Yesterday the sad news broke that Vicky Phelan had passed away. Her two children, Amelia and Darragh have lost their beautiful mother so early in their lives. Our hearts go out to her husband Jim, to her heartbroken parents, Gaby and John, and to Vicky's family and friends who are devastated by her death. The nation mourns with them.

Vicky Phelan was a force of nature. In pursuit of justice she was fearless and relentless. She was unstoppable. If it was not for Vicky's courage, the CervicalCheck scandal may never have been exposed. With inspiring dignity Vicky took on the State that had failed her so badly. It was a battle she should never have had to fight but fight it she did until her very last breath. Vicky endured her illness and she never backed down in campaigning for the women and girls of Ireland. Her legacy will live on. We owe her so much.

Vicky, as has been said, did not want fame or adulation; she wanted purposeful change. The best way to honour Vicky's memory is to complete the work she did. That means bringing the testing of screening samples back to Ireland. Testing continues to be outsourced to labs in the United States at the centre of the CervicalCheck scandal. Currently, 85% of CervicalCheck sample testing is outsourced abroad. The national cervical screening laboratory was due to open in September, yet the women of Ireland are still waiting.

Completing the work also means delivering the long-promised legislation for open disclosure. The Scally review recommended a statutory duty of candour be established to ensure people are told the truth when something goes wrong in their healthcare. Yet, incredibly, the Patient Safety (Notifiable Patient Safety Incidents) Bill published by the Government in 2019 would not cover disclosure of the incidents at the heart of the CervicalCheck scandal. We in Sinn Féin have proposed amendments to rectify this issue but the Minister, Deputy Stephen Donnelly, has for seven months failed to progress the legislation. Again, the women of Ireland have been left waiting. We must also see the reinstatement of the cancer audit review of screening, which was suspended four and a half years ago.

It is the wish of Vicky’s family that these specific issues be raised today because she cared so passionately about this change. Everyone in the Dáil is committed to ensuring that we never again see the failures of the CervicalCheck scandal. We will have to work together to deliver the change that Vicky wanted to see.

Is é an bealach is fearr chun ómós a thabhairt do chuimhne Vicky ná scagthástáil a thabhairt ar ais go hÉirinn agus reachtaíocht a chur i bhfeidhm i gcomhair nochta oscailte. We are all waiting for the national cervical screening laboratory to open. When will this happen? Will the Taoiseach ensure that on its opening, it has the capacity to test all cervical screens conducted in this State? When will the Minister for Health progress the open disclosure legislation? That legislation must be amended to ensure it covers the type of incidents at the centre of the CervicalCheck scandal. The law must provide for open disclosure. Vicky Phelan was very clear. She said:

I want action. I want change. I want accountability.

Let us get this done together for Vicky, for all the women we have lost and for those women who continue to suffer and fight for justice.

I thank the Deputy for raising the issue and for the manner in which she raised it. I agree wholeheartedly that it is extremely important that the work of Vicky Phelan is reflected in action in terms of legislation, in terms of the framework and architecture of the screening programme itself, insofar as it is located in Ireland, and in terms of the renewal of an audit of the screening programme. It is important to her family in particular that her advocacy continues to change things after her passing and that her legacy will be more effective and respectful treatment for the women who come after her. That is extremely important and is an issue we want to follow through on.

On the CervicalCheck programme, the ultimate goal, supported by Vicky and many involved in the 221+ group, is population-based screening, the continuation of the cervical screening programme and participation by women in that programme. Population-based screening has ensured better survival rates regarding different cancer types.

I was involved in the roll-out of BreastCheck. We did it differently insofar as it was a much slower roll-out from one region of the country to the next and took much longer. The CervicalCheck screening programme has saved thousands of lives but, as we know through the work of Vicky Phelan and her decision to ensure there would be no confidentiality, there were significant flaws within the programme. The Government wants to eliminate and eradicate cervical cancer. That is the objective.

We can achieve this through the HPV vaccination programme and an effective screening programme. The Minister recently announced the Laura Brennan HPV vaccination catch-up programme, which will be implemented by the HSE shortly.

