Jack Wall (Kildare South, Labour)
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I wish to share time with Deputy Shortall.

The frightening aspect of this decision by the Minister for Health and Children highlighted in all the letters and e-mails I have received is the mention of the words "save lives". Every newspaper has mentioned "save lives" and has printed headlines such as "A Small Price to Pay to Save Lives", "A Drop in the Ocean to Save Lives", "Budget Cuts that Put Girls' Lives in Danger", "Death Sentence on 12 year olds" and so on.

This is the first time during my membership of the House that actions by the Government of the day knowingly put lives at risk. The equation that €10 million in savings equals ten, 20 or, as suggested in many newspapers, 90 deaths is an unbelievable statistic for a Minister to have attributed to her actions if reports by experts are correct. The so-called saving of 0.7% of the Department's budget of €14 billion cannot be measured as such if lives are at stake. This should never be allowed to happen when there is clear and undeniable evidence, which, amazingly, has not been contradicted by the Minister, her Department or the HSE, that lives can be saved if the scheme is rolled out.

Cancer is a terrible illness, which never goes away. Constant scans, tests, etc., are required for those who are diagnosed and treated. The worry and concern for patients and their families as they wait for results are palpable. I recall on one occasion a nurse informing my wife, a cancer sufferer, that she would receive good news because she saw the state of worry my wife was in even before she saw the consultant. However, the Government has within its remit the powers to prevent such occurrences but is allowing the equation, savings equals loss of lives, to be the accepted formula. In an article in the Irish Daily Mail on Friday, 7 November, a woman who suffered from cervical cancer stated, "Life is not a rehearsal. We should grab every opportunity we have". This is relevant to the debate. There are no replays in life and any dangers to it must be addressed when possible. This is one such occasion.

The Minister has reached great heights, achieved a great deal and will be remembered fondly in history but her record will be blemished if the equation, savings equals loss of lives, is part of her legacy. Many figures are bandied about regarding the costs incurred by the HSE on bonuses, special advisers and the PPARS system, each of which, individually or on a combined basis, could provide the savings necessary to roll out this vaccination programme. The issues highlighted in the newspapers and e-mails could be resolved but, most important, lives could be saved. Nothing is as precious as life and if the Government seeks to face down the Opposition for the sake of procedure later, I am afraid it will be a sad day for the House.

Last August, the Irish Cancer Society welcomed unreservedly the decision to roll-out the mass vaccination programme for all girls aged 12 years. All the evidence relating to such programmes suggest they are a safe and effective way of preventing HPV. Dr. Gráinne Flannelly of the National Maternity Hospital, Holles Street, and chairman of the Irish Medical Organisation medical committee stated, "It is time for Ireland to take the lead in preventing cervical cancer. We cannot delay any longer". The Taoiseach stated earlier a Deputy was using emotional blackmail in this important matter. I assure him that a family in which a loved one is a cancer sufferer would not wish it to be inflicted on anyone else. Is it emotional? Sir, one can bet one's life on it. Is it blackmail to seek to prevent the disease in other instances? No, a thousand times, no, if it means the Minister will restore the programme through savings in other sectors or in whatever way. The threat of cancer to the 100 girls who may die following treatment for cervical cancer is not acceptable. I ask the Minister to change her mind in this regard.

Róisín Shortall (Dublin North West, Labour)
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Like my Labour Party colleagues, I fully support this important Fine Gael motion, which will be a test of every Government Member. From a political perspective, the decision is curious. I am glad the Minister is present and I hope she will respond to a few questions regarding various issues surrounding this matter.

Cancer scares all of us. It poses a huge challenge for the health services and the most frightening aspect of the disease is its random nature. While families have predispositions to cancer and so on because of lifestyle, a significant element of randomness is involved in cancer striking. Few types of cancer can be prevented. Advice can be provided regarding lifestyle such as not smoking and being careful about drinking and food consumption, which can reduce a person's chances of contracting the disease, but no vaccine is available to substantially reduce one's chances of developing most forms of cancer except cervical cancer. That is why the vaccine represents a significant breakthrough in health care and preventative medicine, which is severely under-developed in this State.

For that reason, HIQA recommended earlier this year that the HPV be introduced for 12 year olds. When the Minister considered all aspects of the programme and decided to go with it, everybody warmly welcomed the decision because it was looked on as a good step in developing preventative measures for cervical cancer and it was clearly established that investment by Government in such a vaccination programme would yield dividends in terms of lives saved. That is why from a human, economic and health perspective it was a no brainer. It made absolute sense to introduce this new vaccine. The number of lives that would be saved by its introduction could be identified. In September the Minister decided to go along with it and announced the programme, which was welcomed by everybody.

The Minister's announcement of the U-turn last week came as a bolt from the blue. I cannot understand why this is the case. She is an intelligent, thoughtful and considerate person and it does not make sense that if a vaccine is available to save lives and she announced that she intended to introduce it, that she would do a U-turn on it for the sake of less than €10 million. We have often dealt with issues in the past where there was an emergency and money had to be found. Irrespective of the difficulties within the economy, it could always be found, especially when a small amount was involved. There would be no difficulty in finding less than €10 million, either from the health budget or across various Departments, and it does not make sense for the Minister to say to us that the money could not be found. The only conclusion I can come to is that the Minister's Cabinet colleagues are hanging her out to dry if they are refusing to provide that €10 million. This does not make sense on any front, other than that it is a political manoeuvre on the part of her Cabinet colleagues.

There are umpteen ways in which the money can be found. Today, my party leader, Deputy Gilmore, made the point that there is agreement across the House on the part of every Member that this vaccine programme should be introduced. There is agreement that the sum involved, less than €10 million, is minute in the context of the budget generally. There is agreement that if people sat down and put their heads together they could find that €10 million today, if there was a political will to do so. The offer was made that the other health spokespersons would work with the Minister to identify where the money could be raised. I cannot understand why the Minister will not accept that offer. It is up to her backbenchers tonight to apply maximum pressure and to ensure that she makes the U-turn that everybody so badly wants her to do.

Máire Hoctor (Tipperary North, Fianna Fail)
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I welcome the opportunity to contribute to this important debate.

Brendan Howlin (Wexford, Labour)
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I take it the Minister of State is sharing time with a number of Members.

Máire Hoctor (Tipperary North, Fianna Fail)
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I believe so.

Brendan Howlin (Wexford, Labour)
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I understand she is sharing with the Minister for Education and Science, Deputy Batt O'Keeffe, Deputy O'Connor, Deputy Dooley, the Minister for Community, Rural and Gaeltacht Affairs, Deputy Ó Cuív, and Deputy Conlon. Is that correct?

Máire Hoctor (Tipperary North, Fianna Fail)
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I believe so but I am not certain. We can check that.

Brendan Howlin (Wexford, Labour)
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Very good.

Dan Neville (Limerick West, Fine Gael)
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The organisation of Fianna Fáil is not that great this evening.

Brendan Howlin (Wexford, Labour)
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Deputy Neville is not on the list.

Máire Hoctor (Tipperary North, Fianna Fail)
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The immediate issue is the question of introducing a HPV vaccine, but it is important to set the matter in a wider context.

In September 2007, the Government endorsed the establishment by the HSE of a National Cancer Control Programme, NCCP, to manage, organise and deliver a national programme for the entire population, in line with the National Cancer Control Strategy approved by Government in June 2006. Professor Tom Keane took up his post as national cancer control director on 19 November 2007.

Our first priority, therefore, during the past 18 months has been to invest in putting in place eight designated centres with a multidisciplinary team of experts to be able to care for patients who are diagnosed with cancer. The second priority is screening programmes. Many other European countries and countries beyond Europe have been involved in screening programmes for some considerable time.

