Alan Kelly (Tipperary, Labour) | Oireachtas source

This is a very important discussion, and I have taken a huge interest in the detail of it. I thank everybody in this House for the support provided over recent months which resulted in Pembro being made available to all women with stage four cancer whose clinicians prescribed it. I acknowledge the Minister's contribution towards getting that legislation over the line. Other issues will arise, particularly around its availability for other cancer patients. The Minister knows that. It is something I am seriously concerned about. However, that is a debate for another day.

I will pick up where Deputy Ó Caoláin left off. My main contribution tonight is on the topic he raised. There is a woman in the High Court at the moment called Ruth Morrissey. What is happening there is another national scandal. We have almost become immune to situations like this. What is happening in the High Court is very strange. It is not tolerable. The Government owes a debt to the women who have been affected by the CervicalCheck controversy. The Minister, Deputy Harris, knows that the Taoiseach appeared on the "Six One" news and promised something that could never be delivered. He promised that no woman affected by this issue would end up in the High Court and that the Government would go after the laboratories if necessary. He met Vicky Phelan subsequently and again said that this would not happen. However, it is happening today. It is happening before our very eyes. It is completely immoral and it is unacceptable. Those women should not be going through this.

Mr. Justice Meenan's report has been completed. Frankly speaking, I do not know how many women are going to end up in the High Court in the coming months, but I do know that there will be quite a lot of them. I have spoken to those women and their representatives. There will be many Ruth Morrisseys, unfortunately, who will end up in court before Mr. Justice Meenan's recommendations are in place. The Minister knows it, and I know it. When will the legislation be brought before the House? This is complicated legislation. The Minister has admitted as much. We have to pass it so that the tribunal can be set up and so that it is ensured these women do not have to go into the High Court. That is probably the most important question the Minister is going to be asked tonight. It is intolerable that this lady and others, some of whom I have met, have to go through the High Court to tell their personal stories. Many people do not know their stories. Some members of their families may not know the full details of their stories. It is unacceptable. This legislation must be prioritised, it must be passed and it must be completed so that these women do not have to go through this. I implore the Minister to take that position.

The Royal College of Obstetricians and Gynaecologists, RCOG, review will not be completed this year. I will make a bet with the Minister on that. From my information it is clear that it will not be completed this year. How can we get to the bottom of what happened if this famous review, which was supposed to be completed within months, is not going to be completed in the calendar year of 2019? That is also unacceptable. Will the Minister give me the timelines and show me how the information is going to cross over to ensure that this happens? I do not believe it will happen. It is way behind schedule. We depend greatly on the information that will come from that review. The Minister and I know that, as do those who are affected.

When one gets into the detail of this, it is clear that there are a significant number of women - the total is not yet known - who are not part of the 221+ group but who come from a separate cohort which crosses over from the cancer registry. I want to make a plea to the Minister. I have spoken to and met some of the women affected who are not part of the 221+ group, but their issues and their circumstances are equally as concerning. In some cases, they are in very difficult circumstances. Indeed, I raised the case of one of those women with the Minister as recently as this morning. Those women deserve to have the same opportunities and to have access to the same package that is given to the women in the 221+ group. I implore the Minister to look at those individual cases and give them the same package and the same opportunities as the women in the 221+ group. They are not outside of this. It is an accident almost, due to the manner they came through the cancer registry. It would not take a lot to isolate the most severe cases and to treat them. Some do not have access to medical cards or various other services. In one or two cases there may not be access to Pembro. Their clinicians may decide that it may or may not suit them. The Minister can deduce why I am asking that they be treated the same.

I have a deep concern about the fact that so many women and their legal teams are fighting for access to their slides. Progress has been made, but the length of time it has taken women to get their own slides is inexcusable. They are entitled to access the slides. The consequences are that their cases, or the way in which they are dealing with the problem, are taking more time. The commentary to that end from some people in the HSE is not acceptable.

I am totally in favour of implementing the Scally report, and I am glad that Dr. Scally is being kept on. I am a massive advocate for HPV screening and HPV vaccinations. The Minister in his response might outline timelines for both of those matters. I want to acknowledge, on the record, the work of Laura Brennan and her amazing colleagues who have advocated for the HPV vaccination and the target of achieving herd immunity.

I have some specific questions about the laboratories involved. There are capacity issues in this area, but if the Minister is to have a legacy in this area, it will be established by how he can bring this screening process to Ireland and ensure that we control the screening programme ourselves. It is going to have to happen incrementally over time. I accept that. We must do that to ensure that, in the future, quality control is something we participate in, have knowledge and control of, and that the work is done close to home. We know that the contract that existed included provision for the outsourcing of contracts without the knowledge of the contracting authority, in this case the HSE. Is it true that Dr. Scally has, in the recent past, discovered extra outsourcing? I understand that he has found out about other places, such as Wyoming in the United States, where laboratories received contracts without the knowledge of the actual contractor, that is, the HSE.

We still do not know about quality assurance. This is another layer. How did he not find out about that when he was doing his inquiry? What does that tell us about the contracts? What does that tell us about the legacy of what happened? What does it tell us about what was agreed? I call on the Minister to elaborate.

Obviously, when it comes to the Scally report, implementation of the 50 recommendations is critical. I will support the Minister in implementing them, as will the majority of Members. The matter has been raised in the House. When the Minister made the decision to give a free smear test to all women, we supported him. Questions have been raised about whether this was the right decision. I will not criticise the Minister for this. I have said publically that I believe the Minister made the right decision for the right reasons. However, there should have been analysis of the resources and capacity available. I am not going to criticise the Minister for that, but I am going to put it on the record. There needed to be analysis.

I must make this point because I am concerned following information I have received in the recent past. I asked the Minister a specific question regarding the clinical outcomes for women if they had a 24-week delay. The Minister said that it was low-risk, and I accept that, but I do not believe it is exclusive. We all know about false negatives and that some tests had errors. In a scenario where something like that happens and then women have a 24-week delay on top of that, I am afraid there is capacity for other issues for those women further down the line. I realise the Minister cannot rule out that possibility and I do not expect him to do so. I am simply pointing to the difficulty of a scenario where we know there are issues relating to the past and we have much documented evidence about that. On top of that, we have a situation whereby women were coming back for their tri-annual smears and they had a 24-week delay. That posed some form of risk. In turn, that risk came on top of the fact that it has been proven to me that on numerous occasions when I asked the question, it seems for a long period and even up to the present in the case of some exceptions, we know the HSE could not prioritise between women who needed six-monthly or yearly smears or those who were sent forward for smears versus those who were getting tri-annual smears. That is a concern to which I will return.

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