Tuesday, 3 December 2019
Ceisteanna ó Cheannairí - Leaders' Questions
We learned from The Irish Times today that a further 60 women have applied to join the 221+ support group for those affected by the CervicalCheck scandal after the Royal College of Obstetricians and Gynaecologists, RCOG, expert panel review found abnormalities in their smear tests as opposed to the original tests. These were women who were originally given the all-clear and later developed cancer. The review has produced a result that was different from the original CervicalCheck finding with very negative implications, as we know, for the treatment these women had to go through and for their health outcomes.
I met one such woman last evening, Bernadette Kiely from Cork, with her daughter, Claudia, who has been advocating for quite some time on behalf of Bernadette. What is quite extraordinary is that it was only in November Bernadette Kiely discovered she was part of the original audit by CervicalCheck. If it was not for her solicitor who sought access to her medical records in October just past, that fact would never have come to light. Mrs. Bernadette Kiely was never informed of the fact she was part of the audit and the audit letter, dated 8 July 2017, from Dr. Flannelly was never disclosed to her.
Ms Kiely has applied to become part of the 221+ group. She is a victim of non-disclosure. She has been rebuffed by the Department. She rang the Minister's office 23 times to try to have a conversation with, and to get access, to him but to no avail. She had to email the Taoiseach's office because she was originally refused a medical card. The daughter did all this work on behalf of her mother because the treatment has left an impact so the daughter is fighting the case. Bernadette should have been entitled to the ex gratia payment just like everybody else. She should have been part of the group. It is inexplicable she was not included from day one.
We need answers to her specific case. As the Taoiseach knows, the HSE has admitted liability for non-disclosure to quite a number of women but not to Bernadette. I have all the documentation and all the letters here confirming all of this. The outcome of the RCOG panel review is that both the cytology and the follow-up on colposcopy were inadequate and lacked active management. Both of these represented missed opportunities to prevent cancer or diagnose it at an earlier stage. There was an earlier referral in 2009 for colposcopy. It was 2015 when the second colposcopy happened and she was detected to have cancer.
How many more Bernadettes are out there that we do not know about? It is extraordinary, given all of the controversy surrounding this issue for the past two years, that there are still stories like Bernadette Kiely surfacing and emerging. All the focus to date has been on cytology. Is the Taoiseach satisfied in terms of the quality control mechanisms on the colposcopy dimension to this issue with regard to many of the women involved?
I thank the Deputy for that. I am not familiar with that individual case nor is the Minister for Health, but we will certainly check it out. The Minister has undertaken to speak to the Deputy personally afterwards and take any documentation from him. We will see if we can look into it and see if anything that needs to be rectified can be rectified.
Today will be another difficult day for women affected by cervical cancer, and for their families and friends. I hope it will be another step in restoring confidence in the CervicalCheck programme, which we all know has saved many lives, detected cancer early and prevented many hysterectomies and more radical surgeries as a result of that. I know that when the CervicalCheck audit first became public in May 2017, it caused enormous concern and controversy and led to a very difficult debacle that we have all been managing since then.
Looking back on it, I did not handle it in the way I should have. I made some mistakes, as did the Government, the Opposition and, as Dr. Scally pointed out in his report, the media. I hope that on this occasion we will all handle it a little bit better than we did two years ago. It is encouraging that on this occasion it was ensured that the individual women involved got the information, either by letter or in a meeting if they preferred, long before the report came to Cabinet or was published. It is a significant improvement on two years ago that those affected were informed before the report came to the Cabinet or this House or entered the public domain.
The audit will be published at 3 p.m. today. It was discussed at the Cabinet meeting this morning. Patient advocates are also being briefed on it today. Briefings are being provided for members of the Opposition who want them, particularly the relevant spokespersons. Again, that will happen this afternoon. The Royal College of Obstetricians and Gynaecologists has agreed to come before the Oireachtas joint committee in the next two weeks to explain its report and to answer any questions Deputies may have about it. It is a very technical and scientific area and the college is better placed to explain it than politicians, although we will do our best. The Royal College of Obstetricians and Gynaecologists is the professional body for obstetricians and gynaecologists in the United Kingdom. Its members are experts in their field. It carried out its work totally independent of Government and I thank it for that work, which will help to improve this programme into the future.
