The woman we have just respected, Ruth Morrissey, passed away on Sunday. As the Taoiseach is aware, Ruth was one of hundreds of women impacted upon by failures in the CervicalCheck screening system. She has paid the ultimate price for those failures and is now grieved by her family, including her heartbroken husband, Paul, her devastated little girl, Libby, and her wider family and circle of friends. There are no words I can offer that can adequately convey the magnitude of the loss felt by her death, but suffice to say, the State grievously failed Ruth Morrissey. Tá mo chroí briste ar son clann Ruth. Is tragóid é cás Ruth, agus nílim in ann glacadh leis go raibh uirthi dul chuig na cúirteanna.

Instead of holding up its hands and admitting liability, the State joined the US laboratories that were at fault in this case in dragging a terminally-ill woman through the courts and fought her tooth and nail every step of the way.

Even when Ruth won her case at the High Court, she was hauled before the Supreme Court to suffer one final indignity before she was vindicated. Ruth's solicitor, Mr. Cian O'Carroll, has described this as "deathbed litigation".

All this happened despite the then Taoiseach, Deputy Varadkar, giving a promise to the women concerned that this would never happen. The truth is that this adversarial and aggressive approach has been maintained. I understand there are approximately 203 active claims relating to the CervicalCheck matter, of which eight have been concluded. I would like the Taoiseach to confirm those facts.

This is entirely wrong. The Government should not be joining with negligent laboratories in fighting these women. A decent Government would stand up for them, protect them and ensure justice is done. A decent Government would be acting to ensure none of this happens again. We need to fix the system, and that is the only lasting tribute that can be made to Ruth and the other women involved. As the late Ms Emma Mhic Mhathúna once said, talk is cheap and action must follow.

Will the Taoiseach now intervene and ensure the State accepts and acknowledges its responsibility and liability and stops dragging very sick women through the courts? Will the Taoiseach accept the outsourcing of screening has been a disastrous failure? He has committed to the establishment of a national laboratory for cervical cancer testing and this must happen as a matter of urgency, as 90% of Irish screening is still done in US laboratories. Astonishingly, despite everything that has happened, this is still unsupervised by an Irish inspector. Will the Taoiseach commit to fast-tracking the establishment of the national laboratories for cervical cancer testing as a matter of absolute urgency? In the meantime, will the Taoiseach instruct the HSE that Irish inspection of US laboratories must happen urgently?

The apology by and commitment from the then Taoiseach and now Tánaiste on this matter were made in good faith. As the Deputy knows, the previous Government agreed that the High Court judge, Mr. Justice Charles Meenan, would be requested to review, in the cases of women affected by CervicalCheck issues, mechanisms that would avoid, where possible, women and their families having to go to court. That is the objective of the Government. Emerging from that report, a tribunal was to be established, and it will be established. The legislation paving the way for the establishment was passed into law last year in this House.

There have been delays in the establishment of the tribunal. It was to be established in March and it is the most effective mechanism to enable the women involved to resolve these matters without having to go before the courts. That said, one cannot prevent people from going to court to establish and secure their rights. Every step has to be taken to remove obstacles in the pursuit of the entitlements of women in these positions.

In general, the screening programme has saved many women's lives. Many lives have been saved by the national cervical cancer screening programme. This must be said in fairness to all those who work on the programme, and it has also been acknowledged by many women throughout the country. It is my sense that if we were to remove immediately the outsourcing of screening, we would not have a national cervical cancer screening programme, and we would not have had one from the very beginning. Perhaps it is a debate for another day but we must put this in perspective while acknowledging the failings that occurred. Quality control is essential to achieving the highest standards of oversight of screening programmes and ensuring this highest standard.

That is why the move to HPV cervical screening for the medium term and into the future has already occurred. That is the key to improving the programme from a quality and safety perspective and reducing error and optimising the standard and quality of that screening. Ireland joins a small group of nations that employs what will be the best in class testing to screen their populations for cervical cancer into the future. Others are Australia, England, the Netherlands and Wales. Along with the continued roll-out of HPV vaccinations, that is the key road forward. It is the roadmap for the future in terms of reducing death and grief and also making sure that the quality of the overall programme is much better and more precise for women in this country.

