Marcella Corcoran Kennedy (Offaly, Fine Gael) | Oireachtas source

I thank the Deputies for all their contributions to the Second Stage debate on the Health (Miscellaneous Provisions) Bill.

The provisions in the Bill will allay the fears of recipients of ex gratiaawards which have been approved by Government and which place them over the threshold for supports under the nursing homes support scheme. It would be most unfair if individuals who have endured more than enough pain and suffering were to be disadvantaged in their financial assessment for support under the nursing home support scheme as result of receiving an award from a Government-approved scheme. The usual financial assessment criteria will apply. This is a question that some Deputies raised. I hope this decision will give some peace of mind to the individuals concerned and their families.

There was also a question about enduring power of attorney. This is not covered by this legislation or the scheme specifically.

While not directly relevant to the Bill, issues were raised in the debate about the fair deal scheme, in particular as it applies to farmers. A Programme for a Partnership Government has committed to reviewing fair deal to remove any discrimination against small business and family farms. Any significant changes to the scheme deemed necessary will require legislation and will be addressed at the end of the review implementation process.

The Minister, Deputy Harris, and the Minister of State, Deputy McEntee, have met the Irish Farmers Association, IFA, and invited it to present its submission at the next meeting of the working group that was established to progress recommendations from the report of the review of the nursing home support scheme. The next meeting of the group is this month. Many Deputies will welcome that news.

Deputies also referred to the provision of home care services. These are critical to supporting older people to stay in their homes and communities. We can agree all on that because we want them to maintain their independence for as long as possible. I assure the House that the Government is committed to improving the resourcing of home care services as a priority in the period ahead. This year, €373 million is available to home supports, of which €338 million is available for home help and home care packages. This includes the addition of €40 million provided in June to address the increased demand for services. This year the HSE will provide 10.57 million home help hours and 15,800 home care packages.

The Minister of State, Deputy McEntee, is also considering how the service can be optimally structured to meet the needs of clients in as consistent and transparent a way as possible within the resources available at any given time. In this context the Health Research Board has been asked to carry out an evidence review to examine the regulation and funding of home care services in comparable jurisdictions. This should be completed by the end of the year and will inform future decisions about the structure and governance of home care services.

As Minister of State with responsibility for health promotion, I am particularly interested in the provisions of the Bill which seek to amend the Public Health (Standardised Packaging of Tobacco) Act 2015. Evidence indicates that tobacco packaging is a critical form of promotion. This is more relevant in Ireland where we have comprehensive advertising and marketing restrictions. We know that branding works, especially on children. If the tobacco sector did not get our children addicted, its industry would disappear within a generation. Given that 78% of smokers in a survey stated that they started smoking when they were under the age of 18, it is clear that our children are targeted to replace those customers who die or quit. It is critical, therefore, to reduce the appeal of tobacco products to consumers and increase the impact of health warnings. Standardised packaging of tobacco achieves this, as one of the measures and recommendations in our policy document, Tobacco Free Ireland. The policy includes education, media campaigns, pricing etc. In fact, in 2010, 12% of those aged 10 to 17 years smoked, whereas 8% did in 2014, which I think the House will agree is a significant reduction. We have the potential to see quite soon a generation who will never smoke.

In relation to the Transatlantic Trade and Investment Partnership, TTIP, agreement, which I may not be concluded for some time yet, the Department of Health has indicated that the agreement should not undermine existing public health measures. We will work to ensure any agreement will not prevent or deter Ireland from introducing new public health measures, for example, measures aimed at reducing tobacco or alcohol consumption. I thank the Deputies for their support for this public health measure. The amendments set out in the Bill will enable Ireland to proceed with the introduction of standardised packaging of tobacco products.

The provision in the Bill to amend the Health (Pricing and Supply of Medical Goods) Act 2013 is also intended to benefit the health of the population. It provides that, when considered appropriate in the interests of patient safety or public health, over-the-counter medicines can continue to be reimbursed on the medical card scheme and on the other community drug schemes after May 2018. This means that products such as nicotine replacement products and emergency contraception can continue to be provided under the medical card scheme. Currently, medical card patients can access emergency hormonal contraception by obtaining a prescription from a GP. If they must access this medication directly from a pharmacist, they would be required to pay for it. It is noted that there is an inequality of access to emergency hormonal contraception for women on the General Medical Service, GMS, scheme compared with private patients, and officials in the Department are examining this matter in detail.

If a pharmacist is not satisfied that the supply of the medicine or service to the patient is clinically appropriate or if the pharmacist is unable to supply a medicine such as emergency hormonal contraception to a patient on the grounds of conscientious objection, the pharmacist must take reasonable action to refer the patient to another health care professional, service or organisation who can provide those medicines and services in order that the patient's care is not jeopardised. This is provided for under the statutory Code of Conduct for Pharmacists and all pharmacists must subscribe to this code.

On the reimbursement for products, the HSE has statutory responsibility for decisions on pricing of and reimbursement for medicine under the community drugs scheme, including the medical card schemes. Prior to deciding whether to reimburse for a medicine, the HSE considers a range of statutory criteria, including clinical need, cost-effectiveness and the resources available.

The proposed amendment to the Irish Medicines Board Act will allow the payment of fees to members of the Health Products Regulatory Authority. This is in line with the practice of other similar boards, where fees are paid to members of the board to continue to attract individuals of the highest calibre and expertise to apply for board membership. There will be no additional cost to the Exchequer as the authority is mainly self-financing, and any fees paid will be strictly in accordance with Department of Public Expenditure and Reform guidelines, which include the principle of one person, one salary for those who are already in receipt of a salary from the public service.

I thank Deputies for contributing to the Second Stage debate. I look forward to further constructive examination of the Bill on Committee Stage. It has been a thought-provoking and considered debate from all the Deputies who contributed. I commend the Bill to the House.

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