Duncan Smith (Dublin Fingal East, Labour)
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I move: “That the Bill be now read a Second Time.”

I thank the Minister of State, Deputy Alan Dillon. I acknowledge his endurance this afternoon after taking eight Topical Issue matters in advance of this debate. I also thank Edel O'Shea, a constituent of mine, who worked with me on this Bill. I thank the Irish Cancer Society, which as many of us in this Chamber will know has always been fantastic with providing data and detail on all things related to cancer services, cancer treatment and cancer screening in this country.

This Bill is simple. It would stop workers having to take annual leave for hospital appointments for national screening programmes. Better still, it would encourage those workers particularly who are in insecure or low-paid employment, giving them protections to take part in and take up national cancer screening programmes. It would be a Bill for people who cannot afford to take a day or some time off, whether that be due to insecure work or fear of missing out on any part of their much-needed pay cheque. Ultimately, it is about equity for people so that nobody suffers from developing cancer just because they could not afford to take some time off to catch and detect it early.

There are four national screening programmes: BreastCheck; CervicalCheck; BowelScreen; and Diabetic RetinaScreen. BowelScreen is a home check so the practicalities of this Bill would not apply to it but it would apply to the other three. This is not to say that we are failing in terms of take up. BreastCheck, for example, exceeds the 70% take-up target, which is the standard for screening programmes. There has also been a 36% increase in the number of women who will be completing mammograms this year, and an 18% increase in the number of women who will have cervical screening tests. These are all massively positive and this Bill is not about criticising the Government about the take up of the screening schemes, it is just an opportunity to work together, to work better and to continue to strive for improved take up. As we know, we can always do more.

Important research was conducted for the HSE by Sophie Mulcahy Symmons at the end of 2023 on the take up of national screening programmes. The research indicated, among other things, that people and workers in lower socioeconomic groups are less likely to take up a national screening programme appointment. The majority of people in lower socioeconomic groups are likely to be in vulnerable, insecure or low-paid work. We know that these types of jobs come with fewer safeguards, fewer entitlements and fewer protections. The take up of trade union membership and trade union cover in these areas is also lower.

With this Bill we believe there are no losers. There would be no way to take advantage of the day's leave without having to take part in a screening programme. Safeguards and protections would be included. We do not believe this type of leave would be manipulated or used for any other reasons. As the Minister of State, Deputy Dillon, will know, on a purely financial level it is more cost effective for the State if a cancer diagnosis is caught early and if treatment can be administered as early as possible. It is important to acknowledge in the financial costings for businesses, in that people are not going to be going to a screening every year. This is a facilitator for the year when someone does go to a screening.

As the Minister of State can appreciate from representations in his own constituency, some screening checks involve a geographic distance. For those of us in Dublin or in major centres, the distance can be quite short and workers may only need a short period off in a morning or afternoon. People who live in more remote parts of the country may need to take a full day off work to take part in a screening programme. This should be seen as an investment for each employer to ensure their employees are getting checked through the national programmes as early as possible. If there is an anomaly or, God forbid, someone does receive a cancer diagnosis through the screening, we know that early detection means earlier treatment and the earlier the treatment the less invasive it is and the healthier people can remain. This means they can remain in work for longer and continue to be able to engage in other parts of their lives. We believe this makes sense. It is something that would not have too much of a cost impact on employers or on the Exchequer. In fact, it would be an investment.

We also believe that morally, and from a leadership point of view, it is the right thing to do. It sends the right message that as a State we are placing positive health policy front and centre and that we support people to take part in these programmes to safeguard their health and their ability to be able to continue in the workforce and with their lives.

The Irish Cancer Society estimates that approximately 40,000 people get cancer in Ireland each year and approximately 30% of all deaths per year are from cancer. We know through our own history of screening programmes, and unfortunately the scandals that have brought screening programmes to the fore of people's minds, that the earlier people get checked the greater their chance of survival. We are now in a situation where we have increased trust in our screening programmes and the trajectory of these programmes and their take up is going in the right direction. Trust has been hard won and it is a credit to organisations like the Irish Cancer Society, the clinicians, the practitioners and the people who run these schemes that we are trending in the right direction after so much hardship and tragedy.

