Jerry Buttimer (Cork South Central, Fine Gael)
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I remind members and those in the Visitors Gallery that mobile phones must be switched off or left in flight mode.

Apologies have been received from Deputy Dan Neville. Apologies have also been received from Deputy Peter Fitzpatrick for whom Deputy Regina Doherty is substituting. Deputy Caoimhghín Ó Caoláin also sends his apologies. He was on his way here, but he was forced to return home owing to a family issue. We wish him and his family well.

I welcome the Minister for Health on his first visit to the health committee. He is very welcome and I thank him for being here. I also welcome Ms Deirdre Walsh, Mr. Chris Costello, Mr. Kieran Duffy and Mr. Ciarán Ó Maoileoin from the Department of Health.

The meeting has been convened to consider Committee Stage of the Health (Miscellaneous Provisions) Bill 2014. As this is a select sub-committee, officials cannot participate in the debate, but they can assist the Minister, if he and they so wish. Does the Minister wish to make an opening statement?

Leo Varadkar (Dublin West, Fine Gael)
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No.

Jerry Buttimer (Cork South Central, Fine Gael)
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Amendment No. 1 is in the name of Deputy Billy Kelleher. Amendments Nos. 2 and 3 are logical alternatives. Therefore, amendments Nos. 1 to 3, inclusive, may be discussed together.

Billy Kelleher (Cork North Central, Fianna Fail)
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I move amendment No. 1:

In page 22, line 12, after “optician” to insert the following:“or a suitably qualified delegated staff member working under the supervision of a registered optometrist or dispensing optician, such staff member having been delegated, by a registrant of the designated profession of optometrist or dispensing optician, to carry out non-clinical functions of the dispense such as selection of frames or sale of spectacles”.

Sandra McLellan (Cork East, Sinn Fein)
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I want to propose an amendment to clarify that some roles can be delegated in the purchase of spectacles.

Jerry Buttimer (Cork South Central, Fine Gael)
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The Deputy cannot propose an amendment now, but she can comment on the amendment tabled by Deputy Billy Kelleher.

Sandra McLellan (Cork East, Sinn Fein)
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I want to have it clarified that some roles can be delegated in the purchase of spectacles.

Robert Dowds (Dublin Mid West, Labour)
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I ask the Minister to clarify the role of the optician in dispensing spectacles. Opticians raised a concern about this role and I am interested in hearing the Minister's comments.

Leo Varadkar (Dublin West, Fine Gael)
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I have had a close look at the matter in the past couple of days. First, I want to clarify that the Opticians Act, 1956 does not currently restrict the employment of assistants to help in selecting frames or processing payments. That means that there will be no change to the status quo under the Bill.
By way of background, section 34 of the Bill inserts a new Part 7A into the principal Act to provide for restrictions on prescribing, dispensing prescriptions and selling spectacles. Part 7A includes the new sections 81A and 81B which effectively restate and retain in law the provisions of sections 47 and 49 of the Opticians Act, 1956 for the prescription, dispensing and sale of spectacles. In addition, section 81C of the Bill provides for the making of by-laws for the regulation and control of the prescribing of spectacles, the dispensing of prescriptions for spectacles and the sale of spectacles. These matters are best dealt with under secondary legislation in by-laws rather than primary legislation. If in the future the Optical Registration Board wants to clarify further the position on selecting frames or processing payments, it has the statutory power to do so through by-laws and will have to do so following full consultation. Let me put it in simple language. We are not trying to change the status quoin this legislation; rather, we are trying to make sure only qualified dispensing opticians and optometrists can do the work they currently do, that is, examine a person's eyes, give a prescription for glasses or contact lenses and dispense the correct lenses. When it comes to helping a person to pick out frames or handling cash at the till, it does not have to be done by an optometrist. This work can be done by a sales assistant. It does not have to be done by somebody who is a qualified optometrist or a dispensing optician.

