Wednesday, 15 June 2016
Order of Business
“I take this opportunity to congratulate you, a Chathaoirligh, on your appointment and wish you the very best of luck. As Fianna Fáil spokesperson on health, I ask the Leader to invite the Minister to come to the House to discuss the district hospital network with a view to establishing a capital investment programme to upgrade some of the facilities. District hospitals should not be seen as a relic of a bygone era and if adequately resourced, they can provide a vital cog in the delivery of a modern health service. They are a widespread resource. We are not talking about a new layer of bureaucracy. There are more than 100 district hospitals around the country. Without being parochial, in deference to what Senator Craughwell said, there are four district hospitals in Mayo and with the correct level of investment we could alleviate the pressures on the secondary hospital system. The district hospital network operates in three separate ways in so far as they prevent admissions to acute hospitals, facilitate discharges from acute hospitals and can also work as an interface between the fair deal system, which is experiencing some delays even though it has improved in recent months.”
Tuesday, 21 June 2016
I welcome the Minister to the House to discuss important issues regarding the health system. As a GP based in rural Ireland, I would like to outline some of the issues in primary care, which is a crucial aspect of our health sector. I commend the Minister for his support of the ten-year consensus on health care. It is a hugely promising step for the Government, which will refocus discussions on health reform in this House and the Lower House on patient care rather than political gains.As a GP, I also commend the Minister for his recognition of the role of general practice. International studies demonstrate that the strength of a country’s primary care system is associated with improved population health outcomes, regardless of per capita health spend and percentage of elderly patients. Furthermore, the World Health Organization, WHO, has reported that increased availability of primary health care is associated with higher patient satisfaction and reduced aggregate health care spending, and orientation towards a specialist-based system enforces inequality in access.
The time has come for all stakeholders to work together in a pragmatic and solution-driven approach to develop a ten-year plan to reform health care. I welcome Senator Colm Burke’s comment regarding Senators being members of the ten-year committee. There is a need for better integration between primary and secondary care. This approach is supported by international evidence that it will deliver efficiency and better patient outcomes. Every €1 spent on primary care saves €5 elsewhere. This model works in Kilkenny, with the success of the local area integrated care committee and acute medical assessment unit. Kilkenny provides an example of what is possible for integration between primary and secondary care resulting in shorter patient waiting times, and giving GPs greater access to diagnostics. That will prevent the patient ending up in the wrong place at the wrong time. Patients often self-refer to accident and emergency departments, for example.
We have a current manpower crisis in general practice. A total of 157 GPs are trained per year, but we are currently exporting half of these highly-trained professionals. An Irish College of General Practitioners survey of trainees and newly qualified GPs in 2014 found that only 37.5% of GP trainees were definitely planning to stay and work in Ireland and only 43% saw themselves as a principal in a GP practice or partner in a group practice. An option for the remainder would be as employees in salaried posts. In the current climate, however, few existing practices have the finances to do this. While training more GPs is necessary, until an environment that will encourage those who are trained to stay is created, we cannot begin to solve this looming manpower crisis. A further concern is the ageing demographic of the current GP workforce. A report commissioned by the National Association of General Practitioners, NAGP, in 2015, by LHM Casey McGrath, found that more than 900 GPs – close to one third of the current workforce – expressed an intention to retire or emigrate in the following three to five years.
General practice currently carries out 22 million consultations per year with a greater than 95% satisfaction rating. This is expected to increase to 35 million annually in the next three to five years. The projected number of GPs needed to meet this demand is approximately 4,000. Currently, approximately 2,400 GPs have GMS contracts but with the projected retirements in the next few years, we stand to have only half the required numbers. However, we regularly hear from GPs who have emigrated to Australia, New Zealand and Canada. They consistently highlight that the major difference between our health care system and theirs is their timely access to diagnostics such as X-rays, scans, physiotherapy, counselling and expert opinion, the difference it makes to their working day and the benefit to their patients, which cannot be overestimated. In recent years, the State has rightly built primary care centres. However, this is not all about bricks and mortar. It is important that activity takes place within these centres to keep patients out of the secondary care system.
Ultimately, many of the challenges faced by GPs boil down to the terms and conditions of our working lives, which are dictated, as the Minister said, by an ancient contract between the State and the HSE. I hope he will confirm in due course that the NAGP will be invited to negotiate a new contract on behalf of its members. I believe he had constructive meeting with the association’s representatives last week and I welcome his commitment to further engage with them in the coming weeks. The organisation has made significant gains in progressing key issues for GPs since its relaunch in 2013.
With regard to the Supplementary Estimate for health, Fianna Fáil welcomes the allocation of an additional €500 million with €40 million for home care services, €31 million for disabilities, €20 million ring-fenced for mental health services and €40 million for the new winter initiative. Should the Oireachtas health committee have extensive hearings with the Department and the HSE as to what is required to meet both the demographic demand and unmet need in order that all areas of proposed expenditure can be fully examined and scrutinised? In particular, the HSE should be invited to make a submission to the committee similar to that which was sent to the Department last August in order that health expenditure requirements can be extensively debated and analysed in advance of the budget in October.
Tuesday, 5 July 2016
Some 266 people were handed the gift of life in 2015 through organ donation. This figure has increased substantially due to the diligent work of Organ Donation and Transplant Ireland, which is headed by Professor Jim Egan. Outcomes for transplant recipients in Ireland continue to rank among the best in Europe. Currently, organ donation in Ireland is based on a voluntary donation system and it occurs in 32 intensive care units throughout the country. The National Organ Procurement Service operates a 24-hour service 365 days per year. Its highly trained and motivated staff travel to the relevant hospital and guide the family through the very traumatic experience. All stakeholders are treated with dignity and respect. The service does good work and I ask the Leader to ask the Minister to ensure its funding is secured and maintained.
Tuesday, 12 July 2016
Order of Business
I share my colleagues’ concerns regarding the leaked recommendations from the trauma steering group, published in The Sunday Business Post. As of three hours ago, 419 people were waiting on trolleys in emergency departments in this country, and this is the middle of the summer. The hit list of emergency services covers all parts of the country. As we know, overcrowding in accident and emergency departments is a problem. All the data suggest that it leads to increased mortality among patients who attend them.
We used to bemoan the fact that some counties did not have an accident and emergency department. If some of these cuts come into practice, we might have whole regions without one. While I understand why we need to centralise services, and I welcome the BreastCheck and the prostate referral system, we cannot over-pressurise accident and emergency departments that are already overcrowded. That would be my concern. Also, these types of leaked recommendations are not helpful to staff working in the hospitals and GPs who would refer frequently to their local services. For example, Cavan trauma cases could be transferred to Beaumont Hospital or Connolly Memorial Hospital. Both these hospitals have major capacity issues. Kilkenny, Mullingar and Wexford trauma cases could transfer to the Mater or St. Vincent’s. All these hospitals are bursting at the seams. This is coupled with an ambulance service that is under-resourced. We have an ageing fleet. Often the roads from the accident or the emergency to the trauma centre have poor infrastructure. I ask the Minister to come in to discuss some of these issues.