I put two questions to the Taoiseach. Media reports suggest that 60 more women have applied to be part of the support group for women who have been involved in this controversy. I asked the Taoiseach how many more Bernadette Kielys are out there. There is correspondence going back to 2016 and 2017 between CervicalCheck and Bernadette Kiely's consultants. Some of the letters have a familiar ring to them. It is interesting that a letter to her consultant stated that a review of colposcopy was conducted based on the cervical screening history of Ms Kiely prior to her diagnosis. I will not go through the whole letter but it states the case had been discussed at multidisciplinary team meetings for quite some time. My understanding is that there would have been a comprehensive trawl of all records and that all of the women involved would have been identified. It is extraordinary that this documentation only emerged in November following a discovery order to the hospital. The letter also states: "Please ensure that this correspondence is added to Ms Kiely's medical record" and "If open disclosure is indicated in this case, please follow the local hospital guidelines." We have seen those lines before.
How many additional women who should be part of the support group have been discovered through the Royal College of Obstetricians and Gynaecologists process? The media estimate a figure of 60. With regard to the question I asked on quality control and the colposcopy element of this matter, the expert panel review is very critical of the lack of active management of this case and the lack of follow-up. Is the Taoiseach satisfied that colposcopy services have performed adequately in light of this ongoing controversy?
Once again, I am not at all familiar with Ms Kiely's case. We will have to look into it. Not being familiar with the case, I cannot tell the Deputy how many cases are similar to it. I would not be able to answer that question. It might be worth sharing the six conclusions of the report with Deputies. The first is that cervical screening saves lives, including many of those women who consented to take part in the review. The second is that cervical screening cannot prevent all cases and will fail to prevent between 30% and 35% of cancers, even in well run programmes. Of the 1,034 women who took part in this audit, it is to be expected that 30% to 35% would have discordance. That was the case. Some 29.8%, or 308 women, had discordance and in approximately half of these cases, it may have had a clinical impact. I suppose that is the number of women who could apply to join the group.
The third conclusion is that the pattern of discordance in this review resembled that in a similar but larger-scale slide review in England. When the service was audited in England, the same or similar levels of discordance were found.
The fourth conclusion is that screening failures have serious consequences for the women affected, as we know.
The fifth relates specifically to colposcopy. Scrutiny of colposcopy revealed that there were cases where better management could have yielded better outcomes. It found evidence that clinical practice guidelines had not always been adhered to. While this will not usually result in cancer, when we examine cancer cases following colposcopy it is expected that suboptimal management will be identified. This is far from concluding that colposcopic practice in the CervicalCheck programme is substandard, but it serves as a reminder that guidelines are in place to minimise poor outcomes.
The sixth finding is that the CervicalCheck programme is working effectively. There is no evidence that the population risk of cancer, having been screened in the programme, is significantly higher than that in any other national programme.
Workers and families delivered a damning verdict on the Government's housing failures in the by-elections last weekend. Today, Sinn Féin has welcomed our newest TD, Deputy Mark Ward, to the Dáil. He is a Deputy who understands the impact that the Taoiseach's policy failure is having on the lives of ordinary people. His first job of work today will be to vote no confidence in the Minister for Housing, Planning and Local Government, Deputy Eoghan Murphy. That is the mandate he has been given. The people deserve better. People throughout the State tell us daily of their suffering under the Minister's housing failures. They must be listened to. They tell us of rents reaching highs of €2,000 per month, of years on waiting lists for a council house, of working every hour of the day with no prospect of ever owning their own homes and of scrimping and saving every last penny and still barely getting by.
Every day, our newspapers are filled with the real human impact of the failure of Fianna Fáil and Fine Gael to tackle the housing crisis and today is no different. Today, Fr. Peter McVerry has written to The Irish Times. He tells of attending court with a young homeless boy who was charged with the theft of a bottle of orange of a value of €1. He also tells of a homeless man charged with the theft of four bars of chocolate of a value of €3, and another charged with the theft of two packets of Silk Cut cigarettes. He then contrasts that with a Deputy on his way to or from a very highly-paid second job in Brussels, who stops by at the Dáil to sign in so he can collect his full €51,600 of expenses for attendance at a Dáil that he does not in fact attend. Does that not illustrate how absolutely out of touch this Government is and how glaringly cut off it is from the realities facing ordinary people's lives? I understand that the Deputy in question will make a guest appearance today. He will be here, it seems, to save the bacon of the failed Minister for Housing, Planning and Local Government.