There are a number of different bodies with an interest in this area, including the Irish Association of Dispensing Opticians and the Association of Optometrists of Ireland, and these have already been involved in the consultation process. Another body, the Federation of (Ophthalmic and Dispensing) Opticians, FODO, is relatively new to Ireland and was not involved in the process. FODO tends to represent large retailers such as Tesco, Boots and Specsavers. We want to ensure that in all cases sales assistants will be in a position to continue to do their job - namely, to assist people in choosing frames and process payments. We would be reluctant to allow the work of optometrists or opticians in dispensing prescriptions to be delegated to sales assistants. I can understand why big businesses might wish to delegate such work but we would not support them in that regard.

Robert Dowds (Dublin Mid West, Labour)
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Is the Minister stating that opticians have nothing to be concerned about in the context of their professional status being protected and that appropriate individuals will be charged with dispensing prescriptions?

Leo Varadkar (Dublin West, Fine Gael)
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The whole point of the legislation is to protect dispensing opticians and optometrists and not to allow their work to be delegated to people who are unqualified.

Ciara Conway (Waterford, Labour)
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Will the Minister clarify what is meant by the term "dispensing"? I have worn glasses for a long time and I am seeking to alleviate people's fears in respect of the legislation. Is the Minister referring to the actual writing of prescriptions or is he stating that a qualified person must oversee the fitting of glasses containing new lenses? Will it be the case that a person who calls to collect his or her glasses on a particular day will just be able to take them away?

Leo Varadkar (Dublin West, Fine Gael)
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The intention is that there will be no change to the status quo. Let us compare the position to that of pharmacies: the person who serves one at the counter might not be a pharmacist but rather a sales assistant. In this instance the person who writes a prescription will be either a doctor or someone with prescribing rights and the individual who dispenses the medicine will be a qualified pharmacist. We do not allow sales assistants in pharmacies to choose which drugs should be dispensed.

Billy Kelleher (Cork North Central, Fianna Fail)
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The stated intention of the legislation is to allow sales assistants to hand over people's glasses and to take payments from them. It is for this reason that I do not believe the amendment to be onerous in any way in ensuring that this remains the practice. I accept that the key person to be protected is the customer, particularly in terms of ensuring that he or she receives the correct glasses or other equipment that he or she has been prescribed. The main issue is that we should not tie down professionals behind the counter by obliging them to wait behind the counter, hand over people's glasses and then take payment for them. I presume the Minister is stating that current practice will continue to be followed.

Leo Varadkar (Dublin West, Fine Gael)
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That is absolutely correct. Obviously, I do not want the work of qualified opticians or optometrists to be delegated to individuals who are not suitably qualified. I do not believe anyone wants this to happen. What we are seeking is clarity in ensuring that what happens at present will continue to be the case. In other words, sales assistants in eyeglass shops will continue to be able to help people to choose spectacles, process payments, etc. There is no attempt here to change that. I accept that there may be concerns with regard to the legislation being overly tight. I will consider that matter carefully between now and Report Stage and I will obtain legal advice in order to ensure that no difficulties will arise. The intention is that the Opticians Board will be able to make by-laws. If there is a need to provide greater clarity in this area, then this can be done by means of such by-laws. Many of the different groups to which I referred earlier are represented on the board and will therefore have a say in the making of by-laws, if they are needed.

Robert Dowds (Dublin Mid West, Labour)
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Will the by-laws have the same standing as the primary legislation in terms of compliance?

Leo Varadkar (Dublin West, Fine Gael)
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By-laws are laws. As long as they do not conflict with the primary legislation, that is fine. Between now and Report Stage I will clarify that there is nothing to prevent the board from making such by-laws.