Thursday, 14 July 2016
Health (Amendment) Bill 2016: Second and Subsequent Stages
I welcome the Minister of State to the House. Along with my party, I will be supporting the Bill. I am disappointed that it is necessary and that there are still many residential centres that are non-compliant with HIQA regulations. While I appreciate that measures are being taken to make said centres compliant, it is unfortunate that the deadline needs to be extended by a further two years. Ideally, Fianna Fáil would like to see more people with disabilities living independently and less need for residential centres. However, as long as we have them it is important that they are well regulated and compliant with regulations.
The Health Service Executive, HSE, funds services for approximately 8,000 people in residential support settings, including 1,400 places at HSE-run units at a cost of €900 million per annum. The Health Information and Quality Authority, HIQA, which today published its annual overview report, assesses disability homes against 18 standards during each inspection,
including residents’ rights, health and welfare needs, staffing levels, medication management and governance. On publication of today’s report, Ms Mary Dunnion, chief inspector of social services and director of regulation at HIQA, said that the initial inspections carried out in 2014 found that there was a lack of understanding of how to meet the requirements of regulations and standards and that where there were competent people in charge who had sufficient oversight of the quality and safety of the service being provided, centres were able to meet the regulations and standards. It is important to note that where there were competent people in charge standards were met.
In 2015, HIQA carried out 561 inspections of the 937 designated centres for adults and children with disabilities in 2015. There were 741 inspections in total. At that time, more than one third of the HSE-run homes inspected did not comply with any of the standards. For example, in Cregg House in County Sligo, where there are 108 residents, there was major non-compliance in 19 of the 23 areas inspected: exits were locked, there were no push buttons nearby to facilitate an exit in the case of a fire, staff were constantly in reactive mode, and patients had received excessive chemical restraint in the few months prior to the inspection.Recently the HSE has taken control of three homes run by the Irish Society for Autism. The centres which care for 47 residents are Cluain Farm in Kinnegad, Dunfirth Farm in Johnstownbridge and Sarshill House in Kilmore, County Wexford. The criticism levelled at these institutions was damming. They were labelled as unsafe and chaotic. Again, drugs were used as chemical restraints, residents left the homes without being noticed or recorded, many residents self-harmed, management was poor, staff were badly trained and inspectors found deficiencies in the administration of anti-psychotic, sedative and pain relief medication.
In 2014 we had the horrendous debacle of the Aras Attracta controversy. How can any of us forget those degrading images of vulnerable human beings on our television screens? Their treatment flew in the face of any semblance of human nature. Regressive, neglectful care such as was highlighted cannot be tolerated. The answer, of course, is to move away from the congregated setting model and opt for more supported placements in the community. What is needed is integration, not segregation.
The HSE prioritised the transition of just 150 people in 2015. In December 2015 the projected outturn was only 112. The number of people living in congregated settings is 2,725. The programme for Government states its objective is to reduce this figure by at least one third by 2021. At this rate, it will be 2031 before everybody is out of a congregated setting. We must be mindful to respect the trauma residents can experience when being moved to unfamiliar surroundings and aware that unsupported relocation causes great stress. It is not all that long ago when a UN special committee on torture issued a report which came extremely close to describing institutionalisation as a form of torture.
While we will support the amendment, it is time to redouble our efforts to end congregated settings. It is time to redirect funds from this malfunctioning and often antiquated system to the people who can instigate change for the betterment of service users and to ensure the service user will be listened to through assisted decision-making legislation.
Wednesday, 20 July 2016
Order of Business
I wish to bring to the attention of the House the fact that, despite the Government’s assurances that the recovery is going strong, much-needed services are still being disbanded throughout the country, which is affecting those who need them most. This week, I was told of an autistic child in the Waterford region whose specialist therapists, who the child knows well and has become comfortable with, were removed. Instead of four specialist therapists with whom the child is confident and content, the child will now just have one unfamiliar general therapist. The specialist therapists, who provide vital language and speech support and occupational therapy, have been reassigned to the general system. If the child wishes to be seen by them, the child must begin from scratch on the waiting list. How can it be that this child, for whom routine is so important, is left without any kind of specialist therapy and can be put on a waiting list for as much as a year?
The National Council for Special Education, NCSE, recently published the first major report in 14 years on the education of students with autism. The report indicates that almost 14,000 students, just 2% of the total, had an autism spectrum disorder, ASD. The report also shows that a July provision scheme, which is similar to summer school, open to the country’s 13,874 students with ASD and valued by parents, could threaten the well-being of students. The NCSE believes that the staff recruited will not be familiar with the behaviours and needs of individual students, which could lead to challenging behaviours. Like so many others, autistic children require specific help that is tailored to their needs. Instead, they are being let down by a Government purporting to help them.
Wednesday, 20 July 2016
I thank the Minister of State, Deputy Helen McEntee, for coming to the House. I want to ask for a review of parking charges at HSE hospitals across the country to ensure low-cost parking is available to patients and visitors to the public hospital system. I also want to ask if any single organisation has a contract with the HSE to charge for parking and-or clamping on hospital grounds. Will the Minister of State inform us of the cost of such contracts and make a statement on the matter?
I spoke about this in a different context prior to getting elected to the Seanad in my role as secretary of the National Association of General Practitioners. I felt many patients were attending hospitals unnecessarily for investigations that could happen in the community. Various investigations into hospital car parking fees have shown a severe lack of consistency in the rates being charged across the country. To give some examples, there is a charge of €3 per hour at the Mater Hospital, with a maximum charge of €15 per day; it is €2.70 per hour at Cork University Hospital, with a maximum charge of €15 per day; it is €2 per hour at University Hospital Galway, with a €9 daily rate and a rate of €30 for one week; and at Kerry Hospital, the first 20 minutes is free, 20 minutes to one hour is €3 and there is a €12 daily rate.
As the House can see, due to the lack of regulation, there are vast differences across the State. Going by the above figures, the average daily rate is €10 or €70 per week. This is a lot of money for many families and particularly for long-term patients. I appreciate that many hospitals have special consideration for people who require longer-term parking but there are also many instances where hospitals are not identifying people in need of special discounts.
This unpopular charge is generating millions of euro of income for hospitals. For example, Cork University Hospital was the highest earner, collecting over €2.8 million last year from car park fees, working out at an average of €8,000 per day, University Hospital Waterford collected €1.48 million, Wexford Hospital collected €700,000 and Our Lady’s Hospital for Sick Children collected €349,000. These fees are causing increased distress to the sick and their relatives and are an active deterrent to people visiting hospitals. Those who have long-term illnesses may need to spend several hours in a car park, and it is, in effect, a tax on a sick person. There are certain hospitals which add to the distress by imposing clamping fees but the release charge also varies and can be as high as €120 in some hospitals.My colleagues throughout the country have brought this up time and again. For example, Councillor Norma Foley, a Fianna Fáil councillor in Kerry, has said it is no longer simply an issue for the people visiting the hospital, but one for the entire community surrounding the hospital. In housing estates in the vicinity of the hospitals residents are struggling to get parking at their houses as a result of the area being overrun with traffic. There is a knock-on impact as a result of the fees.