People deserve better than that. They deserve better than the nod-and-wink politics of jobs for the boys. They certainly deserve better than a housing Minister who lacks the ability or even the humility to admit and accept that his housing policy has failed. That policy is now in its fourth year and it is simply not delivering. In fact, the problem has got worse. Many of the families, young people and pensioners who may be listening to proceedings in this Dáil find their housing situation is grimmer than ever. It is not good enough to keep spinning, to try to explain things away or to ignore the problem that is evident. Business as usual will not suffice. We need solutions. People want affordable homes to rent and buy, they want measures to deal with out-of-control rents and they want radical solutions to these very real problems. The Minister does not have these solutions and he will not listen to those of us who are offering them.
Does the Taoiseach accept that the Minister for Housing, Planning and Local Government, Deputy Eoghan Murphy, is simply not up to the job and must go?
No. I do not accept that. The House will have its opportunity to make that decision, on behalf of the Irish people, this evening.
Once again, I congratulate Deputy McDonald on her party's by-election success. Sinn Féin had a fabulous "get out the vote" operation. We will not be caught off-guard on that on the next occasion.
I think, however, that Sinn Féin should not over analyse the success, or congratulate itself too much. Across the four by-elections, my party won many more votes than Sinn Féin, and Fianna Fáil more still. The result was certainly no endorsement of Sinn Féin's policies.
I spoke with Deputy Dara Murphy over the weekend. Deputy Murphy is willing to co-operate with any investigation by any statutory body into his attendance in Dáil Éireann, be it the ethics committee, the Committee on Members' Interests or the Standards in Public Office Commission. It is right and proper that the Deputy should do that and he is willing to answer any questions they may ask or provide any documents that may be necessary. I believe that it has, however, shown that our expenses system in this House, while it has significantly improved from ten years' ago with expense now largely being vouched or verified, is far too lax. In this House we have a system that is essentially designed by politicians for politicians and that should change. I will write to the Ceann Comhairle and to the party leaders to suggest that this whole issue should not be a system run for ourselves by ourselves.
It should be one handed over to the Standards in Public Office Commission and the next Dáil should have a different regime when it comes to expenses and to verifying attendance. This should be done independently and separately of this House. The time when we make rules for ourselves should end.
I am not interested in self-congratulation or in any congratulation. I have raised with the Taoiseach the real experiences of people who cannot get a house and who do not have a home. I raise with the Taoiseach the scenario where children will wait for Santa Claus in bed and breakfasts, in hotels and in family hubs. I raise with the Taoiseach a situation where people live in the box-rooms of their parents' homes, including - in cases I know of - children with very severe health conditions and significant disabilities, some of whom are waiting for surgeries. I have raised with the Taoiseach the reality of what is a human misery, and I raise the fact that an entire generation of our people have no real hope that they will ever own their own homes. Those same people understand that they will struggle from month to month just to make the rent. The Taoiseach has failed again to address those realities. If the Taoiseach was to admit out loud that these things are rife across our society then he could land on no conclusion other than his policy is failing, that we need a change in policy and that we need a change in Minister. That is the logical outcome of the reality we face. I will put the question to the Taoiseach again. The Government's housing policy has failed. This is manifestly the case. We need a change in policy and a change in Minister. When will the Taoiseach deliver that?
The housing crisis is very real and it affects many of our citizens and our constituents, including people we know, in many different ways be it through high or unaffordable rents in some cases, be it the struggle to secure a mortgage and to raise a deposit to buy ones own hone, or the sharpest end of the housing crisis, which is rough sleeping and family homelessness. Rebuilding Ireland is our five-year housing plan. We are now three and a half years into that five-year plan and it is reasonable to ask the question as to whether it is delivering. The Deputy has asked that question and I will give a few examples on how it is delivering. In 2015 only 7,000 new homes were built in Ireland. This was the year before Rebuilding Ireland. This year, over 20,000 new homes will be built in Ireland, roughly a trebling of housing supply since Rebuilding Ireland, our housing plan, was launched.
House prices were rising at 7% or 8% per year. They have now levelled off. We know that, before Rebuilding Ireland was introduced in 2015, the social housing stock was only being increased by about 6,000 per year. It is going to be 10,000 this year, the largest increase in any year this century during boom and during bust. We will see from the figures that will come out today, if they have not come out already that, while overall homelessness levels continue to rise, we are seeing a fall in child homelessness, a fall in family homelessness and the number of people rough sleeping-----
The Government's procurement programme was supposed to be a key element of the public service reform agenda. Among other elements, it was supposed to ensure that the awarding of contracts would be transparent, open to competition and represent best value for money for the State and the taxpayer. Through a series of replies to parliamentary questions that I asked of each Department, however, it is now clear that this process is deeply flawed and contracts are being awarded in the complete absence of competition and without any clear sense that value for money is being achieved or that the interests of the taxpayer are being protected. This has happened not on a handful of occasions or even a few dozen occasions; astonishingly, contracts were awarded outside of the formal tender process on several hundred occasions between 2017 to 2019.