We do, however, have an opportunity to progress more. We must do everything we can to reduce every barrier in people's way to ensure they can take up these screening programmes. We believe this is a truly common-sense measure. It is a pro-health measure and the type of measure the Government often claims the Opposition does not offer. We believe it is constructive. We have just had this year's Daffodil Day where the right to be forgotten was supported by this Government in what is a really good piece of legislation. It is the Government taking a really positive step. This Bill, either in its current form or through an amendment, would be a win for the Government.

I will work with the Ministers for Health and enterprise, and with the Minister of State currently in the Chamber, to get this through. In 12 months, on Daffodil Day 2027, perhaps this Bill or the core principles of it will be something we can celebrate going into Government.

Alan Dillon (Mayo, Fine Gael)
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I thank Deputy Smith for introducing this Bill. It is understood that this Bill seeks to amend the Organisation of Working Time Act 1997 to create a statutory entitlement to leave with pay from employment in order to enable an employee to avail of cervical, breast or colon cancer screening programmes provided by the national screening service or any other screening programme recommended to employees by his or her medical practitioner. Improving participation in the HSE’s national screening service is something we all recognise as a public health priority and while the intention to support participation in the service is understood, and while it is constructive, the Government opposes the Bill for two key reasons. First, the Organisation of Working Time Act is not the appropriate legislative mechanism for introducing a new health-related leave entitlement. Second, increasing access to screening services is considered a more sustainable and equitable solution than legislating for paid leave.

I will outline these reasons in further detail. Government is of the position that the Organisation of Working Time Act is not the appropriate legislative vehicle to provide for such entitlements. The Act is a statute with a specific and narrow function. It gives effect to the EU working time directive, and in doing so, it regulates maximum weekly working hours, rest periods, night work and paid annual leave. It is a framework for managing working time and not a framework for health-related entitlements. The Bill would extend the Act into areas that relate to public health screening, which are matters that the Act was never designed to address. The Act is not aligned with Departments or agencies responsible for public health. Placing a medical entitlement within a horizontally applicable working-time statute creates a structural misalignment between the nature of the entitlement and the purpose of the legislative instrument. Irish law has consistently located health-related and care-related leave such as maternity and parental leave, adoptive leave, medical care leave and carer’s leave in stand-alone Acts or within broader family- or care-related statutory frameworks overseen by the Departments of Health or of Children, Disability and Equality. These frameworks reflect the medical, care-based and equality-based nature of those entitlements. Placing health screening leave into the Organisation of Working Time Act would represent a major departure from these long-established approaches, and the Government is therefore satisfied that the Act is not the appropriate legislative home for such an entitlement.

My colleagues across government and I believe that enhancing access to the HSE’s national screening service is a more sustainable, equitable and inclusive solution than legislating for employer-paid leave. This work is already under way across all four national screening service programmes, which are BreastCheck, CervicalCheck, BowelScreen and Diabetic RetinaScreen. The service’s equity framework is designed to ensure that population-based screening programmes in Ireland are accessible, inclusive and effective for all eligible individuals, regardless of their background, socioeconomic status or employment situation. Screening eligibility is based on age, gender and clinical criteria and not employment status. This ensures that people who are unemployed, self-employed or in insecure work are not disadvantaged in being invited or receiving care. The national screening service carries out a range of programmes and projects to support accessibility and equity, and the outcome of these efforts is clear. Recent data from quarter 1 to quarter 3 of 2025 show strong and often above average participation, including that BreastCheck achieves an uptake rate in the region of 74.7%, exceeding the 70% target Deputy Smith outlined. CervicalCheck screened 74.8% of eligible women within a five-year period, against a target of 80% and BowelScreen reached 52%, above its 45% target. These results show that the public is highly engaged with preventative health programmes, which is an essential factor in early detection and reducing cancer mortality.

