Micheál Martin (Cork South Central, Fianna Fail)
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Last week, I questioned the Tánaiste about the "Prime Time" special on the quality of services in crèches and early childhood services. We both agreed the early years are the most crucial in terms of development of children, with the most critical years being from zero to three.

Anyone who watched "Prime Time" last night, as I did, would have been shocked and concerned at the footage that RTE took in a number of crèches. It is fair to say the programme uncovered cruelty, emotional abuse, physical heavy-handedness with children being flipped and thrown on to mats, verbal abuse and exclusion of very young children. In many respects it was the very antithesis of what should happen in any early childhood care setting. There was clear evidence of gross mismanagement of these centres. There was a fundamental abuse of the trust parents place in the management of these services. There was evidence of fraudulent recording of attendances to fulfil the requirements for funding under the preschool year and there were clear breaches of preschool regulations.

It emerged that 75% of all child care services nationally were in breach of regulations in 2012 and 48% of crèches were in breach of adult to child ratios during inspection. Would the Taoiseach ask the Minister if, in retrospect, it was a good idea to increase the preschool ratio from 10:1 to 11:1?

Fundamentally, there is an issue surrounding the extent and quality of the inspection regime itself. We still have no inspectors in five of the local health office areas of the HSE: Dublin south city, Sligo-Leitrim, Louth, Cavan and north Monaghan. The quality of the inspection is compliance-based as opposed to development-based and the model has been called into question.

We were promised the Children First legislation and I hear it might not be ready before the end of the session. There is an onus on the Oireachtas, having witnessed what we saw last night, to work collectively to ensure two elements of legislation that were promised over the past 12 to 18 months are accelerated as a response to the situation - the Children First Bill and the child and family agency. We are willing to have an all-party committee approach, which we had before in the 1990s during the first Child Care Act and was a breakthrough at the time. This is a wake up call for anyone who is concerned about this area. We are willing to co-operate to ensure the Children First legislation is brought through the House as quickly as possible. When can we expect that Bill to come before the House and to be fully enacted into law?

Enda Kenny (Mayo, Fine Gael)
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I thank Deputy Martin for the manner in which he has raised this matter. There is nothing more important to this country than the children of the nation. I did not have the opportunity to see all of the programme last night but what I saw shocked me. It was clearly an abuse of the responsibility entrusted by parents to people when they hand over their children to have them looked after while they go about their business. No one who watched that programme could not have been moved by what they saw. It is important to say all child care services around the country are not as was demonstrated in the worst of what I saw yesterday evening.

It is important to say that, from a Government's point of view, we will be happy to work with other parties in terms of co-operation in dealing with the child and family agency Bill. That will be brought before the Government in the next four to five weeks so we will co-operate with all parties to see the passage of that Bill takes place. There is an opportunity for the image, brand and culture that has existed for some time to be smashed by the setting up of the new child and family agency.

It is not just a case of the introduction of a new agency with a new title that ticks the same old boxes; the programme yesterday evening showed what is happening in a number of crèches. God knows what has happened in other locations. Most people in this House have been through this in one form or another with their children. Any parent can understand the circumstances that apply, and can get an impression of the environment and the atmosphere and the responsibility that is evident in child care centres. Clearly, the appointment of the Minister for Children and Youth Affairs, the children's referendum, the bringing in of the child and family agency and the putting of children's rights on a statutory basis, with the heads of that Bill coming before the Government shortly, are all matters of serious importance in the interests of children. I accept Deputy Martin's offer of support and co-operation in dealing with these two Bills. I am sure Sinn Féin will offer the same co-operation to get this dealt with.

It is also important to understand that the nature of inspections must change. As the Minister for Children and Youth Affairs has pointed out, the emphasis must be on quality and on a much broader spectrum than merely checking the environment that applies to items such as light switches or water or the general facilities. This is about the child and should be child-centred in that sense. Child care is a profession, as is child protection. I do not like to see this referred to as a business, a sector or an industry. Unfortunately for some, that is what it has turned into. We will accept the co-operation of the House to deal with these two Bills when they come before us and we will prioritise them.