Some people have tried to justify the charges with the argument that they are necessary to deter motorists who are working or shopping from using the car parks for free at the expense of spaces for patients and visitors. If this is the case, then the costs should be nominal. Could we consider a flat nominal nationwide fee? Could we have a barcode system whereby if a patient receives an outpatient appointment, at the bottom of the letter a barcode could facilitate access to a car park and give the patient two or three hours of free parking while attending the hospital.
Tuesday, 4 October 2016
Order of Business
According to the HSE, on average at least six people die accidentally from carbon monoxide poisoning each year. Everyone in this House will be aware that last week was Carbon Monoxide Awareness week. The reason I raise this matter today is that this is a preventable issue. The risk of carbon monoxide poisoning is something that we should be aware of 365 days a year and not just for one week. The campaign was a timely reminder to us all of the importance of increased awareness of carbon monoxide. Due to the fact that it is a colourless and odourless gas it is highly dangerous. Every year people die unnecessarily from carbon monoxide poisoning in this country while many more people attend accident and emergency departments and GP services with symptoms such as nausea, headaches, breathlessness and vomiting.
I ask the Leader to schedule a debate on this important issue as I know other Senators are concerned about this matter. Senator Norris was a co-sponsor of a Private Members’ Bill that was tabled by former Senator, Mr. Feargal Quinn, two years ago. The legislation was called the Building Control (Carbon Monoxide Detection) Bill 2014. My party colleague, Senator Brian Ó Domhnaill, spoke on the legislation at the time. Carbon monoxide awareness is a major issue for families, homeowners and landlords. Responsibility for the issue falls between two Ministers – the Minister for Communications, Climate Action and Environment, Deputy Denis Naughten, and the Minister for Housing, Planning, Community and Local Government, Deputy Simon Coveney.
The State, through the 31 local authorities, is the largest landlord in this country. The local authorities have made provision in their 2016 budgets to receive rental payments of €391 million from local authority tenants. The role played by each local authority is crucial. I want to know whether they are meeting their legal and statutory obligations in terms of ensuring that all domestic boilers are serviced annually. On foot of information supplied to me by elected local authority members, I have submitted detailed queries on this matter to the chief executive of each local authority. I have asked them to outline the number of local authority homes in their areas and the corresponding number of boilers that have been serviced in the each of the past five years in the same areas. Everyone in this House has heard of the Hippocratic Oath, which I have taken. There is a phrase in it that everyone knows instinctively but which is often overlooked when it comes to public policy. It reads, “Prevention is preferable to cure”. Illnesses and deaths from accidental carbon monoxide poisoning are preventable; therefore, I urge the Leader to arrange a debate on this and related matters in the coming weeks during which we can examine proposals that would place a much greater onus on landlords and the State to ensure safety standards are maintained.
Oireachtas Joint and Select Committees
Thursday, 13 October 2016
Joint Oireachtas Committee on Health
Open Disclosure: Department of Health
I have two very brief points. Dr. Holohan said that the senior clinical physician may be engaged in the reporting mechanism. On a practical level, patients spend a lot more time in the community than they do in hospitals. How would Dr. Holohan envisage this reporting happening in a community or a primary care setting where the health professional might be working in isolation, be it a GP, a public health nurse, a physiotherapist or an ancillary member of the primary care team. Who would take the lead in the reporting mechanism in those instances? With regard to Deputy O’Connell’s point about the legal protection offered for the health professional, and considering the soaring medical insurance costs at the moment especially for doctors in private practice who may not get some funding from the HSE, does Dr. Holohan believe this may foster a culture of unwillingness to co-operate with the whole process?
Thursday, 13 October 2016
Order of Business
At the end of December in the Dublin north-east regional health forum a motion was put forward relating to dental health in children. The motion called on the HSE to make available sufficient funding to ensure all primary schoolchildren receive a minimum dental service in second and sixth class and, ideally, in fourth class as well. The motion comes as a result of the problem posed by tooth decay in children.
Tooth decay is a major oral health problem in most industrialised countries affecting 60% to 90% of all children. It remains the most common chronic disease in children aged six to 11 years and adolescents aged 12 to 19 years. Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years. Cavities, even in children who do not yet have permanent teeth, can have serious and lasting complications such as pain, tooth abscess, tooth loss, broken teeth, chewing problems and serious infection.
My party colleague, Dr. Claire O’Driscoll, has said that realistically, once children start getting teeth they should be seen annually by a dental professional. Given that almost one in three young children drink sugary and sweetened drinks every day and that 411 million litres of sugary sweetened drinks were sold in Ireland in 2014, it is clear the need for dental professionals is only going to increase. According to the chief executive of the Irish Dental Association, Fintan Hourihan, the population of children under the age of 16 years in Ireland has increased by 20% in the past decade to 1.1 million. However, the number of dentists tasked with looking after these young people has fallen by 20% in recent years due to the recruitment embargo. The result is that a large number of primary schoolchildren are missing school screening and their dental problems are not being identified in the early stages. This can have knock-on effects with regard to emergency cases in later life.
As in the case of so many preventable diseases, these problems are a strain on our embattled health service. Irregular access to dental care results in higher use of emergency services. We all know we need to make smarter use of our health service. We need to use preventative measures. We need to stop the problems before they really start. Here is a prime example of where we can do just that.
Wednesday, 19 October 2016
Order of Business
One image or storyline often defines a conflict or tragedy. For example, we often think of the iconic image of nine year old Kim Phuc, the girl pictured naked as she fled horrific violence in south Vietnam in 1972. In the midst of the carnage and the suffering she experienced as a result of severe burns on her back, there can seem to be no hope at times. Seventeen surgical procedures were performed during her 14-month stay in hospital. She survived and today lives with her husband and two children in Toronto. She also established the KIM Foundation in the United States, with the aim of providing medical and psychological assistance for children of war.
Much closer to home, we have seen the images of a three year old Syrian boy, Alan Kurdi, who perished in the Mediterranean and was washed ashore in Turkey in September 2015. As a father of a young boy, these images had a profound impact on me. In the midst of the terror being experienced by fleeing Syrian refugees, one heart warming story brought a smile to my face. Ahmed Soda, an 11 year old Syrian refugee, recently helped Patrick Sarsfields GAA Club win its first Antrim juvenile hurling title in many years. Ahmed and his family who are originally from Aleppo arrived in Belfast last December.
The crisis in Syria, specifically the humanitarian catastrophe in Aleppo, has been mentioned by many Senators. Last week, for example, the issue was raised by Senator Ray Butler. The Fianna Fáil Party spokesman in the Dáil, Deputy Darragh O’Brien, has been forthright in his condemnation of recent attacks on United Nations and Red Crescent convoys. I echo this condemnation and despair when I see media reports of medical and United Nations facilities being targeted and destroyed. In this context, I wholeheartedly support the comments of the Taoiseach who wants Ireland to introduce a Naval Service hospital ship to deal with global emergencies. It is perhaps fitting that he made this pronouncement earlier this week while launching a new Naval Service patrol vessel, the LE William Butler Yeats, named after a former Senator who served in the House in the 1920s. The introduction of a Naval Service hospital ship to deal with global emergencies would be a practical response to ongoing humanitarian catastrophes throughout the world.
