Wednesday, 6 July 2022
Health (Miscellaneous Provisions) (No. 2) Bill 2022: Committee and Remaining Stages
Amendments Nos. 1 to 7, inclusive, and 10 are related. Amendment No. 10 is consequential on amendments Nos. 1, 3, and 5 to 7, inclusive, being accepted. Amendments Nos. 1 to 7, inclusive, and 10 will be discussed together.
I move amendment No. 1:
“In page 3, line 12, after “Act” to insert “(other than section 5)”.”
Amendment No. 1 is a consequential amendment required as a result of the amendment inserting the contraception provisions. Amendment No. 2 is a drafting clarification in relation to how the Health Act 1970 is referenced within the Bill. Amendment No. 3 provides that the new section, section 53C(9)(bb) of the Health Act 1970, which gives effect to the exemption from charges for acute inpatient services for children under 16, is included for reference within section 47A of the Health Act 1970. The existing section allows the Minister for Health to issue guidance in relation to the concept of a person being ordinarily resident. The amendment is now required because the exemption from such charges is available to children under 16 who are ordinarily resident within the State.
Amendment No. 4 is a drafting clarification in relation to the definition of the Health Act 1970 within the Bill. Amendment No. 5 inserts a new Part 3 into the Bill to provide for the free contraception scheme for women aged 17 to 25. The amendment also ensures that the new section 67E of the Health Act 1970, which gives effect to the contraception scheme, is included within section 47A of the Health Act 1970 that allows the Minister for Health to issue guidance in relation to the concept of a person being ordinarily resident. This is required because the scheme is available to women aged 17 to 25 who are ordinarily resident within the State.
Amendment No. 6 inserts a new section 67E into the Health Act 1970. It contains the main provisions for the free contraception scheme for women aged 17 to 25. Within this proposed new section 67E there are 11 subsections. Subsection (1) provides that the HSE will make available without charge access for women aged 17 to 25 to GPs for the purpose of accessing contraception and a prescription, for the fitting and removal of long-acting reversible contraception, LARCs, and provides that prescription contraception is available free of charge. Subsection (2) provides that a woman can choose to access the scheme in any GP who has signed up with HSE to be a scheme provider. Subsection (3) provides that free prescription contraception will be accessed via pharmacies. Subsection (4) provides that a woman who had a long-acting reversible contraception inserted before her 26th birthday can access the scheme for the purpose of having it removed, even though she might be over 25 and would therefore not otherwise be eligible.
Subsection (5) provides that the Minister, after consultation with the Minister for Public Expenditure and Reform, may make regulations to vary the age cohort eligible for the scheme. Subsection (6) provides that the age cohort cannot be extended below the age of 17 by way of regulation. However, should it be proposed by Government that the age cohort would be extended to any age below 17, we could still do that via a legislative amendment before the Oireachtas. Subsection (7) provides that the Minister, with the consent of the Minister for Public Expenditure and Reform, may set the fees to be paid to GPs and pharmacists under the scheme.
Subsection (8) provides that regulations made under subsection (7) can be prescribed different fees in relation to different cohorts of women and different scheme providers. Subsection (9) provides for general regulation-making powers. Subsection (10) provides that every regulation must be laid before the Oireachtas after it is made. Subsection (11) is a definitions section.
Amendment No. 7 contains a number of consequential amendments to the Health (Pricing and Supply of Medical Goods) Act 2013. These arise from the introduction of the free contraception scheme to provide the legislative framework for the provision of free contraception products for women age 17 to 25. Amendment No. 10 is to confirm that the contraception provisions are part of the Bill under this Title.
I will be supporting most of the amendments, with the exception of one. I just want to make a number of points first, speaking to amendment No. 6, which is a very substantial amendment. I want to welcome the overall proposal, because it is an important measure that will help and support many women. It is important from a family planning perspective. I welcome that it includes the range of contraception products, including long-acting reversible contraceptives. I also welcome the clarification the Minister gave, which is that full cost of contraceptives, including GP consultations and all of the costs that go with it, will be included. It is important for us to acknowledge that. That is a really important step forward in this area under the Minister’s leadership, which I support, as I did on Second Stage.
It is equally important to many who need the pill to help balance hormone fluctuations throughout their cycles. It can help to regulate and regularise their menstrual cycles. It reduces pain and discomfort, relieves symptoms of premenstrual syndrome and it helps to reduce the risk of uterine cancer, ovarian cysts and anaemia and it can be helpful for the management of endometriosis. For all of those reasons, the inclusion of the full range of contraceptive products, including LARCs, is really important.