I will briefly explain some of the accessibility and equity programmes and projects which the service has developed, in addition to some recent improvements in the delivery of the programmes themselves. The national screening service has developed a wide range of initiatives aimed at improving equity, access and participation, including the community champions health promotion project, which trains community health workers to provide practical information and support about screening services, an intervention toolkit to support community workers to encourage screening uptake, a pregnancy-specific eye screening pathway for women with diabetes, accessibility training for staff to better support people with disabilities, a cancer prevention and screening project with the Traveller community, a literacy-focused initiative to support diabetic eye screening among Travellers, improved access to cervical screening within Limerick female prison and dedicated breast screening initiatives for Ukrainian women.

While increased flexibility of appointment times remains a key objective of health service policy, the national screening service is committed to actively promoting its service and ensuring that screening is accessible, inclusive and effective for everyone across Ireland. This approach not only aligns with national priorities but also guarantees equitable access, empowering individuals to take charge of their own health. Recent developments in each of the four screening services have also improved equity and accessibility for users. BreastCheck is currently offered through a network of 24 mobile and four static units nationally, enabling women to be screened close to where they live. These additional mobile screening units have been added since 2020. The service is also upgrading the mobile fleet and has identified three new sites for additional static units. BreastCheck now sends text reminders and appointment details through the HSE health app, making it easier for users to confirm, change and consent to appointments, helping to ensure that no screening slot goes unused. CervicalCheck is delivered by over 6,500 sample takers providing screening nationally through GP practices and clinics. There are 15 colposcopy clinics nationally providing follow-up testing and treatment for women who need it, also close to where they live. BowelScreen is now offered to people aged between 58 and 70. The number of BowelScreen units nationally has increased and the newest unit opened in late 2025 in Cork University Hospital, bringing the total number of units to 16. BowelScreen is accessible with a home test, making it widely accessible and flexible to people. Diabetic retina screening is provided through 146 screening locations nationally and a network of eight treatment centres for onward referral and treatment. A new screening mechanism is being piloted, meaning people will be able to drive to and from appointments, increasing accessibility.

In 2026 appointment information will also be provided through the HSE app to make it easier to confirm, change and consent to appointments.

Considering the breadth of existing initiatives under the national screening service, including ongoing improvements in accessibility and service delivery, the Government believes these measures represent a more sustainable and equitable approach than creating a new statutory entitlement to paid leave for employees. It is also important to be very clear the Organisation of Working Time Act is not the correct legislative vehicle for introducing a health-related entitlement of this type. For these reasons the Government is opposing the Bill.

Johnny Guirke (Meath West, Sinn Fein)
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I thank Labour for bringing this Bill forward. As usual, the Government is opposing anything constructive that comes from the Opposition.

Paid leave for health screening purposes should be a must for workers. I recognise the employers that already pay their workers for time off for screenings and cancer-related appointments. This is done through their good will. The Government must recognise the significance of this legislation in protecting workers’ rights and ensuring they have access to essential healthcare and screening without being punished financially for taking time off work. Sinn Féin firmly believes no worker should have to choose between their health and their income. This Bill, which proposes as statutory entitlement to paid health screening leave, is a step in the right direction. It allows employees to attend cervical, breast and colon cancer screenings without the fear of losing pay or facing repercussions at work. This is especially important as we know early detection can save lives, particularly with the cancers targeted by this Bill. We support the introduction of fully-paid health screening leave but we must also acknowledge the cap of three days per year may not be sufficient. Many screening appointments require travel and preparation and if multiple screenings are needed workers could easily exceed this limit. Many screening appointments require travel and preparation and if multiple screenings are needed workers could easily exceed this limit.