Micheál Martin (Cork South Central, Fianna Fail)
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I would be concerned at the time lines for the legislation. After the children's referendum, we were told that the child and family support agency Bill would be ready and the heads of the Bill had been approved at that stage. The Taoiseach did not indicate the timeline for the Children First Bill, which is the critical legislation on child protection and welfare.

There are immediate issues that could be dealt with fairly quickly. First, will the Taoiseach publish a timeline for recruitment of additional inspectors, crucially, in areas where there are no inspectors for a variety of reasons? Second, a workforce development plan for early childhood and care staff in education was published in 2010. We need a clear time line for the activation of that work-force plan because what emerged last evening was quite a significant number of staff not trained. Approximately one quarter of all staff in these settings are not trained or do not have qualifications. That workforce development plan is ready to action. Could the Taoiseach indicate when the Government intends to action that?

There has been much talk about the model of compliance and the inspection regime. I asked last week - the Minister was asked some months ago - whether, given what has transpired, there is an urgent need to bring the Health Information and Quality Authority, HIQA, into this area and to ask HIQA to oversee and take over the inspection of these settings. The public has confidence in the Health Information and Quality Authority's objectivity, independence and capacity to bring rigour, in terms of inspection and the enforcement of quality control in a variety of settings. There is a need to reflect on that. The Minister, in reply to a parliamentary question, stated that HIQA may, but HIQA has not been given that role. Given what has happened, I ask the Taoiseach to consider that.

Enda Kenny (Mayo, Fine Gael)
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First, on the timeline for the child and family support agency Bill, there are over 100 heads in this Bill. It is the largest single reform or change in this area since the foundation of the State.

Micheál Martin (Cork South Central, Fianna Fail)
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No. We had the Child Care Bill. It was bigger. All-party committees dealt with it.

Enda Kenny (Mayo, Fine Gael)
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The agency Bill is fundamental because it is to establish a child and family support agency. That Bill will be before us here in a short few weeks and I hope we can get that through in this session.

The heads of the Children First Bill will be back before Government in the next couple of weeks. They are complex. There is a range of challenging issues here. There is much consultation going on. In respect of the legacy issues, they need to be addressed in terms of quality, training, inspection, standards and management.

As I stated, I hate to hear this being branded as a business, as a sector or as an industry. Child care is a profession. Child protection is a profession. We need a far more robust, comprehensive and quality-focused regime of inspection.

The Minister for Children and Youth Affairs, Deputy Fitzgerald, will advise the House when she has a response from the HSE on the recruitment and training that is going into the extra inspectors who are needed. As Deputy Martin will be well aware, this must be about the focus on the quality of the environment and the education for the children. This is why Deputy Fitzgerald, as a Cabinet Minister, has been strong on the need for the early years focus and the preschool year, which is so important for a seamless transition into the education system.

What I saw last night in part is an abuse of responsibility. We must take whatever measures are necessary to stamp out that appalling situation. That is why there is a Garda investigation and a HSE investigation going on.

When this family agency is set up, I do not want to see it as merely another agency with a new name and the same old standards. We will not stand for that. The Minister will supervise it.

Gerry Adams (Louth, Sinn Fein)
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On behalf of Sinn Féin, I also offer support. We have a long history, under Deputy Ó Caoláin's leadership, of working with the Government on children's rights issues and I am sure the Minister will testify to that. We also will work with the Government to ensure that children have the proper legislative protection.

Last night's investigation by RTE, as the Taoiseach acknowledged, uncovered some disturbing realities. We should recognise the excellent work done by many child care workers who do their jobs properly. Unfortunately, this is a business and it is for profit, and we need to face up to that reality also. The needs of the children in many cases, as we saw last night, are not being met. In reality, they are being violated - young child strapped to chairs and locked in rooms, daily diaries falsified, children being treated and thrown about as if they were ragdolls. This is emotional and physical abuse of these citizens and at the core of it there is a failure of regulation and governance. These breaches are widespread. There is no adequate robust inspection regime. We are told some crèches in some parts of the State have not been inspected for four years.

