Billy Kelleher (Cork North Central, Fianna Fail)

I welcome the Bill and support its passage through the House as quickly as possible. I suppose it could be described as a technical Bill but in the context of what the Minister said and in the broader context of the provision of health care in this country, the issue of ensuring that standards and integrity of treatment are protected and maintained at all times is critically important.

As the Minister knows, we did not crown ourselves in glory in how we treated a group of people whose lives were destroyed many years ago as a result of contaminated blood products. I know we are talking about clotting products here and that they are synthetic but it is important that when we are talking about these issues, we acknowledge the damage done by the State to many people from the haemophiliac community who were given contaminated blood products years ago.

I mention the Lindsay tribunal, which was established in 1999 to investigate that, and all that followed from that in the context of the hurt and the pain caused and the forms of redress. Some people still feel aggrieved, and rightly so. They believe there has not been full acknowledgement of the damage done to them in terms of services, supports, medical cards and access to other medical treatment they may require because of the complications resulting from the contaminated blood in the 1980s and before then. Clearly, when we talk about these issues, we must also accept that great wrongs were done previously and that we must always learn from them.

This Bill is quite short and, as the Minister said, it is technical in nature. He stated:

To protect the health of consumers of the clotting factor concentrates and other biological medicinal products, the IBTS at present and St. James's Hospital into the future, as the contract holder, must take the advice of the Product Selection and Monitoring Advisory Board in relation to safety and efficacy of all products prior to selecting the successful tender bid. This board was set up on an ad hoc basis following the Lindsay tribunal of inquiry by the then Minister. Its membership includes the Irish Haemophilia Society, the National Disease Surveillance Centre, clinical consultants and nurses, the National Virus Reference Laboratory, the Irish Medicines Board, the HSE and my Department.

Is it necessary to include in this legislation a provision which would legally oblige St. James's Hospital to take the advice on board? Perhaps we could include a provision on Committee Stage so that St. James's Hospital would be legally obliged to take the advice on board. It may be included in another health Bill but I cannot see it.

The Minister spoke about efficiencies, which we welcome given the amount of money being spent. He said transferring good practice across the health services is critical in the area of clinical care but it is also important in terms of administration. The Minister said there were savings to be made in this context, which we welcome.

If this procurement process is being transferred from the IBTS to St. James's Hospital, will there also be a transfer of staff? Will support staff be made available? Will staff leave the IBTS and transfer to St. James's Hospital or will St. James's Hospital be given additional support for the procurement of the various clotting factor concentrates and other biological products? Obviously, it will involve a tendering process, vetting of tender documents and all that flows from that. Will supports be put in place in St. James's Hospital to assist on the administrative side? Obviously, the quid pro quo would be, will the same number of staff be required by the IBTS given the loss of this procurement process?

The Minister referred to ensuring best practice is transferred across all health services. It is critically important that is the case but it is also important that worst practice is not transferred across all health services. That is something of which we must be very conscious. The Minister said it is important to listen to front line staff. I accept that and I never question anybody's bona fides in trying to make things better but front line staff are telling me different stories in terms of the supports being given to them to carry out their functions as clinicians, nurses and key front line staff to ensure the best care is provided in our hospital system.

The Minister talked about the reduction in the number of people on trolleys, the special delivery unit, the clinical programmes, the interaction between the various sections and groups which provide health care but I genuinely believe there are still areas which need much work in the context of ensuring there is a flow of patients through hospitals.

When the Minister talks about best practice in the context of this Bill, he must ask himself whether reducing the number of community nursing home beds in the public system will have an impact on acute hospitals and admissions through accident and emergency departments. Many of those suffering from haemophilia and other immunodeficiency disorders are the most vulnerable and need critical care very quickly. The people about whom we are talking, who would avail of the clotting factor concentrates and other biological products, are very vulnerable at certain times and have weaker immune systems.

I refer to the movement of patients out of the acute hospital system into residential and long-term care or, more important, back home. When we talk about trying to move people through hospitals, we must look at the key area of home help and home care packages, which are very often for people who are older and moving towards long-term residential care. However, many people go through the acute hospital system, have very invasive surgery and require supports for a period of time afterwards at home. A key area that must be addressed is to ensure there are home care packages which can assist.

Embracing the technology which is now available and working very effectively is another area we should examine. One need only look at what some Irish companies are doing with Enterprise Ireland. Many of the software companies are now exporting wonderful solutions in the area of diagnostics and treatments worldwide and we should look at that.

There is also the idea of the virtual hospital system whereby people can move from hospital to step-down facility to home and where, using technology, proper supports and services are put in place in the home environment in order to have the patient monitored, and all that flows from that. That system would use key supports in the community through primary care teams and units, public health nurses and even through voluntary organisations that could assist to ensure that all the resources are used efficiently and effectively. We have been very slow in this area. Even though we have some of the best software solutions providers in the world in health care we are slow to adopt the idea of the virtual hospital in the community where people who need care for a period of time after heavy surgery would have those facilities installed in their home through the Internet or satellite television, something that is now common throughout the world. That is a key area if we are talking about best practice and ensuring people can move through the hospital system.

The reason we are doing all of this, of course, is to ensure we free up the emergency services, the accident and emergency wards and the front line staff involved to deal with patients who are vulnerable and who need critical care at very short notice when they present. As the Minister noted, many of the people who suffer from haemophilia and other immuno-deficiencies are those who present in vulnerable states. That they should lie on trolleys for hours, possibly even days, as is the case, is simply unacceptable.

More broadly, the Bill is a simple technical piece of legislation and it has been welcomed and supported by the haemophilia societies. It is important we listen at all times to this vulnerable group which was betrayed and neglected by the State for many years in the aftermath of the blood contamination scandal. We must ensure the people concerned are included in any decisions made in the context of services being changed or moved or enhanced. They should be involved in all levels of discussion in those key areas. We must ensure we provide a proper consultation platform for those who represent haemophiliacs.

If the Bill does what it says in ensuring there is proper procurement, with efficiencies and savings, these savings must not fall into the deep black hole of the central Exchequer and be lost but must be put towards benefitting those who need the health services. The health budget must be protected and those savings and efficiencies that are brought about must be used to facilitate and enhance health services in other areas.

While the Bill is broadly welcome I would like to have clarity on the point I raised about the product selection and monitoring advisory board. We must ensure this area is covered in the legislation to bring about clarity and certainty rather than have an ad hoc board established on foot of the Lindsay tribunal's recommendations. We are trying to change legislation for the better but I would have concerns about the administrative side of it. Supports should follow the legislation and not be left behind in another area. As the Minister acknowledged, all hospitals are under pressure, even on their administrative side, and this is clearly a big undertaking. They have been involved previously, as the issue affected them, but now they will be the agents for all other medical facilities and the supports must follow. I support the Bill.

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