Denis O'Donovan (Fianna Fail)
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Tá fáilte roimh an Aire Stáit, Deputy Finian McGrath.

Colette Kelleher (Independent)
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I thank the Minister of State for coming here and I thank the Cathaoirleach for selecting my Commencement matter.

In light of recent media reports concerning St. Luke's Hospital in Kilkenny, I raise the issue of access to the full range of termination of pregnancy services there and in the 19 maternity units in Ireland. The obstetricians in St. Luke's have argued that the hospital is not an appropriate location for medical or surgical abortion. I welcome the decision made by the Minister for Health to appoint an additional obstetrician to St. Luke's last week. However, hospital-based termination of pregnancy cannot be delivered by one staff member alone.

The issues in Kilkenny are symptomatic of wider access issues. Only ten of the 19 maternity services currently provide the full range of abortion services under the 2018 Act. In addition to situations of fatal foetal anomaly and serious risk to the woman's health or life, women may need access to hospital-based abortion care for many reasons, for example, individuals for whom medical abortion is contra-indicated, and women and girls, such as those living in homelessness or violent relationships whose personal circumstances may not be amenable to home self-management of medical abortion.

The absence of an abortion service in nine maternity units also impacts on community provision. The ability of GPs to serve the needs of women requires a referral pathway for women to their nearest maternity unit in those situations, for example, where the pregnancy exceeds nine weeks or in the rare event of a failed medical abortion. As the Minister of State will know, women have a legal entitlement to the termination of pregnancy, and the HSE must organise services where this right is vindicated in practice through local accessible abortion services.

If St. Luke's has declined to participate on the basis of resources, has it also refused to provide care to women undergoing a miscarriage? If not, how can this discrimination against women who need abortions be justified? The recently circulated letter assures local GPs that women who are morbid or septic will be dealt with. What does this mean? Is the Minister for Health satisfied that the hospital's position is in compliance with the law? Would a woman presenting at St. Luke's whose life is at risk be referred to another hospital or be required to wait until her health has deteriorated to the point where the medical team is satisfied that a termination is justified? Under the legislation there is no right to conscientious objection in emergency circumstances where a woman's life is at imminent risk or her health is at risk of imminent serious harm. Is St. Luke's providing for those women and how?

Beyond St. Luke's, on what basis are other hospitals refusing to provide abortions? What referral pathways are in place and to where? Have women requiring abortions who presented at these hospitals been referred elsewhere or been required to travel? How many women are we speaking about? Does the Minister foresee any risk of legal action due to medical negligence, for example, if a number of hospitals decline to participate in the abortion service?

Will the Minister of State outline what actions have been taken to roll out services in the remaining nine units, including Kilkenny? Is there a national implementation plan by the HSE? Has the €12 million allocated for abortion services in the 2019 service plan been released in full? Will abortion care in early pregnancy be available in all 19 units by the end of 2019? Do smaller units have the facilities and expertise to provide abortion care in cases of fatal foetal anomaly and risk of serious harm to a woman's health? If not, how is a woman's care managed in those situations? Are there clear and robust referral pathways to larger hospitals?

Perhaps the main issue here is an issue of fear and fear of the unknown. Dr. Nóirín Russell, a consultant obstetrician and gynaecologist at Cork University Maternity Hospital, CUMH, has made the useful suggestion to partner the non-providing hospitals with a providing hospital to help.

Dr. Mike Thompson, a general practitioner and spokesperson for Start, the Southern Taskgroup on Abortion and Reproductive Topics, a group of doctors who support reproductive rights, expressed a worry that the attitude of the doctors in St. Luke's would "embolden other hospitals" to issue a similar diktat. He said that it was "effectively institutional obstruction", and that while they were trying to "conflate it with resources", St. Luke's was no less resourced than any other hospital.Given that we gave a resounding vote for such law to be put in place, I would like the Minister of State to outline how he will ensure that every woman in Ireland has access to safe abortion care and what the position is in respect of those hospitals that are refusing care so that all 19 maternity units can offer all the care that they need to.

Finian McGrath (Dublin Bay North, Independent)
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I welcome the opportunity to address this House on behalf of the Minister for Health, Deputy Simon Harris. He sends his apologies and has asked me to take this debate on his behalf.