However, the substantial point I want to make is that I think the Minister would accept that amendment No. 6, in and of itself, merits its own Bill. If the Opposition had tabled an amendment similar to amendment No. 6, it would have been ruled out of order, because it significantly alters the scope of the Bill. I am sure we would have been sent a letter to say that our amendment had been ruled out of order. The merits of the proposals of the amendment, as evidenced by amendment No. 10, show that this is well beyond the scope of the original Bill.
I accept the reasons the Minister is doing this. I accept also that we want to get this done as quickly as possible. Equally, we have to point out that this almost always happens in the approach to the summer recess. We have legislation being rushed through without proper scrutiny. If we had a separate Bill on this issue, we would have had a more fulsome debate on the issue of contraceptives. We would have had a debate on how we get to universal free contraception for all, about what that transition will be and about the Minister's plan to move beyond what is in the scope of this Bill. However, we did not have that chance.
We had Second Stage speeches that had to concentrate on a range of issues, including this issue as well as all of the other elements in this Bill. For that reason, this amendment should have been a stand-alone Bill. It is product of the fact that we do not move the legislation as quickly as we should and then there is this rush towards the summer recess. That happens every year and we have these omnibus Bills that are a mix and match of all sorts of different issues. It is not the best way to progress legislation but there we have it. We are where we are.
There is a significant part of amendment No. 6 with which I do not agree. I am disappointed to see that it has been included. That is subsection (6) of section 67E, proposed to be inserted by amendment No. 6. This prevents the extension of free contraception to people under the age of 17. I understand the rationale to base the eligibility on the age of consent. That is a logical position in some respects but it misses the point in relation to the use of contraceptives, particularly the pill.
As I outlined, the pill is very important to many women for regulating their menstrual cycles and reducing the associated pain and discomfort. There is no reason these products should not be made available free of charge to women aged under 17 who are pubescent for this reason. There are other reasons as well. We can have a discussion about the age of consent but we could also have a grown-up discussion about what unfortunately happens in the real world whether we like it or not. History teaches us that the more we make contraceptives available to everybody, the better it is.
There is just one part of amendment No. 6 with which I cannot agree. I checked and it is not possible to move a Fourth Stage amendment. If I were moving a Fourth Stage amendment, however, it would be to delete that subsection under Standing Order 191. I have been told it is not possible. For that reason, unfortunately, I will have to oppose amendment No. 6 when it comes up and call a vote on it. That is how strongly I feel in relation to it. I do not believe we should be limiting the use to women aged 17 and over. From my perspective, we could have gone further and reduced it to women of a lower age as well. I have given the reasons.
I will make this point because we did not have a chance to make it in what would and should have been a Second Stage debate on the issue of rolling out contraception for women of that age. Given that this is a substantial amendment of the original Bill, as the Minister would accept, it is important that when the Minister gets a chance to respond, he sets out what he sees is the trajectory with regard to universal contraception. What is the next step? This is a very important first step. I do not want to in any way take away from the significant advance this will be. I already commended the Minister on what has been done. Like many areas in relation to healthcare, however, we had previous discussions very recently in the context of free GP care and free primary care, which are all part of Sláintecare. Lots of these promises about universality have been made but it is taking an awful long time to get there. I do not know what the direction of travel is beyond what is in this Bill.
Perhaps the Minister might be able to spell out to us whether he intends to go further than what is in this Bill in the upcoming budget. If it is not in the upcoming budget, has the Minister a timeframe on which he is working to expand free contraception beyond what is permitted in this Bill? It would be important for the Minister to set that out. I make the point again that for the reasons I gave, I cannot support amendment No. 6 because of one element of it. Because I cannot move a Report Stage amendment, however, I have no choice but to oppose the amendment as is.
Likewise, I think this should have been separate legislation. It is very important legislation. Many of us participated in the committee that looked at repealing the eighth amendment of the Constitution, as did the Minister. The recommendations of the Citizens' Assembly dealt with this issue quite substantially. One thing that we know substantially reduces crisis pregnancies is the provision of contraception.
