Health (Miscellaneous Provisions) Bill: Report and Final Stages

Wednesday, 30 June 2010

Dáil Éireann Debate
Vol. 714 No. 1

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An Ceann Comhairle: Information on Seamus Kirk  Zoom on Seamus Kirk  The first amendment to be dealt with is in the names of Deputies Quinn and Jan O’Sullivan.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  According to the list of amendments, the first amendment is in my name.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  The first amendment is an additional amendment.

An Ceann Comhairle: Information on Seamus Kirk  Zoom on Seamus Kirk  The first amendment to be dealt with is in the names of Deputies Quinn and Jan O’Sullivan.

Minister of State at the Department of Health and Children (Deputy John Moloney): Information on John Moloney  Zoom on John Moloney  It is amendment No. a1.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  I move amendment No. a1:

This is a drafting amendment that was circulated after the list of other amendments and I do not propose to delay the time of the House on it.

Will the Ceann Comhairle clarify if any of the other amendments are grouped or are they all being taken separately?

An Ceann Comhairle: Information on Seamus Kirk  Zoom on Seamus Kirk  The list of amendments have been circulated. It is proposed to group amendments Nos. 1 to 3, inclusive, for the purpose of debate.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  Amendment No. a1 is a drafting amendment and I hope the Minister of State will accept it.

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  The advice from the Attorney General is that it is not proposed to accept the amendment. I will outline his position on it. The Attorney General’s office has advised that if a provision of this nature were to be inserted, the wording proposed in this amendment should not be used. This is a miscellaneous Bill which amends a number of Acts and it is not appropriate from a technical standpoint to collectively cite the whole of the Bill when enacted with the other health Acts. It is not proposed to accept this amendment as the Bill, as it stands, does not require it.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  I will withdraw the amendment as I do not want to delay the time of House discussing it further.

Amendment, by leave, withdrawn.

An Ceann Comhairle: Information on Seamus Kirk  Zoom on Seamus Kirk  Amendments Nos. 2 and 3 are related to amendment No. 1. Therefore, amendments Nos. 1 to 3, inclusive, may be discussed together.

[65]Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  I move amendment No. 1:

I do not wish to delay the House unduly on this amendment. We discussed this issue at a meeting of the Select Committee on Health and Children. I proposed that I would table an amendment on this matter for Report Stage. I want to read into the record what I said on this matter at the Select Committee on Health and Children. I said:

I also make another point which is not relevant to this matter. I will cite, for the benefit of the Minister of State as the Minister for Health and Children is not here, what the Minister said in reply. She said: “I am happy to agree to Deputy Reilly’s suggestion.” Therefore, I am somewhat surprised to see amendment No. 2, which does not reflect what I sought, unless amendment No. 2 is to be subsumed into the amendment I tabled. The difference between the Minister’s amendment and the proposal I highlighted clearly on Committee Stage, to which the Minister agreed, is that any proposal for any changed uses of lands at St. Luke’s would be laid before the Dáil and the Oireachtas Select Committee on Health and Children.

The Minister’s amendment states “the Executive shall use the land vested in it by this section for the purposes of the delivery of health and personal social services within the meaning of the Health Act 2004”, but it does not stipulate, as I did in my amendment, of which I gave notice and to which the Minister agreed, that any proposal for any changed uses of the lands would be laid before the Oireachtas by the Minister. The purpose of doing that is to allow the Oireachtas act on full information and to allow the people to see precisely what plans are being put in place before such plans are acted upon. That is what democracy is supposed to be about. It will not in any way tie the Minister’s hands per se. If the then Government were to have a majority on such a proposal, then it would have a majority, but at least the people of Ireland who have used this wonderful service would know of the proposal.

We have all been at one in praising the service provided by St. Luke’s, in particular, its ethos, the manner in which it looks after patients and their families in such a holistic fashion, and the great work done by the organisation, Friends of St. Luke’s. They all want to be assured that the people, as represented by their elected representatives through the Houses of the Oireachtas, will be able to have a say on what happens to St. Luke’s Hospital. That is reasonable. I was very pleased that the Minister agreed to that proposal. She said: “I am happy to agree to Deputy Reilly’s suggestion.” I hope there will not be any rowing back from that position.

I appeal to the Minister of State, in representing his senior Minister, to accept this amendment. What I have said is true and it can be checked in the “blacks”. There is no question of my trying to in any way to twist what the Minister said. What I cited is a direct quote from her from the record of the Committee Stage debate.

I propose that this amendment be accepted. I believe it will meet the concerns of many people who have used St. Luke’s, are very proud of their association with it and who wish to see the wonderful ethos in it continue throughout our oncology services.

[66]I do not wish to end on a negative note but the reality is that the HSE does not have such an ethos and we are deeply concerned that the ethos in St. Luke’s could be lost and equally that those lands and buildings could be lost. We do not want to see that happen.

Deputy Ruairí Quinn: Information on Ruairí Quinn  Zoom on Ruairí Quinn  Amendment No. 3 in my name and that of my colleague, Deputy Jan O’Sullivan, states:

To translate that into vernacular English, we want to hold on to St. Luke’s as a centre of cancer excellence; we do not want it to be sold. If the Minister wants to sell it, she or her successor will have to bring such a proposal back to this House and make a persuasive case for it. It is pretty simple.

The Minister of State is not the senior Minister responsible and therefore he is not accountable for undertakings given by the Minister verbally in the Chamber. Any verbal undertaken given by any Minister in any Administration is not worth the paper it is not written on. For the Government to suggest, with the arrogance that only a tired Administration can command faced with an election in 2012, that it will not implement a decision in 2014 makes Robert Mugabe look like a reluctant tyrant. Let us be realistic. This Administration will not form the next Government, according to all the opinion polls. To suggest instinctively, that I as Minister or that Deputy Harney as Minister would give a verbal undertaking that the Government would not be disposed to do as we seek indicates the reason for the Government parties’ rankings in the polls and why the Minister’s party has disappeared.

I attended the opening of Lios na nÓg, a Gaelscoil in Cullenswood House last Monday. I persuaded the Minister of State’s colleague, Deputy Treacy, when he was junior Minister with responsibility for the Office of Public Works, in 1987, after much argument and persuasion, not to proceed with the firesale of Cullenswood House. As the Minister of State may recall it was the birthplace of Scoil Éanna, the birthplace of the Gaelscoil movement and the birthplace of the school that Pádraic Pearse established in Oakley Road for the teaching of young people through the medium of Irish in the early part of the 20th century. The then Minister of State, Deputy Treacy, listened to the arguments I put to him, namely, that this was a dilapidated building in poor condition. The Office of Public Works then faced similar economic constraints and firesale conditions, although the conditions were not as bad as those now faced by the Minister of State’s Department and the Government. I advised the then Minister of State that the building was a building site and that little or no money would be secured from its firesale and that it would become an apartment block of anonymity and privacy. He was persuaded by my argument. Through a long process of preservation, consultation and gestation, having regard to the original purpose for which the building was preserved or held on to by the Cullenswood House committee, the building was transposed into the provision of a new Lios na nÓg school beside Scoil Bhríde, which was one of the original Gaelscoileanna in this country. President McAleese had the honour of opening that school less than ten days ago. If the then Minister of State, Deputy Treacy, had not had that courage, which I hope the Minister of State possesses, we would not have had that celebration less than ten days ago. This building would probably [67]become an anonymous, badly built, speculatively constructed, apartment block, something of which Ranelagh does not need more.

  4 o’clock

We have been told nothing will happen for another four years, until 2014. The property market will probably have recovered in part by then but our economic circumstances will remain difficult. The temptation to sell off this property in Dublin 6, as my constituency colleague, Deputy Lucinda Creighton, will concur, will be strong. If it were to be sold off and the proceeds transferred to the Health Service Executive which would then provide an equivalent facility of the same quality in another location, I would be somewhat open minded though still not persuaded. However, the idea of handing over that haven of calm, as one speaker described it on Second Stage, to the chaos of the HSE is beyond belief.

The Minister of State’s party will not be in government in four years’ time. He must not allow this facility to become the bureaucratic entitlement of the Department of Health and Children or the HSE, which is accountable to nobody. In the case of the Department, we can at least see our public servants in the Chamber today. Under the old system, some of us were members of health boards, possibly including the Minister of State, Deputy Moloney. However, the HSE is like the KGB, with public representatives never seeing or meeting with its officials. They do not answer our questions and are entirely unaccountable.

