Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

Except for us, a Cheann Comhairle.

I am very pleased to introduce the Health (Miscellaneous Provisions) Bill 2024 to the Dáil. The legislation has three main aims. First, it will provide for an exemption of rent-a-room income of up to €14,000 per annum to be disregarded from the medical card and the GP visit card income assessment process. Second, it amends current legislation to clarify regulatory powers concerning the supply and administration of medicinal products. Third, it will provide for the establishment of regulations to help to deal with shortages of medicines. This will include a framework for therapeutic substitution by pharmacists in line with a clinically approved protocol or in other words, the supply of a specified therapeutic alternative medicinal product in limited circumstances where there is a shortage of a prescribed medicine.

I will begin by focusing on the exemption of rent-a-room income from the medical card and GP card assessment processes. Rent-a-room tax relief was put in place by the Revenue Commissioners in 2001. It allows participants on the scheme to earn up to €14,000 per year tax-free if they rent out a room or rooms in their home for use as accommodation by others. At present, income eligible for rent-a-room relief is included in the medical card assessment process. In such cases, this income is a contributing factor when deciding whether a person qualifies for a medical card. Exempting income eligible for rent-a-room relief from medical card and GP card assessment will benefit two groups of people: those who will now be able to apply for a medical card or GP visit card as a result of the disregard of rent-a-room income, and those who already have a medical card or GP visit card and may now choose to rent out rooms because of this increased allowable income. Currently, people with spare rooms may choose not to rent them out because that additional income would essentially put them over the threshold for the medical card or the GP visit card. The proposed exemption can help to address the shortage of accommodation in the State by making more efficient use of existing housing and by stimulating supply for renters, including of course students. This income disregard is an important addition to a much wider set of measures that have already been introduced by the Government in response to housing challenges. There are homes that are well located but which are currently underoccupied. We hope this legislation will help bring these further into use by providing greater options for people seeking to rent and those wishing to rent out rooms. This measure will assist in removing potential barriers to people benefiting from the rent-a-room scheme. It is an important step towards the Government's goal of providing additional accommodation to alleviate acknowledged challenges with the availability of residential rental accommodation.

I will outline the changes proposed to the Irish Medicines Board Act 1995, also known as the IMB Act. The IMB Act makes broad provision for arrangements for the control of medicinal products, including in relation to the manufacture, sale and distribution of medicinal products. Section 32 of the Act empowers the Minister for Health to make regulations that further the overall purpose of the Act. The House will note that the Act dates from 1995. Notwithstanding amendments that were made in 2006, updates of some provisions are advised to ensure the Act is more in line with the current needs of public health and of our health services. To that end, there are three amendments proposed to the IMB Act in this legislation.

The first of those changes concerns access to certain approved prescription medicines. During Covid, we widened the pool of health professionals who, with appropriate training and support, may supply and administer Covid vaccines. I have asked that this be retained and extended in order that we will have a permanent ability to call on a wider range of professionals to provide this service. This amendment will strengthen current legislation. It will give clarity on the professions who may administer medicinal products including, but not limited to, vaccinations. A further change, which is primarily being made to remove any doubt, explicitly includes "pharmacy" as a named location where the administration of medicinal products may take place.

On the second change to the IMB Act, the House will be aware of my ambitions for pharmacy as a profession. Pharmacists are highly trained professionals who can support a greater level of access to care for all of us in our own communities. I established a pharmacy task force last year to support this goal and its work is progressing well. This amendment will provide that pharmacists can sell and supply approved medicines without the need for a prescription. This primary legislative amendment will be subject to appropriate regulation and controls, to be set out in secondary legislation. This amendment also provides for expanded provision of vaccinations by pharmacists. It is my intention that regulations will be put in place to facilitate the sale and supply of oral contraceptive pills by pharmacists in the absence of a prescription. Such regulations will be subject to further clarity as to the appropriate framework and of course consultation with stakeholders.

The third change to the IMB Act concerns management of medicines shortages. I am proposing changes to mitigate medicines shortages nationally, and to complement work happening at EU level on medicines availability.

These measures will introduce medicines substitution protocols, MSPs, and related actions which will help to mitigate the impact of medicines shortages. MSPs allow pharmacists to supply a specified therapeutic alternative medicinal product in limited circumstances where there is a shortage of a prescribed medicine. This will be done in strict compliance with approved protocols specific to a known or anticipated shortage and for a limited time. It will enable us to be agile in our response to emerging shortages and further utilise the expertise of pharmacists.

I ask the House to note my plans that a further measure to support the management of medicines shortages and enhance security of supply, to be introduced on Committee Stage, will be included within this Bill. This will take the form of a further amendment of section 32 of the IMB Act to introduce reporting obligations for actors in the medicines supply chain and to allow for this information to be used in national medicinal planning systems. These reporting requirements, which are in line with European obligations, seek to improve visibility of the medicines supply chain to Ireland and help the management of medicines availability in Ireland. These measures will support the national system for the management and security of medicines supply and will facilitate a more proactive system for the management of medicines shortages.