I wish to make similar points to Deputy Cullinane regarding amendment No. 6. One provision that is really very confusing, and on which I want the Minister to answer a few specific questions, is subsection 6 of the proposed new section 67E in this amendment, which explicitly states, "In making regulations under subsection (5), the Minister shall not prescribe an age under the age of 17 years." The Minister said that to change this would require a legislative amendment. Therefore, somebody in the House would have to introduce a Bill to amend that some time in future. Otherwise, it ties the Minister and future Ministers for Health into precluding anybody under the age of 17 from having access to free contraception.
I checked the ancillary recommendations of the Committee on the Eighth Amendment of the Constitution, one of which explicitly states that it is recommended that all people shall have access to free contraception. The upper age limit of 26 and above is an element on which I reckon the Minister will talk about costs. That does not mean it protects people who may have had enough children and want to control the size of families but find doing so very expensive, which contraception and visits to doctors are. This is a very worrying detail, however. The reason I say it is worrying is because there is a good report by the HSE to which I would like to draw the Minister's attention, although he probably knows about it, entitled, Information Summary about Teenage Pregnancy in Ireland 2000-2020. A number of factors are leading to a decline in teenage pregnancies. It is great to see that crisis pregnancies and pregnancies in general among teenagers are reducing. The report goes through a list of examples as to why this is the case, including schemes to reduce student disengagement with education, schemes to support young people at risk of early school leaving, the introduction of better sexual and relationship education in the curriculum, the development of a well-being policy and so on. It finishes with increased access to contraception and information.
Obviously, we welcome the reduction in crisis pregnancies, in particular, and pregnancies in general among teenagers. The Minister is putting a barrier in their way, however. I would like the Minister to be able to answer why this clause was included. I was shocked when I saw it in the Bill. Why did he have to include that? He is not just saying that the age of consent might be the legal thing or whatever but he is actually precluding changes to this for future Ministers for Health without a Bill going forward. The decline in teenage birth rates is very significant; it is 73% over that 20-year period I talked about. Teenage births as a share of the total births have declined even further, emphasising the reduction in this cohort.
Surely, we want to see this continue. If we want to see it continue, whether anyone in this House or the rest of the world likes it or not, and this is shown by more evidence from the Irish Family Planning Association, IFPA, we cannot deny the reality that studies on behaviour among school-aged teenagers show that approximately one in five girls and one in four boys aged 15 to 17 report having had sexual intercourse. The more we can do to help them to understand sexual relationships and protect themselves in those sexual relationships, the better. Specifically precluding them is actually baffling to many of us. Young people in care are also identified as a particularly vulnerable group and report early sexual initiation from their peers. All this puts younger people at risk. I believe it flies in the face of all the progressive measures in which we wish to engage. That is pointed out very well by the HSE report. If the Minister includes that clause, it will make it difficult to reach the most vulnerable in our society who are under the age of 17 and help them to avail of free contraception.
I wish to ask the Minister a couple of questions. First, will he please explain to us why he specifically put that clause into this legislation? Instead of addressing a gap that exists for that group, he is now closing down access to it even further. There needs to be a rationale for this amendment. What proposals does the Minister intend to bring forward to resolve the legal uncertainty with respect to the age of sexual consent and access to sexual and reproductive health services? What is the timeframe for addressing this extremely serious exclusion of this vulnerable cohort from the free contraception scheme? If the Minister had left it out we would not have a problem, but he specifically included it. I ask him to please address those questions.
I apologise for being late. I was at a briefing and was caught out with the early start.
I agree with points made by other speakers about the rushed nature of this. We all want to see this scheme coming in as soon as possible but we were caught unawares last week. After the briefing took place, for which I thank the Minister, I tried to table amendments and discovered that the deadline was actually the morning of the day we got the briefing. That was very unsatisfactory and the Ceann Comhairle agreed to extend that by one day. It is all very rushed, however, and there has not been time to consider the issue adequately.
I support points made by the two previous speakers. This issue was drawn to our attention by the IFPA.
It is difficult to understand what is the thinking behind the wording. My understanding from the briefing is that while this current scheme is for women aged between 17 and 25 years, the upper age limit can be changed by regulation but the lower age limit cannot. Why is that the case? Why was it not left in a situation where the Minister could lower or increase the age by regulation? Why is the Minister providing under subsection (6) that, "In making regulations under subsection (5), the Minister shall not prescribe an age under the age of 17 years"? Where did that come from and what is the thinking on that?