If this legislation is passed in its current form, St. Luke’s Hospital is gone. If the Minister of State does not accept the Labour Party amendment, this vital facility is doomed. Can he name another hospital anywhere in the country that could evoke the same degree of emotion, sympathy and support which the Friends of St. Luke’s Hospital have been able to mobilise? It is not simply a question of a feel good factor, as many mothers of children born in certain maternity facilities feel good about the process of having given birth there. We are talking about something much more substantial. We are talking about people who went through a journey which they may or may not have survived. They and their families attribute their survival, or the calm acceptance of the alternative outcome, as being greatly assisted by the calm environment of St. Luke’s Hospital. Yet the Minister is going to substitute it for St. James’s Hospital. We are going to transpose St. Luke’s Hospital and everything that surrounds it into the facility off St. Stephen’s Street. Who is in charge here?

Once state-of-the-start medical practice has measured and identified what is wrong with an individual patient — Deputy Reilly is more familiar than I with what is involved in that — the course of therapy is outside the narrow confines of measured medical interventions. There are other factors that cannot be measured but which contribute to the recovery or palliative care of patients. Just because we cannot measure them does not mean they do not exist. That immeasurable quality exists in St. Luke’s Hospital, yet the Minister of State is going to let the HSE flog off the facility even though his party will not even be in government when it happens. The Minister of State will regret, when he is in opposition in four years’ time, that he did not have the courage to say he did not agree with the permanent officials of the Department of Health and Children or the monster that is the HSE. A future Minister will have to come into this Chamber in 2014, stand where the Minister of State is standing today and persuade the House that it is a good idea. It is certainly not a good idea in 2010. Why is the Minister of State ceding to people in the HSE — people who never have to face election or accountability of any kind — the power to destruct a facility that has won the hearts and affections of hundreds of people throughout the State? For whom and for what is that being done? It is mind blowing.

We have not made a success of the reorganisation of our health services; everybody in the House would agree with that. There is much work to be done. I am advised by people who know far more than I about the mechanics and science of medicine that national centres of [68]excellence and the centralisation of cancer services is the best way forward. I do not dispute that, but the reality is that we do not know everything. What we do know, however, is that St. Luke’s Hospital works. Why impose a death certificate on this cancer treatment facility, which is what the Bill will do if our amendment is not accepted? It is a death certificate with a time stop of four years.

I have collected four boxes of petitions, which will be delivered to the Minister’s office, from people throughout the country. Deputy Creighton will concur that this is not simply a constituency issue. St. Luke’s Hospital is a national institution which happens to be located in the constituency of Dublin South-East, and the vast majority of the people who have petitioned me and Deputy Creighton do not live in the constituency. This is not parish pump politics; it is a question of national solidarity with an institution that works and whose existence has evoked an extraordinary loyalty. Yet the Minister of State wants to destroy it. I urge him to accept our amendment. If necessary, the Minister, Deputy Harney, can introduce the change in the Seanad. I ask the Minister of State to do a “Noel Treacy” on this and save St. Luke’s Hospital.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  Our objective is to save the best aspects of our health services. St. Luke’s Hospital has indisputably played an enormous part in many people’s recovery from cancer — people from throughout the country — over many years. I say this in the context of being fully supportive of the cancer strategy. Whenever we raise issues at the edge of the cancer strategy, the Minister disingenuously claims we are not supportive of the strategy itself. That strategy is about centres of excellence; it is not about doing away with the elements of excellence that already exist in the system. We are not arguing that St. Luke’s Hospital should be a stand-alone centre of excellence. Rather, we are arguing that it should be linked into one of the designated centres for the Dublin area while retaining its unique character and continuing the work it has been doing for generations.

It is difficult to measure the positive benefits for people recovering from or undergoing treatment for an illness like cancer of the type of atmosphere offered by St. Luke’s Hospital. A substantial body of research suggests that one’s state of mind, one’s environment and the way is which one is treated all contribute significantly in terms of recovery and response to treatment. Those elements are uniquely available at St. Luke’s Hospital in a way they are not in the large acute hospitals that have been designated as cancer centres.

We are not suggesting that diagnosis or surgery should be available in St. Luke’s Hospital, we are suggesting that there is a role for it to be attached to one of the other centres.

As health spokesperson for the Labour Party, I would hate to have been involved in throwing out all of the good elements of our health service to fit it into a straitjacket-style strategy; that is why I am arguing this point even though I support the core of the Minister’s strategy with regard to providing excellence in cancer treatment, where we do not do everything all over the place, which was the reality in the past and which needed to be addressed. This is different, it is about preserving something unique and special that could not be reconstructed.

There is protection until 2014 in the legislation and on Committee Stage when I tabled this amendment, the Minister appeared sympathetic to our arguments and said she would come back with a positive amendment. Initially, when I read the amendment she tabled, I thought she was responding to what we had raised. When we look at the detail of the amendment, however, it is subject to subsection (5) — that the executive must use it for the purposes of the delivery of health and personal social services. That subsection states that the executive may not without the consent of the Minister sell, exchange, let or otherwise dispose of any land vested in it by this section. If that is turned around the other way, with the Minister’s consent, [69]the executive can sell St. Luke’s Hospital. That is why the amendment is meaningless, it simply restates the contents of that subsection, it does not deliver what it promises at first reading. It does not give any reassurance beyond 2014 that St. Luke’s will be retained for health services.

Also, the Minister’s amendment relates to general health services while ours relates specifically to cancer. I am not satisfied with the Minister’s amendment despite the fact that on Committee Stage she seemed to take on board what we were saying.

The Minister of State, Deputy Moloney, might be able to offer a more holistic response on this issue. My experience of debating with the Minister for Health and Children on these issues is that for her it is about winning the debate, not about the health issue. I am trying to get agreement on the unique contribution of St. Luke’s Hospital and how to preserve that into the future without in any way interfering with the cancer control strategy.

There is no reason there could not be a centre in the hospital that does not offer surgery or diagnosis but that offers the sort of unique atmosphere in which follow-up treatment can be continued, such as specialist supervision under the auspices of the cancer control programme. That is what I envisage for all patients who will need these services, as well as for those families who are currently involved in treatment and want to ensure we maintain what we have.

We can develop strategies that look great on paper, and which deserve our support, but there are elements that are unique and different that can contribute something extra, which is what St. Luke’s Hospital does through its ethos. I do not see any reason why that cannot be incorporated within the strategy.

I ask the Minister to keep an open mind on this and to listen to the arguments of the Opposition and the voices of the public we are responding to on this issue.

Deputy Lucinda Creighton: Information on Lucinda Creighton  Zoom on Lucinda Creighton  I welcome the opportunity to speak on this and I acknowledge the work done by Deputies O’Sullivan, Reilly and, in particular, my constituency colleague, Deputy Quinn in pursuing this issue and offering a reasonable solution to the challenges facing us in this legislation.

I am pleased the Minister is here. I accept and understand this is a busy period from a legislative point of view but it is regrettable that legislation is being rammed through. Two weeks ago, there was a week where there no votes, no legislation of any substance and a week where the Government was completely unaccountable, wasting the time of Opposition Deputies, when legislation such as this could have been taken and we could have dealt with it in depth.

I do not want to give a Second Stage speech but I have profound concerns about the HSE. It is a failed entity and the transfer of the assets, resources and board of St. Luke’s Hospital to it is a fundamental error. St. Luke’s Hospital has worked for decades, since the early 1950s, but it will be broken if it is subsumed into the monster that is the HSE.

As an Opposition Deputy who has only been here for three years, it is depressing to see Opposition Members putting forward constructive amendments to improve legislation, as we did on Committee Stage last week, only to see Deputies from the Government side coming into the committee to vote against them without having even listened to the debate. That is precisely what happened last week and I presume it will happen again today. I regret that.

There are two substantive amendments. The first was tabled by the Labour Party last week — and I support it completely — to secure the land and buildings of St. Luke’s Hospital for public health care use, particularly cancer treatment. Deputy Reilly has also proposed an amendment that I understood from the Minister’s comments on Committee Stage she would be willing to accept, that in the event the Labour Party amendment is not acceptable, the Minister would put in place a safeguard that would oblige the Minister to appear before the [70]Dáil and the committee to detail any future changes to St. Luke’s Hospital. It now appears neither of these propositions is acceptable to the Government for some reason.