The question which gets to the core of all of this - these crèches receive State funding - is how this can happen. How can taxpayers' money be given to a crèche when it has not been inspected? There are no inspectors in local health offices in Dublin south city, Sligo, Leitrim, my constituency of Louth, Cavan and north Monaghan, and yet these crèches receive millions of euro of taxpayers' money. There seems to be an overemphasis on the business interests of child care providers and an under emphasis on standards, training of staff and regulation. We also must recognise that this is a very profitable business, not least because the State is funding it. Would the Taoiseach ensure that no State funding will be provided without a stringent inspection regime, proper training and robust regulation?

Enda Kenny (Mayo, Fine Gael)
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Any incident of a lack of compliance here must be followed up rigorously and changes must be seen to be implemented to the highest standard. I accept Deputy Adams's comment. I am aware of Deputy Ó Caoláin's interest and co-operation in this matter over the years. This affects everybody in the country and we need to get it right.

I share Deputy Adams's view. Regulation is meaningless unless it can be implemented and seen to be implemented. This must not be seen as a box-ticking exercise. Nor is it politics, nor should it be about economics. It is about our children. Parents make the choice where there is a preschool year and the money follows the child, but the choice is made by the parents. Parents to whom I speak have taken their children from one facility to another depending on their particular circumstances. What we need is a far more comprehensive regime of inspection here. The brand image of the child care profession must be seen to be of the highest standard.

What has happened in the past period includes, not only the appointment of the Minister to have political focus as the head of a Department but the Children First guidelines on which heads of the Bill will come back to Government shortly, the referendum which was passed, and the child and family support agency which, as I stated in response to Deputy Martin, is not to be seen as a new agency with inferior standards. This is an opportunity to break that culture and improve the brand image with proper inspections focused on the quality of what the children get in these centres. The National Vetting Bureau (Children and Vulnerable Persons) Act 2012 is part of that. There are 25 additional staff being recruited. The Minister will respond when she has details from the HSE as to when that training will be completed. Plans are also advanced to require registration for all child care providers because one wants to put this on a national basis with a national standard. Whether they are in Belmullet or in Baltinglass, up in Baltray or down in Ballinskelligs, the standards must be the same. Whether they are for profit or not for profit, this is about children and we will not accept any inferior standards. We will see to it. The Minister with the political responsibility as head of the Department of Children and Youth Affairs, the agencies of the HSE and any other under the legislation for which I thank the Deputies for their co-operation, will see to it that these standards will be implemented.

There will be no complacency. I welcome the fact that whereas this programme was a shocking exposé, it has confirmed that this applies in some cases. I know of the highest standards being implemented in other places, and in many cases there is online application and visibility for any parent as reports of inspections are available.

Róisín Shortall (Dublin North West, Independent)
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They are not available. That is the problem.

Enda Kenny (Mayo, Fine Gael)
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We need these standards to be seen to be implemented and there is no place in this profession for those without the capacity to measure up to those standards.

Gerry Adams (Louth, Sinn Fein)
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We agree with the Taoiseach's comments about what the service should be, but the reality is this is a private, for-profit sector for child care. That is a fact from which we cannot get away. No matter how we come to this, there is an absence of trained staff and a lack of enforcement standards. There is a weak inspection regime, which has led in this case to the abuse of citizens who happen to be small children.

The Taoiseach did not answer a matter I cannot forget. If there is no inspection in a facility for four years or there is no inspector in regions of the State, how can State funding be given to those projects? A carer looking after a loved one at home is put through a hoop and a person in the community sector trying to get some funding for disadvantaged children or elderly people is also put through a hoop. In this sector there are millions of euro in State funding being put into a system which I accept has many good examples of child care but which is also an example of a private, for-profit operation where the emphasis is on running it like a business, cutting corners and getting the most profit. The children suffer as a result.