As a person living in the mid-west, we were one of the first groups to benefit under the pilot scheme for the cervical screening programme. That was a great success where the vast majority of women turned up at the general practitioners' clinics and where the nurses carried out the cervical screening programme. We in the mid-west led it in some ways and we see that it has been a great success. We are delighted to see the roll-out of a national cervical screening programme, which began in September of this year.

Cervical screening has the capacity to prevent 80% to 90% of cervical cancers. Some 70 to 100 women present with cervical cancer each year. A national screening programme for women aged between 25 and 60 has the capacity to eliminate the incidence of cervical cancer by 80% to 90%. The cervical screening programme will cost €35 million in a full year. An extra €25 million will be allocated to that programme next year and an extra €15 million will be allocated to the cancer control programme to allow Professor Keane continue to recruit the expertise we require in the eight centres to provide, in particular, multidisciplinary care. That €50 million funding has been identified for those two programmes. Surely this is evidence, if evidence were needed, of the Government's commitment to tackling cancer in all its forms, and cervical cancer in particular.

Despite the extremely difficult economic circumstances facing us, the Government has been able to make a total additional allocation of €15 million to the National Cancer Control Programme in 2009 for service developments. With this funding the National Cancer Control Programme will concentrate on developing high quality services to combat lung and prostate cancers which together account for over 2,000 deaths each year.

On cervical cancer specifically, our immediate responsibility is to women who have already been exposed to HPV and who may already have pre-cancerous changes or undetected cervical cancer. Vaccination is a long-term investment which will only be offset by improved health outcomes and treatment savings in 15 to 30 years in the future.

Each year between 250 and 300 new cases of cervical cancer are diagnosed, with an average age at time of diagnosis of 44. The impression now being created by some people is that there is no preventative programme against cervical cancer in Ireland, which is entirely untrue. The clear international evidence is that the first step is to organise an effective screening programme, and to then follow it with HPV vaccination. This is exactly what we are doing.

Population based cervical cancer screening carries both immediate and long-term benefits. It carries the significant advantage of delivering earlier benefits than a vaccination programme. The requirement for a screening programme will not be eliminated by a vaccination programme, although in the long term, it is hoped that a vaccination programme would reduce the reliance on screening. The highest priority must be attached to implementing and sustaining the national cervical screening programme.

The national programme provides screening in a primary care setting every three years for women aged 25-44 and screening every five years for women aged 45-60. It will deliver a national quality assured, organised cervical screening programme and it will be implemented in line with best international practice. All elements of the programme will be quality assured — call and recall, laboratory services, and colposcopy will be managed to deliver a single integrated national service. Results will be available to women within four weeks of their smear test and all smear test slides will be read twice by two separate cytotechnologists.

Difficult times require that we make difficult decisions. These decisions need to be evidence based and scientifically sound. I am satisfied that we have got our priority right here in terms of our decision to invest, in the first instance, in rolling out the national screening programme.

Batt O'Keeffe (Cork North West, Fianna Fail)
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I welcome the opportunity to contribute to this important debate. The focus of our discourse here this evening must be on prevention because that is what the free screening programme for cervical cancer is intended to achieve.

The screening programme, which has been available throughout the country since September, aims to pick women up before they develop cervical cancer. Smear tests have the ability to identify pre-cancerous cells. I commend the Minister for rolling out the programme nationally. As the House will be aware, it was available only in the mid-west of the country as a pilot programme.

The Government has allocated an extra €25 million for the CervicalCheck screening programme. The full-year cost is €35 million. It is projected that, in total, approximately 100,000 women will have been screened by the end of the year. If a woman has already developed cervical cancer at the time of her smear test, this can also be detected. It is estimated that the screening programme can reduce deaths from cervical cancer by between 80% and 90%.

In September 2007, the Government endorsed the establishment by the Health Service Executive of a National Cancer Control Programme to manage, organise and deliver a national programme for the entire population in line with the Government's National Cancer Control Strategy.

Over the past 18 months, the HSE, supported by the Government, first prioritised investment in putting in place eight designated centres with a multidisciplinary team of experts to care for patients who are diagnosed with cancer. This approach adheres strictly to international best practice in the treatment of cancer, which is an indiscriminate disease that has touched so many families across our nation.

The second priority is the development of screening programmes. The breast screening programme will be completed during next year for those five counties to which it has not yet been rolled out. The cervical screening programme, which began in September for women aged between 25 and 60, has the capacity to eliminate the incidence of cervical cancer by 80% to 90%. Some 70 to 100 women present with cervical cancer each year. The HPV virus vaccine is just one part of helping to prevent deaths from such cancer. We must bear in mind that the requirement for a population-based cervical cancer screening programme is not replaced by the introduction of a vaccination programme. At least 30% of cervical cancers are caused by HPV types not covered by the vaccine.

The Opposition has tried to suggest that girls who do not get the vaccine are placed in such a vulnerable position that some of them will die. This argument is wrong. It is intended as emotional blackmail. The fact is that girls who are now aged 12 and do not get the vaccine will still be able to take full advantage of the extremely effective screening process at the appropriate age.

Given the nature of the development of cervical cancer, screening programmes generally do not start until women are in their 20s. Our programme is now offered to women between the ages of 25 and 60. The virus that leads to cervical cancer is transmitted by sexual activity. It is very rare that someone who has not been sexually active would contract such cancer from this virus.

For all these reasons, it is wrong for the Opposition to claim that without a vaccination programme starting next year more than 50 girls who are now aged 12 will die from such cancer. This implies that no screening programme or treatment services would be in place.

James Reilly (Dublin North, Fine Gael)
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So HIQA is wrong again.

Dan Neville (Limerick West, Fine Gael)
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Fire HIQA.

Batt O'Keeffe (Cork North West, Fianna Fail)
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As long as the individual uses the screening process, which would normally mean approximately ten or 11 screenings during the course of her lifetime, it will prevent 95% of cervical cancers. This is the medical reality, although the Opposition would like to distort it in its own political self-interest.

We are living through extremely challenging economic times and the Government has had to make difficult budgetary choices. Despite this, the Government has been able to make a total additional allocation of €15 million to the national cancer control programme in 2009. With this funding, the National Cancer Control Programme will focus on developing high-quality services to combat lung and prostate cancers which together account for more than 2,000 deaths annually.

Early presentation and speedy access are critical to improve outcomes for patients. This is the reason the cancer control programme is so crucial. It will establish rapid access diagnostic clinics for lung and prostate cancer. Patients with symptoms will be referred to the nearest designated cancer centre for diagnosis so their treatment will be fast and effective.

Charlie O'Connor (Dublin South West, Fianna Fail)
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I wish to share time with Deputies McDaid, Dooley, O'Hanlon and Conlon.

Brendan Howlin (Wexford, Labour)
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Is that agreed? Agreed.

Charlie O'Connor (Dublin South West, Fianna Fail)
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I am anxious to contribute to this debate and I am pleased the Minister for Health and Children, Deputy Harney, is present and it is significant that she is. Despite what has been stated across the floor I believe the Minister, Deputy Mary Harney, has a great interest in this subject. I have known her for a long time and I have worked with her in my constituency and in the Dáil. Since becoming a Deputy I have had first-hand knowledge of the care she has shown with regard to this issue. She has worked closely on it with the Joint Committee on Health and Children, of which I am pleased to have been a member for the past six years.