The apology, when it was made, was for the non-disclosure element of this scandal. The family of Ruth Morrissey have made it very clear that they are not interested in apologies. That ship has very sadly sailed for Ruth Morrissey. What we need is action. The tribunal to which the Taoiseach referred is an adversarial mechanism. If I can quote Ms Justice Mary Irvine on the matter. She stated that the claims before the tribunal are to be heard in the same manner as the High Court hears and determines personal injuries actions for negligence and the High Court determines such claims in what is described as an adversarial process. That is the fact. In addition, the tribunal mechanism has no means of fast-tracking cases, bearing in mind that we are dealing with very sick women. The truth is that this State has not made available to these women a mechanism that is non-adversarial or a mediated mechanism for the State to acknowledge and to carry its full liability for the damage to these women's health and, in many cases, for the loss of their lives and the loss of them as women and mothers to their families.

At the heart of this scandal is another scandal, and it is that of the outsourcing of screening services. I wish to recall that when that decision was made the House was warned of the many dangers of proceeding in that direction and, tragically, those warnings have come home to roost. It is essential that the national laboratory to which the Taoiseach has committed is established and resourced as a matter of urgency.

The time is up, Deputy.

It is also absolutely essential that while screening continues in the United States that it is invigilated. I cannot believe, after everything that has happened and on the day that we mark the passing of Ruth Morrissey, that the Taoiseach cannot accept the absolute necessity for Irish inspection of what is 90% of screening.

Please, Deputy, you are way over time.

I ask the Taoiseach to address the questions. How will he provide a non-adversarial mechanism for these women; what is the timeline for the national screening laboratory; and will he insist that there is supervision and Irish inspection of screening, which continues in the United States?

First of all, a compensation tribunal is far less adversarial than any court system. We know that from experience in a variety of medical scandals going back to the various scandals relating to blood products and so on. In my view the tribunal is far more effective than a courts process. Ms Justice Mary Irvine is no longer in a position to take up the position as chair having been appointed President of the High Court, therefore, the Minister for Health is working with the Attorney General to make sure that the positions will be filled to allow us get the tribunal under way as quickly as possible.

Regarding outsourcing, we need to be honest with ourselves and everybody here that we must be clear about our objectives. As Minister for Health, I was involved in setting up BreastCheck. That took quite some time - four years or more - and we built it up nationally to world-class standards. I recall the huge waiting lists for testing for symptomatic cervical cancer patients. They were waiting for a long time. Outsourcing at that stage became an intervention that almost eliminated those waiting lists.

Following on from that, the whole idea of a screening programme using that model was developed. I accept the Deputy's point that it is not optimal, but we simply would not have a national cervical screening programme if that was not pursued. We need to be honest. The capacity simply was not there at the time and is not there now. We have a decision to make if that is the route people want to pursue. We simply will not have a national screening programme for the foreseeable future. It has saved many lives. That has to be said. Many women are alive today because of the programme. I certainly take the point on oversight and quality control. I answered that in reply to the first question. That should be the case and it has to happen.

Will the inspectors be Irish?

The national cervical screening programme is responsible for ensuring quality and providing regular oversight of the screening programme itself and the test.

Ruth Morrissey was a national hero. She fought the State not once but twice. I received news of her passing from Vicky Phelan on Sunday morning. My condolences go to Paul, Libby and all of her family and friends. The Taoiseach's predecessor, the current Tánaiste, said on "Six One News" after Ms Phelan came forward that no woman would have to go through this again. It has never happened. He should never have said that. He could not deliver it. Ruth Morrissey subsequently spent 36 days in the High Court while terminally ill. She won. Mr. Justice Kevin Cross uttered a now famous phrase referring to "absolute confidence" in testing. In the High Court, the State never contested or even commented on this famous phrase which caused so much consternation.

On 3 May, Ruth said she was proud that no other woman would have to go through this. I know because she said it to me. However, a frenzy followed, led by some people in the medical profession, some people in politics and a small minority in the media. We heard that screening would collapse if this was to be the standard. Despite not even commenting in the High Court, the State contested this clause. As we all know, Ms Morrissey won again. Chief Justice Clarke said it was obvious that many people had not read the judgment.

The State should have apologised after Ms Morrissey won, not today. I know some people's words are well-meaning, but today is not the time. It is too late. Paul Morrissey made that quite clear. The Taoiseach's statement the other day, saying that it was very sad that Ruth had passed away but he had made an apology, was a crass statement. The Tánaiste's statement was a crass statement. The apology that was issued in this House in October of last year did not apply to Ruth Morrissey, because the State was taking her through the courts at the same time. That should never, ever have happened and we as a body politic need to reflect on it. Some professionals in our health service need to reflect on it, as do a small number of people in the media. Testing did not fall apart. In fact, Ruth Morrissey's biggest legacy is that she enforced the standard that applies in the UK for the women of Ireland.