Will the Taoiseach stop State funding where there is no inspection, regulation or adequate training? If this concerned any other sector, there would not be a question about this. Why should we put the taxpayers' money into a private, for-profit sector that is not only not providing for our children but in some cases is abusing them?

Enda Kenny (Mayo, Fine Gael)
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In 2011 and 2012, more than 2,600 child care providers were the subject of inspections by the HSE. That is an inspection rate of more than 60% of all providers in each year. That compares more than favourably with the system applying in England-----

Gerry Adams (Louth, Sinn Fein)
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This is not England.

Enda Kenny (Mayo, Fine Gael)
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-----where Ofsted operates a policy of inspecting child care providers on a three to four year cycle. I have pointed out to the Deputy that regardless of whether the facility is for-profit, the standards must be of the highest level.

Róisín Shortall (Dublin North West, Independent)
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They are not.

Sandra McLellan (Cork East, Sinn Fein)
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They are not. That is obvious.

Enda Kenny (Mayo, Fine Gael)
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I cannot answer the Deputy's question as to what facilities have got State funding that have not had an inspection in more than 18 months or two years, but I am sure we can get that detail as part of the discussions.

Gerry Adams (Louth, Sinn Fein)
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I was asking the Government not to give funding in that case.

Enda Kenny (Mayo, Fine Gael)
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I do not have an answer as to how many would have received State funding where no inspection has taken place as I do not have a detailed list. We will find out. The training of inspectors is under way and the Minister will deal with that.

I am concerned that the inspections taking place should not just be about the environment and checking if the lights or sockets are working. Although these are important, the most important element of all is the child, and we must consider the quality of care and the environment in which children attend a facility. That is where the focus on the quality of inspections must be centred. It needs to be far broader, more thorough and more comprehensive than what has applied in the past. The Deputy and I know that there has been no focus on those under five in this country for a very long time, but this Minister is dealing with a long set of legacy issues going back over very many years and many Governments. She is the head of the Department with a specific focus on the rights of children and facilities used by them. This programme will help to focus on the necessity to have quality at the Department's core with regard to inspections, attitude, treatment and care of children. The early years programme is an example of where high standards can apply with a seamless transfer into the formal schooling system. The matter concerns everybody and when we get the Bill through to the Government, we will ask for the co-operation of parties in helping us put it through the House.

John Halligan (Waterford, Independent)
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With us in the Gallery today are Mr. Tom Curran, the partner of Ms Marie Fleming, and Ms Fleming's daughter, Catriona, along with some friends. I gave the Taoiseach notice of this question because I know the issue is controversial and delicate, although we can be reflective.

When the Supreme Court delivered its ruling last month that Ms Fleming did not have the right to assisted suicide, it was noted by the court that there was nothing to stop the Oireachtas from legislating to allow for assisted suicide in such cases, once it was satisfied that appropriate safeguards could be put in place. Ms Marie Fleming still wants the right to die at the time of her choosing. She remains a competent but terminally ill adult who is in the last stages of multiple sclerosis, is severely physically disabled and suffers frequently from severe pain, which at times is unbearable. She has little mobility and needs help to eat and drink. She must be washed, dressed and repositioned in her wheelchair continuously. She is now losing her ability to swallow.

Mr. Curran remains in a legal limbo because although it is legal for Marie to commit suicide, it is illegal for Tom to assist her in doing so, and if he did so he could face a jail term of 14 years. We all have a right to demand a dignified life, but we also have a right to a dignified and peaceful death. It is everybody's wish to have a peaceful death. In light of the Supreme Court statement, would the Government commit to, or even consider, introducing measures that would allow rational and terminally ill people to choose to have an assisted death when they wish, with appropriate safeguards to ensure that the choice would be rational and without external pressure? We would need to provide the best possible medical care and quality of life for elderly and seriously ill people to ensure they do not come under external pressure to want to die. Such safeguards would not compel anybody to do anything they do not choose for themselves in sound mind. They would only apply to terminally ill, conscious and competent adults who can make autonomous decisions and they would not extend to incompetent and terminally ill adults, children or babies. Such a process would come into play when people's suffering surpasses the will to live, and the choice would be carefully regulated. I ask the Taoiseach to show some compassion to a woman who is critically ill and suffering unbearable pain. As I stated initially, we have a right to and demand dignity in life, but each of us as sentient beings also has a right to dignity in death.