I want to paraphrase Deputy Róisín Shortall who explained how cancer frightens her. Cancer also frightens me and as a small child it was the first disease of which I heard. While it has not affected me, thank God, I have carried the fear through my life. I have lost family members and young people I knew to it. In recent weeks, the Tallaght community was greatly upset by the passing of Margaret Farrell, a well-known former Fianna Fáil councillor. Every one of us will be affected by cancer at one time or another and we all care about this issue.

Today, I received several hundred communications at my constituency office, as I am sure did other colleagues. We have hardly done anything else except deal with them. I am always glad when people in my constituency contact me about issues. The Minister knows this is an issue in Dublin South-West as well as everywhere else.

I do not want to concentrate on my own constituency but on many occasions in this House I have spoken about Tallaght Hospital and the programmes there. The cancer report of 2007 issued by the Adelaide and Meath Hospital in Dublin highlighted in a special way the needs of my wider community as far as cancer services are concerned. To show it is not only about Tallaght, Tallaght Hospital's catchment area stretches through that part of Dublin and out to Kildare and Wicklow to the border at Carnew.

I take a great deal of interest in this issue and the Minister should know we are concerned about it. I am also concerned about the general delivery of cancer services in the Tallaght region. The Minister will know this debate is generating a great deal of attention. Many people are contacting us and I wanted to convey this to her. I wish her well as she deals with the issue.

Jim McDaid (Donegal North East, Fianna Fail)
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While I am fully aware of these difficult economic times for our country, and how impossible it is to explain to our people that we can no longer afford services which we previously took for granted, the withdrawal of a life-saving vaccine is not a measure I can support. We have only to examine the history of vaccinations and see how successful they have been. We have practically eradicated smallpox, polio, diphtheria, tetanus and, to a large extent, tuberculosis. In the future, the world will rejoice the day a vaccine for AIDS is produced.

In our time, we have found a vaccine against a cancer which afflicts 200 of our women every year and which is responsible for the deaths of 70 to 80 of these women on an annual basis. The vaccine has the unanimous support of the world's foremost institutions, including the world centre for disease control. The renowned New England Journal of Medicine advocated it should be given to all female children between the ages of ten and 12, and possibly to those aged up to and including 15 years, depending on the morals and policies of individual nations. The journal also stated it is the greatest scientific advance that any Government can do for its people today. It would protect 70% of the girls from developing cancer and with the welcome introduction of the screening introduced by the Minister, in our generation we could go a long way to reducing the numbers to insignificance in the future.

However, on purely economic grounds — the New England Journal of Medicine contradicts the Minister on this point — the Minister has decided to drop its introduction for the foreseeable future. The sunset period on its effectiveness is why I state that in so doing we will pass a death sentence on a certain percentage of the 12 year old girls whose parents cannot afford the cost of it. Is there anyone in this House who would not give the vaccine to their daughters today?

I have been a friend of the Minister for 20 years and five different Fianna Fáil Taoisigh have recognised her commitment, capabilities and contribution to Irish society over a long period in political life. Yes, these are extraordinary times but I cannot see the logic of her decision, not even on economic terms. We have a responsibility to look after the health of our people and I have admired the Minister on many occasions in this regard. We have a responsibility in particular to look after the future health of our children.

Fifty years from now, it will not be important what my bank account was, what type or car I drove or what size of house I lived in. It does matter to me that during my stay in this House I may have been, just may have been, important in the life of a child. Accordingly, I cannot vote for the Government's motion this evening. I fully realise the implications of this but I trust that my colleagues understand that while I will abstain I will not vote per se against them. I cannot vote against an oath I took 34 years ago.

Timmy Dooley (Clare, Fianna Fail)
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I welcome the opportunity to contribute to this debate, which has been allowed, by some contributors, to become highly charged and emotive. Some Members have taken a populist approach to this issue, but that is certainly not so in the case of my colleague and friend, Deputy McDaid, who comes to this debate as a person with medical training and knowledge. It is something I and others do not have. Those who have taken a populist approach in this debate have referred to "children" and "imminent death" in the same breath in an effort to conjure up misplaced concerns among the parents of young children. There is no basis for the claim that young children will suffer as a result of the Minister's decision to postpone the introduction of the cervical cancer vaccination programme until some time in the future.

The facts circulated by some individuals are misleading. An e-mail campaign under way today highlights the orchestrated nature of the effort to mislead in an underhand and callous way. Nowhere in the instructions or directions in the chain mail is any effort made to explain the complex nature and causative factors of cervical cancer. Nor is any effort made to explain the limitations of the HPV vaccine or to identify the immediacy of the requirement to detect pre-cancerous conditions through the national cervical screening programme.

As I understand it, the two vaccines licensed for use in this State have a capacity, at best, to vaccinate against 70% of cases of cervical cancer. Therefore, there will remain 30% of women whose cancer will not be prevented by the introduction of a vaccination programme. I understand the long-term benefits of the vaccine have not been established in medical trials longer than five years. This is not to take from the importance of putting the vaccination programme in place. However, it is more important, prior to implementing that programme, to put in place an effective screening programme that caters for the entire population. As the resources become available, a vaccination programme should be introduced in the future, in line with other vaccination programmes. However, it is important to recognise that those vaccinated will still be required to undergo screening, as the vaccine does not guarantee protection against all forms of HPV.

In the delivery of identification and preventative medicine in regard to cancer in general and cervical cancer in particular, priority must be given to women who already have cervical cancer or pre-cancerous conditions of the cervix. To this end, a well resourced national screening programme based on the cervical smear test is the best solution. As the Minister of State, Deputy Hoctor, remarked, it has already been rolled out as a pilot programme in the mid-west region, where it has been very effective. Lest anybody think that women in the mid-west have been treated more favourably than others, we are still awaiting the full roll-out of the breast screening programme. That too will be welcome when it is introduced in the mid-west. Resources have clearly played a role in regard to the roll-out of breast cancer screening services. This has always been the case in terms of the roll-out of preventative medicine. The cervical cancer vaccination programme can be no different, particularly in the stringent times in which we are operating.

The McCoogan report of 2004 alludes to research in Britain which shows the benefits of a national screening programme. It is estimated that the introduction of such a programme in this State will reduce current mortality rates by 80%. This is a good benchmark towards which we should aim. We must get the screening programme right before focusing on the vaccine. Screening is not a test for cancer but rather a method of preventing it by detecting and treating early abnormalities. It is a method we must embrace.

Margaret Conlon (Cavan-Monaghan, Fianna Fail)
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I welcome the opportunity to contribute to this debate. The best possible protection for women is for us to ensure we fully implement CervicalCheck, the free screening programme for cervical cancer which is available since September 2008. In addition, we must continue to invest in the development of top quality cancer care treatment at the eight designated centres. As the Minister said in the House last night, we do not have a good record of cancer care outcomes except in child cancer. The reason for this is that child cancer care is centrally located in Our Lady's Children's Hospital, Crumlin. The Government's main consideration, therefore, has been to invest in the implementation of multidisciplinary teams to care for cancer patients. Fragmented cancer care does not serve the public well and we are all agreed that we want better outcomes for cancer patients.

CervicalCheck will cost some €35 million this year and an additional €25 million next year. The impression being peddled by the media and between the lines of the speeches by Opposition Members is that there is no preventative programme against cervical cancer. That is wholly untrue. International experience has shown that a screening programme is the most important step in prevention, before proceeding to the introduction of a vaccination programme. Genital HPV infections are passed primarily through sexual activity. Accordingly, the risk factors include early sexual activity and the existence of numerous sexual partners. Smoking has also been shown to be a contributory factor. The Government can and will do a certain amount but there is also an onus on the individual to minimise the possibility of developing HPV infections because all cervical cancers develop as a result of such infection. The cervical check will provide free smear tests to the 1.1 million women living in Ireland aged between 25 and 60 years. That is welcome, as it is rare for women under the age of 25 to get this form of cancer. The objective is to identify the women before they develop the cancer, and the smear test has the ability to identify pre-cancerous cells.

