Dr. Tony Holohan:

In response the first question, I completely agree with the Deputy's points about folic acid, the importance of the lack of an understanding that one would like to think exists and the measures that must taken in this regard. I know of a variety of different mechanisms in place here, not least the work being done through the women and infants programme, which is led by a number of obstetricians. Professor Turner, of whom the committee may be aware, is doing work on the development of guidelines on folic acid to deal with the very concerning increase in this country in the incidence of neural tube defects. There may be other factors to explain why we are seeing this increase but the use of folate is certainly not at the level at which we would wish it to be. This is a question that we have looked at and will continue to look at at a policy level, particularly in terms of the public health measures that could be taken to deal with this. I am conscious that I am in the presence of someone who is far more expert than myself in these matters, namely, the former Master of the Rotunda, Dr. McKenna, and he may be in a position to add something to what I have said here. I will deal with the other questions and then hand over to Dr. McKenna.

Members may be aware that the specialist register is essentially a mechanism through which specialist registration can be recognised in a number of different specialties, which are organised at European level. General practice is one of those specialties, so a doctor on the specialist register who is a general practitioner is covered. If the change in law was such as to enable both access to prescription and the dispensing of medicines, the types of services that have been described are well within the sphere of competence of a doctor who is on the specialist register in general practice.

On the question of complexity, in the current situation, a doctor who is in possession of medical records relevant to the care and treatment of a woman who is receiving services elsewhere is allowed to make those records available, if it is wished for. In a more general sense of course, in the case of anybody who has a medical procedure in one jurisdiction and travels in short order to another jurisdiction, the general concern one would have as a medical practitioner for the person's health and well-being would be significant.