I reiterate to the Minister that Deputy Reilly, during his contribution on Committee Stage, said that he would table an amendment on Report Stage to have any review of services or new plans for St. Luke’s Hospital brought before the committee by the Minister. This would allow Members to have their say and to act on the basis of full information. In response to that, the Minister for Health and Children replied that she was happy to agree to Deputy Reilly’s suggestion. The Opposition Members present took that in good faith; unfortunately, it is not observed or being put forward in a substantive way in the amendment proposed by the Minister. As pointed out by Deputy Jan O’Sullivan, it is essentially an enabling provision which states that subject to the approval of the Minister the spirit of the proposal can be overridden. This is very unfortunate.

I accept that the Minister speaks in good faith when she states that she wishes to see the lands of St. Luke’s preserved and used long into the future for the public health service. Most of us on the Opposition benches would like to see them committed to cancer care services. Unfortunately, the Minister’s word will not be binding. Her word will not be enough if and when there is a change of government, and who knows who will be the future Minister for Health and Children. Unless it is written and woven into the legislation there will be no safeguard for St. Luke’s Hospital. I concur with the point made by Deputy Quinn that St. Luke’s Hospital will be given away and will no longer have the protection of legislation if the Bill is carried by the House today, even with the amendment proposed by the Minister. That would be unfortunate.

It is fair to state that while St. Luke’s Hospital is located in my constituency, it provides a national service and has done so for many years. It would be a sad day for the health service, cancer care and the tens of thousands of people who have benefited from the service through the years if either the Labour Party amendment or the Fine Gael amendment is rejected in the Chamber today. I appeal to the Minister to think carefully and to consider accepting one or other of the amendments proposed by the Opposition in good faith. It would stand to the Minister in the spirit of co-operation and trying to secure the best possible outcome for the hospital and its patients.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin  Zoom on Caoimhghín Ó Caoláin  I will preface my remarks on the amendments before us by stating that I am vehemently opposed to the passage of the Bill because it will result in the closure of St. Luke’s Hospital as we know it by 2014. That is something with which I strongly disagree. I also disagree with it because it is part of a flawed plan on the provision of radiation oncology throughout the State that will see entire communities and regions north of a line from Dublin to Galway discriminated against, including the constituency that I represent in the House, namely, Cavan Monaghan.

I support amendment No. 1 as far as it goes and I fully and enthusiastically endorse amendment No. 3. The very least that can be done if the Bill is to be passed today is to ensure that the lands and buildings of St. Luke’s remain in use for the provision of cancer — and I emphasise cancer — health services after 2014. I wish to stress further that this should be for public health services as the amendment tabled by Labour Party colleagues clearly states. I want to lay emphasis on this because it is a very important point.

There will be legitimate concern as to the future of the buildings at St. Luke’s and the site if it is left in the hands of the HSE with the approval of any Minister in the future as to what purpose or service it will be put. In my view, it should not only be with regard to health and [71]personal social services as the Minister’s approach suggests. It should be particular to the continuation of the treatment of cancer patients and in the public health service.

As I have stated on many occasions, the Minister and the Government have pursued a policy of health privatisation and a tax on public provision. I fear that, whether she and it be at the helm when any future decisions are taken, once the position is provided for the HSE will present a case to a future Minister and Government seeking approval for the disposal of these lands or their employment in some other purpose. That is unacceptable.

As I stated on Second Stage, last year I had the sad experience of attending in St. Luke’s my brother-in-law who died — a younger man than me. While everyone does not have happy outcomes, there is no question as to the care and special location. I stated on Second Stage that I found the experience of visiting at St. Luke’s, distressing though it is for any of us who are family members watching a loved one in such a deteriorating condition, a new hospital experience. I have an abiding memory of it, which concurs with the case put by other voices this afternoon and over a protracted period of time in support of the continuation of St. Luke’s for the particular and wonderful place it is.

Amendment No. 2 from the Minister is absolutely inadequate, as will be clear from what I already stated. It is still subject to section 6(5) of the Bill, which would allow the HSE to dispose of the St. Luke’s premises and lands with the approval of the Minister of the day.

It was signalled last year — and I asked for clarification because it has not been asked so far — that after 2014 St. Luke’s would continue to be used as a cancer care facility. I refer specifically to the remarks of the chair of the hospital board, Padraic White, who stated as such as I recall. Will the Minister or Minister of State — whoever is replying — confirm that the chair of the hospital board, Padraic White, made that commitment?

In support of amendment No. 1 and, in particular, of amendment No. 3 and in rejection of amendment No. 2, St. Luke’s is rightly regarded as a unique hospital facility in the Irish hospital and health care experience. It is worthy of special mention and a special case, even with the Minister’s ongoing intent with the roll-out of her cancer care plan. Its quiet atmosphere and peaceful surroundings all contribute greatly. I wish to pay tribute to the particular care provided by the most important resource of all that I noted during my visits last year, which is the excellent staff.

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  Deputy Reilly concluded his contribution by stating he did not want to end on a negative note; I do not want to begin on a negative note. I will reply to some of the issues raised. I have been here 13 years and it is the first time I have been the direct subject of a lecture from Deputy Quinn. I watched him on several other occasions over the years. It is my turn to respond.

Deputy Ruairí Quinn: Information on Ruairí Quinn  Zoom on Ruairí Quinn  It is called democracy.

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  Coming from Deputy Quinn it is a talk down. I have watched it before.

The Deputy appealed to me to show courage. I wonder if courage is all about supporting the popular thing in the constituency or if it is about supporting what is laid down in the national cancer strategy. I would like to show the Deputy that having knowledge of St. Luke’s Hospital is not confined to Dublin Deputies.

Deputy Ruairí Quinn: Information on Ruairí Quinn  Zoom on Ruairí Quinn  As I said.

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  The Deputy did not really say it. He explained he knew about the peace and tranquillity of the hospital. I know it quite well as my aunt died there some years [72]ago. The Deputy has a habit of thinking that Fianna Fáil Deputies are lesser beings or representatives.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  This is not acceptable.

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  Can I respond?

An Leas-Cheann Comhairle: Information on Brendan Howlin  Zoom on Brendan Howlin  Through the Chair.

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  For a number of years I have considered the question of supporting best practice and what is best for the patient. When the former Minister for Health, Deputy Noonan, selected the hospital in the next county to me in Tullamore for the national cancer strategy, as opposed to my hospital I, along with four councillors in Laois, were the only people to support the next county. Therefore, I do not need a lecture in courage or doing the right thing.

When we debated this issue, one would imagine that all of the health professionals were opposed to the Government proposals. Yet, I read about the support for Professor Tom Keane and Professor Donal Hollywood, whom we hold up to be some of the most reputable experts in the area of cancer treatment and who support the Government’s proposals. The Friends of St. Luke’s Hospital are due to meet the Minister on 9 July. I would have thought it would have some input into what future it holds for the hospital.

I am not interested in where I will be in three or four years’ time; I am discussing the current health strategy as best practice. I have to take issue with comparing the KGB and the HSE. I am not sure how often Deputy Quinn attended the meetings in this House in the audiovisual room held by the HSE. It came in on many occasions but the meetings were disbanded because so few Deputies attended them. I see no connection whatsoever between the KGB and the HSE. In fact, I fully support what the HSE is doing.

The HSE was set up to try to bring unity of purpose to the delivery of health services, which is what we support. We want to see it happen and I see it happening in the national cancer strategy. Some have been selective in suggesting that I support the amendments which ignored the national cancer strategy proposals for best practice. I do not see the connection and that is why I fully support the Minister. I also support everything she has done in terms of the national cancer strategy.

On the commitments made by the Minister, no Member of this House can single out any commitments she made over the years upon which she has reneged. The issue of the sale of St. Luke’s Hospital was the Deputy’s main point. There is no intention to sell it off, a point which has been made clear by the Minister on Committee Stage and previously. It could not be sold in future without the permission of the Minister for Health, regardless of who that will be. Therefore, I do not see how it can be an issue for the Minister.

To return to amendments Nos. 1 to 3, inclusive, it is important to reiterate what the Minister said on Committee Stage and subsequently. As we know, radiotherapy services will continue at St. Luke’s Hospital until 2014. The Minister stated on Second and, I understand, Committee Stages that it is her intention that the site will continue to be used for healthcare purposes in the future. I can understand the media coverage is showing some concerns about the future use of the land and buildings of St. Luke’s Hospital. There are concerns that there may be an intention to sell off the site.

