Rónán Mullen (Independent) | Oireachtas source

Cuirim fáilte roimh an Aire.I support the Bill. I commend my colleague, the father of the House, Senator Norris, on persisting with this important cause. I commend Senators Boyhan and Craughwell for also sponsoring the Bill.

The Bill is welcome. It has two main effects: it puts the national screening advisory committee on a statutory footing; and, in the context of that committee's work, it requires the committee to make recommendations, not about the conditions tested, but about the expansion of the conditions tested by the national newborn blood spot screening programme. Several Senators have spoken about the importance of such recommendations and the expansion of screening.

Any initiative that allows increased screening of citizens for serious conditions should be supported in order to allow for early intervention, give clinicians a head start and allow those with diagnosed conditions to deal with them or to be helped in the best way possible. It is important that we increase screening for newborn children, particularly those who may be at higher risk because of a family history of certain illnesses.

It is good that the House is discussing screening. We all know that, in the context of Covid-19, our healthcare system has been under considerable pressure. Even getting treatment for conditions has been difficult. As a result of the need to focus on treatment, there has been an unfortunate halting of BreastCheck and CervicalCheck appointments during the pandemic. Sadly, that will probably cost lives in the years to come through certain conditions being diagnosed much later than would otherwise have been the case. We understand the reasons for the pressures on the healthcare system and for screening to take second place to the treatment of identified conditions, for example, cancer, but we must get back to having a well-focused and well-funded approach to screening. BreastCheck, BowelScreen and CervicalCheck have performed a vital service for women and saved many lives in recent years, notwithstanding the failings that have been highlighted.

I wish to mention a number of issues. Senator Norris is clear in the Bill on the need for openness and transparency in the provision of our health services. Putting the national screening advisory committee on a statutory footing is intended to follow through on the letter and spirit of the Scally report, which recommended and led to the committee's establishment. However, I am particularly taken by section 5(4) concerning the committee's recommendations. We need to be clear that it is not just in the context of the expansion of the national newborn blood spot screening programme that the committee is empowered to make recommendations. Rather, it has a broad remit under section 3 to make recommendations, and that is as it should be. However, section 5(4) provides: "If the Minister does not accept a recommendation of the Advisory Committee ... the Minister shall, within one month of being given a copy of the recommendations [containing the recommendations] ... prepare and lay ... a statement of the Minister’s reasons for not accepting it." I have not had an opportunity to look at how common this kind of requirement is, but at a time when there is concern in Ireland and, indeed, Britain about the important role of governments in making decisions and the need for parliaments to restore their level of oversight of important decision-making, this is another way where, with great respect to our Government and the important function of the Minister, accountability is sought and ensured by requiring that, where a recommendation is not to be accepted, a reason for not accepting it is given fairly promptly. I welcome that. I wish to raise a number of issues that I touched on during the debate we had last July which the then Minister of State at the Department of Health, Finian McGrath, acknowledged as important. He said that the Department was seeking information from other EU member states on them. I refer first to the question of the efficacy of screening programmes. I understand that there is a debate abroad about the effectiveness and benefit of certain forms of screening and DNA testing in particular. In the United States, there is a view that new screening should only be targeted at children within families where there is a history of certain serious conditions. Non-specific testing obviously has a large cost and perhaps we should be directing resources to provide the maximum range of testing to those at highest risk. That said, I favour the broadest approach to screening but would ask whether this is a policy consideration that will underpin the work of the committee or whether the Minister thinks that it should. I am also interested in the question of conflicts of interest. I have previously raised the fact that screening and DNA testing are often a cash cow for the pharmaceutical industry. Eruofins Biomnis, the company that produces the Harmony test, for example, has made enormous profits. The Irish and British medical councils have also issued warnings about potential conflicts of interest in circumstances where doctors have a financial interest or incentive to recommend certain testing. These are also important issues that do not contradict in any way the spirt or the aims of this legislation. Ní thagann siad salach ar bhunspriocanna an Bhille seo but it is important that they are considered. It would also be important that the committee, once given statutory underpinning, would tread carefully and take such issues into consideration.

I wish to raise an issue that is not directly connected but about which I would like to ask the Minister, although I am not necessarily expecting a response today. I raise it in the context of prevention and the early identification of conditions, as well as taking early steps to ensure the future treatment of conditions. I am interested in the whole area of so-called chord blood banking, the process whereby blood is taken from umbilical chord or placenta after birth which contains stem cells that could be retained for later use. Sometimes this blood is retained in private clinics while in other cases it is publicly held. I understand that this is relatively common abroad but is not common in Ireland. Is this something upon which the Minister has a view? Is it something that is being looked at in the Department?

Finally, I wish to return to the committee and the qualifications required of its members. I note that 18 specialties are listed and correctly so, including genetics, laboratory services, nursing and midwifery. I also notice, however, that journalism is included. That jumped out at me because it is the only clearly non-medical specialty listed. It jarred slightly with me. I am not sure I have a settled view but I am wondering why it was felt that journalism should be specifically included. Is it to do with having somebody on the committee who could help to explain its work, make sure its reports are well written or help to explain its position in lay person's language? I have a limited former career in journalism, which is perhaps why I am intrigued by it. Of course, one might add that at the rate that journalists are becoming Government advisers, maybe that should also be included as a category for possible consideration. This is a question that jumps out at me because it would be a stretch to say that journalists have the same type of technical or academic qualification that the other specifically named specialties can provide to the committee. I wonder about that while not having a very strong feeling about it.

In summary, I commend Senator Norris on bringing forward this very important Bill and I am very happy to hear the Government's positive response to it. I look forward to its early enactment and to the strengthened work of the national screening advisory committee. The proof of the pudding, of course, will be when we see an enlarged number of conditions being tested for in the context of the national newborn blood spot screening programme.