The incredible work of the Naval Service and the crews of the LE James Joyce, LE Róisín, LE Eithne, LE Niamh and LE Samuel Beckett is an inspiration to us all. The trauma Naval Service officers will have encountered is hard to comprehend. As a medic working on the west coast, I regularly liaise closely with the Irish Coast Guard and experience at first hand its members’ bravery and commitment to serving the public while putting their lives in danger. They face danger on every call-out. The crews of Naval Service vessels working in the Mediterranean deal with hundreds of traumatic scenarios daily.
The image of young Ahmed Soda with his hurley among friends in west Belfast provides an important counter-balance to the awfulness unfolding in his home city and country. This is what we must all focus on as we recommit to Ireland playing its part in dealing with the humanitarian crisis unfolding in the Middle East and the Mediterranean.
Wednesday, 19 October 2016
Ireland Strategic Investment Fund Investments
I thank the Minister of State for taking this important motion on investments held by the National Treasury Management Agency, NTMA, through the strategic investment fund. This is a health and financial policy issue, because tobacco use is the leading cause of preventable death in Ireland and is an enormous strain on our health system. We always want to see the NTMA generate a significant income for the taxpayer through prudent and strategic investments. The strategic investment fund has a statutory mandate to invest on a commercial basis, and I fully acknowledge the independence of the NTMA in carrying out its important work. The long-term strategic investment of taxpayers’ money is something that can and should be done professionally and devoid of political interference.
My Fianna Fáil colleagues, Deputies Sean Fleming and Michael McGrath, have previously raised this broad issue on ethical investment with the Minister of Finance and the CEO of the NTMA, Mr. Conor O’Kelly. We know from the NTMA’s most recent annual report that the State held more than €7.2 million in quoted equity and debt instruments for Philip Morris, British American Tobacco and other major tobacco firms. This is incredible and is part of almost €35 million of taxpayers’ money invested in the alcohol, tobacco, aerospace and defence industries.
I wish to concentrate on the tobacco companies for health and financial reasons. A detailed study, an assessment of the economic cost of smoking in Ireland, was produced by the Department of Health in 2016. The estimated cost of smoking on the health care system is more than €500 million per year. This is made up of direct costs in three areas. These are hospital-based costs of €211 million, primary care costs amounting to an enormous sum of €256 million, which could solve our primary care crisis at least five times over, and domiciliary costs of €40 million. It is estimated that approximately 6,000 people are killed annually by smoking. This is equivalent to the population of an entire town such as Bandon in County Cork, Westport in County Mayo, Kells in County Meath or Carrick-on-Suir in County Tipperary. The direct cost of €500 million year does not include lost productivity from ill-health and other huge drains on our public services. Department of Health data from three years ago shows an average cost of €5,400 every time a smoker was admitted to hospital with a tobacco-related illness, for example chronic obstructive pulmonary disease, COPD. In 2013, which is the most recent year for which I have statistics, there were 31,000 such admissions at €5,400 per admission. This does not include the primary or GP care costs and associated costs such as medication.
I am aware that investment by the NTMA in specific companies is made through fund managers, lest it be suggested the NTMA actively seeks to invest in such companies. However, it is the case that over the summer, the NTMA CEO told the Committee of Public Accounts that armaments is the NTMA’s only restricted investment category. In 2015, information made available by the Minister for Finance outlined that the strategic investment fund has excluded 14 companies from its investments. These companies are not named, but it beggars belief the Irish taxpayer still has €7.2 million in equity and debt instruments in tobacco giants such as Philip Morris and British American Tobacco. In case anyone has forgotten, these are some of the same companies that threatened to sue my Seanad colleague, Senator James Reilly, and his successor as Minister for Health, Deputy Leo Varadkar, for doing their job.
This area is above party or partisan politics. We all need to address it and provide leadership on it. When he was Minister with responsibility for health, Fianna Fáil leader, Deputy Micheál Martin, led the way in pioneering our move in Ireland towards a tobacco free society with the ban on workplace smoking. Other countries followed suit once they saw the success it was having. The area of ethical investment is another area in which we should take the lead because while wholly independent, the strategic investment fund’s investment policy is set out by the National Treasury Management Agency Act 2014. According to the Minister for Finance, the strategy is determined, monitored and kept under review in accordance with the Act. This is the basis for my call for a process to be put in place to put investment in tobacco companies on the list of prescribed investments.
I struggle to understand how holding equity and debt instruments in such companies is in keeping with what various Ministers said regarding their intention to establish the Ireland Strategic Investment Fund. Former Minister of State, Deputy Fergus O’Dowd, spoke on Second Stage of the legislation in 2014. He stated, “The intention is that the Ireland Strategic Investment Fund, ISIF, will channel its resources towards productive investment in the Irish economy and leverage its resources with private sector co-investment and target investment in areas of strategic significance to the future of the Irish economy”.
Wednesday, 26 October 2016
Public Health (Alcohol) Bill 2015: Committee Stage (Resumed)
I welcome the comments of my fellow Senators on alcohol advertising. I acknowledge what the Minister of State has said with regard to securing European agreement. However, the whole process needs to be accelerated, especially with regard to online advertising. Much of the time children do not watch television; they are on their iPads all the time. We are going to be behind the ball if we leave it to some European directive. We need to accelerate this process, especially in the context of Brexit.
I wish to comment on section 17. We have no amendments to the section but we question how it will be enforced, especially with regard to the importation of magazines with alcohol advertising. What is the situation in respect of magazines printed outside the country? How does the Minister propose to deal with that?
Wednesday, 26 October 2016
Public Health (Alcohol) Bill 2015: Committee Stage
Fianna Fáil welcomes the Public Health (Alcohol) Bill. Harmful drinking is a major issue. More than 8,000 people were treated for problem alcohol use in 2012. Alcohol is associated with 2,000 beds being occupied every night in the acute hospital sector, one quarter of injuries suffered by those presenting at emergency departments and over half of all attendances at specialised addiction treatment centres. I have first-hand experience of this situation in that I have worked in many of Dublin city’s accident and emergency departments, as well as for the NHS. I know the trauma that alcohol causes the people involved as well as to the staff of accident and emergency departments.
It is estimated that three people will die in Ireland everyday as a result of alcohol. That equates to 88 deaths per month and more than 1,000 lives lost every year. This is five times more than the number of road traffic deaths every year. A study by the HSE in 2012 estimated that alcohol-related costs amounted to approximately €3.7 billion per annum. For these reasons, Fianna Fáil is supportive of the legislative measures to curb alcohol abuse and excessive consumption. We aim to strike a balance in our amendments and to be solution driven and pragmatic.
