Vicky Phelan died three weeks ago. The Taoiseach knows she spent her final years fighting for change. She was very clear on what she wanted to see. To recall, she said to the political system:

I don't want your accolades or your broken promises. I want action. I want change. I want accountability.

It was a most eloquent and heartbreaking call to action for all of the women and their families affected by the CervicalCheck scandal.

As the Taoiseach knows, mandatory disclosure and a duty of candour was one of Vicky's core demands. Mandatory disclosure means a legal obligation on clinicians and healthcare providers to tell a woman if there had been a discordant, erroneous or incorrect reading of her cervical cancer screening slide. There was consensus in the Oireachtas that the original patient safety Bill did not provide for this demand. The week that Vicky died the Taoiseach assured the Dáil that an amendment to the legislation to correct for this flaw would be brought forward.

At that time I said to the Taoiseach that the Opposition would work with the Government to get the legislation right and get it over the line before the Christmas recess. This remains my position and our commitment. However, we have a problem in that the amendment proposed by the Minister, Deputy Stephen Donnelly, does not provide for mandatory disclosure. There is provision for a right to review and this is welcome. However, there is a distinction between a right to review and a positive obligation on a clinician or a health service provider to reveal and pass on information. Mandatory disclosure where the legal responsibility is on clinicians and organisations is what the women fought for. It is the measure recommended by Dr. Gabriel Scally in his scoping inquiry.

Let me cut to the chase in all of this. I believe there are still serious flaws in the legislation. I do not believe the amendments the Minister has proposed address these flaws. Above all else there is no way that two hours today is sufficient time for us to tease our way through this legislation to get it right. The objective here has to be to get this right. I do not believe either that the House should divide on this matter. We were of one voice when we marked the death of Vicky. We said that we would work together. I am asking the Taoiseach as head of the Government for us to work together. What this means in my strong opinion is that we have the debate for two hours today after which we adjourn it and that more time is made available next week.

There is concern beyond the definition of mandatory disclosure or the duty of candour about the review process itself. There is no legal obligation for the woman at the point of diagnosis to be told she has a right to the review. What is very worrying from my point of view is a provision that means in the case of CervicalCheck and the laboratories that the laboratories themselves would decide the scope and shape of the reviews. I do not believe that we can pass legislation that lets these things go. Again I ask the Taoiseach to work with us. I know I have the support of the Labour Party and others on the Opposition benches. We really have to get this right. I believe we can get it right and over the line before we rise for Christmas.

I appreciate Deputy McDonald raising the issue and the manner in which she has raised it. We did all agree that we would commit to getting the legislation through the House before the recess, particularly in light of Vicky's passing and her strong exhortation that we would fulfil all of the recommendations arising out of the Scally review and the expert reference group that dealt with interval cancer. The report was published in October 2020 and the legislation is in line with this report. We must remember that the report was made up of input from professionals as well as patient representative groups and all involved from a patient perspective.

The report recommended, essentially, that CervicalCheck should establish a process to conduct patient requested reviews of all invasive cancers and establish a standard operating procedure for this purpose:

Patient-requested reviews should only be undertaken following receipt of written consent from the patient. These reviews should be available to all women diagnosed with invasive cancers, including historic cases of women who did not participate in any other National Screening Service or Royal College of Obstetricians and Gynaecologists cytology review processes.

I am quoting directly from the expert reference group's interval cancer report. The expert reference group recognised the educational value of programmatic review of cytology of all invasive cancers including interval cancers. The report states:

The Expert Reference Group recognises the educational value of programmatic review of cytology of all invasive cancers including interval cancers. The Expert Reference Group therefore recommends that Clinical Audits be conducted only where either (1) such Clinical Audits are both blinded and anonymised; or (2) legislation protecting the confidentiality of Clinical Audits is passed by the Oireachtas.

Essentially persons presenting for screening would be advised that they may seek a review of their case files in the event of an interval cancer arising between a first and second screening. The Bill now states there is a mandatory obligation to disclose to every patient who seeks such a review of their files and an that the files would be made available to the patients. This is exactly in line with what the recommendation of the expert reference group has ordained. This is a positive amendment and we need to go with it. It would deal with issues the Sinn Féin spokesperson raised at the committee with regard to the patient review approach. It was not in the Bill when it last came before the House. The Minister undertook to go back and has come back with a very important amendment that provides for mandatory disclosure. This is what we are all seeking.

The expert review group went through, in quite considerable detail, clinical audit as opposed to a patient requested review.