As others have said, there are plenty of surveys to show that a proportion of young people in Ireland, like those in most other countries, are sexually active before the age of 17 years. A HSE study of 41 young people aged 13 to 18 years found that 58.5% had experienced sexual intercourse. The mean age for first sex was 13.5 years. On average, young men had first sex at 12.9 years compared to young women at 14.5 years. That is substantially lower than 17 years. While that is not to be encouraged, and there is a lot of other work that needs to be done in terms of modern relationship and sexuality education, RSE, programmes and so forth, the reality is that a significant number of people under the age of 17 years are engaging in sexual intercourse.
A Crisis Pregnancy Agency study of sexual health issues, attitudes and behaviours in early school leavers found high levels of early sexual initiation and inconsistent use of contraception reported among this group. This is obviously a vulnerable group of young people who may not have great opportunities in life, who are early school leavers and who are more predisposed to engaging in risky behaviour. The implications of that are very considerable for their future life.
In the UK, the Fraser guidelines support healthcare professionals to advise young people about contraception and sexual health. The Minister often argues that the GP is best qualified to take key decisions about whether to prescribe particular medication or to give health advice to patients. I wonder why the Minister is tying the hands of GPs if, in a particular situation and given particular circumstances, a GP is of the view that contraception should be prescribed for somebody under 17 years. Why is he not allowing the freedom for that? The fact that there are those guidelines in the UK means that healthcare professionals can assess the maturity of the patient and help patients to make an informed decision. It is particularly important for vulnerable young people, and healthcare professionals should be able to support them in the lifestyle they have.
This is a mistake. Can the Minister explain the thinking behind it? Where has that restriction come from? Along with other Members, I strongly urge the Minister to amend this or to postpone Report Stage of this legislation and allow it to be held up until next week. We would be happy to facilitate him in that if he will bring forward an amendment on Report Stage to provide that flexibility. Just as the Minister has the flexibility to raise the age for the scheme, the Minister should also be able to lower it. I strongly urge the Minister to do that.
I thank colleagues for their contributions. I believe we are in agreement that this is a landmark policy change and that it is broadly supported, notwithstanding the concerns that have been raised today. I visited the Irish Family Planning Association team in Parnell Street recently. That was set up decades ago specifically in response to women's healthcare needs because of the ban on contraception. The team members were very enthusiastic about the fact that this is happening now and has political support. I will come directly to the concerns that have been raised but it is important to say that this is a very important change to healthcare provision in Ireland and our move to universal healthcare. It is a move that is in line with Sláintecare, and it is important. It is a good day that we are passing a Bill that will abolish hospital charges for children - obviously we want to continue after that and look at adults, and we will deal with amendments in that regard later - and that is making contraception free in this country. It is a really important day, given that contraception was illegal in the country not so long ago.
As has been mentioned, it is covering all the costs. It covers consultation, prescriptions, medicines, devices, check-up, fitting and removal, which is very important. It was one of the commitments given under the repeal of the eighth amendment and it is important that we do this now in the context of that repeal. There are other important things happening there. The review of the operation of the Act that emerged from the repeal is ongoing, we are progressing with the safe access zones legislation and we are making contraception free, starting with young women. The experts' advice was that we should start with this group. There is a lot of really important stuff happening this year, and this is one of those pieces.
There is an awful lot of money being allocated for this. The full-year cost for this measure, which it is hoped will be passed today, is €26 million for next year. To put that into perspective, the entire additional funding for the national cancer strategy for this year was €20 million and the entire funding for this year for the national maternity strategy was €9 million. This is €26 million, a serious investment by the Oireachtas and the Government in women's healthcare and women's reproductive health. The intention is to expand it. I want to see this available to everybody, but we have to start somewhere. I hope colleagues will at least accept that. With €26 million for full-year cost, we have to start somewhere. However, we all want to see it expanded to everybody.
I come now to the subsection which provides that we can increase the age by regulation but we cannot go below 17 years by regulation. When I saw this, I asked the same questions. My view is that we should go down, that we can go younger and that we will go down lower, so why have this there? It is not something the Deputies wanted and it is not something I wanted. The answer is that the working assumption in the preparation for this scheme was that it could be done on an administrative basis, but there was recent legal advice that if we wanted this to be watertight and to make sure nobody could challenge any of it, and we all are aware that there are those who might try to stop us with this scheme for the reasons we all understand, it had to be put on a statutory basis.