In response to the amendment tabled by Deputies Reilly and O’Sullivan, the Minister reiterated on Committee Stage that it is her intention that St. Luke’s Hospital should continue to be [73]used for healthcare purposes after 2014. It is built into the Bill and will be considered when radiotherapy services cease at the hospital. On amendment No. 1 tabled by Deputy Reilly, it is the Minister’s view that it is not an appropriate way to address the concerns that have been raised or to provide any guarantees about the future uses of the hospital. It would lead to an unwieldy decision making process that will not provide any certainty about the future of St. Luke’s Hospital.

On amendment No. 3, the Minister does not consider it appropriate that the use of the site should be restricted to a specific aspect of healthcare, such as cancer care, as is proposed. Therefore, it is not proposed to accept amendment No. 1 or amendment No. 3. I refer to Committee Stage and Second Stage in the Dáil, on which the Minister was clear that her intention was that the site should be used for any purposes other than the provision of health services. In this regard, the board of the hospital, in conjunction with the Friends of St. Luke’s hospital, has commissioned a report on the best use of the facility and until that is received and there is an opportunity to engage with the various parties involved, the Minister does not wish to be prescriptive on this Bill.

On Committee Stage the Minister stated that she would reflect on the concerns raised about the use of St. Luke’s Hospital site for public health facilities before Report Stage. Accordingly, I propose that amendment No. 2 is accepted by Deputies. The Minister believes the amendment will address the concerns the Deputies have expressed on the future use of St. Luke’s Hospital after 2014 when radiotherapy services cease.

Section 6 addresses concerns about the future use of the site by explicitly requiring the consent of the Minster for any disposal of the land. However, the Minister acknowledges the concerns which remain and proposes this amendment to bring certainty and clarity to the position. As a result of this amendment the Bill will explicitly provide that the hospital site will be used by the HSE for the purposes of providing health and personal social services in line with the Health Act 2004. I ask Deputies to support the amendment.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  I remind the Minister what I and Deputy Creighton have already told the House and her words to me when I said I would table an amendment on Report Stage to have any review of services or new plans for St. Luke’s Hospital brought before the committee by the Minister. This would allow Members to have their say and act on the basis of full information. The Minister told me she was happy to agree to my suggestion. I regret the Minister of State’s belief that my amendment would serve no purpose. It sets out its purpose clearly. There is no benefit in reiterating it if the Minister chooses not to hear it.

The Minister of State also said that he had never known the Minister to renege on her word. Unfortunately, that does not fit with reality. The cervical cancer vaccine and the cystic fibrosis unit at St. Vincent’s which we were promised would be built this year were not delivered. There was a co-located hospital policy that was to fast-track 1,100 beds into the system five years ago which it still to give us a bed, have a sod turned or a brick put in place. I understood we had agreement on this. I know the Minister agreed to it because it is on the record of the House for the Select Committee on Health and Children. I can do little other than remind her what she said. I can only appeal to her to see the benefit of what we proposed, namely, to allow the people to have their say in any future review of the services, buildings and plans for St. Luke’s Hospital.

I fully subscribe to the Labour Party amendment. It was defeated at the Select Committee on Health and Children. This is a compromise which I again remind the Minister she agreed to at the meeting. I can only lay my case before the House and let others be the judge.

[74]Deputy Ruairí Quinn: Information on Ruairí Quinn  Zoom on Ruairí Quinn  I have listened with interest to what the Minister of State said. I regard any person elected in this republic and to this assembly as an equal citizen with the same mandate. There are no first or second division Deputies, irrespective of what party they belong to or if they belong to none. If what I might have said or the way in which I said it suggested that I did not so believe, that is not the case. I do believe, however, that just as the KGB was the secret service in the Soviet Union, the HSE in the way in which it relates to directly elected Members is the secret service of our health system because we do not get answers. I was with Professor Drumm in the Alexander Hotel when the best of things were promised and I had great hopes for that kind of response. The reason I stopped writing to the HSE or attending those meetings is that they ceased to be effective.

As my colleague, Deputy Jan O’Sullivan has stated, we support the national cancer strategy. We support the experts. My Second Stage speech on this Bill did not challenge that. I merely pointed out with a degree of humility and on behalf of this generation of human beings that we do not know everything. The things we can measure are not all we can experience and the calm haven of St. Luke’s to which Deputy Ó Caoláin referred has benefited many people. We are not seeking to change the national cancer strategy or its timetable. All we want is to add a belt and half a brace to the legislation, which will only become active in 2014 — who knows what will prevail by then — so that the decision making process will be delayed to allow the continued delivery of a residue of cancer treatment in the calm haven of St. Luke’s.

Minister for Health and Children (Deputy Mary Harney): Information on Mary Harney  Zoom on Mary Harney  I wanted to be here earlier but I was taking the prescription charges legislation in the Seanad. When that debate concluded I came to the Dáil, although I do not mean to imply I have no confidence in the capacity of the Minister of State, Deputy Moloney, to address the issues arising. I wish to make some remarks for the record because I have grown weary of Opposition Deputies constantly saying they support the cancer control programme only to criticise specific parts of it.

Four years ago, 32 hospitals performed breast cancer surgery in Ireland. In one instance, a surgeon carried out a single procedure in a year. This was totally unsafe and it produced bad outcomes for patients and the health care system. We have changed these practices after asking a group of 23 people, of whom 19 were clinicians, from this country and abroad to investigate the best international practices which this country should follow in organising its cancer services. This group made recommendations which were endorsed by the Government. A group under Professor Hollywood was established specifically to examine radiation oncology. The report of the group recommended that radiation oncology should not stand alone from other cancer services. An evaluation was conducted of all the facilities, including St. Luke’s. The evaluation committee, which comprised nominees from the National Institutes of Health in the United States, the European Society for Therapeutic Radiation and Oncology and a radiation oncology institute in the UK, gave the following scores: St. Luke’s, 3,965; St. James’s, 8,897; St. Vincent’s, 8,497; and Tallaght, 7,484.

All hell would break loose in this House if I moved a facility that received a score of 8,000 to one with a score of 3,900. I would be rightly told, as I was during Private Members’ business last night, that I did not put patients first. A motion has been put before the House which asks us to establish a new authority that would put patients first, yet every clinician who works solely in the public system favours this approach, as do the Irish Cancer Society, Europa Donna and every other patient advocacy organisation I have encountered.

I fully acknowledge that St. Luke’s has a terrific reputation and I want to preserve its ethos. Until relatively recently radiation oncology could be administered only in St. Luke’s. Members of all our families have been given a fantastic service at the hospital. Health care moves on, however, and developments in cancer care are revolutionary as well as evolutionary. We either [75]go with the pace of change in order to achieve better outcomes for patients based on evidence or we stay fixed in time and deliver less. Neither I, as Minister for Health and Children, nor the Government is prepared to take the latter option.

I made the remarks to which Deputy Reilly referred in the context of a Bill which at the time lacked provision to maintain public health services at St. Luke’s. I have now come forward with an amendment because my word was not trusted. Since this decision was made, I have stated it was never intended to use St. Luke’s for any purpose other than public health because, God knows, we have relatively few facilities close to the centre of Dublin and its growing population. Instead of giving my commitment to discuss the issue in committee, I am writing it into the legislation. How much stronger could I be?

Do not pretend I am reneging on my word because I do not renege on the policies I make. We were required to put the cystic fibrosis unit at St. Vincent’s to public tender but the company which came first was not in a position to make the tender bankable. I am confident that a successful tender will be found shortly. I do not choose who constructs these projects but I stand over the policies I make. I accept the cervical cancer vaccine was delayed for financial reasons but all the girls who were affected in that year are being covered. The programme was delayed but it was not reneged on and the Deputy needs to use his language carefully.

I know that patients have had a happy experience in St. Luke’s and many of them are sad and, in some cases, emotional about what is happening. However, all the clinical expertise we could assemble, both from within this country and from abroad and including an expert of Professor Keane’s global reputation in radiation oncology, supports what we are doing. I do not wish to ring fence the future use of the facility for cancer treatment because it could also serve palliative patients. Not all palliative patients are cancer patients. Perhaps it could incorporate a long-term care facility. Prospectus is producing a report for the Friends of St. Luke’s Hospital and we will engage honestly with regard to the future use of the hospital. I had thought a guarantee that it will be used for public health services would be good enough for the Deputies opposite and I am sorry that is not the case.

