Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I move amendment No. 1:

To delete all words after "That" and substitute the following: "Dáil Éireann resolves that the Health (Regulation of Termination of Pregnancy) (Amendment) Bill 2023 be deemed to be read a second time this day twelve months, to allow for consideration by the Joint Committee on Health of the legislative proposals contained in the Report of the Review of the operation of the Health (Regulation of Termination of Pregnancy) Act 2018."

I thank the Deputies for tabling the Health (Regulation of Termination of Pregnancy) (Amendment) Bill 2023. I note its publication and very much welcome the opportunity to speak to the issues raised. It is particularly appropriate, as has been said, that the debate this evening takes place on the fifth anniversary of the repeal of the eighth amendment, something I and many others here worked hard on.

As colleagues will be aware, when I was appointed Minister for Health I made it clear that we needed a revolution in women's healthcare. We were not looking for things to get a little better each year. Our ambition has been to move much faster than ever before to make up for the decades of underinvestment in and underprovision of healthcare services for women. Our aim is to provide new services and financial supports. Those cover important areas such as menopause, gynaecology, endometriosis, contraception, maternity services, breastfeeding, perinatal health, both physical and mental, and fertility.

To that end, this Government has invested in women's health services in a completely new way and at a completely new level. In the budget for last year I ring-fenced €31 million for new developments in women's healthcare, and the budget for this year saw an additional allocation of €70 million. By next year, the full-year impact of the last three budgets, before we add any new development funding for next year, will see an additional €150 million in the base for women's healthcare services. I know from talking to women and clinicians around the country that the impact of that is being felt. It is making a big difference.

As colleagues will be aware, as part of this work, later this year we will extend free contraception to women aged 16 to 30 and introduce State funding for IVF for the very first time.

In the context of this evening's debate, I take this opportunity to reiterate my commitment to ensuring that termination of pregnancy services can be accessed quickly and easily by those who need them and, critically, that they can be accessed without judgment or bias. This includes introducing legislation this year establishing safe access zones around termination of pregnancy services.

As Deputies are aware, the Health (Regulation of Termination of Pregnancy) Bill 2018 was signed into law on 20 December 2018. Expanded termination of pregnancy services have been available since 1 January 2019. The Act allows terminations to be carried out where: there is a risk to the life, or of serious harm to the health, of the pregnant woman; there is a condition present that is likely to lead to the death of the foetus either before or within 28 days of birth; and without restriction up to 12 weeks of pregnancy. This is in line with the recommendations of the Joint Committee on the Eighth Amendment of the Constitution, which published its report and recommendations in December 2017. Prior to the referendum to repeal the eighth amendment in May 2018, the general scheme of the Bill was published. The final legislation enacted is consistent with the published proposals, such that it reflects the will of the people who voted for repeal.

Initially, it is important to acknowledge the progress made in the roll-out of the service to date. As the report quite clearly lays out, there is much more work to be done, but it must be remembered that the service is relatively new, having been in operation for just over four years. For much of that time, it has been functioning under the constraints associated with the Covid pandemic. Notwithstanding these difficulties, it has embedded well into the wider health sector. The report acknowledges that much progress has been made in rolling out the services, but it is recognised that challenges remain. I acknowledged before the report was completed that there are challenges. However, the report is a really thorough, detailed and useful piece of work in pointing out many of the operational challenges. My Department is aware of these and is working with the HSE and other relevant stakeholders to expand access to services.

To ensure that the service is performing as it should be, and in line with statutory and Government commitments, I commenced the review of the 2018 Act at the end of 2021. The review was based on independent research and comprised two phases. The first was an evidence and information gathering exercise that consisted of public consultation and research into the operation of the Act from the perspectives of both services users and service providers. The public consultation provided organisations, stakeholders and advocacy groups working in the area, and all other interested parties, with the opportunity to have their say on the operation of the legislation. Believe it or not, nearly 7,000 submissions were received as part of the consultation process, which was very thorough.

Research to inform the service-user strand was carried out by Dr. Catherine Conlon, who has completed a large qualitative study investigating unplanned pregnancy and abortion care. The study, which was commissioned by the HSE's sexual health and crisis pregnancy programme, has generated an in-depth understanding of the experiences of women who have accessed abortion care services since the commencement of the Act. The study was published in July of last year.

Research into the views and experiences of service providers was carried out, following a tendering process, by Manchester Metropolitan University. That was the first phase. The second was led by an independent chairperson, Ms Marie O'Shea, who assessed the extent to which the objectives of the 2018 Act have been achieved, analysing the findings of the three strands of work from the first phase. She drew on the findings of other relevant peer-reviewed research and consulted further with stakeholders as necessary before providing conclusions. The final report of the review was submitted to me on 28 February 2023. I thank Ms O'Shea, and all those who contributed to the review for their dedication to and input into this important work.

There will be a debate on the various measures, the debate tonight being a good example, and there will be a lot of discussion, but I imagine that we can all agree the work was very detailed and thorough. Certainly from my perspective, there is a lot of useful detail and feedback from service users and providers in respect of improving the services.

The report makes a range of recommendations, most of which are operational in nature, with a relatively small number proposing legislative change. The review was comprehensive and included a wide range of perspectives on termination-of-pregnancy services. Consequently, it is important that we accord the recommendations in the final report due consideration and deliberation.

The report was considered by the Cabinet on 25 April. I recommended to the Government that the HSE establish an implementation group to progress the operational recommendations and that the report, particularly the legislative proposals, be referred to the Joint Committee on Health for its consideration. The Government agreed. The HSE group is being established and the report is now with the Joint Committee on Health. I am particularly interested in the health committee's views on the legislative recommendations but it is of course free to consider anything it wants, including all the operational recommendations. It may well have views on these.

It is recognised that the proposed legislative changes require careful consideration and discussion. These matters are not just for the Government; they are for the entire Oireachtas. Given the committee's cross-party composition and oversight role regarding the health service, it represents an effective and, critically, appropriate forum in which to consider the changes proposed. It is important to allow the Joint Committee on Health members the time and space they need to complete their deliberations before proceeding with any potential legislative change.

In the meantime, regardless of the health committee's recommendations, the debates we have here in the Dáil and Seanad and any Government recommendations or decisions, I will be absolutely focused on continuing to improve the services. There is an awful lot that can be done in parallel with any legislative change, regardless of its extent. As colleagues will be aware, 19 hospitals in the country have maternity units but only 11 of these are currently providing termination of pregnancy services. That is not acceptable to me and I do not believe it is acceptable to many here. The very clear goal is to have all 19 hospitals providing the services required. There is a lot of very useful detail in the report on making this happen. I assure colleagues that I am working directly with the HSE and the national women and infants health programme, which is leading on this, to ensure all the barriers to implementation across all 19 hospitals are identified and addressed. Colleagues will also be aware from the report that there are over 400 GPs providing services. That is a large number, particularly given the number was zero when the legislation was passed. Nonetheless, the report quite rightly points out – colleagues have already alluded to this – that there are parts of the country where there is very sparse provision. I am working with the Department, the HSE, the national women and infants health programme, GP representative bodies and GPs themselves to ensure we understand what is required to increase the number of GPs providing the services.

I fully respect the debate happening tonight and that there will be an ongoing debate on legislation and operational matters. I assure colleagues that, regardless of the debate, there is a health service already provided for under law. It needs to be available right across the country. Much progress has been made and there is much more that we need to make, so, in parallel with the debates we will be having here in the Oireachtas, I will continue to work closely with the HSE and Department to ensure the services already provided for under law will be provided to the greatest extent possible. I will also be making progress on the legislation on safe access zones for the reasons we all understand.

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