Professor Jonathan Hourihane:

I thank the members of the Joint Committee on Health and Children. As a paediatrician, I recognise that children are a neglected strata in the country - they have only just had their constitutional rights recognised. It is my contention that if Emma Sloan had been an adult female, we would already have the legislation because this committee drove through the hearings on pregnancy, etc., last year after the death of Savita Halappanavar. Children's deaths in this country have not counted for many years, in Tuam and elsewhere. The fact that this was a child means that we are still here so long afterwards. That is my personal view as a paediatrician.

Many of the questions committee members have asked relate to my expertise and I will start there. I will not talk about the EU legislation or reviews, etc. Why are there fewer allergists than in other countries? I have no idea. I do not think the HSE had any idea that it had an allergist until I arrived into an academic post in University College Cork on the basis of my research expertise. It was terrified as to what it would mean for its hospital to have an allergist in it. It means that they do fewer tests, patients turn around faster and have less restrictive diets. So it is cost effective. It may take the money-following-the-patient programme, which is at least part of the discussion, for the HSE to realise that an allergy clinic is low cost, high volume, highly effective and the money flows in for that service. That is how allergy services in the United Kingdom have flourished from a similarly low base. I gave evidence to the British House of Lords in 2007 and on the basis of those hearings the mandate was given to the NHS that each region needed to have two adult allergists and two paediatric allergists with full support teams around them.

We would probably need four or eight for the whole country and that would be fine.

I was asked how we could put this in place without legislation. I understand the HSE sends out mandates to do this or that all the time and causes major panic about trolleys or breast cancer or whatever it may be. I am not trivialising any other area and I know we cannot compete with trolleys or breast cancer and I am not asking that we should, but it would be possible for the HSE to require each hospital that has an emergency department to have the capacity for some physician in that hospital to be responsible for the after-emergency care and the community integration of the care for the people in their region. If they have children and adults in their emergency departments they should have a paediatrician and an adult physician available to them. The most common cause of anaphylaxis is medical equipment, biological agents for cancer and anaesthetics. The anaesthetist looks after those in a crisis but then these people drop off the radar again. It should be mandatory for the HSE to deliver on this but it would probably not be cost neutral.

In response to the question on the circumstances for lay use, there is no situation in which one should not do it. We have discussed that. I was asked about the negative effects. There are no negative effects and as we say to families when they come and see us, the kits are so easy to use that a man could do it.

It is usually the mothers who come and we insist that the fathers come to us for the training so that they are not getting badgered to do what the mother was taught by us. There is an expert disparity between the parents and it is always the mother who is the expert. That is nature and nurture and we would like everybody to be able to use these in a way that is understandable.