It was very important for me that this came in on time. We committed to this in last year's budget and we want it in place by the end of August or the start of September. If we were to miss this Dáil term, we would not be debating this until October. It was very important for me that we got it done. That gives the HSE, the GPs, the pharmacists and the system time to implement or operationalise it so it is, in fact, available to women from the end of August or the start of September. I actually agree with the point that there is not enough time for this. I agree that, of course, one could see this as a stand-alone Bill, but I was faced with a choice. Given the legal advice I received quite recently, if I put it into a separate Bill there was a risk that we would not be able to get to it until October, so I took the decision to introduce it here. I fully accept that this is not ideal, but I was responding to the legal advice I received and I was very keen that the deadlines were met. That is why it is here as an amendment.
With regard to the 17 years provision, I asked the exact questions the Deputies have asked. Why would we tie our hands legislatively and not be able to move to 16 years or indeed lower, as I think we should be able to do? The answer I received was that once we move below the age of consent, there are legal complexities that have to be worked through.
I reiterate that the working assumption is this could be challenged. People could try to stop this scheme. Time is required to make sure it is constitutionally and legally completely robust through consultation with the Attorney General, the Chief State Solicitor's Office, CSSO, and other stakeholders. The reason that subsection is in the Bill is to make sure we can get in place the scheme we have agreed and that is funded for 17 to 25-year-olds when we said we would, namely, the end of August or start of September. I have already asked the Department to engage - it is doing so anyway - in that more complex legal discussion and to start preparing amending legislation so we can all come back to the House and pass that legislation.
I fully accept it is not ideal. It is a mainly a function of getting advice quite recently that this provision needed to be in a Bill. That is the only reason it is there. Deputies can obviously vote how they want, but it would be a great pity for Sinn Féin or anyone else to vote against this. What we are doing here is very important. It would be wonderful to send out a message that the House is united on this, or at least those who are present are united. I fully accept the concerns that have been raised. I raised exactly the same concerns. I foresee that the Department will work the CSSO and the Attorney General's team. They will go through the complexity, which they are beginning to work through now, and will come back with something we know is legally and constitutionally robust and that can survive the legal challenge we think will happen. I may need a decision from the Government. I am telling Deputies what my position is right now, which is that we move below the age of 17.
For example, it would not be reasonable to say to a young 16-year-old woman that we will not fund her contraception but we will fund a termination. That is not a position we should be in. I would like to see that changed as well, but there is a legal reality I have to deal with. I do not want to get this wrong now only to open it up to a legal challenge, when it is something we can make right properly. We need to get this scheme up and running as quickly as possible.
I can come back again to respond but I hope Members will reflect on that. They will obviously vote whatever way they want, but it would be nice for the Oireachtas to send out a strong message that we are united on this.
I have accepted during my speech on Second Stage and in my earlier contribution that all the elements of this Bill are big steps forward. I have acknowledged that. I accept the rationale the Minister has given regarding the time constraints, the legal advice he has been given and the reasons that amendment has been proposed. I accept at face value what he said to us. The only part of the amendment I oppose is section 67E(6), read out earlier, which states: "In making regulations under subsection (5), the Minister shall not prescribe an age under the age of 17 years." I had hoped to move an amendment on Report Stage but I do not have the ability to do that because of the time constraints we are under and because Committee and Report Stages are being taken together. This is a Bill that covers many different issues but I do not have the option of tabling that amendment.
However, what the Minister said is reasonable. We do not want to divide the House on this when it is a big step forward. I also agree we have to start somewhere. This is a good start. I accept the logic given to the Minister that there are legal complexities here that have to be worked out. If we are not to oppose this, I ask the Minster to commit to working with the Oireachtas Joint Committee on Health on the matter. It is not something that can be forgotten about and put on the long finger. I do not know what his legal advice is. I assume the complexities are related to the legal age of consent and the potential for court challenges. I imagine they can be worked out because, as the Minister said, someone can have a termination at the age of 16. I hope that can be worked out.
On that basis, and in the spirit of wanting to support this Bill, which I do - I support the amendment apart from the one element of it I mentioned but I cannot move a Report Stage amendment regarding it - I will not push this to a vote. It is obviously up to others what they want to do. I will not push for a vote based on what the Minister said. I have taken that on board, but I seek a commitment from him that there will be a move to reduce that age quickly and that he will work with the Oireachtas health committee on the legal complexities he has outlined.
