agreement in this regard. Under the agreement, the Irish and British Governments, first, "recognise the legitimacy of whatever choice is freely exercised by a majority of the people of Northern Ireland with regard to its status, whether they prefer to continue to support the Union with Britain or a sovereign united Ireland"; second, "recognise that it is for the people of Ireland alone, by agreement between the two parts respectively and without external impediment, to exercise their right of self-determination on the basis of consent, freely and concurrently given, North and South, to bring about a united Ireland, if that is their wish, accepting that this right must be achieved and exercised with and subject to the agreement and consent of a majority of the people of Northern Ireland"; and, third, "affirm that if, in the future, the people of the island of Ireland exercise their right of self-determination on the basis set out above, it will be a binding obligation on both Governments to introduce and support in their respective Parliaments legislation to give effect to that wish".

The holding of a referendum in this jurisdiction is therefore connected with the calling of a Border poll, under the terms of the Good Friday Agreement, in Northern Ireland. While the decision to hold such a poll in Northern Ireland rests with the Secretary of State for Northern Ireland, the Government of Ireland does not believe it likely at present that such a Border poll in the near future would result in a decision on the part of a majority of the people of Northern Ireland in favour of constitutional change. In these circumstances, it is the Government's view that a referendum on Irish unity against the background of the ongoing political impasse in Northern Ireland and the increased uncertainty created by Brexit would only add to that uncertainty and division at an already difficult and sensitive time for everybody on the island of Ireland.

In the absence of the prospect of a referendum in the near future, the Government has not made specific preparations on this issue and does not have immediate plans to do so. The Government's immediate priorities are twofold, namely, to ensure the protection of the agreement in all its parts and the gains and benefits of the peace process in the context of UK withdrawal from the EU, and to secure the functioning of the devolved power-sharing institutions in Northern Ireland and the North-South Ministerial Council. As the Senator is aware, the Government is currently actively involved in a talks process to achieve that.

Issues of risk relating to Northern Ireland are considered as part of the annual national risk assessment. Although a Border poll would not be regarded as a risk, and the very important and sensitive policy issues related to it would not be dealt with in the risk assessment process, the question of relationships on the island of Ireland and between Ireland and Britain is always considered as part of the annual national risk assessment. In this regard, the national risk assessment was one of the first official acknowledgements of the risks posed by a potential Brexit, including associated risks for Northern Ireland. Further reflecting the Government's commitment to identifying, preparing for and mitigating risk, earlier this week the Government published its updated Brexit contingency action plan. This reflects the extensive work which has taken place at EU level and on a whole-of-Government basis, including the Withdrawal of the United Kingdom from the European Union (Consequential Provisions) Act, to prepare for a no-deal Brexit. It sets out the next steps to be taken between now and 31 October. It also makes clear that it will pose particular risks for the Good Friday Agreement, the all-island economy and for Northern Ireland's economy, political stability and community relations.

In the event of a future referendum within the consent provisions of the Good Friday Agreement, the Government has confirmed that it would make all necessary preparations in accordance with the terms of the Constitution and the principles and procedures of the agreement.

I thank the Minister of State. With regard to his last statement that the Government will prepare for the referendum when it is triggered by the Secretary of State for Northern Ireland, the Government is clearly not learning the lessons of Brexit. It will only take action when the referendum is called. We all know that a referendum, particularly on the issue of unifying Ireland, requires long-term engagement, indeed, years of engagement, and not just when the Secretary of State calls a referendum. That would only give us months.

Finally, I will refer to the Taoiseach's statement in the national risk assessment in 2018 about the overview. He said the aim of the national risk assessment was to counteract groupthink and to ensure all voices are heard by the Government. He said it seeks to prevent a repeat of mistakes of the past when dissenting voices were not heeded, leading to catastrophic consequences for the people of Ireland. For the Tánaiste and the Taoiseach to state that they did not see a Border poll as a risk and that it was too sensitive to be in the national risk assessment beggars belief.

Even the Minister must be questioning the reply he was asked to give here today, which states: "Although a Border poll would not be regarded as a risk, and the very important and sensitive policy issues related to it would not be dealt with in the risk assessment process ...". We deal with everything from global terrorism to global warming to the housing crisis yet we are not willing to deal with the main aim of the State in the national risk assessment process.

Two issues arise. The Senator mentioned Brexit on a number of occasions. That is in the risk assessment. Brexit is separate and distinct from a Border poll. Brexit is not a method of unifying Ireland. There have been two distinct opinion polls on this issue. Opinion polls have been taken consistently in Northern Ireland. The latest one taken last March by The Irish Times indicated that only 38% of people thought there should be a Border poll.