Wednesday, 26 October 2016
Order of Business
Since the Seanad commenced its sitting this morning, over 200 calls will have been received by the emergency call answering service, which is responsible for all 999 and 112 calls. In 2015, it received 1.8 million calls, an average of 5,100 per day. The reason I raise this issue today is because Hallowe’en night is only days away and, unfortunately, has become a byword for stories about attacks on our emergency services. I ask the Leader to consider scheduling a debate on our emergency services and how they are protected in carrying out their work on our behalf. It is not just a Hallowe’en problem. In May, a gang of around 15 youths attacked fire-fighters in Limerick city. One fire-fighter was struck over the head with a pool cue. In April, a fire-fighter in Dundalk was hospitalised after his crew was attacked with missiles. Nationally, there are hundreds of incidences of assaults on gardaí every year. Nurses are regularly victims of unprovoked assaults, prison officers are routinely hospitalised and fire officers and paramedics are often more in danger from the thugs who attack them than from the incident or fire to which they are responding. A couple of years ago, my colleague in Fianna Fáil, Deputy Dara Calleary, proposed the Assaults on Emergency Workers Bill 2012, which is designed to crack down on assaulting or threatening an emergency worker in the line of duty. A central part of this Bill was a proposed minimum jail term of five years for anybody convicted of assaulting or threatening the life of a member of the front-line emergency services while they are on duty. We need to get real about this type of behaviour. Anyone who goes out of their way to assault, harm or threaten an on-duty emergency responder should know that the law will come down heavily on them. Throwing rocks at an ambulance and its crew as it brings a sick man to hospital, as happened last Hallowe’en night, is the behaviour of thugs. We now have a crazy situation in many accident and emergency departments whereby there are as many security guards as there are consultants or doctors on duty. This is farcical. This thuggish behaviour requires the Oireachtas to act. I strongly believe that assaults on our on-duty emergency services personnel should incur a much stiffer penalty than currently exists, to act as a deterrent.
Thursday, 27 October 2016
Order of Business
I again bring to the attention of the House the National Treasury Management Agency, NTMA, and the strategic investment fund equity holding in tobacco companies. Last week in the House, the Minister of State, Deputy Eoghan Murphy, confirmed to me that the NTMA and the Ireland Strategic Investment Fund, ISIF, have equity holdings in three separate tobacco companies. I acknowledge that all of us want to see the NTMA generate a significant income for the taxpayer through prudent and strategic investments, and I understand the ISIF has a mandate to make investments on a commercial basis. However, I ask that the interests in tobacco companies be brought to an end given that tobacco is the leading cause of preventable death in this country, accounting for 6,000 deaths per year, and that there are 31,000 admissions, costing €5,400 per admission, as a result of direct cigarette-related illnesses.
I have written to both the Minister for Finance, Deputy Noonan, and the Minister for Public Expenditure and Reform, Deputy Donohoe, asking them to pursue the divestment of those legacy investments. If that approach is not sufficiently strong, I will raise this matter with other Oireachtas colleagues, including each Senator here, with a view to seeking to include the publication of draft legislation, which would make such investments illegal.
A target date was set by Senator Reilly when he was Minister for Health for Ireland to be tobacco free by 2025. It is an ambitious target but one which could be achieved readily by the commitment that taxpayers’ money will no longer feature in investments in tobacco giants. It is wholly hypocritical that this country is attempting to be tobacco free by 2025 yet tobacco companies do not feature on the excluded investment categories of the NTMA. It is also hypocritical that these same tobacco companies are suing the State and issued proceedings against the then Minister, Senator Reilly. That should be brought to an end as a matter of priority.
Wednesday, 9 November 2016
Health (Amendment) (Professional Home Care) Bill 2016: Second Stage
Fianna Fáil is happy to support this legislation, which stems from a Law Reform Commission report published five years ago. The legislation provides for a regulatory framework and legal standards to be put in place for professional home carers engaged in the provision of care to people in their own homes. Similar legislation based on the Law Reform Commission report was published by Deputy Billy Kelleher in 2012.
As Senator Colm Burke stated, it is recommend that HIQA should be given additional regulatory and inspection powers to ensure that appropriate legal standards are in place for undertakings that provide professional home care.The report did not propose that the HIQA regulatory and inspection system would apply to informal carers such as family members. That is important in so far as it has allayed fears among people in the community. I heard that at first hand in the practice. The report made 29 recommendations for reform of the law and also included a draft health Bill to implement them, which is the one before the Seanad today. The LRC pointed out that it is well known that the proportion of people living in Ireland who are aged over 65 has been increasing in recent years and is projected to increase at an even greater rate in the coming decades.
I wish to highlight a few welcome provisions in the Bill, but I will not go through them all. It provides that palliative care be included in the definition of professional home care. That is very important, as it is a basic human dignity that people can spend their final days in their own home, surrounded by their loved ones – friends and family. The assessment must include an assessment of companionship, which is also very important. As a rural GP I am very well aware of how mental illness affects the elderly population. Those elderly people are often without a voice. Companionship needs may include preparing snacks and monitoring diet and eating. Malnutrition is rife in this country and we do not realise it, especially among the elderly population who have chronic diseases such as chronic obstructive airways disease. Other elements of companionship include arranging appointments, reminders for medication, which is also important because it is estimated that half of all medications are taken incorrectly in this country. In turn, that would prevent admissions to secondary care.
In developing a Bill such as the one before the House it is important that it is matched with investment in primary care. By that I do not necessarily mean primary care centres, although they are important in certain locations. I am referring to the provision of care in terms of bodies on the ground – the provision of nurses and GPs. It is about the activity that happens within the primary care centre more so than the bricks and mortar of the centres. If the Bill is to work we need investment in the carers who provide the front-line services in communities.
In terms of making home-care packages a statutory right, that was the aim behind a Fianna Fáil Bill introduced by Deputy Willie O’Dea in the Dáil prior to the recess. If passed, the Bill would be an enormous step forward in helping to empower older people. It would enshrine in legislation their right to services to allow them to stay in their own homes and communities for as long as possible, which would not only benefit the individuals concerned and their families but also the State due to less demand being placed on long-term residential care services. It is time we gave older people a greater choice in determining the care they receive.
Wednesday, 9 November 2016
Order of Business
On this day in 1989 all of us were alive and probably watched the evening news as the Berlin Wall came crashing down, a moment we will never forget. We have just had a bitterly divisive US presidential election where one candidate, now the President-elect, decided to whip up anti-migrant sentiment and anger with the suggestion of building a wall on the Mexican frontier. Here, on our island, there are 109 so-called peace walls dividing communities and enforcing segregation. We want to see them consigned to the past.
There is a disgusting undercurrent of populist anti-migrant sentiment creeping into mainstream political discourse across Europe. What is happening in Calais and the despicable treatment of some of the most vulnerable people on this planet is vile. Many blame the likes of UKIP. However, the former Prime Minister, David Cameron, has a lot to answer for as he helped, through his actions, to unleash a level of mainstream bigotry on those of different colour and race. It is worth remembering that one in four doctors in the NHS is a UK foreign national. I used to be one of them. The British health system, no more than our own in Ireland, would cease to operate if these bigots got their way. The decision to hold a referendum to leave the EU was taken to appease the rebellious Conservative backbenchers who blame everything on Europe and foreigners. We are all now reaping the fruits of what Cameron and others have sown.
Separately, this Friday, as Senator Feighan noted, is armistice day. England play Scotland at Wembley in a world cup qualifier and there is an ongoing dispute with FIFA about the plan for both teams to wear a black armband with a poppy on it. In a great desire to appear even-handed, FIFA has decided to threaten the FAI and Ireland over the jersey worn, a photo of which I have with me, in the international friendly with Switzerland on 25 March last. The jersey displayed the beautiful 1916 centenary logo. Last week, a FIFA spokesperson said that the disciplinary committee of FIFA is evaluating the matter. Is it some kind of sick joke that an organisation which presided over criminal mismanagement and questionable financial probity would have the cheek to try to sanction Ireland over this? I remind Members that this logo is not the logo of the FAI, is not a commercial logo and is not a party-political logo. It is the logo of this State and it is proudly on display in images on the website of the President, the Taoiseach and the Minister for Foreign Affairs and Trade.