This measure is a massive step forward. It is the four-year anniversary of when we voted to repeal the eighth amendment. Part of the commitment to the people of Ireland at the time were the ancillary recommendations from the Citizens' Assembly and the Oireachtas committee, which included free contraception for all. We waited for four years and we are now rushing this through. I accept the points that have been made. It is a shame we are rushing this Bill through with that particular clause contained in it.
The Minister has just pointed out something that is very contradictory, whatever about the legal opinion he has. As an elected Member, I find it difficult to accept the Minister has been given a legal opinion, full stop, but we get no indication of what that legal opinion may be. He said that opinion indicates there are complexities we must work through. We have had four years to try to work through them and, all of a sudden, bang slap against the summer recess, we are presented with this. The Minister has pointed out another complexity which is that, legally, we can now provide a termination of pregnancy to people under the age of 17 but we cannot legally supply them with free contraception.
What was the point of sitting for hours and hours in committee rooms discussing with witnesses, some of whom came from abroad, how important it was to have free contraception and non-ethos-based sex education to reduce crisis pregnancies, particularly among the younger cohort who are sexually active? This just undermines all of that work. I have no idea what that legal opinion is but I suspect it is probably coming from the same forces the Minister talked about who are outside Leinster House. I have no idea. He said people would like to undermine this legislation. I am sure they would.
I do not know what the legal opinion is. The Minister is not showing it to us. There is a major contradiction in us being able to provide termination of pregnancy, free of charge, to people under the age of 17, but we are not prepared to provide them with the contraception that would prevent pregnancy in the first place. I find this bizarre.
I will not push it to a vote either because nobody wants to stop the provision of free contraception to people, even with the age limits that are outlined in the Bill. We hope the Minister will move very quickly to change that and will bring another Bill to get rid of this clause, once the legal complexities are worked through, but the situation is totally unsatisfactory. He keeps repeating he is in favouring of lowering the age but he will not do it. I find this whole conversation kind of bizarre because his answers are not satisfactory. Why did he explicitly put this provision in the Bill? We still do not know the answer to that.
This has significant implications for a very vulnerable cohort of people, including younger people, who can ill afford to pay for contraception. I do not know about where the Minister lives, but I live in a community where teenage pregnancy is an issue and the affordability of contraception is a major issue. Going to the doctor and buying any form of contraception is a significant issue for a certain class of people, including vulnerable people and young migrants. We are just throwing the baby out with the bathwater. It is disgraceful we are now being put in a position that voting against this amendment would make us look absolutely regressive. This clause is totally regressive.
There is no doubt this situation has thrown up a serious anomaly. It is an indefensible situation where a 16-year-old can have a termination but is not being facilitated with free contraception.
This is so last minute and rushed we are not in a position to challenge what the Minister has said. We have to take it at face value. The key thing is that this situation is not let lie. We need a very definite timescale. The Minister said he has asked his officials to work on this and that work is already under way, which I welcome. I would like him to give a commitment to come back to the Oireachtas Joint Committee on Health on this issue before the end of October.
That is a reasonable timescale. I ask the Minister to come back to the committee with proposals on how he will address this anomaly before the end of October. If the Minister is prepared to do that, I am happy to accept his word.
I thank the Deputy. I see no issue in coming back to the committee before the end of October. The officials are working on how we move below the age of 17. I agree with the Deputy's point on the anomaly. I am putting forward similar arguments. That is my view on it. The reason we have chosen the 17 to 25 age group has nothing to do with any legalities. The reason we have started with the 17 to 25 age group is that we received expert advice to that effect. It is based on an expert recommendation to have the biggest impact for women. It is only where we are starting. We had to start somewhere. The age group of 16 and under is not related to the legislation here. I just want to make sure the legislation is legally robust. As I have said, we got recent legal advice that we needed to do this by statute. Previously, the understanding was that we did not need to bring forward legislation. The view was that it was just an administrative scheme, and what we planned on doing was just like adding elements to the drug payments scheme or something similar. However, it turns out that is not the case, which is why we have the legislation before us. I am more than happy to come back to the committee. I and my officials can engage with the Joint Oireachtas committee on Health on the matter. I fully intend for us to come back here in the next Dáil term to pass amending legislation this year. The plan for this year was always to provide services for the 17 to 25 age group. I invite Members to engage with me and to pass on their views on the provision of services for other age groups. We can have a discussion on other age groups and the funding involved. It is expensive. Given that we will have a set amount of money for new developments in health for the budget for next year, if we want to put aside €5 million, €10 million or €15 million, there will be areas we cannot fund. We need to bear that in mind. I would love to see funding being directed towards the provision of IVF in the next year through the budget. I would like to get that going. I am very happy to hear the thoughts of Members on that and to engage with them on the issue.