All I am asking for is preparation. I am not asking for a Border poll.

Senator Daly, please take your seat.

I am asking for preparation. The only reason the Government would call for a referendum is if-----

Only 32% of people would favour reunification at this time.

Fifty-six per cent of people in Northern Ireland said they would vote for a united Ireland in the event of a hard Brexit.

The Senator is not reflecting the views of people in Northern Ireland, which have to be reflected.

I am only talking about the opinion polls.

Proposed Legislation

I will try to be less cranky. The Minister of State has got an expanded brief today. As the other Members are in absentia, I know the response will probably not be very satisfactory but I thank him for coming to the House.

By way of background, in 2012, an expert group was appointed to review the Mental Health Act 2001 by the then Minister of State, Kathleen Lynch, and in 2015, a total of 165 recommendations were made. That seems like an eon ago but nothing has happened since then.

As a former psychiatric nurse and union representative, I was very involved with the review of the Mental Health Act and the law in terms of those working on the ground also. We saw that there was a dire need for the Act to be overhauled. Its aim was to protect people who go into hospital to avail of mental health care and treatment.

To date, only two of the expert group’s recommendations have come into effect. The Government has failed to meet its own timetable. In June 2016, the then Minister of State with responsibility for mental health, Deputy Helen McEntee, publicly stated that this would be done by the end of that year. Since then, numerous dates have been given for publication of the draft legislation but nothing has happened. These delays are hugely problematic given the lengthy duration of the review of the Act to date and the seriousness of the gaps in human rights protections for adults and children receiving inpatient mental health treatment.

We are all in favour of moving away from antiquated, Victorian-like methods to modern day treatments where people can have a say and be included in their treatment. That provides people with ownership of their treatment and it is much more effective and beneficial for the patient in terms of their recovery.

We are still only at the infant stage of this process, which has been going on a long time. We are waiting for new legislation but a body of work can be done in the meantime. I had legislation ready but, unfortunately, it was rejected. It concerns 16 to 17 year olds consenting to treatment. An anomaly exists in respect of the human rights of those individuals. Teenagers of that age can consent to physical treatment and dental treatment but when it comes to treatment of the spirit or the mind, whatever one wants to call it, they are not allowed consent. It will only take one young person to take this issue to the High Court for this Government to move very quickly on it, as it did earlier last year following instructions of the High Court on detention for periods of more than six months in a psychiatric hospital.

I acknowledge Deputy Buckley in the Gallery. Yesterday, I moved First Stage of the Assisted Decision-Making (Capacity) (Amendment) Bill 2019, which goes a long way towards protecting the rights of involuntary patients.

I have been naive in the past but in the three and a half years I have been a Member of the Seanad, I have become much more clued in to the way politics works. When one sits down with the Minister or officials in the Department of Health, one comes away wanting to shut down the Department. Are they so mean that they cannot share democracy? They covet everything. Measures cannot be seen to come from the Opposition yet it is in the spirit of democracy and the human rights of involuntarily incarcerated people that we try to give voice to them. That is not being allowed to happen because work has not yet been done on this reform yet Opposition Members like myself and Deputy Buckley are working away on it. The Bill was passed by the legislative department here. We have worked very hard on the Bill only for it to be shut down without an alternative being offered other than to say it will be dealt with later.

Thank you, Senator. The Minister of State to reply.

It is as if they cannot allow any kudos to be given to Sinn Féin or other legislation proposed by the Opposition, including in terms of many money messages.

I thank Senator Devine. I certainly do not think she is naive.

On behalf of the Minister of State, Deputy Jim Daly, who is abroad this week on Government business, I thank the Senator for asking this very important question. As she will know, the expert group review of the Mental Health Act 2001 was completed in 2015. The group’s final report had 165 recommendations, most of which relate to changes to the 2001 Act. Shortly after publication, the then Government gave approval to prepare the heads of an amending mental health Bill to reflect the group’s recommendations.

Among the many changes to be made are the proposed expansion of the existing authorised officer service to play a more prominent role in examining alternatives to inpatient treatment as well as initiating applications for involuntary admission, the review of the detention of patients after 14 days rather than 21 days and also, as the Senator will be aware, allowing 16 and 17 year olds the right to consent to or refuse mental health treatment.