The decisions taken by the Government were based on the best clinical expertise we could assemble from within this country and abroad. The three nominees from the aforementioned institutes, along with two doctors from Ireland, evaluated all the submissions and scored them accordingly. We may not like the scores but we must be prepared to accept them. For that reason, I am not in a position to reverse my decision or to maintain what is broadly known as a stand-alone radiation oncology facility at St. Luke’s beyond 2014. As I want to maintain the hospital’s ethos and name, the new unit at Beaumont or St. James’s will be called the St. Luke facility. However, this issue is about more than just a name because we are focused on achieving the best outcomes and care for our cancer patients.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  Once again the Minister is distorting what Opposition Deputies have said. I previously stated that we did not believe 32 hospitals should carry out surgery and we completely supported her decision in that regard. She should not shake her head because I want the same respect as the Minister of State, Deputy Moloney, demanded. We are entitled to this respect as public representatives.

We are not insisting on maintaining St. Luke’s as a stand-alone radiation oncology unit. I am sick and tired of having my words distorted when I speak about cancer in this House. As Labour Party spokesperson on health, I support the national cancer strategy but we are trying to maintain St. Luke’s as a facility for the treatment of ailments related to cancer in public patients in a manner and form to be determined by the HSE with the consent of the Minister. That language is open enough to allow other forms of palliative care if that is what she desires, although I doubt she will still be Minister when this provision comes into effect. I do not want [76]my words distorted. I support the concept of excellence and the type of strategy enunciated by the Minister. However, having moved surgery, certain diagnostics and other services from Sligo to Galway, the Minister agreed, following talks she and Professor Keane had with people in Sligo, that patients could have subsequent care provided in Sligo General Hospital in a safe manner. Why is a similar position not allowed in the case of St. Luke’s Hospital? Why can the hospital not be linked into one of the Dublin centres of excellence? What is the difference between St. Luke’s Hospital and Sligo General Hospital?

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Radiation is not provided in Sligo General Hospital.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  I am talking about cancer not radiation. This is precisely what I meant when I stated the Minister is interpreted our words in a way that suits her argument.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  The Deputy suggested last week that St. Luke’s Hospital should become a satellite centre.

An Leas-Cheann Comhairle: Information on Brendan Howlin  Zoom on Brendan Howlin  Please allow the Deputy to make her contribution without interruptions. I ask Deputy O’Sullivan to conclude.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  The Minister should refer to what is in the amendment, rather than what she imagines is in it.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin  Zoom on Caoimhghín Ó Caoláin  The Minister arrived late, although I do not believe that is the reason she has chosen to present a particular view of Opposition Deputies’ arguments. For my part, my voice is perhaps unique among all the voices in the House in saying that I am not happy with the Minister’s cancer plan, as I will describe it. As I stated before the Minister took her seat, it discriminates against the community I represent and people of all regions north of a line from Dublin to Galway. The Minister will be familiar with the axis from Dublin to Galway but there is another part of the country north of it where people are no less deserving of cancer services at locations in the north west and north east. The current and intended arrangements fall far short of what is required.

There is also potential for real and imaginative cross-Border co-operation. I do not believe the current signalled exodus of people from Donegal to Belfast comes in any way close.

I disagree with the Minister’s proposal on St. Luke’s Hospital. The Bill, as drafted, will remove the hospital and the adoption of amendment No. 2, in the Minister’s name, will not alter a scenario which will present whereby St. Luke’s Hospital will be employed in a non-related, non-cancer area in the HSE or, worse, sold off, perhaps even to fund the working budgetary needs of the HSE in future.

The Minister has failed to take on board the critical concerns of Members. I commend amendment No. 3. The reason I refer specifically to this amendment is it leaves the door open for the decision to be taken on the future of St. Luke’s Hospital in a clear and positive manner in relation to cancer care provision and in the public health service network. This is the future that those of us on this side of the House and many more people the length and breadth of the State and beyond want to see. The issue is not simply a local constituency matter because St. Luke’s Hospital has all too sadly been very much part of the family experiences of too many families up and down the length of the State over many years.

Deputy John Perry: Information on John Perry  Zoom on John Perry  Sligo General Hospital serves a catchment population of 250,000. Information has come to light showing that University College Hospital Galway has inadequate facilities to deal with the overflow from Sligo. I ask the Minister to reconsider the position [77]given that the facility being closed in Sligo General Hospital is being duplicated in Letterkenny General Hospital. The decision has created difficulties and has had a negative impact.

I ask the Minister to reconsider the position in light of the palliative care, haematology services and medical care available at Sligo General Hospital, as well as the 4,000 mammograms carried out at the hospital each year, its catchment population of 250,000 and the information secured under freedom of information legislation last week — information that was concealed — which clearly indicates that the Galway centre of excellence was not in a position to proceed with the transfer of services from Sligo.

The Minister indicated that two beds would be available at University College Hospital Galway for cancer patients from the catchment area of Sligo General Hospital. We have discovered that only one bed is available for this catchment population of 250,000. Is this not an indictment of a failed policy?

Professor Keane who introduced the cancer control policy has left his post. Accreditation was given to Sligo General Hospital and it was placed on a par with the best hospitals in the United States. The HSE is closing down its cancer care facilities and recreating them at Letterkenny General Hospital. Will the Minister reconsider the position in this regard? The matter will not go away and if Fine Gael is in government the service will be reinstated at Sligo General Hospital in the shortest possible timeframe.

Deputy Lucinda Creighton: Information on Lucinda Creighton  Zoom on Lucinda Creighton  I am not opposed to the cancer strategy and, as I stated on Second Stage, I am not in a position to second guess the best medical experts on the roll out of cancer treatment. A similar position applies in the case of most of my colleagues on this side. That is not the point, however. The issue here is one of preserving a facility specifically for public health services. As the Minister correctly noted, there is major pressure and demand close to Dublin city centre.

The issue before us is not only about preserving the name or ethos of St. Luke’s Hospital but about preserving the site and buildings in Rathgar for the benefit of public health care long into the future. My concern is not in any sense to try to debunk or detract from the national cancer strategy. The Opposition parties are trying, in good faith, to ensure the site is secured. We are concerned, however, that amendment No. 2 will not achieve that objective. I take the Minister’s words in good faith and I believe her statement during the Committee Stage debate last week that she is committed to preserving St. Luke’s Hospital. On that basis, she should be constructive and accept amendments Nos. 1 and 3 as alternatives to her amendment No. 2.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Without wishing to repeat myself, I believe my amendment achieves what Deputy Creighton seeks, namely, the preservation of the site for public health services. The Deputy stated this is not about the name or ethos of the hospital but about the site, buildings and land. I agree with her and my amendment will achieve that objective.

On Deputy Perry’s remarks, it is news to me that Fine Gael in government would reverse the decision on Sligo General Hospital. I understood the party’s spokesperson stated in Sligo that the process would be too far gone to reverse it.

Deputy John Perry: Information on John Perry  Zoom on John Perry  It is not that far gone.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  I do not know from where the Deputy has his data. To meet the standards for breast cancer, a centre must have two specialist breast surgeons, two radiologists and two pathologists. Sligo General Hospital has one breast surgeon.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  How many breast surgeons does Letterkenny General Hospital have?

[78]Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  When the breast surgeon in Sligo General Hospital was on holiday or off work there was no service.

Deputy John Perry: Information on John Perry  Zoom on John Perry  The Minister will find ten reasons if she wants to.

An Leas-Cheann Comhairle: Information on Brendan Howlin  Zoom on Brendan Howlin  Please allow the Minister to address the House without interruption.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  That is supported by all the evidence domestically and from patient advocacy groups.

Deputy John Perry: Information on John Perry  Zoom on John Perry  Please do not tell me about evidence.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  On the number of beds, Professor Keane estimated that two beds would be required. The issue is not one of bed numbers but patient services. I understand a number of patients from Sligo are coming to the Dublin area for treatment. This option has been always available. The important issue is that when patients require access to the cancer centre in Galway——

Deputy John Perry: Information on John Perry  Zoom on John Perry  Some 250,000 people are being completely ignored.

An Leas-Cheann Comhairle: Information on Brendan Howlin  Zoom on Brendan Howlin  Please, Deputy Perry.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  ——that that access is provided in a timely fashion so that we can get good outcomes for patients.

Deputy John Perry: Information on John Perry  Zoom on John Perry  The problem will not go away.

An Leas-Cheann Comhairle: Information on Brendan Howlin  Zoom on Brendan Howlin  Please, Deputy Perry.

Deputy John Perry: Information on John Perry  Zoom on John Perry  This is a major issue.