We must ensure health screening leave reflects the reality of people’s lives and the complexities of healthcare needs. While this Bill focuses on specific cancer screening types it is vital that, if possible, we broaden the scope of this leave to include other important preventative healthcare appointments. Workers should not only have access to screenings but also to follow-up care. The ongoing cost-of-living crisis and economic volatility make it more urgent than ever to strengthen worker protections. This Bill helps eliminate the grey area whereby workers might previously have felt compelled to use their annual or sick leave for health screenings. For this Bill to have the intended impact, the Government needs to address capacity constraints and reduce waiting lists for HSE screening programmes to allow for timely screening appointments. Every worker deserves access to healthcare when they need it. This Bill is a significant step forward but is just one piece of a larger puzzle. We will continue to advocate for comprehensive healthcare solutions and robust worker protections. Together, let us ensure every worker can prioritise their health without fear of financial repercussions.

Conor Sheehan (Limerick City, Labour)
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I thank my colleague, Deputy Smith, for bringing forward this Bill. If the Organisation of Working Time Act is not the appropriate vehicle by which to legislate for this proposal, I ask whether it could be done through the Work Life Balance and Miscellaneous Provisions Act 2023. I am very disappointed by the attitude the Government has taken to this Bill because it is a practical one the provisions of which would cover HSE cancer screening programmes and other screenings recommended by a doctor based on age or health status. Workers must currently use their annual or sick leave to attend appointments, which can create financial and workplace barriers to early detection. Many EU countries include preventative health check-ups within their broader paid sick leave regulations and studies have shown that when paid sick leave is mandated and used often for screening, cancer screening rates are higher compared with areas without such mandates.

We have problems with cancer screening and we should not kid ourselves we do not. The European Union’s Beating Cancer Plan, which we have signed up to, ensures 90% of the target population is offered screening but in many ways the country is going in the wrong direction. BreastCheck has missed its attendance target for a number of consecutive years up to 2026. Approximately 40% of first-time screening appointments are missed. If we look at BowelScreen things are even more concerning and we are going in the wrong direction. Our figure is 65% and it is also declining. This is something that disproportionately affects people who are in lower-paid jobs in front-line industries like hospitality, retail and manufacturing. They have rigid rotas and cannot just nip out for an hour or a couple of hours. It is a fact that most of our screening services operate day-time appointments only and clinics rarely operate at the weekend or late in the evenings. This legislation is also something to benefit those who are in precarious work because employees on casual, temporary or zero-hours contracts may, because of the imbalance that is there with their employer, fear requesting time off for a non-urgent medical appointment will lead to them, for example, being offered fewer hours or affecting perception of their reliability to attend their job. There is no legal entitlement to paid leave for cancer screening and employees are often forced to choose between using annual leave or taking unpaid leave, which many people cannot afford, especially given the cost-of-living crisis we are in. There is also an issue with employers not allowing people to take a partial day off or a few hours off for an appointment. This means some people have to take an entire day of annual leave for a 15-minute test. There is an imbalance between the person in low-paid and more precarious work and their employer. These people are often younger and from working-class and migrant backgrounds. There is a real fear there of being perceived as unreliable or of receiving unfair treatment for asking for time off for health-related reasons, especially if they have already used their statutory sick leave.

As I said, this is a practical proposal. It merits much more consideration than being thrown out, essentially, by the Government. If the Organisation of Working Time Act is not the appropriate vehicle through which to legislate for this I really hope the Minister of State can find out if we can do it through the 2023 work life balance Act.

Alan Dillon (Mayo, Fine Gael)
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I acknowledge the contributions from those present. I reiterate the Government appreciates the intention behind this Private Member's Bill and the contributions that have been made. We are all in agreement that increasing the participation rates within the national screening service is something we recognise as vital to our public health priorities. Early detection saves lives and the commitment of the Bill is to supporting better health outcomes and ensuring people live a lot longer and that is very clear.

However, it remains the Government's position that the Organisation of Working Time Act is not the appropriate legislative vehicle to provide health-based entitlements. Most of the entitlements the Government has in place, such as maternity leave, parental leave, care leave, medical care leave, etc., are very much in stand-alone Acts. For that reason it is not appropriate that we would promote and increase access to the national screening service. Moreover, even the definition of what a national screening service encompasses is not clear. It is considered more sustainable and equitable that it would be legislated for as paid leave by the employer.