The following is only a sample. Advice to the Department of Communications, Climate Action and Environment about the national broadband plan at a cost of €14.6 million was not subject to procurement guidelines. That contract must be in jeopardy. The provision of health insurance at the Department of Foreign Affairs and Trade, at a cost of €1.5 million, was not subject to procurement guidelines either. At the higher end of the scale, contracts with a value of more than €13 million were procured on 74 occasions by the Department of Justice and Equality, all without any competitive process. Perhaps one of the worst offenders in terms of how often the guidelines were breached is the Department of Children and Youth Affairs. In 2018, it was found to have issued 60 non-compliant contracts totalling €5.4 million. In 2017, it reported 69 non-compliant contracts.
The Department of Education and Skills awarded 21 contracts, worth €4.64 million, without a competitive process between 2017 and 2018. The Department of Culture, Heritage and the Gaeltacht awarded nine contracts, worth a total of €1.45 million, outside of the guidelines between 2017 and 2018. An "urgent" requirement for printing at the Department of Employment Affairs and Social Protection that cost €262,000 was outside procurement guidelines. As Ms. Stephen McDermott at the Journal.ie has shown in his analysis, at least 348 contracts awarded by Departments between 2017 and 2019 failed basic compliance with procurement guidelines. That is shocking.
When ordinary people hear these amounts and about the breaches of guidelines that they represent, they become furious. Is it any wonder that there was such a low turnout last week? Taxpayers see their hard-earned money being thrown around like confetti at a wedding and resent that deeply. Why should they not? Does the Taoiseach not accept that these replies make a mockery of the Government's apparent commitment to ensuring that value for the taxpayer is achieved? Does he accept that they leave the Government's so-called reputation for responsible financial management in absolute ruins? Will he commit to a total review of the Government's procurement guidelines in order to ensure that the interests of hard-working taxpayers are protected from frivolous and uncompetitive awarding of State contracts?
I thank the Deputy. As he will see from the Exchequer returns being released today, the Government's reputation for competence around the management of the public finances is enhanced. As he will see, this year-----
Is enhanced. As he will see, this year we will record a budget surplus even greater than was projected on budget day. He will be aware that, only the other day, Standard & Poor's raised our credit rating. Therefore, the facts say otherwise - a surplus being recorded that is bigger than we anticipated on budget day and Standard & Poor's improving our credit rating in recognition of the sound management of the public finances by this Government.
When it comes to procurement laws, as the Deputy will know, there are national procurement laws and there are also EU procurement laws.
Generally, contacts are put out to tender and they go to the best tender, taking into account cost, quality and other issues on which a contract may be scored. On the specific contracts the Deputy has raised, I would have to check into them and come back to him and I shall. There are exceptions to procurement policy and sometimes Departments and Government agencies will have continuous frameworks in place rather than retendering every time, every six months or every year. They can put in place a standing framework, which cuts down on bureaucracy and cost. There is also constant engagement on procurement policy and all Opposition groups, including that of the Deputy, are encouraged to engage in it. There is engagement at present with all Departments on specifics that are being looked for.
The Taoiseach cannot have his cake and eat it. He is taking the praise for the reports he is getting. Many of these reports are being issued by people who are getting contracts without any tender process. I get a real sense that the scandal of having 348 Government contracts awarded outside of competitive guidelines has not been acknowledged or accepted. The Taoiseach does not accept it. If Mary Ann or Willie Joe is applying for a downstairs toilet or a basic level flat shower in the house because they are disabled and want a disability grant they have to get three competitive tenders from three recognised and approved builders. They go through all of the process yet you can dish out contracts to your friends and your people here without any recognition and tell me in reply that all of the people are praising you. They are praising him because many of the same people are being hired by him without proper competitive rules. The game is up. The people see this. There are rules and regulations for the daoine beaga, the little people, who must comply with everything, including small business people, small shop owners and small people who cannot supply their local schools because of procurement rules, but the Government can hire and fire and give out contracts willy-nilly without any recognition of the tax and the scandal of the waste that is going on. Someone needs to pinch the Taoiseach and get real if he did not listen to the people that week with the low turnout. They are fairly annoyed and fed up with the Government and its excuses on the children's hospital, national broadband and God knows. It is a gravy train here and the Taoiseach lets it run and roll and stands over it.