It is far easier not to make a decision. While the Opposition and the talk show hosts, who think they are governing the country, deplore the Minister and accuse her of many things, such as allowing 50 girls to die, being devoid of emotion and lacking in compassion——

James Reilly (Dublin North, Fine Gael)
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True.

Margaret Conlon (Cavan-Monaghan, Fianna Fail)
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——they do not reveal the full facts. It is simply incorrect to make those accusations and it is irresponsible to put the terms "young children" and "imminent death" in the same sentence. It implies no screening programme is in place. Our top priority is to put in place a programme that gives protection to women now. By the end of this year, 100,000 women will be screened and the lives of many of those women will be saved. That is a fact.

Dan Neville (Limerick West, Fine Gael)
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I wish to share time with Deputies Ring, Clune, McEntee, Varadkar, Crawford and Kehoe.

I welcome the opportunity to contribute to this debate. On 5 August last, the Minister for Health and Children said:

I accept the expert advice that the introduction of a universal, high uptake vaccination programme for young girls, in conjunction with population based cervical screening, could significantly reduce overall cervical cancer rates. I intend to seek Government approval for the programme and for the required funding in the autumn, based on the implementation of a plan that can be shown to be cost effective in terms of delivery costs and uptake rates.

Today the Government and the Minister claim that to agree with the foregoing and disagree with the removal of the Minister's proposal is emotional blackmail. We are agreeing with what the HIQA said to the Minister and what she believed, and probably still believes, that this is a vital issue in dealing with cervical cancer. Now we are accused of emotional blackmail.

I agree with Deputy McDaid — to withdraw the vaccination is a death sentence. That is what Deputy McDaid, an eminent physician, said about this. It is unconscionable that the Minister would withdraw a life saving programme for minimal savings. Cervical cancer is one of the few cancers whose cause is known. We know how to prevent it and a vaccination is available that will protect our children from it. There are approximately 240 new cases of cervical cancer every year, with approximately 100 women dying of the disease annually. The HPV vaccination is a life saving vaccine that could cause a 65% reduction in the incidence of cervical cancer and a 56% reduction in the number of deaths from the disease.

The Health Information and Quality Authority, HIQA, report published three months ago advised the Minister that it would cost €9.7 million to administer the plan to vaccinate 12 year old girls. The cost of the electronic voting machines would cover this programme for six years. The vaccine can save our mothers, sisters and daughters from a cancer that needlessly claims many lives each year. It is simply unbelievable that the Minister cannot find the €10 million from a budget of €16 billion.

The Minister claims the withdrawal of the vaccine is the result of a choice between it and cervical cancer screening and other important cancer services. That is not the case. It is a choice between the vaccine and bonuses for the bosses, the bulging bureaucracy and cash for consultancy services. The Government found €7.96 million to spend on consultancy services for PPARS, €10 million on special advisers, press officers and constituency staff, €1.4 million for bonuses and €1 million on consultants to transform the HSE, but it cannot find €10 million to introduce this life saving vaccine.

The introduction of the vaccine is also a cost saving measure in that it will reduce the burden on hospital services in the long term. The Government has rowed back on its commitment. The recent development of a cervical cancer vaccine opens the possibility of effectively ending cervical cancer within a few generations. We believe it should be available as a universal public health entitlement, as recommended by experts. I urge the Minister to reconsider her decision to cancel this programme.

Michael Ring (Mayo, Fine Gael)
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My contribution will be brief. I will not make any outbursts. I took my tablets today; the Taoiseach did not take his this morning. The Dáil certainly could not put up with two outbursts so I will be calm and collected. This morning, the Taoiseach accused Fine Gael and the Opposition of being unable to find money. I will make the Minister's job very simple. I found the money for her.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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Is the Deputy taking a 5% pay cut?

Michael Ring (Mayo, Fine Gael)
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Do not mind the 5%.

Jack Wall (Kildare South, Labour)
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Allow the Deputy to speak without interruption.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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I thought the Deputy was helping us to find the money.

Michael Ring (Mayo, Fine Gael)
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Given what the Government is doing at present, it should not be getting paid at all. It should be run out of office.

The Taoiseach this morning pointed to Fine Gael and asked us to find the money. I put down a parliamentary question yesterday about the artists' tax exemption scheme. It was set up in 1994-5. When it was set up, it cost €6.5 million. According to the figures I received yesterday, in 2003 it amounted to €22 million not paid in tax and in 2005 it was a total of €34,800,000. That is almost a 50% increase in two years and the last figure relates to 2005, not 2006 and 2007. All I ask the Minister to do is take 25% of the 2005 figure. It is a simple thing to do. I have found the money for the Minister, so I ask her to reverse the decision immediately. The Minister and the Government need not tell us they cannot find the money.

The money is there. The Taoiseach has asked for patriotism in this country. I am saying to the artists, the patriots, that we are not taking the entire scheme away. All we seek is 25% of it, which will pay for the vaccine that will keep women alive. It will cost €9.7 million, and I have found the money for the Minister. I ask her to do the right thing tonight. I call on the Fianna Fáil backbenchers and the women of Fianna Fáil to vote with us tonight and ensure that this necessary scheme is retained and that young girls will get the vaccination they need. In years to come these girls will not die from cervical cancer. It is a simple thing to do.

I have no wish to hold up the debate. I have made my suggestion and have found the money for the Minister. She should do the decent thing now and accept this motion. The money can and should be found for this.

Deirdre Clune (Cork South Central, Fine Gael)
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I hope the Minister will have a change of heart about this motion and not force the Deputies on the Government side to vote against it. I have listened to speakers on the Government side almost justifying not introducing this vaccination programme. They say it will only affect 70%. We have heard the New England Journal of Medicine quoted, contradicted and riders attached to the quotes. The fact is that the Health Information and Quality Authority, HIQA, was asked to produce a report on the introduction of the vaccination programme. It recommended in positive terms that the programme be introduced for 12 year old girls and that there be a catch-up programme for girls aged 13 to 15 years old.

The Minister agreed with the HIQA report. It was clear and positive. It outlined the figures for the effect the programme would have in reducing the number of cervical cancer cases and the number of deaths from such cases. More than three months ago the Minister positively endorsed the report and announced the introduction of a vaccination programme for 12 year old girls. However, within a short time that decision has been reversed on economic grounds. Having listened to the contributions in the House and in the media on the debate which justify the decision one would think we were discussing a by-pass or other road infrastructure project, whereas we are discussing people's lives. I do not wish to be emotive but practical and I appeal to the Minister to reverse the decision on economic grounds. There is evidence this programme could save the lives of young girls and women in later years. The programme would also save the State money in the long term and withdrawing it is a false economy.

The bottom line is that parents who can afford to provide the vaccine for their daughters will do so, especially following the publicity generated in the past week. People are well educated and are aware of the value of this vaccination programme. Any parent who can afford to pay for vaccination will not ignore the evidence or the figures and will ensure their daughter is vaccinated. However, this only applies to parents who have the means to do so. It is fine for those who have a choice, but there are adverse consequences for those who do not have a choice and cannot afford it. The programme is estimated to cost €600 for the three courses comprising the vaccination. Those who cannot afford the treatment for their daughters are being discriminated against by this unjust and unfair reversal of a decision about which the Minister was so enthusiastic only three months ago. Yet, today we hear it cannot proceed for economic reasons.

