Déirdre de Búrca (Green Party)

The Health (Miscellaneous Provisions) Bill is the first of a number of legislative measures that will come before us in an attempt to rationalise and introduce greater efficiencies in the agencies and statutory bodies we have established over the years. It is interesting to hear the squeals of outrage already coming from the other side of the House from parties which state that if they were in Government they would implement greater efficiencies and on the need to ensure that the public service delivers more effectively. We are all aware that there are less resources available to us and that we will have to rationalise and implement efficiencies. The aim of the Bill is to do so in a way that will not see their functions significantly diminished in any way but that will recognise the need to be more efficient and achieve cost savings in the way the services are run.

From the discussions we have had about our health services, we are all aware that over the years perhaps there has been an over-concentration on administrative infrastructure and much less on front-line services. Whatever efficiencies we implement now we must ensure the front-line services of our health system in particular are protected and supported. We must ensure this legislation works in a way that will not negatively impact on front-line health services. When we consider how the health boards were dissolved to establish the Health Service Executive, which was supposed to be about rationalisation and making more efficient the administration of the health services, particularly at local level, I do not believe those efficiencies were achieved and part of the reason was that the emphasis was more on preserving administrative structures than on the more important issue of front-line services. Let us learn from this experience and ensure that the way in which the necessary rationalisation that will occur over the coming years happens in a way that prioritise front-line services.

The Long Title of the Bill describes it as "an Act to provide for the dissolution of the National Council on Ageing and Older People, the Women's Health Council, the National Cancer Screening Service Board, the Drug Treatment Centre Board and the Crisis Pregnancy Agency". Effectively, we are discussing merging these bodies with the Health Service Executive and in two cases, those of the Women's Health Council and the National Council on Ageing and Older People, redeploying the staff into the broader Civil Service. It would be a mistake to assume that because these bodies are being restructured that any lesser priority will be given to these policy areas.

I am a little concerned that two of the bodies are concerned with women's health. I hope the Minister of State will reassure me that their functions will be just as effectively delivered in the new form in which they will exist, particularly those of the Crisis Pregnancy Agency. Other speakers have discussed the importance of the role and function of the Crisis Pregnancy Agency and just because it is being absorbed into the HSE does not mean it has to perform or deliver its services in any less effective way. The dissolution of these bodies will mean the transfer of their functions, assets, liabilities, officers and staff members. The legislation has attempted to look after all of the issues that might arise in this transfer.

I wish to focus on the Crisis Pregnancy Agency because it has performed a very useful function since it was established in 2000. In this country, the strong right to life protections for the unborn, the right to life provision that exists in our Constitution and the very difficult and prolonged debates we have had on the subject of abortion mean we are obliged to back up our rhetoric on such constitutional protections with resources and services. In terms of the establishment of the Crisis Pregnancy Agency, that was done. Its establishment was recommended in 2000 and it was specifically charged with reducing the number of crisis pregnancies and ensuring women who faced a crisis pregnancy were offered real and positive alternatives to abortion. It was established in 2001 and at that time there was clearly a deficit of services, resources and public health campaigns aimed at empowering men and women with the skills and knowledge to prevent unwanted conception.

We know from the research that has been carried out that crisis pregnancy affects 28% of women and 23% of men. The research also suggests women may be experiencing crisis pregnancy at a younger age than before. The average age for women tends to be approximately 23 years of age and 24 years of age for men. Approximately 15% of women experiencing a crisis pregnancy will have an abortion. Those are the figures we need to keep them in mind when we are examining the continuance of the services provided by the Crisis Pregnancy Agency.

The agency was mandated with reducing the number of crisis pregnancies, reducing the number of women choosing abortion as an outcome of crisis pregnancies and safeguarding women's physical and mental health following the termination of pregnancy. Its progress and achievements have been considerable to date. It reported a decrease of 30% in the number of women travelling from Ireland to the UK for abortion, a 20% decrease in the number and rate of births to teenagers and a 43% decrease in the number of teenagers travelling from Ireland to the UK for an abortion. In 2001 the figure was 932, which dropped to 530 teenagers in 2007, a considerable drop.

Other improvements brought about by the agency include more than a doubling in the number of crisis pregnancy counselling services nationwide, free services being provided in 50 locations nationwide, and providing for a range of choices for potential clients in terms of the range of services offered on a geographic basis. There has been an increase in crisis pregnancy counselling hours of 35% and an increased provision and uptake in post abortion medical services of 37%.

Other contributions for which the agency has been responsible include delivering and evaluating the first strategic plan on crisis pregnancy. It is midway through the implementation of its second strategy. It developed a standardised framework and associated NUI-accredited training programme to improve counselling provision. It published 25 research reports related to crisis pregnancy prevention and support and built research capacity in the field of sexual research. It also worked with the Department of Education and Science to increase the implementation of relationships and sexuality education in post-primary schools.

The Bill concerns dissolving the agency and merging it with the Health Service Executive. The onus on the Government now is to ensure the proud track record of the agency since 2001 is continued in the new form in which it finds itself within the structures of the HSE. Some recommendations made by the agency on sustaining and progressing the advances it has made to date include the need for better access to and information on contraception and contraceptive services, especially for identified groups at risk of crisis pregnancy, and the need for measurable improvements in knowledge about relationships and sexuality amongst adolescents, a lot of which depends on the programmes we are implementing in our schools. Other recommendations include the need for improved access to and delivery of crisis pregnancy counselling services and post-abortion medical and counselling services throughout the country, the need to introduce recognised standards and regulation for crisis pregnancy services, and the need to improve the range of supports to make the continuation of pregnancy more attractive. A range of areas need to be progressed further and require considerable work to be done to ensure the track record of the agency to date as a stand-alone agency is continued and its very important work and achievements are continued into the future.

I am happy to support this Bill, subject to the points I made on the continued delivery of the excellent service to date under the new structures proposed.