Ciara Conway (Waterford, Labour)
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To return to the example the Minister provided, we all know that in pharmacies, a pharmacist must be on the premises before medicines can be dispensed. Do concerns arise on foot of the fact that optician services in large multiples do not always have a qualified person on site? For example, such an individual might only visit certain outlets on two or three occasions each week. Could the legislation lead to a change in that suitably qualified people will be required to be on site every day of the week in order to provide customers with the relevant assistance, or will there be a negative impact in this regard? Some outlets in rural areas do not have full-time opticians on their staff and a suitably qualified individual may only visit from time to time. Will the Minister outline what will be the position?

Leo Varadkar (Dublin West, Fine Gael)
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That is a good question. I would have thought that qualified opticians or optometrists would always be on site.

Ciara Conway (Waterford, Labour)
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No; they are not always present.

Leo Varadkar (Dublin West, Fine Gael)
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If that is the case-----

Ciara Conway (Waterford, Labour)
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I am aware of outlets in Youghal and Dungarvan which are located in neighbouring constituencies but share opticians. What will be the position with regard to what happens in such outlets?

Leo Varadkar (Dublin West, Fine Gael)
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In essence, the current practice will continue. No one will be able to establish a business and begin selling glasses without first employing an optometrist or optician. I presume that dispensing does not occur at the outlets the Deputy mentioned on days when the relevant qualified person is not present.

Ciara Conway (Waterford, Labour)
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I am not in a position to say. Will what is proposed in the legislation mean that people who wish to collect their glasses will only be able to do so on a day on which an optician is present?

Leo Varadkar (Dublin West, Fine Gael)
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No.

Ciara Conway (Waterford, Labour)
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That is okay.

Leo Varadkar (Dublin West, Fine Gael)
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I understand people's concerns and I stress that we are not trying to create a problem. Between now and Report Stage I will seek to ensure that we are not going to accidentally create such a problem. The intention is to allow the existing practice to continue.

Billy Kelleher (Cork North Central, Fianna Fail)
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I am going to withdraw the amendments in my name, but I reserve the right to resubmit them on Report Stage in order to give the Minister the opportunity to clarify the position with regard the legal advice he is going to seek.

Sandra McLellan (Cork East, Sinn Fein)
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I will not be moving the amendment in Deputy Ó Caoláin's name. I will take the same approach as Deputy Kelleher and await clarification from the Minister on Report Stage on the work that can be delegated in the purchase of spectacles. However, I believe the Minister has already outlined the position.

Jerry Buttimer (Cork South Central, Fine Gael)
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The Irish College of Ophthalmologists contacted a number of members with regard to whether there should continue to be two eye doctors as members of the Health and Social Care Professionals Council, CORU, optical registration board, as is currently the case. Is there any plan to remove or retain those individuals, or has a decision been made yet?

Leo Varadkar (Dublin West, Fine Gael)
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There is an ophthalmologist on the board. However, I do not want to include in primary legislation a requirement that there should be a certain number of ophthalmologists on the board. The 1956 Act provides for 44 ophthalmologists, who are consultants, to serve on the board.

This Bill does not provide for specific representation of medical practitioners. However, the interim board currently includes two medical practitioners, one of whom is a GP and one of whom is a consultant ophthalmologist. My intention will be to continue to have an ophthalmologist on the board but I do not want to keep the current set-up, with four ophthalmologists effectively controlling another profession. The nursing board would not have seven doctors on it and the pharmacy board would not have three pharmacologists. The current position dates from the 1950s, when doctors and consultants controlled the professions then seen to be beneath them, which were opticians and optometrists. There has been much change since then. For the sake of common sense, good practice and public interest, it is my intention to continue to have an ophthalmologist on the board, although it should not be a requirement that there be a certain number of them.