There is a lot of merit in how the expert group has proceeded on this front. The Minister stands ready to engage further with Sinn Féin's spokesperson and others on this issue. We want to do what is best for the women of Ireland. This pertains to all screening programmes. Programmatic audits are about identifying issues at system level and we need to have such audits across all various screening programmes, including bowel and breast screenings, etc. That needs to happen regularly to indicate opportunities for improvements in such programmes. The person who has been screened should have a right enshrined in law to access that and this is what the amendment provides.

The Taoiseach does not have to convince any of us of the need for that kind of meta-analysis for educational purposes and, more important, for quality control and assurance. I remind the House that this legislation is about the provision of information. It is not about medical malpractice or any other legal processes. This is about information. I believe the Taoiseach, like the rest of us, wants to get this right for women. There are serious matters in this Bill that need to be teased through to ensure we get it right. Two hours for the debate is simply not sufficient to get that work done. At the end of the day, people will ask what real difference would this have made in Vicky's or other women's cases and what difference it will make going forward. I am concerned about the anonymised nature of the audits. While the right to a review is welcome, there is no legal obligation for a patient under CervicalCheck to be informed of the right of review. These things need a little bit more time and we have the scope, this week or next week, to afford more time to this. I ask that we adjourn after two hours and afford more time to the debate to be absolutely sure that we get it right. We have waited for four years and a half years for this legislation. A couple of more hours is required to make sure we get it right.

Hear, hear.

The expert review group report, which was published two years ago in 2020, is very clear on how programmatic audits should be carried out - properly and professionally. In the most recent report, Dr. Scally stated the CervicalCheck programme was greatly enhanced because Vicky Phelan and others raised very serious issues pertaining to how the programme and audits were conducted. The expert review group, which was informed by patient advocates, representatives of the 221+ group and professionals, recognised the approach of patient requested reviews. The big difference is that people going forward for screening will be told they may seek their files if, for example, an interval cancer arises between the first and the second screenings. As per the programme they will be able to get full access. Due to the amendment to the Bill, it will be mandatory for the programme to disclose all information pertaining to the individual. I will ask the Government Whip to speak to the Sinn Féin Whip about what can be done.

We need more time.

It is imperative we get this through-----

It is imperative we get it right.

-----as we collectively committed to. Remember, this amendment is not being rushed. It is the outcome of a considered analysis by the expert group in 2020.

I ask Members to turn off the electronic devices and phones, please.

The Labour Party reiterates its support for the call for more time on Report Stage to debate the Patient Safety (Notifiable Patient Safety Incidents) Bill. It would be sensible to adjourn the debate rather than to conclude the debate after two hours today, and I note the Taoiseach's comments that the Whips should co-ordinate on that matter. A substantial number of amendments have been tabled and concerns have been raised about flaws in the Bill, therefore, it would be sensible to adjourn the debate and give it a little more time next week. That is the wish of all of us in opposition.

I raise the issue of increasing concerns among parents and teachers in recent weeks. They have been expressing their concern about severe staff shortages in schools, which was the subject of an earlier debate today. I am also increasingly hearing of frustration from parents of younger children, children of preschool age, who cannot access a place for their child in early years education and care in my constituency and others around the country. I have raised this previously and thank the Taoiseach for his engagement on specific issues about individual crèche closures, but this is part of a broader, systematic problem with childcare and early years education in this country. We need urgent State intervention to address this problem. What is lacking is a real acknowledgement at the centre of Government of the lack of provision of childcare services for children and parents who rely on childcare providers and, indeed, a lack of supports for providers that are closing. I acknowledge incremental steps have been taken. In particular, we in the Labour Party have welcomed the establishment of the employment regulation order for early years workers and professionals. I also acknowledge the Big Start campaign and SIPTU's input into that. Notwithstanding improvements in pay for professionals, there is still a problematic and flawed system for parents. They are now being told to reserve their child's place when at the very early stages of pregnancy, before the child is even born, and even then they cannot be sure of getting a place at a childcare facility.

Tonight, Labour Senators will table a motion in the Seanad to address the crisis in Ireland's childcare system and to call for a change in policy to ensure we no longer have the postcode lottery that so often determines the availability of places and their affordability. High, exorbitant and rising fees are a huge issue for many parents. Several parents have come to me to say they simply cannot afford a childcare place even where there is one available. Let us remember Ireland has the highest proportion of private providers of childcare in the OECD and many smaller providers are being squeezed on costs. We need a universal, publicly-funded childcare system in Ireland and we in the Labour Party have been calling for that consistently. Will the Taoiseach commit to the rolling out of such a scheme and will he commit to reduce the cost of childcare as part of that to a cap of €200 per month per child, as we have sought?