Darren O'Rourke (Meath East, Sinn Fein)

I move: "That the Bill be now read a Second Time."

I welcome the opportunity to discuss the Healthcare (Transparent Payments) Bill 2022, which I am co-sponsoring with my colleagues Deputies David Cullinane and Seán Crowe. I thank Dr. James Larkin, senior postdoctoral fellow at the Royal College of Surgeons in Ireland, for his research in this area and for his help in preparing the legislation.

The Bill seeks to make it mandatory for pharmaceutical companies and medical equipment suppliers to declare payments, gifts, donations and all other transfers of value made by them to healthcare professionals and organisations. In some cases, these payments create problematic conflicts of interest that can have significant consequences for patients and the public finances. We know payments to healthcare professionals and organisations can create conflicts of interest.

Evidence shows that receipt of payments from the pharmaceutical industry is associated with higher prescribing rates, higher prescribing costs, increased use of specific drug classes, including opioids, and lower prescribing quality. This is significant and, of course, has the potential to have a profound impact on patient safety and the public purse. The popular show "Dopesick" highlighted this to great effect in the context of the opioid epidemic in the United States.

In Ireland, tens of millions of euro are paid to healthcare professionals and organisations each year by the pharmaceutical industry. While a voluntary register of these payments is currently in place and maintained by the Irish Pharmaceutical Healthcare Association, research conducted at the Royal College of Surgeons in Ireland found that the identity of many recipients is anonymous, while other payments may not be reported at all.

The current voluntary system is inadequate. The Healthcare (Transparent Payments) Bill 2022 is needed to bring Ireland in line with international best practice and is a measure in the interest of industry, professionals, organisations and the general public. This legislation would require pharmaceutical companies and medical equipment suppliers to declare all payments to the HPRA on an annual basis. Failure to do so could result in a fine of €100,000.

The Bill also provides for the HPRA to establish and maintain the register and ensure it is searchable and accessible to the public. The establishment of a centralised, State-run mandatory disclosure system in Ireland would enhance health service trust and integrity, create a fair and competitive innovation environment, support Ireland’s clinical trials landscape and provide significant cost savings for the HSE. Legislation similar to this has been proposed by TDs from other parties, including Fianna Fáil through former health spokesperson Billy Kelleher MEP. In the US, similar legislation was introduced with cross-party support. Correspondence from the Secretary General of the Department of Health, Mr. Robert Watt, to the Committee of Public Accounts in 2021 noted:

The Private Member’s Bill [this Bill] presents an opportunity for a review of the arrangements in place in the context of improving transparency in transfers of value between pharmaceutical companies and healthcare providers.

It is generally positive in that regard. Again, we cannot rely on the current fragmented transferofvalue.ie and transparentmedtech.eu transparency systems. Peer-reviewed research outlined extensive shortcomings in these systems.

The significant consequences of poorly managed conflicts of interest in healthcare have been highlighted in many countries. Examples include the US opioid epidemic, which I mentioned, and the pelvic mesh scandal in Britain. These crises resulted in significant personal costs for thousands of people and significant financial costs for health systems. Ireland is not immune from this and transparency legislation is a key step in preventing such crises. The shared commitment across parties to a strong health service and thriving life sciences sector must be underpinned by a transparency system that ensures a level playing field for ethical industry actors while safeguarding patients. Legislation in the US, France and other countries has proven that payment transparency strengthens public confidence and supports a more competitive and fair research and innovation landscape where the majority of ethical industry actors are not at a disadvantage by comparison with the few unethical industry actors. It is in the interest of everybody to have transparency in the system so we can know and shine a light on conflicts of interest. I look forward to the debate on this and welcome the opportunity to hear from others.

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