Ciara Conway (Waterford, Labour)
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There is a related issue regarding opticians and ophthalmologists. If somebody has an eye injury and goes to a local optician before being referred to an accident and emergency department, that person would be liable for a charge of €100. Somebody presenting to a GP with an eye injury may be sent to an optician, who may also look at the eye. Such a person may be doing his or her best to get advice before presenting at the accident and emergency department but would still be penalised. A referral letter from an optician to an accident and emergency department does not have standing equal to a GP or ophthalmologist, even if a GP instructs a person to go to an optician. I raised this with the former Minister, Deputy Reilly, and we should consider the issue. An optician is probably present in most communities and if people have something in their eye, they would generally tend to go to the optician before being referred to the accident and emergency department, so they would be liable for the charge.

Leo Varadkar (Dublin West, Fine Gael)
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I had not heard that before but it is a good point. I will take a look at it. Part of the charge to attend the accident and emergency department is to encourage people to attend their GP first, which many people do but some do not. One could argue that if somebody goes to a community pharmacist, public health nurse or a physician before being referred to the accident and emergency department, there should not be a charge. I see the Deputy's point but at the same time, opticians are not qualified to diagnose eye conditions. I will give the matter some thought as I see the point being made. It cannot be addressed in this Bill.

Billy Kelleher (Cork North Central, Fianna Fail)
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What is the general make-up of the governing body? Is there a statutory obligation?

Leo Varadkar (Dublin West, Fine Gael)
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It is comprised of 13 members with a lay majority.

Billy Kelleher (Cork North Central, Fianna Fail)
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Is there a gender quota?

Leo Varadkar (Dublin West, Fine Gael)
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No. It is not prescribed in legislation.

Billy Kelleher (Cork North Central, Fianna Fail)
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In view of efforts being made to try to ensure a broad gender representation, will the Government examine that issue in general? Would it restrict appointments to the board too much?

Leo Varadkar (Dublin West, Fine Gael)
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Some members are elected, which could create a problem.

Billy Kelleher (Cork North Central, Fianna Fail)
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For the next Dáil election, some of us will be elected or not elected but there is a 30% quota.

Leo Varadkar (Dublin West, Fine Gael)
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That is for candidates rather than elected people.

Billy Kelleher (Cork North Central, Fianna Fail)
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Yes.

Jerry Buttimer (Cork South Central, Fine Gael)
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Does the Deputy have a personal position on this?

Billy Kelleher (Cork North Central, Fianna Fail)
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I have nothing to declare in that regard. If we are to move towards ensuring we have a proper gender balance, we should start to make efforts across all sections. It is just a point.

Leo Varadkar (Dublin West, Fine Gael)
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Many of these boards have a good gender balance, given the nature of the professions involved. I would be reluctant to prescribe gender quotas in legislation. It is one thing to set a target and try to achieve it but when it is a position like this, particularly involving elected members, it may lead to a case where a person with fewer votes may get a place because he or she is of a particular gender. I understand the Deputy's point.

Sandra McLellan (Cork East, Sinn Fein)
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This might add great cost to members of the public but the cost has not been clearly defined or discussed.

Leo Varadkar (Dublin West, Fine Gael)
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Section 41 is a technical provision relating to section 42. May I comment on both of them together?

Sandra McLellan (Cork East, Sinn Fein)
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I will oppose that section for the same reason.

Billy Kelleher (Cork North Central, Fianna Fail)
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Are we taking section 42 with section 41?

Jerry Buttimer (Cork South Central, Fine Gael)
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We will deal with them one at a time.

Leo Varadkar (Dublin West, Fine Gael)
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Section 41 is a technical provision relating to the terminology used in Part 3. It defines the Act of 2013 as the Health (Amendment) Act 2013 and the principal Act as the Health Act 1970. It is a technical provision.

Billy Kelleher (Cork North Central, Fianna Fail)
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I will not oppose section 41.

Sandra McLellan (Cork East, Sinn Fein)
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We oppose this section for the same reason, as the cost has not been clearly defined or discussed.