Perhaps it did 20, 30 or 40 years ago but it has not worked like that in a very long time. No Minister is involved in making a decision on who does or who does not get a contract.
I thank the people of Dublin Fingal for their support in the by-election and I congratulate my three colleagues who were also elected.
I made a very conscious decision about 20 years ago to dedicate my life's work to the area of human rights. It was a time when immigration was new to Ireland and I was determined to work to help ensure that as a society we would treat people new to our shores in a proper way and that we would recognise the huge richness and value they bring. It is somewhat fitting that I as stand on my first day in Dáil Éireann, the Irish Government is being questioned by the United Nations in Geneva as we speak on its record in upholding its commitments under the International Convention on the Elimination of all Forms of Racial Discrimination.
I will give some of the points the UN has raised on Ireland's performance on tackling racism. It has criticised the Government for failing to reform its legal framework on hate crime and has called for a clear time-bound commitment to make the necessary changes in law. The Prohibition of Incitement to Hatred Act 1989 does not effectively combat hate speech, particularly online attacks. Members of An Garda Síochána still lack training on how to deal with racially motivated crime. The UN has also questioned the impact and effectiveness of the State's Traveller and Roma inclusion strategy and warned of discrimination towards black Irish people and people of African descent in the Irish workplace. On direct provision, the UN has said there is an urgent need for improved reception conditions. This is the UN saying this, not me.
Noting that a national action plan against racism has not been renewed since 2008, which is almost 12 years ago, the UN has questioned whether the State plans to introduce a new plan and whether a timeframe exists. I ask these questions because there was some hesitation from the Minister in Geneva.
In the context of this and the nastiness that reared its head during the by-election campaign and before, is the Taoiseach planning to develop a national action plan against racism? In the context of the by-election campaigns and the various utterances by people in these Houses and outside, does the Taoiseach feel there is a general need for candidates and elected representatives to up their game in how they speak about people who look different or are from a minority?
I again congratulate the Deputy on his stunning by-election victory in Dublin Fingal. Ireland's cross-departmental delegation is appearing before the UN Committee responsible for monitoring the implementation of the International Convention on the Elimination of All Forms of Racial Discrimination. The delegation is headed by the Minister of State at the Department of Justice and Equality, Deputy Stanton, and will be answering questions on our combined fifth to ninth reports, prepared and submitted under the convention. These reports cover the period from 2011 onwards.
Notwithstanding some of the events of recent weeks, I am proud to lead the Government that has led the way on issues of integration, immigration and migration. Since the party I lead came to office, 120,000 people have been made Irish citizens. I am delighted that they are part of our family. We have accepted thousands of refugees from all over the world when other countries refused to do so. We sent our navy to the Mediterranean to help rescue migrants and disrupt human trafficking. We have brought in the new McMahon standards relating to direct provision. These ensure that the quality of accommodation has improved. We have also recognised Traveller ethnicity for the first time, something that was resisted for a long time by previous Governments. We have published and implemented the national migrant integration strategy as well as a national Traveller and Roma inclusion strategy. In addition, we have the Irish Human Rights and Equality Commission, which was established by the previous Government of Fine Gael and Labour.
On hate crimes, as the Deputy pointed out, our Prohibition of Incitement to Hatred Act is out of date. The Act dates from 1989 and needs to be updated. Work in that regard is already under way. I am not sure of the current status of this work but the Minister for Justice and Equality, Deputy Flanagan, launched a public consultation on it a few weeks ago. Should this Dáil be here in the new year, and I am sure it will be, I would hope we can make progress in updating that legislation.
I remind the Taoiseach he did not answer the question about whether he plans to develop a national action plan against racism. I sit on the monitoring committee for the implementation of the migrant integration strategy. There are a limited number of actions relating to racism in that strategy and they are not being implemented. Is the Taoiseach planning to develop a national action plan against racism and does he feel that candidates and elected representatives need to up their game?
We will certainly give consideration to a national action plan against racism. We have established a new anti-racism committee and that has a mandate to review current evidence and practice and to make recommendations to Government on how to best strengthen our approach in tackling racism. As the Deputy knows, we already have a national migrant integration strategy. Strategies are not implemented overnight, they are implemented on a step-by-step basis over time. I am happy to give consideration to a national action plan against racism but the Deputy should bear in mind that much of what is required is being done already by means of the other programmes and strategies we have in place.