I ask the Leader to request the Minister for Foreign Affairs and Trade to convey to FIFA in the most polite terms that it should get its own house in order before it starts interfering in the official State logo we have proudly used in this centenary year.
Oireachtas Joint and Select Committees
Thursday, 10 November 2016
Joint Oireachtas Committee on Health
Quarterly Update On Health Issues: Discussion
I have been liaising with my party colleagues, Deputy Butler and Councillor Murphy, on Waterford hospital. Dr. Heraty recommended that the hospital should be funded for an additional two angiography sessions per week, which would deliver approximately 3,000 more appointments. What is the timeframe for this to be implemented? Will it be later this year or early next year?
I welcome the additional €18.5 million in funding for the primary care strategy and I also acknowledge the work on the development of primary care centres around the country but it is not all about bricks and mortars. It is about the activity that happens within the centres. Bearing that in mind and the serious manpower crisis in general practice, will the Minister consider specific funding for practice nurses in the context of nurse prescribing? There are many inadequacies within our health system in so far as GPs perform nursing duties and consultants perform GP duties. If GPs are considering sending their nurses a on nurse prescribing course, they have to fund it themselves.
Given 90% of all patients are seen in general practice on a day-to-day basis, a specific model to fund practice nurses in nurse prescribing would help the transition of the patient through the system in a more timely manner and would help alleviate the pressures we are witnessing in primary care and it probably would reduce the referral rates to secondary care.
Thursday, 10 November 2016
Order of Business
In July and August my office sent out more than 940 confidential mental health questionnaires to all local authority members throughout the country, from all parties and none. This was the first comprehensive anonymous mental health questionnaire to be circulated to councillors. To tell the truth, the findings, which I presented at an AILG conference in Gorey recently, were stark and startling. Some 79% of councillors said their role as a public representative impinges on their personal life, 82% said their responsibilities had increased in recent years, 47% experienced low mood and, worryingly, 5% expressed thoughts of self-harm. This is a very serious and real issue. We forwarded the results to the Minister for Health, Deputy Harris, and the Minister for Housing, Planning, Community and Local Government, Deputy Coveney. Mental health is a big issue. We lost one of our councillor colleagues earlier in the year. It is important that we have the Minister to the House to discuss and debate this further. I ask the Acting Leader to invite him in as soon as possible.
Wednesday, 16 November 2016
Order of Business
As a health professional, I am concerned about a disturbing and unregulated trend that has emerged in the health care sector of late. I refer to so-called health specialists with no formal medical or nursing training who rent rooms in hotels around the country. They provide cardiovascular health assessments to vulnerable patients using simple probes that can be bought on eBay yet they compare their activities with the gold standard of angiography. It is worrying because these conmen mislead patients and often give them a false sense of security. The assessments are completely inappropriate. It takes six years to qualify as a doctor and at least five years of postgraduate training to have the skills to take an adequate history from a patient, perform an examination, instigate investigations, make a diagnosis and make a prognosis that predicts how a disease will progress. The Medical Practitioners Act 2007 governs what medical practitioners do, and rightly so. Who governs medical fraudsters? The sale of insurance and financial products is highly regulated but the sale of misleading information is not. These conmen take large sums of cash from rural communities on a weekly basis and I would like to see their tax returns for same. I ask the Leader to invite the Minister for Health to discuss this important but worrying matter that has raised its head in the past few months.
Wednesday, 23 November 2016
Order of Business
I recently read that, following a year-long campaign, Trinity College Dublin is set to divest the €6.1 million it has indirectly invested in fossil fuel companies. Fossil Free TCD has been lobbying and campaigning very diligently on this issue for many months, with the culmination this week of a commitment to divest. I believe the students should be applauded on their resilience and commitment to the cause. I know that Senator Ruane, when president of TCD Students’ Union, campaigned and lobbied for the same result. Trinity also has endowments in various other sin stocks, such as arms and tobacco companies, which in recent years students have taken issue with. They feel that these investments contrast with the university’s vision. I too feel that the investments made by the Ireland Strategic Investment Fund, ISIF, using taxpayers’ money are out of line with the vision we have for a tobacco-free Ireland by 2025. This is an issue I have raised before and will continue to raise. In the words of Professor Luke Clancy, it is unconscionable.
Since I first brought this issue to the House on 19 October, 500 people will have died from smoking-related illnesses. If that does not portray the urgency of this issue, I have no idea what does. In response to a parliamentary question I submitted through Deputy Jack Chambers, the Minister for State, Deputy Marcella Corcoran Kennedy, said that she would, in consultation with her colleague, the Minister for Health, Deputy Harris, express concerns to the Minister for Finance about the appropriateness of these investments in tobacco companies in the context of the review of the investment strategy and exclusion policy. I have brought a Commencement debate to this House. I have written to the Ministers, Deputies Donohoe and Noonan, asking them to beseech the ISIF to divest immediately from these holdings and I have also written to the CEO of the National Treasury Management Agency, NTMA. To date, I have received no substantial response. I repeat that 500 people will have died from tobacco-related diseases in the last month.
Later today, I will meet representatives from ASH Ireland, the Irish Heart Foundation, the Irish Cancer Society, the Royal College of Surgeons in Ireland and the Royal College of Physicians of Ireland to seek joint collaboration to bring an end to this hypocrisy. I also have a motion before this House proposing that Seanad Éireann calls on the Minister for Finance to bring to an immediate end the investment of taxpayers’ money by the NTMA and ISIF in the three separate tobacco companies in which they have equity holdings. Based on the lack of response and urgency from the Government, I have been consulting with a number of party colleagues and have legislation prepared which would prohibit the investment of any taxpayers’ funds in tobacco companies and seek the immediate divestment of any funds currently invested. This legislation is currently with the Bills Office and I expect it to be published in the coming days. I put the Leader on notice that I will be calling for the support of my colleagues in this House to ensure this legislation is successful. I look forward to debating the public health (prohibition of tobacco investments) Bill 2016 in the near future.
Wednesday, 30 November 2016
Order of Business
The recent barbaric actions of ISIS have horrified and shocked the world. I am certain every Member of Seanad Éireann agrees that its actions are a stain on humanity. We have been disgusted by the barbarism displayed in the filming and photographing of victims and the subsequent publication of executions for propaganda purposes. There is no place in a civil society for this inhumane activity. It is clear that the Universal Declaration of Human Rights does not apply to ISIS. I refer specifically to Article 3, the right to life and liberty, and Article 5 which states that “No one shall be subjected to torture or cruel, inhuman or degrading treatment or punishment”.
As mentioned yesterday, Cuba is in the midst of nine days of mourning following the death of Fidel Castro. I feel compelled to comment on this. Thousands of Cubans died in front of Castro’s infamous paredón, the wall, by firing squad. Those involved gleefully recorded their actions in photographs in order to assist in their propaganda war at home. It should never be forgotten that Fidel Castro was an oppressor, who sanctioned the torture and murder of gay people. In 1965, his regime established prison work camps, known as military units, to aid production, into which it sent homosexuals, Jehovah’s Witnesses and other undesirables who stepped out of line with the communist ideology. For everyone with a basic understanding of the history of Europe during the Second World War there is a chilling similarity in the tactics of Castro’s regime and that of Hitler in regard to the use of prison work camps.
