Joan Collins (Dublin South Central, Independent) | Oireachtas source

The Health (Miscellaneous Provisions) Bill 2016 essentially tidies up a number of matters in four key areas. Part 2 of the Bill seeks to amend the Irish Medicines Board Act to give the Minister the power to pay a fee to all the board members of the Health Products Regulatory Authority. The Department of Health has indicated that this proposed due to an inconsistency in legislation but will not cost the State anything. The authority itself will pay the fees which have been estimated to cost a total of €61,500 or €7,695 per board member. The members of the board do not have to accept this fee. Those board members who are already in receipt of a public sector salary will not be paid the fee. As a result, there will be no cost to the State from this provision. The provision mirrors those that apply in respect of other authorities, the members of which are paid for a certain amount of the work they do.

Part 3 of the Bill seeks to amend the Nursing Home Support Scheme Act of 2009. It appears that the provisions in this Part will allow certain payments from redress and similar schemes to be exempt from means testing for the fair deal nursing homes support scheme. I wish to raise an issue regarding the fair deal scheme, particularly for people with dementia. An enduring power of attorney is required, which is a long and costly process. Does this Bill provide that such legal costs, if incurred by any of those in redress and similar schemes, will be covered by the State? The Bill makes specific reference to several schemes for different groups of women who were treated brutally in our health services. One of the schemes referred to is the Lourdes Hospital redress scheme for former patients of Dr. Michael Neary at Our Lady of Lourdes Hospital in Drogheda, who number around 119 women. The Lourdes Hospital payment scheme is also included, which is a scheme for former patients of Dr. Neary who were excluded from the Lourdes Hospital Redress Scheme for reasons of age. The symphysiotomy payment scheme for women who underwent symphysiotomy in any hospital in this State between 1940 and 1990 is also included in this Part of the Bill. At the time that we debated that scheme in the House, we learned that approximately 400 women were affected although some of them have, tragically, passed on since then. The provisions in this Part also apply to those individuals who were disabled by thalidomide. I am not sure of the numbers involved but according to the Department of Health, the provisions will apply to approximately 520 people, mainly women, in total.

The explanatory memorandum to the Bill points out that the payments made under the various schemes acknowledge the hardship, pain and suffering which these individuals underwent. I will always remember the feeling of sadness and overwhelming shame at the way the State treated these people, particularly the women who underwent symphysiotomy and who had to campaign for so long for recognition of their situation. They underwent a brutal operation, involving the breaking of their pelvic bone, which was done without their permission. They were left in a dire situation, health wise, which was not recognised for many years. It badly affected the women and their families. Eventually the redress scheme was set up after much campaigning on the part of the women. I welcome the fact that their ex gratiapayment will not be taken into consideration in the context of a means test for the fair deal nursing homes support scheme.

I have a question about one section of the explanatory memorandum which states that "the proposal will not give access to free nursing home care to the various groups, but it will merely mean that the awards/payments they receive will be ignored for the purpose of assessment under the NHSS". Do these women have to pay for nursing home care? I did not think that was the case but it seems, from the explanatory memorandum, that they do not have access to free nursing home care.

The Bill also deals with drug reimbursement and over-the-counter medicines. Part 4 of the Bill provides for the amendment of the Health (Pricing and Supply of Medical Goods) Act 2013. The relevant context for the proposed amendment is that at present, for certain eligible people, namely those with medical cards or long-term illness cards, the HSE covers the cost of their prescription medicines. The HSE maintains a reimbursement list, which is a list of products provided free of charge to eligible people. A pharmacist provides the medication and is later reimbursed by the HSE. The HSE does not cover the cost of non-prescription or over-the-counter drugs for the same people. The legislation provides that the drugs on the reimbursement list must be reviewed within three years. The amendments to the Bill would allow over-the-counter medicines to be put or kept on the reimbursement list if this is deemed to be in the interests of patient safety or public health.

A number of people have told me that they welcome the fact that certain over-the-counter medicines will be put on the medical card reimbursement list. However, I am surprised that more people have not cottoned on to the fact that the morning-after pill is to be put on the list.