Billy Kelleher (Cork North Central, Fianna Fail)
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We raised this matter in the Dáil with the Minister of State, Deputy Kathleen Lynch. There are a number of concerns with section 42, which outlines and defines services, including accommodation provided on behalf of the HSE. It outlines the supports of services other than outpatient, acute inpatient or long-term residential care services under the nursing home support scheme. We understand all of this but when we asked the question of whether costs would be incurred by people who had accommodation provided by the HSE or agents acting on its behalf, we were not given the definitive answer that there would be no extra cost.

A key question is whether the Minister believes there will be any additional costs or expenses incurred by individuals on foot of this? The stakeholders, for example, were very disappointed there was no engagement whatever. We are speaking about openness and ensuring that we have a broad engagement with stakeholders, so one would have thought there could have been discussions and input into this section because it affects members. They came to us because of that more than anything else. They were disappointed there was no engagement and there have been no assurances that this will not bring any further charges or that individuals will not incur costs because of this legislation. In effect, it is an addendum to a miscellaneous Bill, and it could be argued it is not an appropriate vehicle in the first place. It is completely at variance with the rest of the Bill, as this concerns accommodation and charges for people to whom the Health Service Executive provides service.

Mary Mitchell O'Connor (Dún Laoghaire, Fine Gael)
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I apologise for not being here earlier as I was speaking in the Dáil. I heard from my colleague that the Minister will check out the issue we all have about professionals having to carry on in their workplaces, helping customers or clients to choose spectacle frames and putting the sale through the till. Many of my constituents have contacted me about this and I would appreciate it if the Minister could do his best. There is a genuine concern and I thank the Minister for taking that on board.

Leo Varadkar (Dublin West, Fine Gael)
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It is no problem. The Deputy has contacted my office about this already and the intention is not to change the status quo. Sales assistants will still be allowed to help people pick frames, handle cash and so on. The professional function of dispensing will be done by an optometrist or a qualified dispensing optician alone. Between now and Report Stage, I must be satisfied that we have not created any legal issue that would prevent what is already normal practice continuing.

As the Minister of State, Deputy Kathleen Lynch, indicated on Second Stage, this is mainly a technical Bill. The primary purpose of Part 3 and section 42, in particular, is to correct a lacuna in the provisions of the Health Act 1970 relating to residential support services, maintenance and accommodation contributions inserted under the Health (Amendment) Act 2013. Section 42 amends section 67(a) of the Health Act 1970 to define key terms for the purposes of section 67(a) to (d) of that Act. "Accommodation" is defined as accommodation provided by or on behalf of the HSE or arranged in order to facilitate the provision of residential support services for a person whose ongoing costs of maintenance are met by or on behalf of the HSE. The related concept of residential support services is defined as services, other than outpatient, acute inpatient or long-term residential care services provided by or on behalf of the HSE for a person residing in or ancillary to accommodation which is a hospital, a convalescent home, a nursing home or residential accommodation for persons with physical, sensory, mental health or intellectual disabilities. Definitions are provided for the related concepts of excluded costs and costs of maintenance and, taking both definitions together, "costs of maintenance" will mean a person's ongoing essential daily living costs met by the HSE. These include food or other essential household provisions and-or electricity, gas, heating, refuse collection, water supply or other essential utilities but do not include the costs of care, accommodation or non-maintenance costs associated with providing health or personal social care services. Essentially, these are charges for food, gas, electricity and utilities.
On consultation, I am told that Part 3 of the Bill is on foot of ongoing consultation by the Department and the HSE in the past year on the implementation of section 19 of the Health (Amendment) Act 2013. Part 3 addresses an issue identified by the HSE expert group during the implementation planning phase and will ensure the statutory contributions regime will cover ongoing essential daily living costs such as food and utility bills where these are met by or on behalf of the HSE, irrespective of whether the service user is accommodated by or on behalf of the HSE. There will be consultation with the other key stakeholders before detailed regulations and implementation guidelines are finalised. In the vast majority of cases people are already contributing to a kitty to meet the cost of utilities, food and refuse collection and this ensures it will be on a sound legal footing.