I explained earlier the fundamental purpose and structure of the Organisation of Working Time Act. It has always been a statute designed to regulate work hours, rest periods and paid annual leave in line with the EU working time directive. That provides a framework on how time is managed in the workplace, not a framework for clinical entitlements or health-related benefits. That is where we have the misalignment in regard to this Private Members' Bill. Also, introducing a health screening leave entitlement into that Act would cut across the long-established legal framework, which would certainly create inconsistencies for both employers and employees.

Second, it is clear that increasing access into the national screening service can be done more sustainably through measures other than legislating for paid leave. I have spoken about the current targets that are being met across many of the current programmes. On the evidence presented by the Labour Party, I am not sure how paid leave will actually increase achievement of the current targets, even for those who are marginalised or who are not in employment. This measure is specifically for those who are in employment. The national screening service equity framework is designed to ensure that the programmes are inclusive and accessible and that everyone is eligible regardless of their background or even their employment status. The data shows that those initiatives have improved accessibility and equity and are succeeding, even though there are one or two we could improve on. The data is positive, as I explained. The national screening service has undertaken a range of additional measures to improve the accessibility of the service, such as the introduction of mobile screening units and the extension of the age cohort. The use of technology through the HSE's health app has also been an important element in this regard.

These improvements benefit not only employees but also people who are outside employment, those who are self-employed, those who are retired and those who are in casual or insecure work. Legislation that applies only to employees cannot be the main tool for addressing a wide population with public health challenges. For those reasons, and while fully recognising the positive intention the Labour Party is putting across within this proposal, we cannot accept or support the Bill. Nonetheless, our focus remains on promoting and strengthening the national screening service to ensure it is accessible and equitable to all.

Duncan Smith (Dublin Fingal East, Labour)
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I am deeply disappointed by the response. We believe the Organisation of Working Time Act is the correct legislative mechanism for this. What makes this different from carer's leave, maternity leave or paternity leave is that this is a short period of leave of no more than a day, sometimes a morning. This is not extended leave. This is not leave for weeks or months. The Minister of State feels differently. That is very disappointing.

We all agree with the Minister of State "increasing access into the national screening service can be done more sustainably". We have acknowledged the need for an improvement in this regard. Everyone is supportive of that across the House in terms of access to these programmes. We define within this legislation that it is the HSE national screening programmes. There are four of them. They are tightly defined. It is an evidence-based approach. I referred to the Sophie Mulcahy Symmons research which we are basing this on.

We are talking about workers in retail, service workers and workers in insecure low-paid employment. This legislation is not for self-employed people. It is not for retired people. It is for workers in low-paid and insecure employment. If it were applied, it would have a marginal to low impact, but it would have an impact. It would increase the number of people availing of screening. Through word of mouth, it would create a culture of doing so among workers where there is a low density of trade union representation. This word of mouth element would ensure workers know their entitlements in terms of being able to take a few hours off to take part in these screening programmes.

I am aghast that the Government is opposing this Bill on Second Stage and not allowing it to go through for further discussion. There is a constituency out there listening to the debate on this Bill about this potential entitlement who will be disappointed and will make that known to their local Government representatives. I am disappointed the Minister of State did not respond to Deputy Sheehan's question about whether it could be done through the Work Life Balance and Miscellaneous Provisions Act 2023. I thank Deputies Guirke and Sheehan for contributing to this debate. I am disappointed with the Government's response to this. While it is not unexpected for the Government to oppose Opposition legislation, I am surprised - and not just because it is my legislation - that the Government is opposing this Bill.

Louise O'Reilly (Dublin Fingal West, Sinn Fein)
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In accordance with Standing Order 85(2), the division is postponed until the weekly division time on Wednesday, 15 April 2026.