David Cullinane (Waterford, Sinn Fein) | Oireachtas source

It is important that we have time to debate and discuss the provision of abortion services in the State following the publication of the independent review of the operation of the Health (Regulation of Termination of Pregnancy) Act 2018 that was published last month. In 2018 people voted for women to have access to services. The provision of termination of pregnancy services was endorsed by the Irish people by referendum, with a clear picture of what those services would look like and with an understanding that the legislation underpinning these services would continue to be reviewed. Some five years on and the services are still not properly in place. Women should be able to access the services which were voted for.

We welcome the fact that the report has been completed and published. Much work went into it and I want to commend the author and all of those involved. The review has provided 75 recommendations for us to consider as legislators. Most of these are operational, as the Minister said, and can be passed directly to the health service to implement. Others are legislative and policy changes which need to be afforded due process and consideration by the Oireachtas.

We will have an opportunity to engage with the author, Marie O'Shea, at the Joint Committee on Health next week. I want to say - and I am speaking for myself as a member of the Joint Committee on Health - that the committee will examine the report with the author, which is what we should do. We will tease out the review process and the conclusion and recommendations in terms of how they were arrived at and the rationale that underpins them. It is not the role of the Joint Committee on Health to review the process and to repeat the review process. That is not our role and nor is it a role for the Joint Committee on Health to make recommendations on recommendations. The report's recommendations stand on their own two feet and on their own merit. It is for Government and Cabinet to decide whether or not they will implement those recommendations. We cannot kick the can down the road and expect the Joint Committee on Health to repeat a process which has already happened. That would undermine the work of the independent review, which has already been done. The recommendations stand on their own merit. Different groups and parties will have their views on each of the different policy and legislative recommendations, as my party does, but ultimately it is for Government to act and it should do so. The Government must make decisions on these recommendations and act on the expert and medical advice. The committee will tease out the detail but the ultimate decision rests with Government. That work on the recommendations to improve access to services which do not require legislative changes should start immediately.

The report has identified significant barriers in the provision and accessing of services which are pushing women close to and over the 12-week limitation period. The first glaring deficit in services is the low availability. Only 413 GPs, less than 10%, are providing services. Only half of the maternity hospitals are providing services and the review concludes that only 15, at most, will be providing services by the end of this year. The report identifies the lack of staff and support structures as a major reason more providers are not engaged in the service, as well as the levels of conscientious objection.

There is a clear regional disparity of services. The report identifies the south east, the north west, the midlands and Border counties as particularly under-serviced. A geospatial analysis of services is recommended by the review and this makes perfect sense. For the life of me I do not understand why that has not been done already. The Government needs to clearly identify where there are significant service gaps and put in place local and regional solutions for that. There needs to be real engagement with service providers and the report sets out common-sense steps that should be taken. Services need to be mapped and the longest travel distances need to be identified. The report has identified significant barriers to services, the underdevelopment of regional services and barriers such as the three-day wait. The three-day wait should be removed. We want to see these issues addressed in a systematic way and we need to see a clear plan from Government on how it will progress those recommendations.

In light of this ongoing work across the Oireachtas, we will not be supporting the amendment from the Minister. It is appropriate that we work through the process, allow the Oireachtas to complete its examination of the review and then consider the amendments to the existing legislation

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