An Leas-Cheann Comhairle: Information on Brendan Howlin  Zoom on Brendan Howlin  This is a House of debate. The Deputy should allow people to speak.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  I do not want to make political points here, but if I heard the Fine Gael health spokesman say that he would reverse the decision on Sligo, that would certainly be news to me. On the wider issue, I believe the Government amendment satisfies the requirements the Deputies mentioned on Committee Stage.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  I would be delighted to tell the Minister precisely what I said and I am sure Deputy Perry will back this up. I said that if there is a change of Government soon and I hope there will be——

Deputy John Perry: Information on John Perry  Zoom on John Perry  Absolutely.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  ——we will seek to reverse the changes the Minister made regarding Sligo and reinstate the service, but the longer it goes on the more difficult that will be.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  The Deputy spoke about it four months ago.

Deputy John Perry: Information on John Perry  Zoom on John Perry  Yes. So I am saying that if it goes much beyond a year it will be very difficult.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  That is why——

[79]An Leas-Cheann Comhairle: Information on Brendan Howlin  Zoom on Brendan Howlin  Please Minister, as I required silence for your contribution, I require silence for others also.

Deputy John Perry: Information on John Perry  Zoom on John Perry  There are a lot of unhappy backbenchers at the moment.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  Depending on the amount of time that passes, if the staff with expertise are gone, it will be very difficult to reinstate the service. If the staff and all the services are still there——

Deputy John Perry: Information on John Perry  Zoom on John Perry  They are all there.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  ——that is a different matter entirely.

The Minister is a great woman at reframing the question. She stood up and waxed lyrical about the cancer strategy when what is being discussed here is an amendment to a specific Bill on the future use of the lands, facilities and buildings at St. Luke’s Hospital.

Deputy Ruairí Quinn: Information on Ruairí Quinn  Zoom on Ruairí Quinn  No more, no less.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  However, since she has decided to go down the route she has taken, I will certainly challenge what she has said. She said that the commitment on the cervical cancer vaccine was not reneged upon and merely delayed, and that all those who should have got it will get it. I remind her of her original promise to the House, which was that everybody aged from 13 to 15 would get it. Will they get it now? No, they will not. Girls who were 12 last year and are 12 this year will get it and those children who were 13, 14 or 15 years old 1.5 years ago will now not get it.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  The Deputy is wrong.

  5 o’clock

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  The Minister can wag her head all she wants. Furthermore, she very conveniently neglected to mention her failed and utterly discredited co-location hospital policy. Regarding cystic fibrosis, it is the Minister’s duty not just to apportion funds, but also to ensure that those funds are used for the purposes for which they have been allocated and that tendering processes etc. are done in a way that result in the desired outcome that people expect. However, that is not happening. Because it is designed to be paid at the end, in the current economic climate I warrant that the Minister will have grave difficulty getting tenders to go through successfully. In the meantime Irish citizens, many of them living in my constituency are being disadvantaged to the point where they die ten years younger than their counterparts in the North of Ireland do. That is real. It is real for Orla Tinsley who spoke from her hospital bed on radio this week. We are not talking about theoretical situations here; we are talking about reality.

The Minister now wants to deny her own words. In direct response to what I said, the Minister now wants to revisit the context and change the context. What she said is very simple. She said: “I am happy to agree with Deputy Reilly’s suggestion.” I read the suggestion into the record of the House twice and Deputy Creighton has read it in once. The Minister can shake her head all she likes, but it is in black and white for the people to judge for themselves. What little credibility she had is rapidly diminishing.

The cancer strategy is not unlike the concept of the HSE. The devil is in the detail. There is nothing wrong with the concept of the HSE to provide health care for 4.2 million people. However, the manner in which the Minister went about it, amalgamating ten health boards and a shared services unit without anybody being asked to take redundancy, with everyone guaranteed to keep his or her job and stay in the same job has led to the total dysfunctionality [80]we have. The chief executive officer, Professor Drumm, whom the Minister appointed, told our party before I even joined it that there were 3,500 people who did not even know what their jobs were. Nobody in this House believes any longer in the ability of the HSE to look after children in care or run our health service. It is completely discredited which is a terribly sad thing to have to say about the many excellent people who work in the HSE, in administration and medical-wise in nursing and many other areas.

Let us consider the Minister’s cancer strategy, with which I agreed in principle. I have no problem with the centralisation of services for specialised treatment. However, I object to her methodology and the very devious use of statistics to compare outcomes for breast cancer patients from the west coast vis-à-vis the east coast using figures for 2003-04 when there was no specialist in breast cancer, radiology specialising in mammography and pathology in Sligo. As five years survival means five years, the figures from 2003-04 relate to 1998-99 before these people were present. However, when the figures from 2007 relating back to 2002 are compared, they are every bit as good in the north west as they were on the east coast.

The Minister allows private facilities in Dublin to act as satellites with hospitals in America, but she has an issue with Sligo General Hospital doing it with the University College Hospital in Galway, and yet she reproduces that model in Letterkenny. It is the inconsistency and unfairness that bother people. I wanted to address those issues as the Minister raised them.

I wish to return to the core issue, which is that people have a deep concern about what will happen to St Luke’s Hospital. I support the Labour amendment, but I can understand the argument that it ties the Minister’s hands. My amendment allows us to revisit it in this House. In the Minister’s own words that was what she was happy to agree to. However, something has happened in the interim and she wants to reframe everything. For some reason unknown to me, she does not want to agree to what is an extremely reasonable compromise.

Amendment put.

The Dáil divided: Tá, 67; Níl, 70.

Information on Bernard Allen  Zoom on Bernard Allen  Allen, Bernard. Information on James Bannon  Zoom on James Bannon  Bannon, James.
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Information on Brian O'Shea  Zoom on Brian O'Shea  O’Shea, Brian. Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  O’Sullivan, Jan.
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Níl
Information on Bertie Ahern  Zoom on Bertie Ahern  Ahern, Bertie. Information on Dermot Ahern  Zoom on Dermot Ahern  Ahern, Dermot.
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Information on Bobby Aylward  Zoom on Bobby Aylward  Aylward, Bobby. Information on Niall Blaney  Zoom on Niall Blaney  Blaney, Niall.
Information on Cyprian Brady  Zoom on Cyprian Brady  Brady, Cyprian. Information on Johnny Brady  Zoom on Johnny Brady  Brady, Johnny.
Information on John Browne  Zoom on John Browne  Browne, John. Information on Thomas Byrne  Zoom on Thomas Byrne  Byrne, Thomas.
Information on Dara Calleary  Zoom on Dara Calleary  Calleary, Dara. Information on Pat Carey  Zoom on Pat Carey  Carey, Pat.
Information on Niall Collins  Zoom on Niall Collins  Collins, Niall. Information on Margaret Conlon  Zoom on Margaret Conlon  Conlon, Margaret.
Information on Sean Connick  Zoom on Sean Connick  Connick, Seán. Information on Mary Coughlan  Zoom on Mary Coughlan  Coughlan, Mary.
Information on John Cregan  Zoom on John Cregan  Cregan, John. Information on Ciaran Cuffe  Zoom on Ciaran Cuffe  Cuffe, Ciarán.
Information on John Curran  Zoom on John Curran  Curran, John. Information on Noel Dempsey  Zoom on Noel Dempsey  Dempsey, Noel.
Information on Jimmy Devins  Zoom on Jimmy Devins  Devins, Jimmy. Information on Tim Dooley  Zoom on Tim Dooley  Dooley, Timmy.
Information on Frank Fahey  Zoom on Frank Fahey  Fahey, Frank. Information on Michael Finneran  Zoom on Michael Finneran  Finneran, Michael.
Information on Michael Fitzpatrick  Zoom on Michael Fitzpatrick  Fitzpatrick, Michael. Information on Seán Fleming  Zoom on Seán Fleming  Fleming, Seán.
Information on Beverley Cooper-Flynn  Zoom on Beverley Cooper-Flynn  Flynn, Beverley. Information on Paul Nicholas Gogarty  Zoom on Paul Nicholas Gogarty  Gogarty, Paul.
Information on John Gormley  Zoom on John Gormley  Gormley, John. Information on Noel Grealish  Zoom on Noel Grealish  Grealish, Noel.
Information on Mary Harney  Zoom on Mary Harney  Harney, Mary. Information on Seán Haughey  Zoom on Seán Haughey  Haughey, Seán.
Information on Jackie Healy-Rae  Zoom on Jackie Healy-Rae  Healy-Rae, Jackie. Information on Máire Hoctor  Zoom on Máire Hoctor  Hoctor, Máire.
Information on Billy Kelleher  Zoom on Billy Kelleher  Kelleher, Billy. Information on Peter Kelly  Zoom on Peter Kelly  Kelly, Peter.
Information on Brendan Kenneally  Zoom on Brendan Kenneally  Kenneally, Brendan. Information on Michael Kennedy  Zoom on Michael Kennedy  Kennedy, Michael.
Information on Tony Killeen  Zoom on Tony Killeen  Killeen, Tony. Information on Michael Kitt  Zoom on Michael Kitt  Kitt, Michael P.
Information on Tom Kitt  Zoom on Tom Kitt  Kitt, Tom. Information on Conor Lenihan  Zoom on Conor Lenihan  Lenihan, Conor.
Information on Dr Martin Mansergh  Zoom on Dr Martin Mansergh  Mansergh, Martin. Information on Tom McEllistrim  Zoom on Tom McEllistrim  McEllistrim, Thomas.
Information on Michael McGrath  Zoom on Michael McGrath  McGrath, Michael. Information on John McGuinness  Zoom on John McGuinness  McGuinness, John.
Information on John Moloney  Zoom on John Moloney  Moloney, John. Information on Michael Moynihan  Zoom on Michael Moynihan  Moynihan, Michael.
Information on Michael Mulcahy  Zoom on Michael Mulcahy  Mulcahy, Michael. Information on M. J. Nolan  Zoom on M. J. Nolan  Nolan, M.J.
Information on Éamon Ó Cuív  Zoom on Éamon Ó Cuív  Ó Cuív, Éamon. Information on Seán Ó Fearghaíl  Zoom on Seán Ó Fearghaíl  Ó Fearghaíl, Seán.
Information on Darragh O'Brien  Zoom on Darragh O'Brien  O’Brien, Darragh. Information on Charlie O'Connor  Zoom on Charlie O'Connor  O’Connor, Charlie.
Information on Willie O'Dea  Zoom on Willie O'Dea  O’Dea, Willie. Information on Noel O'Flynn  Zoom on Noel O'Flynn  O’Flynn, Noel.
Information on Ned O'Keeffe  Zoom on Ned O'Keeffe  O’Keeffe, Edward. Information on Mary O'Rourke  Zoom on Mary O'Rourke  O’Rourke, Mary.
Information on Peter Power  Zoom on Peter Power  Power, Peter. Information on Seán Power  Zoom on Seán Power  Power, Seán.
Information on Dick Roche  Zoom on Dick Roche  Roche, Dick. Information on Eamon Ryan  Zoom on Eamon Ryan  Ryan, Eamon.
Information on Trevor Sargent  Zoom on Trevor Sargent  Sargent, Trevor. Information on Eamon Scanlon  Zoom on Eamon Scanlon  Scanlon, Eamon.
Information on Brendan Smith  Zoom on Brendan Smith  Smith, Brendan. Information on Mary Wallace  Zoom on Mary Wallace  Wallace, Mary.
Information on Mary Alexandra White  Zoom on Mary Alexandra White  White, Mary Alexandra. Information on Michael J. Woods  Zoom on Michael J. Woods  Woods, Michael.