On Dr. Scally's recommendations, I am informed that actions on all 170 recommendations are near completion or have been completed. The Minister for Health has asked Dr. Scally to conduct a final progress review of implementation. The report in that regard is expected to be submitted to the Minister shortly.

The new national cervical screening laboratory at the Coombe, which will provide enhanced capacity to meet the future needs of the national cervical screening programme will be the national base for training, education and research. The building works for the new lab were completed in October. It is expected to become operational by the end of the year. A workforce plan is in place. Recruitment for the new laboratory is an ongoing priority for the HSE, which is working with the faculty of pathology to build the required expertise. I understand that Dr. Cillian De Gascun was recently appointed as interim director of the national cervical screening laboratory. The new laboratory is designed to ultimately become CervicalCheck’s main provider of cervical screening laboratory services. The HSE is working flat out to see if that can be done before the end of the year.

In respect of the legislation, my understanding is that there was agreement among all parties on Committee Stage that on Report Stage an agreed amendment in respect of full disclosure would be brought forward. There have been many different perspectives among health professionals for a long time although many would support the duty of candour and the spirit, idea and principle of candour in the context of full disclosure to patients. I have had discussions with the Minister and he has indicated that, working with the Office of the Attorney General, we will have that amendment prior to the end of the year. Working with all parties in the House, we can bring this to a conclusion.

I support the Taoiseach's comments regarding the importance of population screening and the importance for women to participate in CervicalCheck. All of us who avail of the service are well aware of its absolute value.

Vicky’s ambition to bring screening home can be achieved. It was a catastrophic error for the laboratory services not to be available and for screening not to be carried out in this jurisdiction. I want to put that on the record. Can the Taoiseach assure us that when the national laboratory opens - and he says he hopes this will happen by the end of the year - that it will not just be additional capacity but that we work for sufficient capacity that screening in its entirety can happen here in Ireland?

On open disclosure legislation, can we just confirm today that we will get this done by the end of the year, namely, before we rise for Christmas? Can the Dáil agree that we will get this done rather than speculating or giving speculative target deadlines? Can we agree that we will work together for that to happen?

I asked the Taoiseach about the cancer audit review and its reinstatement. Will he say something on that matter?

Work in respect of the national cervical screening laboratory at the Coombe is under way. It will take time before it will have sufficiency to offer full national coverage, although I would point out - and we have to be objective as best as we can - that Dr. Scally did not find, in respect of the particular lab, that there was a higher or lower incidence than elsewhere. Be that as it may, it is desirable that we would build up the expertise and education in Ireland and that, similar to BreastCheck, we would recruit the proper experts and personnel over time and have this as not only a national centre but also ensure that it will have the capacity to cover the entire programme. That is the objective.

I already articulated that there should be an audit because audits inform best practice. They are part of the broader approach to ensuring that the programme is effective and is benchmarked against international peer review and international best practice and standards.

I want the legislation concluded by the end of the year. We will work might and main to make sure that happens.

Everyone in this House owes a debt of gratitude to Vicky Phelan. While battling terminal cancer, Vicky took a case to the High Court. She won her case and was offered a settlement if it remained confidential, as we know. It would have been easier for her had she acquiesced, but she refused to accept the culture of secrecy that too often accompanies scandals in Irish public life. This was not in her interests but was in the public interest. Vicky was concerned that if she stayed silent, nothing would change and other women would face the same fate as her, namely, to die of a treatable disease because of faults in the screening system. She was not willing to accept that. Crucially, she felt that when things go wrong, patients and their families must be informed. They should expect openness and honesty. If the health service does not recognise a problem, how can it deal with it?

There has been reform of the cervical screening programme because of Vicky Phelan and many other women who became involved in the cervical check issue. However, some of the important changes that Vicky advocated remain outstanding. The Taoiseach has referred to some of them. I want to pursue a number in more detail.

The HSE introduced a national open disclosure policy in 2013, but we all know that open disclosure does not always happen. The purpose of the patient safety Bill is to change this. It is to make the policy of open disclosure mandatory rather than discretionary. Unfortunately, as we have just discussed, the progress of the Bill through the House has been desperately slow. It was introduced in 2019 and there has been an eight-month delay in moving from Committee Stage to Report Stage. The Taoiseach has to bear in mind that it still needs to make its way through the Seanad, so I ask him whether the commitment he has just given, which is to have the Bill completed before the end of the year, includes its passage through the Seanad.