I can now inform the House that a draft of these heads has been finalised by the Department of Health and were passed on to the Mental Health Commission last week. The Minister of State, Deputy Daly, wishes to stress the importance he attaches to allowing the commission, and this is reasonable, which has an in-depth knowledge of the inner workings of the Act, to contribute to the detail of the Bill.

The Minister of State, Deputy Daly, is on record in the Oireachtas and elsewhere stating that while it is a matter of regret to him that it has taken time to bring these heads to draft stage, nonetheless, this work had to be balanced with the many other calls on the Department of Health to progress not only emergency and Private Members-related legislation but also other mental health strategies and agendas relating to services.

Work on the Bill by the Department has been front-loaded and the commission has effectively been provided with text that is far more detailed than heads alone and represents what the Bill itself would look like. We believe this should ultimately reduce the time required to finalise the actual text, once Government approve the heads of the Bill.

Some have asked if the current draft will be published and whether there will be an opportunity to comment on its contents. The fact is that this is an unfinished and effectively internal draft currently subject to comment from the experts who understand the detailed operation of how the 2001 Act operates. Following consultation with the commission, and when the heads are finalised and approved by Government, they will then be published.

Before the expert group began to discuss the revision of the 2001 Act, there was a full public consultation on the changes that should be made. Some 116 submissions were received at that time and the changes proposed fed into the workings of the expert group.

In addition, as the Bill proceeds through the legislative process, Oireachtas Members and all key stakeholders will have an opportunity to provide further input. I hope that reply allays some of the Senator's fears.

I cannot say that it has, and the Minister of State did not expect me to say it did, but I thank him for the response. I would love an audit to be done on legislation proposed by those Members in opposition to see what legislation has been blocked.

My sense is that everything is being blocked. I know the money message is being used and abused, and there have been questions over that.

These two Bills, the Mental Health (Capacity to Consent to Treatment) Bill and the advance care directives Bill, could be stand-alone Bills. We do not have to wait for the Government to act. I understand the Government is overwrought and busy but when people are overwrought and busy, they seek out a helping hand. Lo and behold, but it will not allow that helping hand to be the Opposition. If that is cynical, that is what I have learned. I ask no forgiveness for continuously speaking out against the blocks that are being put in the way. Meanwhile, people in distress and despair wait for their voices to be heard and their human rights to be legislated for.

I again thank the Senator for allowing me to update the House on behalf of the Minister of State, Deputy Daly. In sending the draft heads to the Mental Health Commission, we have reached a position that Oireachtas Members wanted us to reach - if the Senator recalls, that is what was being asked of us. Oireachtas Members have been requesting this for some time. We are obliged to await the views of the commission on the detailed drafts provided to it. The Minister of State, Deputy Daly, has asked me to reassure the House that he fully understands the importance of having the legislation in place before the expert group begins to discuss the revision of the 2001 Act. As I said, there was a full public consultation and a sizeable number of submissions, some 116, where received at the time. The changes proposed were fed into the working group. In addition, as the Bill proceeds through the legislative process, Oireachtas Members and all key stakeholders, including the Senator, will have an opportunity to provide further inputs. We have made a lot of progress in recent months and we are close to being where the Senator would like us to be.

Medicinal Products Availability

I thank the Minister of State for coming to the House. This matter speaks for itself. There was a lot of talk about this area well in advance of last year's referendum to remove the prohibition on abortion. A working group has been set up by the Minister to see how we will go about providing contraception to women in this country. A public consultation was also launched and is closing on 5 August. I urge the public to partake in that and to give their feedback. That is a prudent way to do business, when making policy, but there is an urgency that needs to be observed.

During the discussions at the Joint Committee on the Eighth Amendment of the Constitution, there was little public discussion of the ancillary recommendations which, to my mind, are extremely important, namely, sex education and contraception, which are fundamental to preventing unwanted pregnancies. That is the crux of this issue, as far as I am concerned. It comes to a point where we have to accept that we have heard all the expert evidence. The Minister has indicated that this is his intention. The October budget is looming. I sincerely hope that, once the public consultation has concluded, the Minister would hear from the working group he has set up in very early course, so this matter can be seriously considered for this budget and for implementation in January.

We cannot have a health service in which termination services are provided freely and contraceptives are not. This goes to the crux of a progressive health system. LARCs, long-acting reversible contraceptives, such as coils and implants, are the most effective method of preventing unintended pregnancy and have a high satisfaction rating. A contraceptive programme which excludes LARCs may incentivise women to opt for less effective methods, such as condoms or oral contraceptives. This exposes them to an increased risk of unintended pregnancy. The availability of a wide range of methods is important because each woman's medical history and risk factors are unique and there is no one-size-fits-all contraceptive method that works for everyone. Furthermore, women's contraceptive needs change throughout their lives and there needs to be that adaptability in the system.