I now want to read into the record of the Seanad nine names, one for every day of mourning. Delgado, 15 years of age, was beaten to death in 1981 when security agents stormed the embassy of Ecuador where his family had taken refuge. Lydia, 25 year of age, who was eight months pregnant, was repeatedly kicked while in custody. She lost her baby and then, having been left without medication, bled to death. A 70 year old woman named Edmunda was beaten to death in 1981 in a Cuban jail. In 1981 two men, González and Lugo, were executed but the regime reported the deaths as suicides. Maleras and Valverde were assassinated in 1994 while trying to obtain asylum. Radio operator Perán was assassinated in 1965 by Cuban state security. Police officer Cortés was executed by firing squad in 1959. On a point of principle, the statement by the President horrified me and I struggled to understand how he could, on behalf of the Irish people, express such glowing tributes to a tyrant and dictator. The glaring omission of the human rights atrocities by the Castro regime was disgusting. The remarks do not speak on my behalf. Words are important and I want to distance myself from the comments of President Higgins.
Tuesday, 6 December 2016
National Treasury Management Agency Operations: Motion
That Seanad Éireann calls on the Minister for Finance to bring to an immediate end the investment of taxpayers’ money by the National Treasury Management Agency and Ireland Strategic Investment Fund in the three separate tobacco companies in which they have equity holdings.
Tuesday, 6 December 2016
Order of Business
I propose an amendment to the Order of Business, that No. 29, motion 9, be taken without debate before No. 1. This motion pertains to the investment by the National Treasury Management Agency, NTMA, and the Ireland Strategic Investment Fund in equity holdings in three separate tobacco companies.
Smoking is the leading cause of preventable deaths in this country. As Professor Luke Clancy said, it is unconscionable to think that the State would invest taxpayers’ money in the tobacco industry and contribute to its commercial viability. I formally wrote to the Minister for Finance over six weeks ago about this issue. Since then, 500 people have died from smoking-related illnesses. I also have had constructive dialogue with non-governmental organisations such as the Royal College of Physicians in Ireland, Royal College of Surgeons in Ireland, the Irish Heart Foundation, the Irish Cancer Society and ASH Ireland.
Smoking-related illnesses cost over €500 million a year to the health care system with up to 6,000 people dying because of them. It is estimated there are 31,000 hospital admissions due to smoking-related diseases every year. Each admission costs €5,400, which comes to an approximate cost of €170 million per year. It is an important issue. I had prepared legislation in this regard. Unfortunately, because of the constitutional constraints of the House, I was unable to push that legislation. My colleague, Deputy Sean Fleming, will be taking this up in the Lower House.
Tuesday, 6 December 2016
Carbon Monoxide Poisoning Campaign
I thank the Cathaoirleach and welcome the Minister.
In this morning’s headlines, there is an unfortunate and heart-breaking story of an elderly man in County Armagh who has passed away as a result of suspected carbon monoxide poisoning. This devastation has been made all the more tragic by the fact that this was another utterly preventable death.
At the end of September, during carbon monoxide awareness week, I raised the issue of local authorities’ obligation to play a role in this silent killer. In Ireland, six people on average die unnecessarily from carbon monoxide poisoning each year. A 2015 study found that 1.2 million are currently living in houses without carbon monoxide alarms, including 100,000 people over the age of 65 who live alone. Furthermore, almost half of these people do not even know where to purchase a carbon monoxide alarm.
After I raised this matter here in the Seanad, I wrote to the chief executive of each county and city council asking them to provide, in tabular form, the number of local authority houses they have and the number of those the boilers of which they have serviced in 2014 and 2015. The responses varied greatly. Some local authorities did not reply at all, some simply provided the figures of the number of boilers they serviced and others stated that it was not their responsibility. As the largest landlord in the State, I strongly believe clarification is needed in regard to local authority housing and I would ask the Minister, Deputy Naughten, whether he is in agreement with the Minister for Housing, Planning, Community and Local Government, Deputy Coveney, that there is no requirement to carry out an annual service on home heating boilers.
Today, I also want to highlight radon, a radioactive colourless odourless tasteless gas occurring naturally as a decay product of radium. Radon is the leading cause of lung cancer after smoking and it is responsible for up to 250 lung cancer cases in Ireland every year. My party colleague, Councillor David Costello of Dublin City Council, brought this serious concern to my attention, and while almost every household in Ireland is familiar with carbon monoxide and its effects, not too many are familiar with or respect the harmfulness of radon gas.Last week, the EPA reported radon levels 24 times the accepted level in a house in County Wicklow. That is the equivalent of 17 chest X-rays every day. Currently, the agency provides a testing service for radon gas in the home, which costs €50, a not insignificant cost for low-income families given the financial constraints of the past decade. However, the real cost kicks in when a house is determined to have high levels of radon following testing. If it is found to have a high level for radon, which is a cancer-causing gas, the EPA will advise the carrying out of remediation works, which can cost between €500 and €12,000 and can achieve a reduction of up to 98%, depending on how much is spent. There is no grant available to alleviate the cost of remediation. The Government is ignoring the International Atomic Energy Agency report by not providing remediation grants.
The home renovation incentive scheme allows homeowners and landlords to qualify for tax credits equal to 13.5% of the cost of renovation, repair or improvement works. The scheme covers work needed to reduce radon levels in the home but the household needs to spend at least €5,000 to qualify for the scheme, which rules out most remediation works below this threshold. The over-65s may be eligible for a grant to have the work carried out under the housing aid for older people scheme but this is at the discretion of individual local authorities. There is no consistency and there is no rhyme or reason to provision. Some of the most vulnerable members of society are eligible for funds to carry out remedial works while others are not.
We need to address these silent killers, ensure compliance with boiler servicing to prevent carbon monoxide poisoning and demand a remediation incentive for dealing with radon gas with consistency in its allocation.
Thursday, 8 December 2016
Cystic Fibrosis Treatment: Statements
I welcome the Minister to the House to discuss this important issue. On Tuesday, many of us listened in the AV room as Ms Jillian McNulty gave a heart-wrenching account of what her life is like living with cystic fibrosis. In Jillian’s words, without Orkambi, she would not be here. Her lung function has improved by almost 10% and she has spent up to a year less in hospital. Jillian’s situation is unfortunately not unique. Ireland has one of the most severe strains of cystic fibrosis in the world and the highest incidence per head of population, which is three times the rate in the United States and the rest of the European Union. Ireland should be at the forefront of new technologies, research and strategies to deal with the condition, but we are not.
About 550 to 600 people in Ireland with CF have the potential to benefit from Orkambi. That is 600 lives which could be improved beyond recognition. I understand the Minister, Deputy Harris, travelled to Portugal yesterday for an EU health Ministers meeting on pharmaceutical drug costs. He sought the assistance of other EU nations to force pharmaceutical firms to slash exorbitant prices, which make it effectively impossible to access new treatments. We need to be realistic here. Vertex Pharmaceuticals has asked the State to pay approximately €150,000 per person annually for the drug and HSE experts are saying a price of €30,000 is fairer. The HSE has challenged the company to stop hiding behind confidentiality clauses.