Billy Kelleher (Cork North Central, Fianna Fail)
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We have had great debates during the years about charging people in nursing homes and certainly did not cover ourselves in glory in that episode in terms of whether people had been illegally charged for many services for a very long time. We must accept that many people in HSE care or care services provided and supported under the nursing homes residential scheme of 2009 are not in receipt of their full cohort of therapy services such as speech and language services, physiotherapy and many other ancillary supports. Nursing Homes Ireland makes the point services are under huge pressure. We do not have enough speech and language therapists and physiotherapists and certainly do not have enough physical therapist hours in nursing homes throughout the country. That is a source of grave concern for the advocacy groups and people in general. Older people in nursing homes are in the care of the HSE and making a contribution to the cost of their care through their pension payments and other forms of funding. At the same time, what I would consider to be basic medical services such as physical therapy, physiotherapy and speech and language therapy services are not being provided. The Department of Health and the HSE would want to be very conscious of their obligations in ensuring these supports are made available. I am not the only one who is saying it. It is also being said to us by people who have family members in nursing homes and making contributions to avail of private physiotherapy services. While the Minister is saying this will not result in additional costs for individuals, additional costs could be brought to bear by the HSE and others to provide basic medical supports and services for individuals in nursing homes.

Leo Varadkar (Dublin West, Fine Gael)
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On the wider point made by the Deputy, there is no denying that services are under a lot of pressure. We have fewer staff working in the health service than in recent years and I am not going to pretend that this is not the case. It applies not only to nursing homes but across the board. However, that is a separate matter from this legislation which does not relate to the fair deal scheme and nursing homes per se. What it is about is people making a contribution to the cost of their food, utilities and so on where they are living in certain accommodation. If somebody is living in the community or his or her own home, he or she must pay for food, utilities and everything else. This is making sure we have a sound legal basis in continuing to require people to make a contribution to these costs. We are not talking about the cost of care; rather, we are talking about the cost of food, heating, refuse collection, gas and other essential utilities.

Billy Kelleher (Cork North Central, Fianna Fail)
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I do not want to labour the point, but if a person is staying in a hotel and paying for a room, there is a good chance he or she will expect it to be clean, the lights and heating to be turned on and have a porter in the hotel if they come in after hours. The point is that this is not happening in many cases. For example, the shortage of community geriatricians is a sad indictment of how we look to protect older people. I accept fully that services are under pressure, but in key areas in which the HSE is providing care for individuals who are making a contribution, it should be obligated to ensure they receive the proper medical services they require, which include physical therapy and speech and language therapy services and that there is the recruitment of geriatric specialists and community geriatricians. It is an observation because it is having an impact on the quality of care for individuals bearing in mind the fact that they are making a contribution to its cost and that this legislation is putting it on a statutory footing.

Jerry Buttimer (Cork South Central, Fine Gael)
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Who sets the amount and why was the year 2009 selected?

Leo Varadkar (Dublin West, Fine Gael)
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The amount will be set by the HSE.

Jerry Buttimer (Cork South Central, Fine Gael)
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How often will it be reviewed?

Leo Varadkar (Dublin West, Fine Gael)
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It will be set by me in regulations on their advice but can be reviewed. To ensure there will be no confusion, I do not want this to be mixed up with the nursing homes support scheme and the fair deal scheme. That is not what this is about. The contributions people will make which most of them already make are contributions to the cost of food and utilities. They do not make a contribution to the cost of a community geriatrician who is paid out of general taxation. If a person is in HSE accommodation, accommodation provided on behalf of the HSE or a nursing home, he or she is not making a contribution to the cost of a community geriatrician. There may not be enough of them, but that is not what the contribution is for.