Will the Minister reconsider this unjust decision which prevents universal vaccination? Such a move would prevent those sitting on the Government side of the House from going through the torture of having to support a motion that, in their hearts, they cannot support. I appeal to the Minister to reconsider this decision.

The Minister stated only two EU countries, namely, Finland and Ireland, do not have this vaccination programme in place. However, I heard on the radio this evening that Finland has a gold card and a cancer prevention programme and that the mortality rates are considerably lower there than in Ireland. Therefore, it does not make sense to compare the two countries. It is clear the cost of the programme is a small amount of money in the overall scheme of things. There have been numerous suggestions put to the Minister on how she could find savings elsewhere in the €16 billion health budget. I appeal to her to reconsider the decision and to re-examine the health allocation to find the necessary means to introduce this programme.

Shane McEntee (Meath East, Fine Gael)
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I am pleased to take the opportunity to discuss this subject. I never considered that when the Minister, Deputy Harney, announced the introduction of the programme last August we would spend a Wednesday evening discussing the way it has been dismantled so quickly. If the Minister is determined to stay in power, she must take back control of the health service. It is a system run with no heart and no business sense. Those in the health service know everything about protecting their own interests, which is usually a job at all costs and this includes the Minister, Deputy Harney.

Since the budget every aspect of expenditure, including health, agriculture or education has been treated in the same fashion. No elected representative who supports the Government, whether from Fianna Fáil, the former Progressive Democrats, the Green Party or Independent, has met with the public to explain its actions and how it came up with certain aspects of the budget.

It is acceptable for anyone to play the political card, especially if one operates in the world of politics, but we are discussing people's lives, and more importantly, saving people's lives. The Government is putting 100 people, at a cost of €100, 000 each, at unnecessary risk of developing cervical cancer each year. This equation puts the life of every woman who will develop this cancer at €100,000. Is this the cost the Government puts on a woman's life?

I refer to another financial point. How much does it cost the State to treat a patient who may or may not live after they have been diagnosed with this cancer? A sum of €100,000 would not see such people through the first six months of treatment when one considers the cost of hospital accommodation, possible surgery, medication and other therapies. This is why the decision is so uneconomic and inhuman. The facts are in the HIQA report. There is no justifiable argument for cancelling the wonderful opportunity which the Minister announced last August.

The Minister should get rid of her advisers and spin doctors. Let us show some humanity in the manner in which we run the country and especially the health service. I cannot understand how we reached this point. When the Minister announced the programme last August it was seen as a move forward. I have been a Member of the House for three years and I was previously involved in such businesses as farming, pubs, restaurants and sales. I learned that one must always approach finances using common sense. In my three years in the House I learned everything is related to money. There was money available and now it is gone. However, in this case one must mix financial needs with those of the heart. I do not know who advised the Minister and I realise she is not listening——

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am listening.

Shane McEntee (Meath East, Fine Gael)
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The Minister is not listening.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I heard everything the Deputy said.

Shane McEntee (Meath East, Fine Gael)
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This move is wrong. I will not speak for women as it is not my job and there are enough women in the House who realise the implications of the decision for them. However, I can speak for fathers and grandfathers. This is the most disgraceful and inhuman decision that any country or any Government could make for their children. There are no children here tonight but if the matter concerned any other lobby group such people would be here. However, this concerns 12 year old children who are at home trying to prepare for Christmas exams. E-mails on the matter have been sent by some children. There is nothing wrong with this and I received 23 e-mails in the space of a couple of minutes.

The Government should not proceed with this decision. It puts the cost of the lives of our girls, and in my case my granddaughters, at €100,000 each. These are the hard facts. The Minister should get rid of whoever devised the budget as those people are a bunch of gombeens. The Minister could not have made this decision as no human being could devise such a budget and put the health of our children at risk, as well as putting education programmes and our agricultural sector in jeopardy. I call on anyone who is a father or grandfather in the House, and the Minister can do likewise for any women, to vote against the Government amendment. One can only be proud of Deputy James McDaid. He remained loyal to his party, but he knows what is right for the country. The Minister should withdraw the Government amendment.

Leo Varadkar (Dublin West, Fine Gael)
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I have only a few points to make and I do not propose to repeat or labour the arguments already made. Previously, I worked for a time in the gynaecologic oncology services in St. James's Hospital and I know something of cervical cancer. I have treated patients who subsequently died from the disease. I have seen the extent to which it is a horribly mutilating disease. I have also seen young women lose fertility and the opportunity to have a family following the removal of the womb to which the cancer had spread. Aside from those who get cervical cancer, there are women who must face repeat smears, attend for colposcopies and letts procedures, and who must go through all the stress and anxiety involved in these procedures. I think of them tonight in this debate.

The gardasil and cervarix human papilloma virus vaccines were mentioned in the debate last night. This is another example of unnecessary inequity. Those who can afford it may visit their general practitioner and pay a fee of €100 or €150 and then pay a further €300 for the vaccine. I do not know if those figures are exact, but they are roughly correct. However, this is not the case for people from poorer backgrounds. The vaccine is not available under the general medical services scheme in the same way that the contraceptive pill, viagra, augmetin and so on are available. Will the Minister make the vaccine available under the general medical services scheme, at least for this year, for parents who wish to see their daughters vaccinated? This would go some way to resolving the issue.

Although I do not receive any remuneration for it, I work in general practice and I encounter young women at high risk. These women start sexual activity at a young age, perhaps at 15 or 16 years. They do not use protection and all I can offer them, because they generally come from poor backgrounds, is the contraceptive pill or the depot, so they do not get pregnant. I cannot offer them a vaccine to protect them from getting the human papilloma virus or cervical cancer later on because I know they cannot afford it. I do not think that is right, and if she can do anything tonight, she should at least give a commitment that the vaccine will be available on the GMS until it becomes part of the screening programme.

Another issue not mentioned tonight is the impact on boys. HPV is not just responsible for cervical cancer, cancer of the vulva and so on. It is also responsible for genital warts and is implicated in anal cancer and cancer of the penis. We should not forget that boys are also affected by this and any inaction on HPV puts them at greater risk. The vaccine is licensed for boys in the UK, although it is not part of the national screening programme for them. For some reason, boys are always forgotten during health debates.

For the doctors in the House, Deputy McDaid has been given some credit for abstaining on this issue. He will probably get a bit of publicity and will come out the winner for it, but women and everyone else will be the losers. If he was more sincere about it he would cross the floor, but there are other doctors on that side of the House. Deputy O'Hanlon and the Minister of State, Deputy Devins, have a strong understanding of this issue and it is very disappointing that they have not decided to vote against the Government on this occasion, or even to abstain.

I am an admirer of the Minister, Deputy Harney. She has been an excellent Minister. She has shown courage, leadership and much honesty in her political career. I do not want to make a personalised attack on her. She has not reformed the health service, but unlike many of her predecessors, she has tried. However, on this occasion she has not tried. She could try a little bit harder and find the €10 million needed for this vaccine, or at least make it available on the GMS for the interim period. I commend the motion to the House.

Paul Kehoe (Wexford, Fine Gael)
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I spoke on this last Thursday afternoon. I thought that the Minister would have seen the light over the weekend, but instead she said that the Opposition is playing politics with this very important motion. We are not playing politics. We see children aged 12 having a chance of living longer, but the Government sees girls aged 12 dying with cervical cancer in the future. As politicians, we all go to funerals and one type of funeral we hate attending is that of a young woman who has died from cancer. We hate going into a mortuary and seeing a young woman dead because of cancer. The Government has a chance to do something tonight, but its Deputies are sticking to the party line and forgetting about people outside of this House.