I welcome the statement by Vertex Pharmaceuticals last night that said it would be entering into renegotiations with the HSE in an effort to reach an agreement on costs. The statement included the following: “Vertex has met with HSE representatives six times in five months, presenting a range of specific workable proposals that could expedite access for all eligible patients.” Vertex has said that it has received no response from the HSE to date. The statement continued: “These proposals have included significant price reductions, guarantees of budget certainty, novel access schemes such as a risk-sharing agreement and ways to reduce the timelines on reimbursement decisions for patients in the future as new medicines become available.”
If this is true, it is simply shocking. The clock is quite literally ticking for these people. It is a matter of life and death. On the one hand, Vertex invested millions in developing new ground-breaking drugs for CF and there are not many patients on which to make a return. Vertex claims it has to get its money back to reinvest in further research. On the other hand, the HSE has the right to get the best price for the product, which is fully supported by Cystic Fibrosis Ireland. We have to be mindful that this is the first drug to treat the underlying cause of the double delta-F508 strain of cystic fibrosis. The drug slows down the progression of cystic fibrosis and reduces hospital admissions by 40%. We all know that a hospital bed costs €1,200 per day. It may make the difference for a patient receiving a lung transplant or not. There is enormous human cost to the patient as well as the financial cost to the State. At the end of the day, a solution needs to be found. If the two parties cannot reach agreement on price, consideration should be given to bringing in an international mediator to arbitrate on this matter to the satisfaction of all.
Before I finish, I will describe an anecdotal situation. In my own area in the west of Ireland, there is a family that I am very much aware of. A good few of the siblings have cystic fibrosis. One young girl lost her life to cystic fibrosis a number of years back. Her brother lost his life to suicide. He also had cystic fibrosis and suffered from a perceived lack of hope. Now that there is a drug that can help, let us all work together to ensure that the people who deserve to get this drug get it in a timely matter.
Thursday, 8 December 2016
Health Insurance (Amendment) Bill 2016: Second Stage
I welcome the opportunity to speak to this Bill and welcome the Minister of State to the House. Fianna Fáil will be supporting this Bill, although it is disappointing that risk equalisation levies are set to increase in 2017. The Health Insurance Authority, which regulates health insurance, states the increases are designed to support risk equalisation and sustain community rating in our health insurance market in order that older citizens and people with illnesses can afford health insurance and are not discriminated against in favour of younger, healthier people. Risk equalisation and community rating is something we have always supported as a party.
The Bill provides for a 10% increase in health insurance stamp duty levies, as recommended by the Health Insurance Authority. Stamp duty in respect of products providing advance cover is to be set at €444 per adult, an increase of €41, and €148 per child, a rise of €14. Whereas we accept the judgment of the regulator as to what is needed to maintain stability in the market, this is a very big increase. A big problem with the levy is that it is a flat levy, so it is socially regressive from a taxation perspective. Somebody who pays €700 for a plan has a levy of €444, the same as somebody who pays over €5,000 for a plan, which is nonsensical. There is no other stamp duty that operates like this within the system. VHI competitors feel the flat rate of the levy acts as an advantage for VHI, as it has the highest premiums in the market and hence is most advantaged by putting in place a flat levy. It is the case that the flat levy means that those on the lowest plans are paying disproportionately more than those on higher plans.
There is another issue that arises with the levy, particularly the fact that the full levy is payable the moment a person pays his or her first premium, even if it is subsequently cancelled. Credits are only provided on a monthly basis and this mismatch causes problems that have previously led to a surplus in the scheme, pocketed by the Revenue Commissioners. In 2009, Fine Gael claimed a €160 levy was anti-competitive and a means to prop up the State-dominated player, while VHI remained super-dominant in the health insurance market. The levy has increased from €160 to €444. Our values as a party are to support older and sicker people. It is not just from a sense of obligation but because we respect and value older people and the dignity of each person in his or her illness, medical condition or disability. That is why while in government we decided on a comprehensive set of actions to support older and sicker people who have private health insurance. We are firm in our view that the principle of solidarity should apply in private health insurance as well as in public health services.
Private health insurance has played an important role in funding and organising health care in our country for more than 50 years. In 2010, it was funding €1.7 billion of health care claims. As the Minister of State knows, in excess of 2 million people in this country have private health insurance cover and among them nearly 340,000 people are aged 60 and over. Many have been paying for health insurance all their adult lives and have the entirely fair expectation that the health insurance market will not be permitted to change in a way that diminishes their cover. It is entirely right for people to expect that they would not face higher health insurance prices just because of their age or a particular medical condition. This is because consistent State policy has been that the health insurance market should be community rated, and people have known and relied upon this.
Irish Life Health has indicated the largest provider of hospital services in the State to the private sector is the Health Service Executive, HSE, which now receives in excess of €620 million from private health insurance. Additionally, it is estimated that consultants working for the HSE also receive in excess of €140 million from fees generated from private work in public hospitals. Irish Life Health also indicates that the evolution of legislation within the health insurance market has led to private health insurers being forced to drive customers into public hospitals and public bed charges have created a situation where public hospitals have a financial incentive to prioritise private patients over public patients, which is morally wrong. This has created inequity for public and private patients, who in effect pay twice to receive the same service. Private patients are charged €813 per night for the same public bed or, in some cases, the same trolley. Normally, they would be seen by the same consultant they would have as a public patient. These people have paid for the service through taxation so they have a double hit. The logical conclusion is that if equity is to be achieved within the public health system, the HSE should cease providing all private health care services and concentrate services on public health. This would require additional funding for the HSE and a fundamental reassessment of the reimbursement model for consultants working within the HSE.
Thursday, 8 December 2016
Order of Business
I have received correspondence about the Irish Coast Guard and the lack of legislation which covers it. As a medic working on the west coast I regularly liaise closely with our coast guard service and experience first-hand its members’ bravery and commitment to serving the public while putting their own lives in danger. They face peril on every call out.
Yesterday, family members of missing people gathered in Farmleigh House to mark National Missing Persons Day. At the event the Minister of State at the Department of Justice and Equality, Deputy Stanton, thanked members of the Garda Síochána for their work and continued support for those families whose loved ones are missing. He also said it is important to remember Irish Coast Guard volunteer Catriona Lucas, who gave her life in the line of duty in September of this year. Ms Lucas was the first volunteer coast guard to die in the course of duty and her tragic death brought home the true nature of the job. They really are unsung heroes.
It is quite unbelievable, therefore, that their work as a primary response agency is not afforded protection under legislation. A few weeks ago the Minister for Transport, Tourism and Sport, Deputy Ross, addressed this House and said safety at sea is vital to this island nation. I commend the Irish Coast Guard, the volunteers, the Royal National Lifeboat Institution, RNLI, and all involved in ensuring safety at sea on their bravery, remarkable courage and heroism in the service of others. These salutations are well meant and well placed but they are not enough. More needs to be done to enshrine in law the duties, roles and rights of our coast guard.