That is her legacy.

A number of people have asked what would be the best way to ensure that legacy. I can tell the Taoiseach that the best way to ensure her legacy is to do three things. The first one is to change the Civil Liability Act to enable dependants of a dying person to claim for losses in one action rather than having to go through the courts again after the person has passed away. I know this is what Ruth Morrissey wanted because she told me so on 19 March. The second thing to do is to ensure testing is brought home. Third, we must ensure that the tribunal, which is not functioning, is not an adversarial tribunal, which it quite evidently will be unless it is changed.

I appreciate the Deputy's comments fully. I know the sincerity with which he makes them because he has been involved in this issue for quite some time and has been engaged with a number of the women who have been to the forefront of the campaign for greater disclosure and transparency around the programme itself and, above all, to enhance the programme in order that it can serve women in this country for the better into the future. Without question, as I have said, the programme failed women in this country. I agree with the Deputy that in situations like this one, non-adversarial approaches should always be the first to be pursued and the State should be very proactive in providing the mechanisms, be they compensatory tribunals or other non-adversarial fora, where the issues can be dealt with in an honest and transparent way. However, that is challenging and it is easier said than done. At this particular point, I think it is important that the tribunal gets established quickly, and appointments be made to the tribunal to enable it to get up and running. I will work with the Deputy in regard to the Civil Liability Act. I think it is a fair point that where someone passes away in such a situation, the family would have an entitlement to pursue those issues.

In terms of the testing being brought home, I am in favour of developing our own capacity on the testing front. We hope, with the passage of time and being in a position to deal with Covid once and for all, that we can then restore the national cervical screening programme, because its overall impact has been to prevent many cancers and prevent many women from dying. We cannot undermine that kind of work, which was ongoing prior to Covid. It is important that we be very clear collectively in terms of the route we want to travel on this. In other words, I have no issue with building up - in fact, I would support building up - our own capacity in terms of laboratory testing and being able to do it here. Moving to the HPV programme means testing is now far better and will give far better outcomes and give certainty and precision around testing. Once the threat of Covid recedes, we must be in a position to make the programme available to as many women as we possibly can. That has to happen in the short term. Over time, I take the Deputy's overall point about the importance of developing the capacity within the State to do the programme here.

There is a famous song by Mike and the Mechanics called "The Living Years". I think we all know the lyrics and can apply them to our own lives in many ways. We need to apply a little bit of them to politics and what happened to Ruth Morrissey. There is no use in apologising now. Her family has made that clear. They do not want an apology. What they want - I know it is what Ruth wanted, as she told me so - is the Civil Liability Act to be amended to do as I just said and as the Chief Justice himself outlined. The Labour Party is going to bring forward that legislation in her honour and I expect the Taoiseach to support it. I expect the House to support it and I expect the Taoiseach to support it.

Not too long ago, the Minister for Health stated the women involved and their families should be put at the heart of the State's response. He stated that this should be done, regardless of whether we think it is the right message, and that, for once, we should just do what they want and put them at the centre of matters. We need to put them at the centre of this.

The volume of cases coming through means that we need to amend the legislation. I will be asking the Taoiseach to honour the Government's commitments to the nth degree when we bring forward the legislation. I will also be asking him to ensure that the process by means of which the tribunal will operate will be changed to make it less adversarial. It cannot be a carbon copy of previous models. There are too many cases out there. If the Taoiseach honours those two requests, it will mean something has been done in memory of Ruth Morrissey.

As already stated in the context of the legislation the Deputy has identified, I will commit to working with him on going through the legislation on the Government side. Obviously, one needs to see detail of legislation before one commits to anything in that regard.

The detail is there.

I agree with the principle, as I already stated. I am mindful that I would like to follow through on whatever I say in the House.

I will take the Taoiseach's word on that.

Equally, I am also stating that we will want to see the Bill the Deputy is bringing forward and so on.

The whole idea of the tribunal was to create a less adversarial environment as an alternative to the courts. People will wish to access the courts as well and that is their entitlement and their right. We cannot take that either away from them.

One lesson that must be learned from the entire CervicalCheck scandal relates to disclosure. The absence of disclosure was, in my view, a significant failing. The results of the audit that took place should have been disclosed. That, in itself, would not have saved lives, but it is a very important principle that people are entitled to information relating to their medical situation at all times. That is why it is particularly important to follow through on the commitments we have made in that regard.