I thank the Senator for raising this important issue. Last year the people of Ireland voted to repeal the Eighth Amendment of the Constitution. They did so, I believe, out of compassion for the women of this country, and out of respect and recognition of the need for safe, dignified and accessible reproductive health care for all. As a result the Health (Regulation of Termination of Pregnancy) Bill 2018 was passed by the Houses of the Oireachtas on 13 December 2018 and signed into law by the President on 20 December 2018. In January of this year, we successfully introduced services for termination of pregnancy in our hospitals and community services, and this achievement is testament to the dedication of the clinicians and staff across the service who worked so hard to ensure that this service was available to women in Ireland as soon as possible following the enactment of the Health (Regulation of Termination of Pregnancy) Bill 2018. The Government allocated a total €12 million in the budget for the provision of termination of pregnancy services in 2019. Terminations up to 12 weeks of pregnancy are currently being provided in ten maternity hospital units. In addition, all hospitals are providing terminations in emergencies, where a woman’s life or health is at risk. Terminations in cases of fatal foetal abnormality are available, generally, in the larger tertiary hospitals, as in such cases, particular expertise, only available in those hospitals may be required to perform the procedure.

Additionally, to date, 325 GPs nationally have signed up to provide the service in the community setting, where women can avail of terminations in cases of pregnancy up to nine weeks of pregnancy. The Minister’s policy is that all 19 maternity hospitals should be in a position to provide termination of pregnancy services under the Health (Regulation of Termination of Pregnancy) Act 2018. In that context I assure this House that there is regular and ongoing engagement between the Department of Health and the HSE on the operation of the service to resolve any issues that may arise.

Regarding maternity hospital units providing the termination services up to 12 weeks of pregnancy, which is the specific issue of concern, the HSE has advised that additional maternity units are expected to begin providing termination of pregnancy services up to 12 weeks in the coming months. The remaining units will then be considered for service expansion. Of course, the Senator raised a very important point on St. Luke's hospital, Kilkenny, the referrals, the legal aspect and the fear of the unknown. These are all important issues that I will raise as well with the Minister for Health However, the most important issue is that women accessing this service can do so with certainty of the quality and safety of the care they will receive. In that regard, my Department will continue to work with the HSE to ensure all women, regardless of location, can access this service quickly and easily, without bias or judgment, and that we fulfil our promise of a compassionate and dignified termination of pregnancy service.

Colette Kelleher (Independent)
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I hope that the allocation of €12 million to the HSE has been, or will be, released in full. The Minister of State answered the question on access to abortions for women at risk of serious harm. How is refusal of care being managed to ensure those who do not wish to be involved in service delivery are not in a position to obstruct colleagues who are conscientiously committed to providing abortion care? What is the HSE doing to ensure hospital staff, including those not involved in abortion care, receive appropriate training with respect to values, professionalism and ethics? In his reply, the Minister of State said that all 19 units "should be in a position" but I want to know whether they will be in a position to do so.Will the Minister of State give an assurance that will be the case? It is really important that this is in place by the end of this year at the very latest.

Finian McGrath (Dublin Bay North, Independent)
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The implementation of the Health (Regulation of Termination of Pregnancy) Act 2018 is a priority for the Minister for Health, Deputy Harris, for myself, and for the rest of us. A woman should be able to access these services in a local maternity hospital. It is expected that, by introducing such services across the country, women will be spared the need to travel lengthy distances to access a termination. At present, ten out of 19 hospital maternity units are providing the full service. The HSE has advised that additional units are expected to begin providing termination of pregnancy services in the coming months with the remaining hospital units being considered for service provision. It should be noted that terminations up to nine weeks of pregnancy are also provided by general practitioners and that 325 GPs nationally have signed up to provide this service in the community setting. The HSE has advised that feedback from a wide variety of stakeholders, including doctors from the START group and the Irish College of General Practitioners, suggests that the service is bedding down well.

The HSE My Options telephone helpline became operational on 1 January 2019. This is a freefone line for persons to call if they experience a crisis pregnancy. The information and counselling service is available from 9 a.m. to 9 p.m. from Monday to Friday, as well as from 10 a.m. to 2 p.m. on Saturdays. It is staffed by trained counsellors. The telephone nurses service is available on a 24-hour basis and is staffed by nurses and midwives. My Options can provide an interpreter for 240 different languages and its information leaflet has been translated into six.

There is regular ongoing engagement between the Department of Health and the HSE to facilitate the efficient operation of the service and to resolve any issues that arise. As the Senator has rightly said, we have to ensure the €12 million is spent and that it is spent effectively and properly. Any suggestion of obstruction or refusal of care must be dealt with under the Act. I will bring these concerns back to the Minister, Deputy Harris, for a more detailed answer.