Billy Kelleher (Cork North Central, Fianna Fail)
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I accept that the contribution is towards the cost of accommodation and other basic services, but I am making the point that if a person is making such a contribution, he or she feels there should be some obligation on the HSE to provide the other services required for an individual in such accommodation. We should bear in mind that it is set by the Minister of the day. I know that the Minister is very understanding of the financial pressures people are under, but I am always concerned when the Minister of the day determines costs. There is no process for engagement with stakeholders.

The Minister of the day may be short of money in the budget and may just decide to increase it. This amendment to the Health Act 1970 will actually give the Minister the power to raise those charges if he or she deems it appropriate, or the Minister may not even deem it appropriate but he or she might just have to make up the numbers. That is why we and the stakeholders have major concerns about it. I will be opposing the section.

Leo Varadkar (Dublin West, Fine Gael)
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The existing arrangements on the level of contributions that are payable are being retained so all existing long-stay charges exemptions will apply to the new contribution regime. For those not exempted, there will be a continuing requirement to pay an appropriate and affordable maintenance-related contribution in line with current long-stay charges. The maximum contribution level will continue to be 80% of the non-contributory State pension and actual contributions will, as now, depend on the individual's income level, so there is a maximum as to how high it can be.

Billy Kelleher (Cork North Central, Fianna Fail)
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The maximum is 80% of the non-contributory pension. If the non-contributory pension is raised, then that automatically goes up as well.

Leo Varadkar (Dublin West, Fine Gael)
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It could do. While it is not automatic, it could be raised. However, the people who are paying 80% of their non-contributory pension are people who are in 24-hour accommodation.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Tánaiste giveth and the Minister taketh away.

Leo Varadkar (Dublin West, Fine Gael)
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We have had no discussions about that.

Jerry Buttimer (Cork South Central, Fine Gael)
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Is the section agreed?

Billy Kelleher (Cork North Central, Fianna Fail)
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It is not agreed.

Sandra McLellan (Cork East, Sinn Fein)
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Again, we are opposing the section for the same reasons, namely, the cost has not been clearly defined or discussed.

Billy Kelleher (Cork North Central, Fianna Fail)
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I have expressed my views. I will wait until Report Stage to deal with the matter further.

Leo Varadkar (Dublin West, Fine Gael)
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It is the same issue so I will add no further comment.

Jerry Buttimer (Cork South Central, Fine Gael)
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Is the section agreed?

Deputies:

It is not agreed.

Sandra McLellan (Cork East, Sinn Fein)
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The section is opposed for the same reasons, namely, the cost has not been clearly defined or discussed.

Leo Varadkar (Dublin West, Fine Gael)
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Section 44 provides for an enhancement of the HSE waiver powers to the benefit of service users by extending these grounds to cover the extent to which the person concerned provides for his or her own maintenance or accommodation, or both, and reflects a key element of the definitional change proposed under section 42. If the section were deleted, the present position would prevail, namely, under section 67D(1)(b)(iii), as inserted by section 19 of the Health (Amendment) Act, the HSE may in whole or in part waive a service user's obligation to pay residential support service maintenance in accommodation where it is satisfied that it is reasonable to do so, having regard to the extent to which the person concerned provides for his or her own maintenance. This is about enhancing the HSE's powers to waive fees.

Jerry Buttimer (Cork South Central, Fine Gael)
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Is section 44 agreed?

Sandra McLellan (Cork East, Sinn Fein)
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It is not agreed.

Jerry Buttimer (Cork South Central, Fine Gael)
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I thank the Minister and his officials.

Leo Varadkar (Dublin West, Fine Gael)
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I thank my officials for their work on this Bill, as well as the committee members and the clerk and his staff for progressing so efficiently. Obviously, I will take into account anything that has been said in advance of Report Stage.

Billy Kelleher (Cork North Central, Fianna Fail)
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I thank the Minister and his staff. I ask the Minister to consider the issues raised on the issue of optometrists. I look forward to Report Stage.

Sandra McLellan (Cork East, Sinn Fein)
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I thank everybody for their attention.