Essentially, I believe that pharmacists can do a lot more than they are currently allowed do under the law. They stepped up during the Covid pandemic. I insisted at the time that the Covid vaccine programme be expanded to pharmacists. There were some who believed they would not step up; they were magnificent in stepping up. They cleared the decks through Christmas. There was one particular wave of Covid during which we had a matter of days, maybe a week or two, to get the most vulnerable vaccinated before that wave hit. If we had not been able to vaccinate those more vulnerable people, many people would have died. The GPs stepped up and the pharmacists stepped up. They were magnificent. Enhanced pharmacies are one of the things we have committed to under the programme for Government. We know they can do more. They want to do more. My Department is in discussions now with the Irish Pharmacy Union about a broad-ranging agreement. This Act will allow pharmacists - again, under strict controls - to begin to provide products that previously required a trip to the GP. GPs are very busy people. We can shift some of that work, like oral contraception, into the pharmacies. As we roll out a minor ailments scheme, there are other things - for example, conjunctivitis - where a pharmacist can very easily spot the problem but cannot provide the product because it requires a prescription. We are looking at those kinds of things to make sure that pharmacists can do more and more. We will tap into their expertise in terms of substituting certain medicines. We know there are medicines shortages around the world and we need to become more agile. There are therefore many steps we are taking with the pharmacists. This evening's Bill is an important step in providing a new legislative basis to tap into their very substantial expertise and their real appetite for doing more and more in terms of healthcare provision right across the country.

I will now provide a brief explanation of the sections of this Bill.

Part 1 is for the preliminary and general provisions of the Bill. Section 1 contains standard provisions setting out the Short Title and citation and provides that the Bill shall be subject to a commencement order. Section 2 contains the full definitions of the Acts being amended in the Bill.

Part 2 provides for amendments to the Health Act 1970.

Section 3 sets out amendments to section 45 of the 1970 Act. It states that in determining a person's overall financial situation, as provided for in section 45(2), relevant sums arising to a person or a person's spouse or civil partner that qualify for rent-a-room relief under section 216A of the Taxes Consolidation Act 1997 shall not be taken into account by the HSE in the assessment of medical cards.

Section 4 sets out amendments to section 45A of the 1970 Act. It states that in computing gross income for the purposes of sections 45A(5) and 45(5A), relevant sums arising to a person or a person's spouse or civil partner that qualify for rent-a-room relief under section 216A of the Taxes Consolidation Act 1997 shall not be taken into account by the HSE in the assessment for medical cards for people of 70 years of age and above.

Section 5 sets out amendments to section 58 of the 1970 Act. It states that in determining a person's overall financial situation as provided for in section 58(2), relevant sums arising to a person or a person's spouse or civil partner that qualify for rent-a-room relief under section 216A of the Taxes Consolidation Act 1997 shall not be taken into account by the HSE in the assessment of GP visit cards.

Section 6 sets out amendments to section 58A of the Health Act 1970. It states that in computing gross income for the purposes of section 58A, relevant sums arising to a person or a person's spouse or civil partner that qualify for rent-a-room relief under section 216A of the Taxes Consolidation Act 1997 shall not be taken into account by the HSE in the assessment of GP visit cards for people of 70 years of age and above.

Part 3 provides for amendments to the Irish Medicines Board Act 1995.

Section 7 sets out the amendment of section 1 of the IMB Act. It inserts definitions relating to the amendment of the IMB Act in Parts 8 and 9 to clarify the meaning of terms inserted for the purposes of the amendments.

Section 8 involves the amendment of section 32 of the IMB Act and provides for three additions. Under subsection 32(2)(k), it inserts "pharmacy" as a location where the administration of medicinal products may occur. It sets out explicitly that pharmacists are a profession to which regulation of the prohibition on the sale and supply of medicinal products without a prescription, and exceptions to that prohibition, may apply under section 32(2)(l) of the IMB Act. An amendment to section 32(14) specifies the health professionals who may administer medicinal products, subject to regulation. This gives clarity as to the professions who may administer medicinal products - for example, vaccinations - but does not confer new powers or scope of practice on any profession.

Section 9 makes provisions relating to medicinal products shortages by facilitating the implementation of a framework for MSPs. During a period of a specified medicine shortage, an MSP will allow pharmacists to therapeutically substitute medications where they deem it clinically appropriate to do so and in line with the protocol issued by the Minister for Health.

In conclusion, this Bill removes potential barriers to the rent-a-room scheme such that income of up to €14,000 yearly is not counted towards medical card and GP visit card assessments. This will ensure that those who utilise the scheme are not at risk of losing eligibility or prevented from getting a medical card or a GP visit card if they apply while renting a room to someone. This measure helps to progress the Government's Housing for All policy by removing potential barriers to the rent-a-room scheme to increase its potential as a source of student accommodation and, of course, other accommodation. The changes proposed to the IMB Act will enable pharmacists and other health professionals to continue to expand the supports they provide within our health services. It is envisaged that when the MSPs are in place, they will assist pharmacists in managing certain shortages of medicines in a swift manner without patients being referred back to prescribers for a new prescription. This will ensure continuity of care for patients and reduce strain on the health service.

I very much look forward to listening to Deputies' views and to working with colleagues across the House to progress this important legislation through the Dáil as quickly as possible. Given that the core objective represents positive actions to benefit students, renters, patients and families, especially in the context of the current cost-of-living crisis and accommodation challenges in Ireland, I hope to enact the legislation as soon as possible to ensure early and timely implementation. The same applies for medicines. Our pharmacists have a real appetite now to do more, and it will be great to get this legislation through both Houses. It will facilitate them in providing more and more care and more advanced care in the communities for all of us.

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