Tellers: Tá, Deputies Emmet Stagg and Paul Kehoe; Níl, Deputies John Cregan and John Curran.

Amendment declared lost.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  I move amendment No. 2:

Amendment agreed to.

[82]An Ceann Comhairle: Information on Seamus Kirk  Zoom on Seamus Kirk  Amendment No. 3 has been already discussed with amendment No. 1.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  I move amendment No. 3:

I wish to press the amendment.

Question put: “That the words proposed to be deleted stand.”

The Dáil divided: Tá, 72; Níl, 68.

Information on Bertie Ahern  Zoom on Bertie Ahern  Ahern, Bertie. Information on Dermot Ahern  Zoom on Dermot Ahern  Ahern, Dermot.
Information on Michael Ahern  Zoom on Michael Ahern  Ahern, Michael. Information on Noel Ahern  Zoom on Noel Ahern  Ahern, Noel.
Information on Barry Andrews  Zoom on Barry Andrews  Andrews, Barry. Information on Chris Andrews  Zoom on Chris Andrews  Andrews, Chris.
Information on Bobby Aylward  Zoom on Bobby Aylward  Aylward, Bobby. Information on Niall Blaney  Zoom on Niall Blaney  Blaney, Niall.
Information on Cyprian Brady  Zoom on Cyprian Brady  Brady, Cyprian. Information on Johnny Brady  Zoom on Johnny Brady  Brady, Johnny.
Information on John Browne  Zoom on John Browne  Browne, John. Information on Thomas Byrne  Zoom on Thomas Byrne  Byrne, Thomas.
Information on Dara Calleary  Zoom on Dara Calleary  Calleary, Dara. Information on Pat Carey  Zoom on Pat Carey  Carey, Pat.
Information on Niall Collins  Zoom on Niall Collins  Collins, Niall. Information on Margaret Conlon  Zoom on Margaret Conlon  Conlon, Margaret.
Information on Sean Connick  Zoom on Sean Connick  Connick, Seán. Information on Mary Coughlan  Zoom on Mary Coughlan  Coughlan, Mary.
Information on John Cregan  Zoom on John Cregan  Cregan, John. Information on Ciaran Cuffe  Zoom on Ciaran Cuffe  Cuffe, Ciarán.
Information on John Curran  Zoom on John Curran  Curran, John. Information on Noel Dempsey  Zoom on Noel Dempsey  Dempsey, Noel.
Information on Jimmy Devins  Zoom on Jimmy Devins  Devins, Jimmy. Information on Tim Dooley  Zoom on Tim Dooley  Dooley, Timmy.
Information on Frank Fahey  Zoom on Frank Fahey  Fahey, Frank. Information on Michael Finneran  Zoom on Michael Finneran  Finneran, Michael.
Information on Michael Fitzpatrick  Zoom on Michael Fitzpatrick  Fitzpatrick, Michael. Information on Seán Fleming  Zoom on Seán Fleming  Fleming, Seán.
Information on Beverley Cooper-Flynn  Zoom on Beverley Cooper-Flynn  Flynn, Beverley. Information on Paul Nicholas Gogarty  Zoom on Paul Nicholas Gogarty  Gogarty, Paul.
Information on John Gormley  Zoom on John Gormley  Gormley, John. Information on Noel Grealish  Zoom on Noel Grealish  Grealish, Noel.
Information on Mary Harney  Zoom on Mary Harney  Harney, Mary. Information on Seán Haughey  Zoom on Seán Haughey  Haughey, Seán.
Information on Jackie Healy-Rae  Zoom on Jackie Healy-Rae  Healy-Rae, Jackie. Information on Máire Hoctor  Zoom on Máire Hoctor  Hoctor, Máire.
Information on Billy Kelleher  Zoom on Billy Kelleher  Kelleher, Billy. Information on Peter Kelly  Zoom on Peter Kelly  Kelly, Peter.
Information on Brendan Kenneally  Zoom on Brendan Kenneally  Kenneally, Brendan. Information on Michael Kennedy  Zoom on Michael Kennedy  Kennedy, Michael.
Information on Tony Killeen  Zoom on Tony Killeen  Killeen, Tony. Information on Michael Kitt  Zoom on Michael Kitt  Kitt, Michael P.
Information on Tom Kitt  Zoom on Tom Kitt  Kitt, Tom. Information on Conor Lenihan  Zoom on Conor Lenihan  Lenihan, Conor.
Information on Dr Martin Mansergh  Zoom on Dr Martin Mansergh  Mansergh, Martin. Information on Tom McEllistrim  Zoom on Tom McEllistrim  McEllistrim, Thomas.
Information on Mattie McGrath  Zoom on Mattie McGrath  McGrath, Mattie. Information on Michael McGrath  Zoom on Michael McGrath  McGrath, Michael.
Information on John McGuinness  Zoom on John McGuinness  McGuinness, John. Information on John Moloney  Zoom on John Moloney  Moloney, John.
Information on Michael Moynihan  Zoom on Michael Moynihan  Moynihan, Michael. Information on Michael Mulcahy  Zoom on Michael Mulcahy  Mulcahy, Michael.
Information on M. J. Nolan  Zoom on M. J. Nolan  Nolan, M.J. Information on Éamon Ó Cuív  Zoom on Éamon Ó Cuív  Ó Cuív, Éamon.
Information on Seán Ó Fearghaíl  Zoom on Seán Ó Fearghaíl  Ó Fearghaíl, Seán. Information on Darragh O'Brien  Zoom on Darragh O'Brien  O’Brien, Darragh.
Information on Charlie O'Connor  Zoom on Charlie O'Connor  O’Connor, Charlie. Information on Willie O'Dea  Zoom on Willie O'Dea  O’Dea, Willie.
Information on Noel O'Flynn  Zoom on Noel O'Flynn  O’Flynn, Noel. Information on Batt O'Keeffe  Zoom on Batt O'Keeffe  O’Keeffe, Batt.
Information on Ned O'Keeffe  Zoom on Ned O'Keeffe  O’Keeffe, Edward. Information on Mary O'Rourke  Zoom on Mary O'Rourke  O’Rourke, Mary.
Information on Peter Power  Zoom on Peter Power  Power, Peter. Information on Seán Power  Zoom on Seán Power  Power, Seán.
Information on Dick Roche  Zoom on Dick Roche  Roche, Dick. Information on Eamon Ryan  Zoom on Eamon Ryan  Ryan, Eamon.
Information on Trevor Sargent  Zoom on Trevor Sargent  Sargent, Trevor. Information on Eamon Scanlon  Zoom on Eamon Scanlon  Scanlon, Eamon.
Information on Brendan Smith  Zoom on Brendan Smith  Smith, Brendan. Information on Mary Wallace  Zoom on Mary Wallace  Wallace, Mary.
Information on Mary Alexandra White  Zoom on Mary Alexandra White  White, Mary Alexandra. Information on Michael J. Woods  Zoom on Michael J. Woods  Woods, Michael.



