Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank the Senator both for the amendments she tabled and her very considered contribution on what she is trying to achieve. I will not accept the amendments and will explain why. However, I fully agree with her healthcare objective, which is to make sure that people who are in addiction and need opioid substitution treatments can get them in as easy a way as possible. It is interesting that the note I got from the Department indicates it did quite a bit of work in preparation for today. I have been reading through it. The Department notes that there are not significant waiting lists for opioid agonist therapy, OAT. While that is great, as the Senator quite rightly said, people are still waiting several hours in a surgery. Even that is something we need to work on. The good news is the number of GPs is increasing. We currently have 68 GPs who are authorised. The cap on level 2 GPs has been extended this year from 35 to 50 patients. There are more GPs and those GPs can now see more people.

On the care that is needed, one of the matters raised with me by the Department in consultation with healthcare professionals is that in a growing number of cases, there is an ageing population with comorbidities. In many cases, it is important to have a GP involved because a lot more is going on and there is a lot more care. While a nurse may be able to prescribe methadone, he or she will not necessarily be trained to consider patients in their totality. More and more multidisciplinary assessment is required. The issue is one I am very happy to explore. I will just make the point that whatever we do, we have to make sure that the people we are treating and supporting can still get access to multidisciplinary support. Nursing support is phenomenal but may not be enough. We need to think that through very carefully. From a policy perspective, and this is something the Minister of State, Deputy Colm Burke, is very involved in as part of his portfolio, further work on ensuring that those in addiction have the greatest access to the best possible rounded care is something we can definitely work on. I would be very happy to talk to the Senator further about it, especially as she brings knowledge from service users as to what they need, which may not always get picked up here. That would be very useful.

Specifically to the amendment, there are two amendments to section 9. One is around including OST in prescriptions and the second is about urgent lifesaving care. I might come back to the latter, if the Senator wishes to speak to it. I will speak to the first part of it. Essentially, we do not need to include OST. In fact, the legislation as it stands is sufficient for the Minister of the day to include it by secondary legislation. The task force, which I will speak about in the wrap-up if I may, is coming to recommendations. We are starting very deliberately on common conditions and OST is more complex. It is not something the task force is recommending for now but what the Senator is very reasonably trying to do is future-proof the legislation. It is in fact future-proofed. If in the future there were a clinical recommendation to move into more complex areas, and if OST happened to be one of those, that can already be expanded under the Bill, as drafted, through secondary legislation. It would require an amendment to the Misuse of Drugs Act as well. There is more that needs to be done, but what the Senator is seeking to achieve with the amendment is already covered. It would be down to secondary legislation and expert recommendations. We would then need to update the Misuse of Drugs Act.

I will ask the Department to send the Senator a detailed note on nurse prescribing. The advice I have is that such prescribing is covered already. We need to make sure of where it is done. Where people need medical or multidisciplinary care and we are looking at comorbidities, that should also be something provided in the service for them.