Progress on another important development has also been far too slow. The State's only cervical screening lab, at the Coombe hospital, is currently only screening private smears. Public screening, including screening for CervicalCheck, stopped after the cyberattack, although private work continues in the laboratory. Meanwhile, 160,000 slides were sent to the United States for analysis in just the first seven months of this year. There was a commitment in the wake of the CervicalCheck failures that the analysis of these slides would be carried out in total in Ireland. Four years later, that has not happened.

Vicky Phelan was always adamant that action was important to her, not platitudes and empty promises. When can we expect that the commitments made to Vicky and the other women who are victims of this failure will be honoured? When will mandatory disclosure be the law of the land in its entirety? I am talking about the passage of the legislation through both Houses. When is it expected that the new national cervical screening laboratory will be fully staffed with appropriate staff and operating? When can we expect all CervicalCheck slides to be processed in Ireland?

I thank the Deputy for raising those issues. I dealt with some of these questions earlier but will deal with the specifics again.

On the national cervical screening laboratory at the Coombe, the building is complete. It was completed in October. It is expected that it will become operational by the end of the year.

There are no staff-----

Sorry, I am answering the question. A workforce plan is in place. Recruitment for the new laboratory is an ongoing priority for the HSE. It is working with the faculty of pathology to build the required expertise. As already stated, Dr. Cillian De Gascun was recently appointed as interim director of the national cervical screening laboratory. A lot will depend on the pace of recruitment. It is a matter of high-level expertise. Thankfully, new technologies that reduce the capacity for human error have emerged for cervical screening. There is a far more significant and enhanced process now than pertained originally.

That is positive. Ultimately, the new laboratory is designed to become CervicalCheck's main provider of cervical screening laboratory services. The HSE is of the view, however, that a secondary laboratory contractor will remain necessary at all times to ensure resilience in the system. The route to go is to create our own national service in respect of this. That then, combined with the HPV vaccine roll-out, would give us a very robust approach to cervical cancer and a real opportunity to eliminate it or significantly reduce it in this country.

In respect of the legislation, Deputy Shortall will know that down through the years there have been various debates around mandatory reporting in different areas of life, for example, child protection, where many professionals believe it can be counterproductive, or at least that was the argument that was advanced. I have never been of the view that the world collapses if we do certain things. My view is that open disclosure is imperative and can be of benefit to the system. On the legislation, the Government and I are at the mercy of the House. To be fair, we do need to produce the amendments, complete Report Stage and the Bill then needs to go to the Seanad. If there is agreement on the amendments and if the Bill satisfies all parties, then I think we can move it through both Houses in a timely manner. We are committed to doing that. I will ask the Minister to engage with his respective counterparts on the legislation.

I will make a general point, which is that the cervical screening programme has saved thousands of lives. It is very important that we continue to advocate for participation in the programme. We can certainly improve and enhance it, and that is what we are about.

I do not think anybody would disagree with the importance of population-based screening. We would all encourage women to participate in CervicalCheck. However, we must deliver on the promises that were made when the failures in CervicalCheck were identified.

In addition to the two points I raised with the Taoiseach, there are three outstanding commitments from the Scally report that must be actioned. These include the commitment to ensure that clinicians meet with their patients or the families of patients who are deceased in order to discuss the failures of the system and the failure to inform them of the outcome of the review of smear tests. That has not been actioned yet. Two other commitments relate to data retention and the implications for other Departments in terms of the learnings from the Scally report.

In December 2020, Judge Meenan issued a report on medical negligence. That has also not been actioned yet. Can the Taoiseach update the House on when we are likely to see progress on each of those issues?

In terms of the clinicians meeting with their patients, I will follow through with the Minister and get a response for the Deputy on where that matter stands. That should have happened. It has happened in a number of cases.

On the implications for other Departments, all Departments will take on board lessons learned from the CervicalCheck scandal and will follow through on best practice in respect of disclosure.

The medical negligence report has been completed and more work is required in regard to it. I will come back to the Deputy with a more comprehensive and detailed response in respect of that issue.