In response to Deputy Smith, the rationale for the clause is exactly as I said. I would much prefer if the subsection were not included in the legislation. It is included only because we need to make sure the Bill, which we are passing very quickly, is legally robust and stands up to any challenge. What I would like, and what I intend to do, is to introduce amending legislation to deal with that, so that we can provide services for those aged under 17.
I move amendment No. 3:
In page 3, between lines 19 and 20, to insert the following:
“Amendment of section 47A of Act of 1970
3.Section 47A of the Act of 1970 is amended by the insertion of “53C(9)(bb)” after “45A, 46,”.”.
I move amendment No. 5:
In page 4, after line 6, to insert the following:
PROVISION OF CONTRACEPTION SERVICES FOR CERTAIN WOMEN
Amendment of section 47A of Act of 1970
3.Section 47A of the Act of 1970 is amended by the substitution of “58B, 58D, 62A or 67E” for “58B, 58D or 62A”.”.
I move amendment No. 6:
In page 4, after line 6, to insert the following:
“Contraception services for certain women
4.The Act of 1970 is amended by the insertion of the following section after section 67D:
“67E.(1)The Health Service Executive shall make available without charge contraception services for women who are ordinarily resident in the State—
(a) who have attained the age of 17 years but not yet attained the age of 26 years, or
(b) who are within such class or classes of ages as may be prescribed by the Minister under subsection (5), and
such women shall, in this section, be referred to as ‘relevant women’.
(2) Insofar as the contraception services relate to the provision of applicable services to a relevant woman, the relevant woman may choose to receive such services from any person who has entered into an agreement with the Health Service Executive for the provision of those services and who is willing to accept that woman as a patient.
(3) Insofar as the contraception services relate to the provision of relevant products to a relevant woman, the relevant woman shall be entitled to receive a relevant product from a pharmacy provider.
(4) Notwithstanding subsections (1) and (2), the following shall apply in respect of a woman who is ordinarily resident in the State (whether or not she falls within the definition of a relevant woman) and who has had a long-acting reversible contraceptive device fitted before she attained the age of 26 years (or such other age as may be prescribed by the Minister under subsection (5)), namely:
(a) the woman concerned may, notwithstanding that she has attained the age of 26 years (or such other age as may be prescribed by the Minister under subsection (5)), choose to seek the removal of such device by any person who has entered into an agreement with the Health Service Executive for the provision of contraception services and who is willing to accept her as a patient;
(b) the Health Service Executive shall, in respect of that woman, make available such removal without charge.
(5) Subject to subsection (6), the Minister, after consultation with the Minister for Public Expenditure and Reform, may, for the purposes of subsection (1)(b) and subsection (4), by regulation prescribe such further age or class or classes of ages in respect of women to whom the contraception services referred to in subsections (1) and (4) shall be made available under this section.
(6) In making regulations under subsection (5), the Minister shall not prescribe an age under the age of 17 years.
(7) The Minister may, with the consent of the Minister for Public Expenditure and Reform, by regulation prescribe the amount or the rate of payment to be made to—
(a) scheme providers in respect the provision of applicable services by them under agreements referred to in subsection (2), or
(b) pharmacy providers in respect of the dispensing of relevant products by them under this section.
(8) Regulations made under subsection (7) may prescribe different amounts or rates— (a) in respect of different contraception services or different classes of contraception services, or in respect of the provision of contraception services or different classes of contraception services to different classes of relevant women, or (b) in respect of different scheme providers or pharmacy providers or different classes of scheme providers or pharmacy providers.
(9) Regulations under this section may contain such incidental, supplementary, consequential or transitional provisions as appear to the Minister to be necessary for the purposes of the regulations.
(10) Every regulation made under this section shall be laid before each House of the Oireachtas as soon as may be after it has been made and, if a resolution annulling the regulation is passed by either such House within the next 21 days on which that House has sat after the regulation is laid before it, the regulation shall be annulled accordingly, but without prejudice to the validity of anything previously done thereunder.