Death from cancer is slow and painful. It is a long, painful road that nobody wants to travel. The Minister states that she is saving €10 million on the vaccination programme and €6 million on its implementation, but that is not a lot of money. If she asked every woman to go out with a bucket and collect money next Saturday, then we could bring in millions of euro between now and Christmas.

I looked up the website of the Progressive Democrats Party this evening. That party is now dead and gone, and it had a long, slow and painful death. I was horrified to read a statement posted on 5 August:

The Minister for Health and Children, Mary Harney T.D., announced (Tuesday 5th August, 2008) that she has asked the HSE to prepare and submit a plan for the introduction of a HPV vaccination programme for 12 year old girls to commence in September 2009.

How does the Minister feel about this right now? The Progressive Democrats Party is defunct, gone and dead. The same will happen to many 12 year old girls if she does not change her mind between now and 8.30 p.m.

I admired Deputy McDaid when he spoke earlier. However, he then said that he was abstaining. He might as well vote with the Government, because if he had something in his heart, he would go up the stairs and turn right with the Opposition. Talk is very cheap. Government Deputies will leave this House tonight and I hope they feel proud of what they are about to do. They should think about what they are voting for — the death of young children. When they are on the streets, or when they go to the shopping centre, they should look at 12 year old girls and think where they will be in the years to come. They will be dead because of this Government.

Máire Hoctor (Tipperary North, Fianna Fail)
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That is a disgraceful comment.

Paul Kehoe (Wexford, Fine Gael)
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I have no apology to make. I have nieces in their teens and friends who have teenage daughters. It is absolutely shameful of the Government to claim it is introducing something in August, but to take it back two or three months later. The Minister said in August that this would save lives. Is it okay to save lives in August and let them die in November? That is what she is saying, as is every Deputy from the Government side of the House. If Deputy Mary White was on this side of the House, she would be jumping up and down. Not one person from the Green Party had the audacity to come into this House and listen to the debate. I have not seen one of them tonight, and I did not see one of them last night. They have not got what it takes. They want to stay in power, but if they had what it takes to be in power, they would do the honourable thing tonight and go up the stairs and turn right.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I am absolutely shocked at this, but I am not surprised. I have known the Minister for a long time. I know what happened in Monaghan. I know what we were told and what happened afterwards. However, this is about 12 year old girls. This scheme was announced in August, at a time when everybody knew the economic situation in which the country found itself, and it was later withdrawn, which is unbelievable. It just shows the problem with planning and structures in the HSE and in the Department of Health and Children. The problem is that there is no planning.

Monaghan General Hospital is being closed down, yet I received a phone call from the father of a 16 year old who has been on a trolley in Cavan for three days. Even his pillows were stolen last night. This is the situation in which we find ourselves. I beg the Minister and the Government to do the right thing. They can find a lot of money for consultants, so they should find the money for 12 year old girls.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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Deputy Kehoe has just subjected us to the worst example of amateur dramatics in the House that I have seen in a long time. His hysterical outburst does not become the Fine Gael Party. I am sure his colleagues, who had to listen to and endure this hysteria, were embarrassed by it. He should take a lead from his colleagues who provided a more balanced and illuminating debate about this matter.

Paul Kehoe (Wexford, Fine Gael)
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Is that because I care for people?

Jack Wall (Kildare South, Labour)
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Please, Deputy Kehoe.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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He comes into this House, time after time, one Wednesday after another, with the same mock indignation, piety and self-righteousness we have to listen to every week.

Paul Kehoe (Wexford, Fine Gael)
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I am sure that if the Minister of State were on this side of the House, he would do the same.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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He did it before we had a recession. It was the same hysteria and amateur dramatics that we have had to listen to again tonight. I do not take lectures from Deputy Kehoe.

Shane McEntee (Meath East, Fine Gael)
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If he did so he would be far better.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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He is a disgrace to his party. He should withdraw some of these accusations he is making.

Shane McEntee (Meath East, Fine Gael)
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He is not a disgrace to his party. We are glad to have him in our party.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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Deputy McEntee can have him.

Jack Wall (Kildare South, Labour)
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Please, Deputies.

Alan Shatter (Dublin South, Fine Gael)
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Where was the Minister of State when this decision was made?

Shane McEntee (Meath East, Fine Gael)
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We are very proud of Deputy Kehoe.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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The first thing to emphasise is that the HPV vaccine, while a valuable initiative, is just one part of helping to prevent deaths from cervical cancer.

Shane McEntee (Meath East, Fine Gael)
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We are not like the sheep on the other side, who all go out the one gap.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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The second point to note is that HPV vaccination is not and cannot be a replacement for routine cervical screening. We know that countries that have organised cervical cancer screening programmes have substantially reduced both the number of new cases and deaths from cervical cancer. The Government's investment of €35 million in this programme demonstrates our commitment to a national screening programme. Far from the Opposition having a monopoly on empathy for children and young women, as they would purport to do in some of their contributions, that is not the case. We are facing very difficult times and will be facing tough economic times next year.

Shane McEntee (Meath East, Fine Gael)
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It is all his fault.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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Talk about having the courage to make these decisions——

Shane McEntee (Meath East, Fine Gael)
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He blew it.

Jack Wall (Kildare South, Labour)
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Please, Deputy McEntee. Everyone listened to you.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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Next year it will be tough again.

Shane McEntee (Meath East, Fine Gael)
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Every other country can do it.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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We will have to see how things will be then. We learn two things from contributions like that. First, that the Opposition is not fit for Government and, second, that the people were right. Anticipating the economic downturn we were going to have they voted for Fianna Fáil and the Progressive Democrats at the last election.

Shane McEntee (Meath East, Fine Gael)
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Fianna Fáil did not tell them the truth. It told them a pack of lies.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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Deputy Mary Harney's record as Minister for Health and Children will always be a great one.

Shane McEntee (Meath East, Fine Gael)
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They told a pack of lies.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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Four years ago, the debate on health was all about consultants' contracts, primary care teams and waiting lists for treatment. We have made huge progress on all these issues. The one major indicator of improvements in our health service is that the average lifespan is over 80, way ahead of the European average. We have made major progress on this over the years, which is down in large part to the reforming zeal of the Minister, Deputy Harney. Only today, I read in the newspaper that treatments for day-care patients are up by 40%. We are getting people through our hospitals much quicker. We are making beds available in that way through reform and that was recorded today. Has there been a word about this in the House, or do we have to listen to this hysteria about us not caring about the deaths of young children?

Shane McEntee (Meath East, Fine Gael)
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We have no beds in the north east.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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Some balance would be appreciated. I am sure the people watching this debate would acknowledge that if the Opposition was a bit more generous we would believe the other stuff they come out with.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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What about a 60-year-old in Cavan? There was no bed for him.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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However, when they talk nonsense it is possible to ignore what the Opposition has to say. It is important to bear in mind also that at least 30% of cervical cancers are caused by HPV types not covered by the vaccine, as many contributors have already pointed out.

In the context of the cancer programme upon which the Government has embarked, there are a number of priorities from a clinical point of view. Clearly, the first priority is to ensure that we organise our cancer services to deliver better outcomes for patients. This includes supporting the national roll-out of the cervical screening programme. We remain persuaded as to the important role that HPV vaccination can play in preventing cervical cancer. The evidence on this is clear. Unfortunately, however, the finances require that we make these difficult choices. I assure the House that we are fully committed to the introduction of a vaccination programme——

Paul Kehoe (Wexford, Fine Gael)
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Do it.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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——in future funding decisions, as we proceed to implement the national cancer programme.

Alan Shatter (Dublin South, Fine Gael)
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I wish to share time with Deputies Enright and Reilly.