Enda Kenny (Mayo, Fine Gael)
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By any standards this is an extraordinary case involving an extraordinary woman. If the House were asked to find words to describe adequately the impeccable courage, dignity and compassion of Ms Fleming, it would probably be rendered mute. When we speak about this particular case, we speak about life and death, but also about compassion, love and commitment, and the commitment of her partner and family are there for all to see. What we, as the people of the country, have seen in this is something rare and privileged. It is not for me or anybody else to intrude on the privacy of this family forced by appalling circumstances to share their distress with the public.

The court made its decision on 29 April and acknowledged the hugely distressing circumstances. It held the Constitution does not contain either a right to commit suicide or to arrange for the ending of one's life at a time of one's choosing. The court held further that the prohibition on assisted suicide was neither discriminatory nor contrary to the European Convention on Human Rights. The court made it clear that nothing in its judgment should be taken as implying necessarily that it would not be open for the State to legislate for assisted suicide where the Oireachtas is satisfied that measures with appropriate safeguards might be introduced. This is not the same as stating the Oireachtas should legislate to provide for assisted suicide. As a consequence of the judgment, the offence of assisting another to take his or her life remains in place. Such an offence is necessary to safeguard the lives of individuals who are nearing end of life and who therefore might be at risk or vulnerable. Deputy Halligan made comments to me yesterday and I understand the grief of this extraordinary woman and the commitment of her partner and family, but it is not open to me to give him the commitment he seeks.

John Halligan (Waterford, Independent)
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I thank the Taoiseach for the compassion he has shown towards the family. I am sure they are grateful to hear him say it. None of us ever hopes to have to avail of assisted suicide, and this is quite clear in most people's minds. The reality is that in the absence of a debate on this issue, very many people like Marie Fleming are being deprived of this freedom to make a dignified exit from this life through extraordinary pain. In an opinion poll published in The Irish Times in 2010 on behavioural attitudes, 55% of people indicated that terminally ill people should have a right to a dignified exit from life if they choose this way. We know of terminally ill people who, because of the severity of their circumstances and pain, refuse food and hydration as a means of ending their life. Many doctors are coming forward to state that people are coming to them asking for help because they find their pain unbearable. I ask the Taoiseach and party leaders to consider at least a debate at some stage in the Dáil. I do not know whether it would require the introduction of a Bill. If so, I will do this.

Anybody who speaks to Marie and her family will see the unending pain and torture she is going through with an end in sight anyway. To have to see this end in unbearable pain is undignified. Not alone as it undignified for the woman herself, as she will tell one, it is undignified for us as a society to allow this to happen, particularly with somebody who is competent and intelligent, who knows she is inflicting pain on her family and friends and who wants to have a dignified exit. At the very least we have a right to have this debated in the House.

Deputies:

Hear, hear.

Enda Kenny (Mayo, Fine Gael)
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As I stated, pain management is part of the science of medicine in the modern world. I am quite sure that at some stage or other we have all attended at the bedside of family, friends or acquaintances who have passed on and who, despite the medical attention they received, left this world having gone through a period of distress, discomfort and pain. I know Deputy Halligan has raised this case out of his understanding and a sense of compassion for Ms Fleming. It may be possible that at some future opportunity, these matters can be raised and reflected upon at the Oireachtas Joint Committee on Health and Children. The court made its decision and is clear, and to respond directly to the Deputy's question, it is not open to me to do this. I understand the circumstances of this extraordinary woman and her courage. It is distressing to hear Deputy Halligan describe the circumstances in which she finds herself at this time.