Tim O'Malley (Limerick East, Progressive Democrats)

I wish to conclude tonight's debate by thanking all Members for their constructive contributions on the Bill. I realise that this is a most sensitive debate and I am aware of the concerns raised tonight and in recent days on the contents of the Bill.

Each element of the Bill has been given long and detailed consideration. I would not be supporting it here tonight if I was not convinced that each section is serving a necessary purpose. It must also be remembered that the proposed insurance scheme is a unique provision among the many states where, tragically, members of the population were infected by contaminated blood.

I believe this scheme will remove the impediments experienced by people who up to now have had difficulties in obtaining insurance. It will clarify other aspects of the supports available to persons with hepatitis C so that all three supports — the compensation scheme, the special health care package and the insurance scheme — operate effectively to provide the required services.

There have been some suggestions that the section on the definition of diagnosis is extraneous to the insurance scheme and should not have been included in the Bill. However, I would argue that this section is of vital importance and is intrinsic to the Bill, since it affects the definition of eligibility for the insurance scheme, as well as the other two support schemes which are already in place. This matter has been given careful consideration, and the Tánaiste and Department of Health and Children have received expert advice in regard to the internationally accepted diagnostic tests for hepatitis C.

The views of the four support groups for hepatitis C and HIV — the Irish Haemophilia Society, the Irish Kidney Association, Positive Action and Transfusion Positive — were also taken on board and, accordingly, two other tests which are internationally recognised as being the best methods currently available for diagnosing either the presence of the hepatitis C virus or its antibodies in the system have now been added by amendment. Not only are these tests used for health care purposes but all the international standards on blood transfusions use these tests to determine if blood is safe enough to transfuse to seriously ill patients. The intention at all times has been to be as inclusive as possible and that is why claimants will be required to satisfy only one test.

The ELISA and RIBA tests show that an individual was infected by hepatitis C in the past, so it is not necessary to show evidence of being currently infected. In this country, compensation and health care services have always been available to persons who demonstrated evidence of having been infected, rather than current infection. It has always been sufficient that a person has tested once on one of these tests to demonstrate an entitlement to compensation and the special health care package. Even if a subsequent test proves negative or indeterminate, one positive result is sufficient. It is difficult to see how anyone could put in place a fairer or more inclusive system than this.

The Tánaiste has also taken into account the views expressed that medical science is advancing all the time and that newer and more accurate tests are being developed. The Bill now provides that additions may be made by regulation to the list of diagnostic tests accepted for demonstrating the presence of either the hepatitis C virus or antibodies, if and when such tests become available. This will ensure that infected persons are given every assistance in obtaining an accurate diagnosis which can be scientifically corroborated.

Let us not forget that the diagnostic process is a medical and not a legal process in the first instance, and its purpose is to establish, with as much medical certainty as possible, a person's health status. This is the most important function of the diagnostic process regardless of what medical condition is involved. It goes without saying that the purpose behind it is that the patient can be given access to whatever medical treatment and supports are appropriate to his or her condition. In order to be as inclusive as possible in its definition of the diagnosis of hepatitis C, the Bill includes a provision whereby a person who displays symptoms of acute infection by reference to the presence of jaundice within 16 weeks of the administering of anti-D will also be considered to have a positive hepatitis C diagnosis.

Consortium is defined as "the living together as husband and wife with all that flows from that relationship including companionship, the rendering of services, sexual intercourse and affectionate relationship between spouses". As the Tánaiste explained, this is a heading of compensation which applies in law to the uninfected party only. The rights of infected persons, whether young or old, in first or subsequent relationships, are not affected by this section.

Persons who were directly infected with hepatitis C or HIV are compensated at the compensation tribunal in their own right, on the evidence presented, for all the effects of hepatitis C or HIV on their lives, including its effects on their relationships, in the past and into the future. As noted by the Tánaiste, the chairman of the tribunal has confirmed that this is the case, and that everyone making a claim to the tribunal has the right to present evidence on all the effects — past, present and future — which infection has had or will have on their lives. It is also worth pointing out that tribunal claimants are represented by experienced and capable legal companies, whose job it is to assist their clients in putting forward to the tribunal a comprehensive and accurate picture of both tangible and intangible losses.

However, it was never the intention to compensate future partners in relationships formed long after their partner's diagnosis with hepatitis C. For a loss to be compensated, the relationship that was lost or damaged must have existed in the first place. A person who forms a long-term partnership with an infected person does so in the knowledge of the diagnosis and the effects this has on their lives. Again, it cannot be reiterated too strongly that the infected person has and will continue to have this taken into account in his or her own compensation award. The younger the sufferer, the more account is taken of the potential effects of the virus on his or her personal relationships.