Jack Wall (Kildare South, Labour)
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Is that agreed? Agreed.

Alan Shatter (Dublin South, Fine Gael)
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Last night, the Minister, Deputy Harney, acknowledged that we have a poor record on cervical cancer when compared with other countries. She acknowledged that the UK has had a screening programme for 20 years — our programme only commenced in September. She failed to acknowledge she has been part of a Government which for almost 12 years failed to roll out the required programme despite regular promises that it would be put in place.

Some 13 European countries have now made provision for a cervical cancer immunisation programme. Such programmes will start shortly in a number of other European countries. The Minister's cancellation of the immunisation programme announced in August will ensure that in future years we will continue to have a bad record on cervical cancer.

Having announced the immunisation programme last August, the Minister attempted last night to diminish its importance, stating that every young woman who does not get the vaccine would be offered a screening programme. The Minister of State with responsibility for children played the same game. However, screening is a second best alternative. As both Ministers and the Taoiseach should know, prevention is better than cure.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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Screening is prevention. The Deputy does not understand what he is talking about.

James Reilly (Dublin North, Fine Gael)
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Yes he does. The Minister of State does not.

Alan Shatter (Dublin South, Fine Gael)
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In the Dáil this morning, the Taoiseach callously and hysterically dismissed Deputy Kenny's call for the immunisation programme to be reinstated to protect the lives of women. He also made reference to the screening programme. In non-clinical terms, it seems the Government regards it as acceptable that women develop pre-cancerous and cancerous cells, and that they be denied a life-saving vaccine. We now know that had the vaccine been available a number of years ago, of the 93 deaths from cervical cancer in 2004, 52 would not have occurred.

The Minister for Health and Children herself acknowledged that two particular forms of the HPV virus cause 70% of cervical cancers and that the vaccine prevents these two particular strains. The essential ethos of a national cancer strategy should not merely be detection and treatment but also prevention where possible. At a time of financial stringency, it seems that this Government is now prepared to sacrifice the lives of women on the altar of political expediency.

The Minister has made much of her need to identify €700 million in cuts for next year. She has annually costed the immunisation programme at €10 million. An extra six cent on a packet of 20 cigarettes, as part of a cancer strategy, would provide the funds required by the Minister for this programme annually.

The Minister is right when she said it is about making choices. She made the right choice in August when announcing the start-up of the vaccination programme, but made the wrong choice in doing a U-turn to cancel the programme in October. The truth is that this Government has no moral compass and no commitment to a recognisable value system.

I do not believe in demonising the Minister but she and her colleagues have been in Government for so long that they are incapable of making the right choices, are out of touch and institutionalised. Detached decisions are made which impact on the lives of real people with whose plight this Government cannot identify. It is a morally bankrupt Government that agrees to deny to young girls a vaccine that it acknowledges will prevent cervical cancer. It is incomprehensible that we have a Minister for Health and Children who can describe herself as a strong proponent of a life-saving vaccine and then announce and defend her cancellation of the programme to administer it.

This is essentially about an immunisation programme for children. Has any thought been given to the rights of these children? There is an extraordinary hypocrisy in a Government engaging in cross-party discussions for a children's rights amendment to the Constitution while simultaneously denying to children life-saving immunisation. This is a Government engaged in serial and tragic incompetence on an epic scale. That incompetence was clearly illustrated in the embarrassing contribution of the Minister of State with responsibility for children, who attempted to defend the indefensible. It is clear that in the context of his child protection duties, the Minister of State completely failed to play any meaningful role in Cabinet when this scandalous and indefensible decision was made.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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That is not a children's issue, as the Deputy well knows. He is playing politics.

Alan Shatter (Dublin South, Fine Gael)
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If he attempted to play a role, it was obviously one that had no impact of any description.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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It is not a children's issue?

Paul Kehoe (Wexford, Fine Gael)
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My God.

Alan Shatter (Dublin South, Fine Gael)
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It is not a children's issue? That is an extraordinary statement, which shows how out of touch the Minister of State is.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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The average age of diagnosis is 44. That is a fact.

Jack Wall (Kildare South, Labour)
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Deputy Shatter, without interruption.

Shane McEntee (Meath East, Fine Gael)
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The Minister of State is totally out of touch.

Alan Shatter (Dublin South, Fine Gael)
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Fine Gael's motion is a pro-life measure. Voting on this motion is not about party politics, but moral values. It requires all of us as politicians to make moral choices which go beyond party political allegiance or obligations to obey the party Whip. The challenge for Government Deputies is to act as legislators and support Fine Gael's motion, or to abdicate their constitutional responsibilities and simply behave as lobby fodder.

In making their decision, they should reflect on the reality that there are few Members in this House who have not experienced the tragedy and trauma of the death of a close relation or friend as a consequence of cancer. They should ask themselves whether they want to vote to condemn others to such a death. It is time for the Deputies opposite, for once, to display both courage and responsibility.

Olwyn Enright (Laois-Offaly, Fine Gael)
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This is a simple and specific motion and I doubt if there is anyone on the opposite benches who, in his or her heart, disagrees with it. Last August, practically everyone in this House, including myself, welcomed the Minister's announcement. We were disappointed there was not to be a catch-up programme for 13 to 15 year olds but we welcomed the fact that 12 year olds would be able to avail of this vaccine.

The Minister and the Government are full of contradictions on this issue. They have blamed the economic downturn as the reason this vaccination programme is not proceeding. Yet the announcement was made by the Minister four weeks after the emergency mini-budget or financial announcements in July and four weeks before the announcement that the budget would be presented earlier than planned. When the Minister for Finance, Deputy Brian Lenihan, announced that the budget would be early, he said that in July the Government also made it clear that additional economies would be required in the event of a further fiscal deterioration. I do not think there was a person in this country in early August who did not realise that our fiscal position was going to deteriorate further and I do not think the Minister for Health and Children thought that either when she made her announcement. In August we knew the economy was in tatters and still the Minister made her announcement.

In her contribution to the debate last night and to which Deputy Shatter also referred, the Minister said we live in a country where our cancer outcomes are not what they should be. How is the decision she has made going to improve our cancer outcomes? It will do anything but improve it. The Minister said she is seeking to reorganise services for patients who already have cancer and this is welcomed by everybody. However, what about the issue of prevention?

I cannot understand how she can claim to be a strong proponent of the vaccine while at the same time refuse to supply it to 12 year olds. The main economic contradiction in the Minister's speech was when she stated that if it were a once-off sum of money, it would not have been a difficult decision but that it represents an ongoing sum of money for this year, next year and the year after. She then referred to Dr. Reilly's point that the companies were willing to defer payment for the first year. In response she stated the decision was not to introduce it in 2009. That is the first year. She could have gone ahead with it, based on what was being offered by the pharmaceutical companies yet she said earlier it was a year on year decision. Which is it?

I agree it is important to have a national screening programme but neither of the programmes are mutually exclusive and both are needed because the use of both is what delivers the best outcomes. Our record on cervical cancer is not good and this decision will not change it.

The Minister of State, Deputy Mary Wallace, said last night in her contribution that this is a cancer which affects younger women more than many other forms of cancer, younger women who have children, commitments and responsibilities. Today's 12 year olds are tomorrow's younger women, whom I hope will be given the chance to have those children, have those commitments and have those responsibilities. I remind the Minister of State, Deputy Barry Andrews, that this is a children's issue because those children of today and tomorrow want to have their mothers around with them.

Deputies:

Hear, hear.