It is complicated enough but we are in danger of over-complicating it. This is something that needs to happen. If we are serious about gender equality, access to contraception is fundamental to women's empowerment. Political commitments were made in this area and I would like to see them realised in this budget. I look forward to hearing from the Minister of State.

I am taking this matter on behalf of the Minister for Health, Deputy Harris. I commend Senator Noone on the wonderful work she did as Chair of the Joint Committee on the Eighth Amendment of the Constitution, where her direction was incisive and very progressive.

As I am sure the Senator is aware, the issue of access to contraception has been the subject of particular attention in recent months following on from the recommendations of the Citizens' Assembly to improve women’s access to reproductive health services and the recommendation of the Joint Committee on the Eighth Amendment of the Constitution to introduce a scheme to provide “the most effective method of contraception, free of charge and having regard to personal circumstances, to all people who wish to avail of them within the State.” Following on from these recommendations, the Minister, Deputy Harris, established a working group within the Department of Health to examine the range of policy, regulatory and legislative issues arising in regard to improving access to contraception. The group has been working since 30 April and launched a public consultation earlier this week. The Minister would encourage everyone to have their say in what will be a fundamental policy change. It is intended that this group will report back to the Minister at the end of September with recommendations on policy options and next steps.

More generally, the HSE sexual health and crisis pregnancy programme has responsibility for the implementation of the national sexual health strategy 2015-20. The programme is supportive of initiatives that facilitate access to contraception for women, including long-acting reversible contraception, LARC, such as intra-uterine devices, subdermal implants and so on. The high efficacy rates associated with LARC in preventing crisis pregnancies are well-recognised. Crucially, there is no potential for user error with LARC, which makes it more effective than other methods of contraception, given that many crisis pregnancies occur due to failure of the contraceptive method or incorrect use on the part of some people.

With regard to use of LARC among women in Ireland, the last Irish contraception and crisis pregnancy study suggested that uptake is at a low level but increasing across all age groups. This study found that the proportion of women aged between 18 and 45 using LARC rose from 5.7% in 2003 to 10.9% in 2010, although I do not know the statistics after that date. We know there are barriers to accessing contraception, and cost certainly appears to be an issue for some women in regard to LARC. Data suggest that among women who had considered using LARC, 27% said the costs associated with this type of contraception prevented them from choosing this method. However, we must also remember that hormonal LARC devices are provided free of charge to those with medical cards, which is an important measure in terms of addressing access to contraception. It is also important to acknowledge there can be other barriers to contraception aside from cost, such as difficulty accessing services in a particular locality or feelings of embarrassment.

For example, in the United Kingdom, where contraceptive services and supplies are free of charge, a high proportion of pregnancies are still deemed unwanted or unintended. These are fair statistics. Clearly, this is a complex area and the working group has been established to inform the development of the most appropriate policy response. That is reasonable. The group will forward to the Minister whatever it sees as the most appropriate response.

I am aware of much of what the Minister of State has said. I just wish to emphasise again the urgency of this matter. The country in which we live has made huge progress in recent years. We should all be very grateful for that but it is not that long ago that a woman needed a man's consent to get contraception in this country. It is not that long ago that it was illegal. It was only legalised in 1979 and then only in restricted circumstances where a person was married. We have come a long way but, if we are to be a progressive society, termination services cannot be freely available to women while contraceptive services are not. This is about gender equality. I want to live a country in which women are empowered in this area. I hope the Minister will hear from his working group in the middle of September rather than at the end. We know the information. The Minister has indicated that he wants his policy to follow along these lines. There is political momentum at the moment and I do not want it to be lost. I hope this will be included in the budget with a plan for implementation from next January. I thank the Minister of State for his response.

I would like to make three points very briefly. The level of use of long-acting reversible contraception is still quite low, despite the advantages I know it has. There are different reasons for that. There is no question but that cost is a factor. At the same time, we should not lose sight of the fact that the Irish contraception and crisis pregnancy study showed that 88% of respondents did not report difficulty in accessing contraception. The data also show that 78% of sexually active heterosexual adults who did not wish to conceive used contraception at all times. The facts bear out the idea that the use of contraceptives in Ireland is high and stable. That should be welcomed.