Women who have concerns about getting pregnant after having sex will be able to get the morning-after pill. It normally costs a woman approximately €20 to go in and buy it. Women can get it over the counter by using their medical cards. I am really concerned that they have to go to a doctor to get a prescription to actually get that over the counter. The Irish Pharmacy Union has said it is concerned about this. The earlier a woman has access to the morning-after pill, the fewer her health concerns. There are also concerns about discrimination against poorer women who have to go to a doctor to get a prescription before going to the pharmacist with a medical card to get the morning-after pill. According to the Irish Pharmacy Union, the emergency contraception pill is 95% effective if it is taken within 24 hours of having sex, 85% effective if it is taken within 24 to 48 hours of having sex and 58% effective if it is taken within 48 to 72 hours of having sex. It appears to me that the earlier a woman can access the emergency contraceptive pill, the better it is for her health. According to the briefing material we have received from the Library and Research Service, the Department has clarified:

This [the proposed amendment] does not mean that pharmacists can supply such products to medical card patients without a prescription. A number of policy issues would need to be considered before this could be contemplated, including the potential cost from loss of prescription charges, or otherwise.

I am not sure by whom this "loss" would be incurred. It seems that the pharmacists would have no problem with such an arrangement. They would not mind having to hand the emergency contraceptive pill over to people who do not have a prescription. I think that should be taken on board. We should look at ways of ensuring women do not have to go to their GPs to get prescriptions when they need the emergency contraceptive pill. As I have said, the current provisions in this regard are discriminatory because they made it more difficult for poorer women to access this form of contraception as quickly as possible.

Part 5 of this Bill seeks to amend various sections of the Public Health (Standardised Packaging of Tobacco) Act 2015. As I understand it, the purpose of the 2015 Act was to control the design and appearance of tobacco products and packaging and to contribute to improving public health by reducing the appeal of tobacco products to consumers. It was intended that this legislation would increase the effectiveness of health warnings on the packaging of tobacco products and reduce the ability of the packaging of such products to mislead consumers about the harmful effects of smoking. I take the point made by Deputy Lawless about seeing younger people smoking as they walk across the street. It must be remembered that it is very difficult to give up this serious addiction. It is said that in some cases, giving up tobacco is more difficult than trying to give up heroin and other hugely addictive drugs that people can get hooked on. Some people seem to think addicts can just stop, but that is not the case. I tried to stop smoking on eight occasions because I knew it did terrible harm to my body from a health point of view. It always proved difficult and I ended up going on and off the cigarettes again and again. I am vaping at the moment. I think the Government should be careful not to make it more difficult for people to access vaping products because they have played a role in my campaign to stop smoking and move onto alternatives with the intention of moving off them over a period of time.

We know that smoking is very dangerous. It causes huge health problems, including chronic illnesses and diseases, over a person's lifetime. It is good that plain packaging has been introduced because it is less attractive. The legislation before the House today provides for various ways of changing packaging to ensure no particular brand is mentioned on it and to make it as unpleasant as possible. As I have said previously, people who are addicted to cigarettes and tobacco tend to buy nice fancy containers to put their cigarettes into. They choose designs with their friends. I have seen them in the shops around Moore Street. People prefer to put their cigarettes into these containers, which have lovely designs, pictures, photographs and all types of things on them, rather than leaving them in boxes that look brutal. They will continue on in that way.

I would like to see more evidence of the actual impact that plain packaging is having on smoking levels. I know that when plain packing was introduced in Australia, a cigarette company took a court case on the basis that its profits were being affected. This should be a big concern that sends an alarm to people in this country and elsewhere in Europe, especially in the context of the TTIP and CETA trade agreements, which could allow tobacco companies to challenge in secret courts public sector wage increases or anything else that they consider might have an impact on their profits. I do not think it is really known out in the ether of general society that these trade agreements, unlike normal trade agreements, contain such provisions. Philip Morris has brought Australia and another country - I cannot remember which - to court and that process is continuing. Any measure that can assist people who are trying to give up cigarettes would be good. It looks like a very plain type of packaging will be provided for. It will include the word "cigarette", small calibration marks, some text indicating the contact details of the manufacturer and a statement of what is contained in a packet of cigarettes. They will be very plain and therefore will not attract more people. As I have said, those who smoke do not carry these packets around with them. They get a nice little box to put their cigarettes into. They choose something they can carry in their bags and put on the table in front of them when they smoking in a pub or hotel on a night out.

As I have said, it does not appear that the various areas covered by this Bill will lead to increased costs or have an effect on the State's coffers. All of them seem to be self-funding. Obviously, the manufacturing companies will have to dip into their pockets to meet the plain packaging rules. It does not seem that the changes in prescription costs will have an impact on the State's coffers. Many of these provisions are welcome. In general, I support them. I ask the Minister to answer the questions I asked about legal costs that may be incurred when the power of attorney process is invoked and whether nursing home help care is being paid for. I will leave it at that.

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