Olwyn Enright (Laois-Offaly, Fine Gael)
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Before they vote, I ask everyone in this House to think of somebody they knew or somebody they cared for who either had a successful outcome or who died from cancer. I am sure everyone would have offered to do anything in the world to prevent them from dying or to prevent them from going through that treatment. We have an opportunity to do just that in the case of this one form of cancer that is preventable by vaccination yet the Government is turning its back on that opportunity. I do not believe the Minister thinks this is right. Even if it means a few less sod-turnings and a few less foundation stones being laid and a few less official openings for the HSE across the country, let us put this vaccine in place.

James Reilly (Dublin North, Fine Gael)
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I have heard tonight the usual Fianna Fáil tactic from the Minister of State, Deputy Barry Andrews, of attacking the messenger instead of dealing with the issue and his extraordinary statement that this is not a childhood issue when this is a vaccination that will allow children to lead in adulthood a life free of cervical cancer.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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How does it touch on paediatric oncology?

James Reilly (Dublin North, Fine Gael)
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I thank the people who have contributed to this debate. This is a highly emotive issue and rightly so. We are at a moral crossroads when we as a nation put fiscal rectitude and budgetary considerations ahead of the lives of our children and ahead of the lives of a future generation. There are two wonders here: the wonder that we have a vaccine against cancer which is the only one I know of, and the wonder that we have a Government which will not use it.

This morning the Taoiseach told Deputy Enda Kenny that he was wrong when he said that 51 women would die from this illness if this vaccination programme did not go ahead. This is clearly not so. Deputy Kenny quoted from a document which I have referred to on many occasions, the Health Information and Quality Authority assessment of benefit analysis of proceeding with this vaccine. It is worth repeating the name of that agency, HIQA, the Health Information and Quality Authority. It states very clearly that out of 10,074 pre-cancers, 3,680 can be averted. It states that out of 200 cases of cervical cancer annually, 111 can be averted. It states that out of 93 deaths a year, 52 can be averted. That means 52 women will not die if this vaccine is put in place. How can the Minister ignore this stark advice from the Health Information and Quality Authority, which is supported in its conclusions by the Marie Keating Foundation, the National Immunisation Advisory Board, the World Health Organisation, the European Cervical Cancer Organisation, the Irish Family Planning Association, the Well Woman Centre, and many others? The Taoiseach is rubbishing his own Health Information and Quality Authority report. Furthermore, an attempt has been made to make this argument into an issue of either screening or cervical cancer vaccination. It never was, it still is not and it will never be a question of either-or. It will always be a case of both cervical cancer vaccination and screening if we are to rid our island of this scourge.

The Taoiseach made the point this morning that vaccination has never preceded screening in any other country. This is disingenuous. In many other countries, screening has been available for 40 years and it is a damning indictment of this country and this Minister and this Government, that it has only been brought out in the past year, when it started in the mid-west ten years' ago. The fact the vaccine has only been available in the past two years answers the question why it has never preceded the screening programme.

The Daily Mail has a map which shows all the countries in Europe——

Máire Hoctor (Tipperary North, Fianna Fail)
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What about Sweden?

James Reilly (Dublin North, Fine Gael)
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How clever of the Minister of State. She wants to go to the far side of Europe to find another country. They have it 50 miles up the road in Newry——

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy is wrong. He should get a better source.

James Reilly (Dublin North, Fine Gael)
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The Taoiseach was wrong when he said that 3,680 pre-cancers cannot be averted. He was wrong when he said that 111 cancers cannot be avoided. It is particularly the Taoiseach who is wrong when he replied to Deputy Kenny this morning that 51 deaths would not be averted. In fact, there will be 52 deaths, according to HIQA, his own Health Information and Quality Authority.

A Member said here today that Fine Gael is being populist. I will be populist every time if it saves lives. The decision of this Government to deprive women of the facility of cervical screening is an indictment, particularly during a period of economic boom. We have asked where this money could be found. HIQA has said the vaccination programme could be done for €9.7 million. The Minister is trying to tell us we cannot find €10 million out of €16,000 million. What about the bonuses for the HSE bosses, the consultancy fees for PPARS, the €110 million in legal fees, the €300 million on travel in the HSE? These are just some of the areas in which a less lazy Minister for Health and Children might have looked before she picked on the elderly, the disabled and the young. With regard to e-voting machines, the then Minister for the Environment, Heritage and Local Government, Deputy Noel Dempsey, commented, "What is €50 million in the overall scheme of things?". That would pay for five years of this programme.

It boils down to a Government and its priorities, a society and its morals. This is not the island that Pádraig Pearse died for or for which Éamon de Valera and Michael Collins risked their lives. This is not an Ireland that leaves the weak behind and exposes our young people like this Government wishes to do. Even in Famine times, neighbours helped each other out. What has gone wrong with this Government that it can allow itself become so detached, that it becomes consumed by fiscal rectitude and everything else takes second place?

Deputy McDaid spoke earlier and I commend him and I hope he will vote for this motion and go the whole way rather than halfway up the road. Members on the opposite side of the House may be looking into his or her daughter's eyes in a few years and explaining why her best friend has cervical cancer because he or she would not take action to protect her, or why the wife of his or her son may have cervical cancer. We in this House all know that we will vaccinate our children — we will protect our children. Again, it will be the poor who will lose out. We are at a defining moment. Just when we think the Government cannot sink any lower, it scores another own goal. If one believes in equality, social inclusion and social justice, this should be a case of one for all and all for one, as it is across the map of Europe, which I demonstrated. However, if the motion falls tonight, it is clearly a case that this Government believes in an "I'm all right, Jack" approach to the children of today and the women of tomorrow.

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Deputy's time is concluded.

James Reilly (Dublin North, Fine Gael)
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What about the legal risk of doing nothing? The Government sought advice from HIQA and the National Immunisation Advisory Committee, which approved the vaccine as cost-effective and worthwhile to implement. The option of doing nothing is not tenable. The greatest negligence occurs when one knows the danger and fails to provide protection against it, for example, with regard to the Army deafness cases which have cost this country millions.

John O'Donoghue (Kerry South, Ceann Comhairle)
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I must put the question.

James Reilly (Dublin North, Fine Gael)
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The Government has no excuse if it ends up before a court in the future and the judge asks why, knowing the clear danger existed, this protection was not afforded to our children.

Tonight is a night for walking the walk. So many times before, Government Deputies have stood up and talked the talk and then walked up those aisles and voted against the very thing they spoke for. Let not tonight be one of those nights. If this decision was right in August, why is it wrong now in November? Reverse this penny wise, pound foolish, morally bankrupt decision. Tá mná agus páistí na hÉireann ag féachaint orainn anocht. Ná teip orthu. Vote for this motion. Vote for this generation of children because they are our future.

I commend the motion to the House.

Paul Kehoe (Wexford, Fine Gael)
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I, and the Fine Gael Party, feel strongly about the emotive part of this motion. We have given the Government every opportunity on this. As the Taoiseach is in the Chamber, if he wants to lead his troops up the steps of the lobbies to turn right, under Standing Order 69 I call for the vote to be taken by other than electronic means.

John O'Donoghue (Kerry South, Ceann Comhairle)
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That vote will now proceed.

Amendment again put.

Paul Kehoe (Wexford, Fine Gael)
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It was noticeable in this debate that the Green Party sent no speakers. We wish to give the so-called Independent Deputy Joe Behan an opportunity to vote with the Opposition. Under Standing Order 69 I call a vote other than by electronic means.

John O'Donoghue (Kerry South, Ceann Comhairle)
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As Deputy Kehoe is a Whip, under Standing Order 69 he is entitled to call a vote through the lobby.

Question again put: "That the motion, as amended, be agreed to."