Kate O'Connell (Dublin Bay South, Fine Gael) | Oireachtas source

I thank the Minister for coming before us. I will start with the national children's hospital. I have not read the entire report yet but something in it under governance neatly sums it all up. The report stated that:

The level of trust that the National Paediatric Hospital Development Board (NPHDB) placed on the National Paediatric Hospital (NPH) executive and design team gave rise to insufficient scepticism and challenge. The structures above the NPHDB became reactive, limited by their terms of reference.

I have read the executive summary and the recommendations. The price is now reflective of the quality of the project and what is being put forward as to what is going to be above the ground. The Taoiseach said the report made for grim reading and I am sure the Minister did not find the report overly pleasant. The board was in place to be accountable to the taxpayers of Ireland. When we see fancy designs, and I mean this in the nicest way possible, and when we see big glass curvy buildings, that is just an architect's dream. That is when people with a specific remit, which is design, go down that route. Usually, in a project, there are quantity surveyors on both sides. A group of quantity surveyors acts for the client while another group acts for the builder and some other contractor. Somewhere along the line, it is decided to how much money will be spent on a metre of cable or whatever the basic product is. My interpretation of this is that it was almost free rein, there was no challenge to the design and, therefore, by the time the design was done and set in stone, it was too late to pull back. I believe the Minister made the correct decision. I know Deputy Jonathan O'Brien said he probably had no choice but to make that decision but, as Deputy Durkan said, this project was first mentioned in 1962. For so long, we have said that we are desperately in need of a children's hospital. The Minister made the right decision and it was the only decision to make. If he had made a different decision at the end of last year, this hospital would never be built. It definitely would not be built in my lifetime or his. Despite the political challenges, historic and current, and despite the hospital and medical politics and every other form of politics, delivering this will, hopefully, be key to what the Minister has done along with the rest of his achievements to date.

That does not take from the fact that for taxpayers and all of us, when there is a large sum and the report basically says that the people representing us on the board did not challenge, it is annoying. It is frustrating because it seems obvious that if we were talking about a big fancy curvy glass building, a quantity surveyor on our or the taxpayers' side would say, "Hold on now a second, is there a need for that many curves or that much glass or is there need for that much aluminium?" That is normally what happens. That is what people find so frustrating in light of some of the overruns in the past. They find it frustrating that it does not appear that the people we were paying - the quantity surveyors acting on behalf of the HSE, the board or the taxpayer who are, ultimately, supposed to represent good value for money - did this for us. What recourse exists when the State pays fees to a professional body to act on its behalf in an expert role and that body does not do its job right?

We have discussed CervicalCheck and the capacity issue for so long but, again, like the national children's hospital, it is worth remembering where CervicalCheck has come from. I imagine that the Chairman is very much aware of the pushback 15 years ago when cervical screening and HPV vaccination became possible. I remember a particular bishop in the south of Ireland suggesting that HPV vaccination or cervical screening would not be needed if women led pure and chaste lives so we have come a significant distance from that sort of rhetoric to where we are now. I think I am correct that as a result of cervical screening, 65,000 women have had issues picked up which required minor intervention up to and including invasive treatment. I think I heard the Minister say that in the Chamber. If the Minister who brought that in had not been brave enough to have done that back in the day, some of those 65,000 women would be dead while some of them would be incapable of having children or would have varying degrees of complexities as a result of no intervention.

There was commentary last week about suspending the system. There was a lot of discussion regarding other countries that ramped up capacity in cervical screening before they brought in HPV screening. I am not here to advise the Minister as there seems to be so many people who advise him, but given the amount that has been invested in cervical screening and the amount of personal capital invested by progressive Ministers for Health over the years, it would be the wrong decision to pull back in any way on a system that has had a positive impact on 65,000 women and the others who did not have a negative result.

I mentioned it here last week. We were operating in an information vacuum when it broke. We did not know who owned the slides and, in the immediate instance, whether they were in the custody of a laboratory. We did not know if it was a standards issue in the laboratory and what the reason was for the emerging cases. That caused huge fear, about which I have spoken and there is no need for me to repeat what I said. How does the Minister for Health reassure women and their families in some cases, given that there was destructive commentary from many sections, with people talking about a misdiagnosis and using terms that were not reflective of the situation? What is the best way to reassure them? Is it by sending them a note? Is it by putting an advertisement on television? Is it by running a radio advertisement on Newstalk? In the following week or two weeks, would it have been of any benefit to me or any other woman of my age to listen to an advertisement on Newstalk: "Don't worry women of Ireland. You are in safe hands. Cool off. There is no need to go to the doctor"? It is my personal view that neither the public health nurse nor the community pharmacist was skilled to deliver this reassurance. The only person who was capable of delivering it - with no offence to the Minister - was the GP. The Minister and I are not medical doctors. The level of reassurance required had to be given because we were in an information vacuum, something which seems to have been forgotten. Reassurance is sometimes very personal. If somebody had a history, including a family history, she might have needed a level of reassurance that was greater than that for somebody else. The Minister might speak to the reassurance issue.

On vaccines, what are we going to do about the massive drop in measles vaccination rates? We have been very successful with the HPV, with the help of Laura Brennan, the Department and various others, which has meant we have got the rate back up to over 70%. However, it is a little late when there are wards and isolation units full of children infected by measles, at which stage, it is out of control. We can have problems with Brexit and the national children's hospital, but if there is a measles outbreak where the patches and pockets join up across Ireland, we will have something far bigger than Brexit, the national children's hospital or whatever other issue with which we are dealing. Babies and those who are immuno-compromised will actually die, while children will be left with life-limiting conditions as a result of infections. We can spend all of the money we want on health services, but if the basic fundamentals of protecting population health are not maintained, there will have been a huge waste of money since vaccines were invented. I know that the Minister has a commentary in the newspaper today, although I have not yet read the article. He might speak to that issue in terms of how we protect the population and get value for the money we have invested. There would obviously be a massive cost if there was to be a massive outbreak of measles.