David Cullinane (Waterford, Sinn Fein) | Oireachtas source

It has got very messy when we have four or five amendment lists, amendments to amendments and so on. The manner in which this Bill was crafted and worked its way through the Oireachtas was a bit chaotic. Notwithstanding that, I thank the Minister for his co-operation in recent weeks. We did the right thing in December in pausing this and taking the time to engage with the 221+ group. I told the Minister in this Chamber and in private briefings that my view was that group was not supportive of the Bill as it stood. That was the case, as we have now seen. We have had intensive engagement and if there is a lesson to be learned, it is that the engagement could have happened much earlier with the 221+ group. However, I welcome that it happened and also the Minister’s contribution, which got these amendments over the line.

I understand these are complicated issues and, for all the right reasons, the Minister’s officials will give him sound, clinical advice. We have to take all that advice and try to frame a Bill, which is complicated because we can have an intention to do something but providing for something complex in legislation can be difficult. I accept that and thank and commend the Minister for his co-operation.

The amendment we are discussing will be superseded by an amendment to amendment No. 19, which the Minister is bringing forward. I think that is the one we now want to see put in place. The establishment and implementation of procedures on how we give women further information is important. Will the Minister clarify - I am sure we will get to this if we get to the amendment in question - that the 221+ group will be central to that process and its input will be important when its gets to implementing the processes and procedures? It is important that when there is a diagnosis women are informed of the right to initiate a review at the point of entry into the system and in as many ways as possible. We need to make sure it is done at the right time. The right time for one patient might not be the right time for somebody else. The concern was that the point of diagnosis, when a patient is being informed he or she has terminal cancer, may not be the best time to tell somebody that he or she has a right to a review. From my understanding of a conversation I had with the Minister and the 221+ group, the details of that will be done separately. That makes sense and I support it. I imagine, in the context of the Minister’s amendment which we will get to, the amendment we are now discussing will be withdrawn.

I will not push any of my amendments to a vote. We have had a good engagement and discussion. It is a good day when a Minister is prepared to listen and work with the Opposition on a sensitive issue. Consensus on this issue was and is important. I said when we first discussed this Bill and again on Second Stage that I wanted to support it. I wanted a Bill the 221+ group could buy into and support and one that was fit for purpose.

There will be different arguments down the road on the type of audit that may or may not be put in place. That is not part of this Bill, as such. The Department has not agreed what an audit will look like. We can come back to that later. I ask that when we do that work there will be a role for the Joint Committee on Health. Once the audit is agreed, it could come back to the committee for consideration and there could be further engagement with the 221+ group. I will not rehash all the arguments on that issue because we have made significant progress. I have spoken in recent days to members of the 221+ group and they are pleased we have got to a point where they can give their support to a Bill. It is a good day for them and for patients.

There are recommendations, as Deputy Shortall said, in the Scally report which still have not been implemented. One is that people cannot make a complaint about clinical decisions. That was a concern Dr. Scally had. I accept that is a difficult and complex area but we have to have further discussions on it. We cannot pass this Bill and park all those other issues, notwithstanding the fact they are complicated. Dr. Scally also called for a greater duty of candour generally in healthcare. He was critical of that not being dealt with in the Bill. I accept the complexities of that as well. None of this is easy. It is difficult to legislate for these matters. Sound clinical judgments and arguments come back to us. We had discussions with the chief clinical officer, Chief Medical Officer and chief nursing officer. They made sound clinical arguments on why certain things are not possible. We understand the complexities. We all accept that but we had an independent report from Dr. Gabriel Scally that made recommendations, not all of which are dealt with in this Bill. I see this as work in progress. This is an important first step.

I thank the Minister for his co-operation. It was worthwhile. It is not often we see it from a Minister. Very often, that is not the way we do business in this House but, given the sensitivities of this issue and the journey we have all been on in supporting the 221+ group and all of the women involved, it was the right thing to do to reach consensus in this Chamber and have their support as well. The fact we are at that point makes this a good day for politics, as well as for the members of the group and their families.

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