(11) In this section— ‘Act of 2013’ means the Health (Pricing and Supply of Medical Goods) Act 2013;
‘applicable services’ means—
(a) such number of consultations with a scheme provider required by a relevant woman in a year for the purposes of obtaining a prescription for accessing relevant products, and
(b) the fitting (including such further follow-up consultation as is necessary) and removal by a scheme provider of a long-acting reversible contraceptive device;
‘contraception services’, means, in relation to a relevant woman—
(a) applicable services, or
(b) relevant products,
or both, made available without charge under this section;
‘pharmacy provider’ means a retail pharmacy business (within the meaning of section 2(1) of the Pharmacy Act 2007) who has entered into an agreement with the Health Service Executive for the dispensing of relevant products;
‘registered medical practitioner’ has the same meaning as it has in section 2 of the Medical Practitioners Act 2007;
‘relevant products’, subject to sections 20 and 23 of the Act of 2013, means contraceptive drugs, medicines and products (including long-acting reversible contraceptive devices and emergency contraceptives) for the time being—
(a) standing approved by the Heath Service Executive, or
(b) on the Reimbursement List within the meaning of section 2(1) of the Act of 2013;
‘scheme provider’ means a registered medical practitioner who has entered into an agreement with the Health Service Executive for the provision of applicable services.”.”.
I move amendment No. 7:
In page 4, after line 6, to insert the following:
“Amendment of Health (Pricing and Supply of Medical Goods) Act 2013
5.The Health (Pricing and Supply of Medical Goods) Act 2013 is amended—
(a) in section 20—
(i) in subsection (1), by the substitution of “section 59, 62A or 67E” for “section 59 or 62A”,
(ii) in subsection (2), by the substitution of “section 59, 62A or 67E” for “section 59 or 62A”, and
(iii) in subsection (3), by the substitution of “section 59, 62A or 67E” for “section 59 or 62A”,
(b) in section 23, by the substitution of “section 59, 62A or 67E” for “section 59 or 62A”.”.
I move amendment No. 8:
In page 4, after line 6, to insert the following:
“3.The Minister shall, within 3 months of the passing of this Act, prepare and lay a report before both Houses of the Oireachtas setting out the implications of extending the exemption from statutory charges for in-patient and day case care in public hospitals to all cancer patients.”.
I am not going to repeat the points made by Members of the Social Democrats and other Members of the House a number of months ago when we debated a private members' motion on the need to remove inpatient charges for cancer patients. There is an unanswerable case for doing that. Due to the constraints of the opposition, I cannot move an amendment to ask the Minister to introduce the measure. The amendment seeks to require the Minister to produce a report on the implications of extending the exemption from inpatient charges to all cancer patients. On amendment No. 9, the Sláintecare report recommended the removal of all inpatient charges, across the board, for the whole population. That was to happen in year 1 of the implementation of the reforms. I made points on the issue last week on Second Stage. There is no justification for charging people when they have to be admitted to hospital. I ask the Minister to agree to produce a report on the implications of the measures set out in amendments Nos. 8 and 9 within the next three months.
I am not in a position to accept the amendments within the Bill. However, I am very happy to discuss the matter with the Deputy and with members of the Joint Oireachtas Committee on Health before the budget, if that works. Amendment No. 8 relates specifically to inpatient charges for cancer patients. We looked at the issue in respect of the provision of medical cards. Some asked whether cancer patients should be provided with medical cards. A good piece of work was done on the issue, which I am sure the Deputy is familiar with, looking at different categories of diseases. The finding was that from an ethical perspective, we should not create any hierarchy of diseases. For example, should we abolish inpatient charges for cancer patients, but not for motor neurone disease patients or others? I am looking at an extension of the abolition of inpatient charges more generally. The way I think we should proceed on it is not on the basis of a patient having a particular disease. With medical cards, provision is not based on a patient having a particular disease. It is based on other criteria, such as age and income. I hope that suffices.
The time permitted for this debate having expired, I am required to put the following question in accordance with an order of the Dáil of 5 July 2022: "That the amendments set down by the Minister for Health and not disposed of are hereby made to the Bill; in respect of each of the sections undisposed of, that the section, or as appropriate the section as amended, is hereby agreed to in Committee; the Title, as amended, is hereby agreed to in Committee; the Bill, as amended, is accordingly reported to the House; Fourth Stage is hereby completed and the Bill is hereby passed."