Níl
Information on Bernard Allen  Zoom on Bernard Allen  Allen, Bernard. Information on James Bannon  Zoom on James Bannon  Bannon, James.
Information on Seán Barrett  Zoom on Seán Barrett  Barrett, Seán. Information on Joe Behan  Zoom on Joe Behan  Behan, Joe.
Information on Pat Breen  Zoom on Pat Breen  Breen, Pat. Information on Thomas P. Broughan  Zoom on Thomas P. Broughan  Broughan, Thomas P.
Information on Ulick Burke  Zoom on Ulick Burke  Burke, Ulick. Information on Joan Burton  Zoom on Joan Burton  Burton, Joan.
Information on Joe Carey  Zoom on Joe Carey  Carey, Joe. Information on Deirdre Clune  Zoom on Deirdre Clune  Clune, Deirdre.
Information on Paul Connaughton  Zoom on Paul Connaughton  Connaughton, Paul. Information on Noel Coonan  Zoom on Noel Coonan  Coonan, Noel J.
Information on Simon Coveney  Zoom on Simon Coveney  Coveney, Simon. Information on Seymour Crawford  Zoom on Seymour Crawford  Crawford, Seymour.
Information on Michael Creed  Zoom on Michael Creed  Creed, Michael. Information on Lucinda Creighton  Zoom on Lucinda Creighton  Creighton, Lucinda.
Information on Michael D'Arcy  Zoom on Michael D'Arcy  D’Arcy, Michael. Information on Jimmy Deenihan  Zoom on Jimmy Deenihan  Deenihan, Jimmy.
Information on Andrew Doyle  Zoom on Andrew Doyle  Doyle, Andrew. Information on Bernard Durkan  Zoom on Bernard Durkan  Durkan, Bernard J.
Information on Damien English  Zoom on Damien English  English, Damien. Information on Olwyn Enright  Zoom on Olwyn Enright  Enright, Olwyn.
Information on Charles Flanagan  Zoom on Charles Flanagan  Flanagan, Charles. Information on Terence Flanagan  Zoom on Terence Flanagan  Flanagan, Terence.
Information on Eamon Gilmore  Zoom on Eamon Gilmore  Gilmore, Eamon. Information on Brian Hayes  Zoom on Brian Hayes  Hayes, Brian.
Information on Tom Hayes  Zoom on Tom Hayes  Hayes, Tom. Information on Michael D. Higgins  Zoom on Michael D. Higgins  Higgins, Michael D.
Information on Brendan Howlin  Zoom on Brendan Howlin  Howlin, Brendan. Information on Paul Kehoe  Zoom on Paul Kehoe  Kehoe, Paul.
Information on Enda Kenny  Zoom on Enda Kenny  Kenny, Enda. Information on Ciaran Lynch  Zoom on Ciaran Lynch  Lynch, Ciarán.
Information on Kathleen Lynch  Zoom on Kathleen Lynch  Lynch, Kathleen. Information on Pádraic McCormack  Zoom on Pádraic McCormack  McCormack, Pádraic.
Information on Shane McEntee  Zoom on Shane McEntee  McEntee, Shane. Information on Dinny McGinley  Zoom on Dinny McGinley  McGinley, Dinny.
Information on Finian McGrath  Zoom on Finian McGrath  McGrath, Finian. Information on Joe McHugh  Zoom on Joe McHugh  McHugh, Joe.
Information on Liz McManus  Zoom on Liz McManus  McManus, Liz. Information on Olivia Mitchell  Zoom on Olivia Mitchell  Mitchell, Olivia.
Information on Denis Naughten  Zoom on Denis Naughten  Naughten, Denis. Information on Dan Neville  Zoom on Dan Neville  Neville, Dan.
Information on Michael Noonan  Zoom on Michael Noonan  Noonan, Michael. Information on Caoimhghín Ó Caoláin  Zoom on Caoimhghín Ó Caoláin  Ó Caoláin, Caoimhghín.
Information on Aengus O Snodaigh  Zoom on Aengus O Snodaigh  Ó Snodaigh, Aengus. Information on Kieran O'Donnell  Zoom on Kieran O'Donnell  O’Donnell, Kieran.
Information on Jim O'Keeffe  Zoom on Jim O'Keeffe  O’Keeffe, Jim. Information on John O'Mahony  Zoom on John O'Mahony  O’Mahony, John.
Information on Brian O'Shea  Zoom on Brian O'Shea  O’Shea, Brian. Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  O’Sullivan, Jan.
Information on Maureen O'Sullivan  Zoom on Maureen O'Sullivan  O’Sullivan, Maureen. Information on Willie Penrose  Zoom on Willie Penrose  Penrose, Willie.
Information on John Perry  Zoom on John Perry  Perry, John. Information on Ruairí Quinn  Zoom on Ruairí Quinn  Quinn, Ruairí.
Information on Pat Rabbitte  Zoom on Pat Rabbitte  Rabbitte, Pat. Information on Dr James Reilly  Zoom on Dr James Reilly  Reilly, James.
Information on Michael Ring  Zoom on Michael Ring  Ring, Michael. Information on Tom Sheahan  Zoom on Tom Sheahan  Sheahan, Tom.
Information on P. J. Sheehan  Zoom on P. J. Sheehan  Sheehan, P.J. Information on Sean Sherlock  Zoom on Sean Sherlock  Sherlock, Seán.
Information on Róisín Shortall  Zoom on Róisín Shortall  Shortall, Róisín. Information on Emmet Stagg  Zoom on Emmet Stagg  Stagg, Emmet.
Information on David Stanton  Zoom on David Stanton  Stanton, David. Information on Billy Timmins  Zoom on Billy Timmins  Timmins, Billy.
Information on Joanna Tuffy  Zoom on Joanna Tuffy  Tuffy, Joanna. Information on Mary Upton  Zoom on Mary Upton  Upton, Mary.
Information on Leo Varadkar  Zoom on Leo Varadkar  Varadkar, Leo. Information on Jack Wall  Zoom on Jack Wall  Wall, Jack.

Tellers: Tá, Deputies John Cregan and John Curran; Níl, Deputies Emmet Stagg and Paul Kehoe.

Question declared carried.

Amendment declared lost.

Bill reported with amendment and received for final consideration.

Question put: “That the Bill do now pass.”

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin  Zoom on Caoimhghín Ó Caoláin  It is not agreed.

An Ceann Comhairle: Information on Seamus Kirk  Zoom on Seamus Kirk  Will the Deputies claiming a division please rise?

Deputies Caoimhghín Ó Caoláin and Aengus Ó Snodaigh rose.

An Ceann Comhairle: Information on Seamus Kirk  Zoom on Seamus Kirk  As fewer than ten Members have risen, I declare the question carried. In accordance with Standing Order 70, the names of the Deputies dissenting will be recorded in the Journal of the Proceedings of the Dáil.

Question declared carried.

An Ceann Comhairle: Information on Seamus Kirk  Zoom on Seamus Kirk  The Bill will be sent to the Seanad.


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