The parameters of the insurance scheme were discussed and agreed between officials in the Department of Health and Children and representatives of the four support groups during 2005. Part of the agreement was that the maximum levels of mortgage and life cover would be indexed by the relevant current indices, or their successors. In order to fairly reflect the passage of time since these monetary levels were decided, a request from the support groups to update these limits was agreed and included in the Bill as amended. The implications of these changes for the benefits available under the insurance scheme were alluded to by the Tánaiste.

Travel insurance has always been a priority with the four support groups. It had always been the intention to implement the travel element of the insurance scheme as soon as possible after the commencement of the mortgage and life cover. The support groups asked that a timeframe be given for this measure. Accordingly, a statutory commitment was given that annual travel insurance will be provided as a benefit under the scheme within six months of its establishment day.

During negotiations on the terms of the insurance scheme, agreement was reached with the support groups that certain benefits will be available for everyone during an open period of one year after establishment day. Thereafter, some benefits will be made available on an incremental basis depending on the age and insurance rating of the applicant. It was always the intention that the phasing in of benefits would only apply to persons who were deemed uninsurable, either because of infection with hepatitis C or HIV or another medical condition. This was agreed with the support groups and was to have been specified in the regulations to be made under the Bill.

However, the groups have asked that this be specified in the Bill itself for the avoidance of doubt and this was agreed. It was included on Committee Stage and is in the amended Bill. Benefits for the category of claimant deemed insurable subject to the payment of an additional premium will apply immediately and will not be subject to a phasing in period after the initial open period. Another of the innovative aspects of the insurance scheme relates to the exclusion of other medical conditions which may affect claimants from being taken into consideration by insurers. For example, a person with hepatitis C or HIV who also has a serious heart condition but wishes to join the scheme will be able to take out insurance at the same basic premium that would apply to another person of the same age and gender who has neither hepatitis C nor a heart condition. This was negotiated early on in discussions with the support groups and was always a key feature of the plans for the scheme.

Some illnesses which are not immediately apparent to the lay person are linked with hepatitis C. There are other illnesses, such as diabetes, for example, of which there is a disproportionately higher incidence in the hepatitis C cohort than there is in the general population for reasons which medical science cannot yet explain. There are yet other conditions which, though not caused by hepatitis C, are exacerbated by the illness or their treatment made more difficult. The case has been made that it would be so difficult to separate out the direct and indirect effects of hepatitis C from other completely unrelated illnesses, that in fairness to all concerned this should not even be attempted. This provision was agreed from the outset but in discussion with the support groups after the publication of the Bill, they did not feel that the wording in the Bill was clear enough on this point. For the avoidance of doubt, it has now been stated more clearly.

Ease of access to the insurance scheme will obviously be a key concern for those people affected and it was intended to address this by regulation. However, the support groups were most anxious that this be specified in the Bill itself and the Tánaiste has taken this on board. Officials in the Department of Health and Children have been in discussion with the support groups on this matter and I understand the list of ways in which eligibility can be established for the purposes of this scheme meets with their requirements. Thus, a person who already has a Health (Amendment) Act card given by the HSE will be able to use this card to demonstrate his or her eligibility for the insurance scheme and will not be obliged to provide medical details again to another administrator. This is eminently fair and reasonable. It will maintain the confidentiality of the person applying for insurance and will not only benefit that person but will also be administratively efficient.

From the first anniversary of the commencement of the insurance scheme, the scheme administrator will make decisions on applications within 28 days of the applications being received, or within 28 days of the application satisfying the information requirements of the scheme. A reduction in the timescale for achieving the 28-day response time is not feasible. The first year of the scheme will be an open period during which all eligible parties will be able to apply for a range of benefits without restriction.

While the scheme administrator will be expected to make every effort to deal with these claims as expeditiously as possible, it would not be reasonable to expect a statutory guarantee that a 28-day turnaround time should apply to all claims made within such a short period of the scheme becoming operational. The four support groups asked to extend the time limit for leave to appeal decisions of the scheme administrator from 28 days to 90 days. Although 28 days is the more usual time limit for appeals in regard to most schemes, the views of the groups on this matter were listened to and their concerns taken on board. Accordingly, the time limit for appeals has been extended to 90 days.

We have all been reminded today of the tragic events by which 1,700 people became infected with hepatitis C and HIV through the administering within the State of infected blood and blood products. Nothing can erase the pain and suffering of the men, women and children affected by either virus, or the suffering of their loved ones. The State has tried to do all possible to support the victims of infection since this tragedy came to light. The enactment of this Bill will result in the establishment of an insurance support scheme for persons with hepatitis C and HIV and marks a significant initiative which addresses a major obstacle encountered by these people because of their infection.

I give this Bill my full backing and I urge Members to support its passage into legislation tomorrow. This will allow the much-needed insurance scheme to be established and insurance products to be made available to persons with hepatitis C and HIV as a matter of priority.