Seanad debates

Wednesday, 14 May 2014

Public Health (Sunbeds) Bill 2013: Second Stage

 

Question proposed: "That the Bill be now read a Second Time."

1:20 pm

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I am pleased to have the opportunity to address the House on Second Stage of the Public Health (Sunbeds) Bill 2013. I am sure Members will be aware of media coverage reports that skin cancer is the most common type of cancer in Ireland. It is a particular problem for Irish people because of our fair skin. The number of new cases of melanoma diagnosed in Ireland has been steadily increasing since the national cancer strategy began publishing data in 1994.

According to figures issued recently by the National Cancer Registry, there were more than 10,000 cases of skin cancer in Ireland in 2011. The most recent projections from the registry show that the incidence of cancer in Ireland is projected to double by 2040. Based on current trends, the number of women diagnosed with melanoma is projected to increase by a factor of between 93% and 175% in the period up to 2040 and, in the same period, the increase for men could be of the order of between 134% and 327%. This is a significant threat to the future health and well-being of our people and requires urgent action. I am sure everyone agrees prevention is better than cure.

There are approximately 150 fatalities per year from melanoma, with approximately 7,000 people living with this disease in Ireland. These are not mere statistics. Behind each of these numbers are people fighting painful and debilitating cancers. Many of them are winning that fight, but far too many are losing. The impact of these cancers on individuals and their families cannot be underestimated. Long-term treatment and its cost on individuals, families and the health system are significant. Data from the HSE indicates that the cost of treating skin cancer ranges from €6,000 to €10,000 per patient, depending on the complexity of the disease. New high-tech oncology drugs, such as ipilimumab, have become available recently. This treatment is effective in a number of cases, but is extremely expensive. It costs between €50,000 and €80,000 to treat each patient with this drug. Between 60 and 80 patients present with such advanced melanomas each year.

Skin cancer is preventable in many cases. If we take the proper precautions and protect ourselves and our children, we can avoid much of this disease. It is a threat that must be tackled now to prevent the harm that exposure to UV radiation causes and to reduce future costs to the health system. For most people, the main source of exposure to ultra-violet radiation is the sun. UV, ultra-violet, radiation is responsible for up to 90% of skin cancers and most UV damage is caused during childhood and adolescence. A child's skin is most sensitive to UV radiation. Up to 80% of a person's total life-time UV exposure is accumulated in childhood. Therefore, protecting children from the damaging effects of UV radiation is very important.

Many people are exposed to high doses of UV radiation through artificial sources. Sunbeds and sunlamps used for tanning purposes are the main source of deliberate exposure to artificial UV radiation. All forms of such radiation contribute to skin cancer. There has been a growing body of evidence over recent years that the use of sunbeds, especially by children, should be restricted because of the associated increased risk of skin cancer and other health problems. Other expert recommendations include ensuring that protective eyewear is provided to users; that users are informed of the health risks associated with the use of sunbeds; and that sunbed operators are prohibited from attributing health benefits to sunbed use.

The World Health Organization's International Agency for Research on Cancer is a recognised leading expert scientific body charged with providing evidence-based science to underpin global cancer control policies. In 2009, the agency reclassified UV-emitting tanning devices from a group 2A carcinogen - one that is probably carcinogenic to humans - to a group 1 carcinogen - one that is carcinogenic to humans. In 2009, the chief medical officer conducted a review of the international literature on health effects associated with the use of ultra-violet emitting tanning devices. He found that the medical evidence justifies a complete prohibition on the use of sunbeds by children up to 18 years of age, based on the significantly increased risks associated with exposure to ultra-violet radiation in early years. The CMO recommended that the issue of the increased risk posed by UV radiation for certain sub­groups of the adult population could be dealt with by way of regulation and awareness raising.

Healthy Ireland is the Government framework that sets out our vision to improve the health and well-being of the population. To realise this vision, Healthy Ireland will draw on existing policies, such as the strategy for cancer control in Ireland, but it will also go further by instituting new arrangements to ensure more effective co-operation to achieve better outcomes for all in reducing the incidence of skin cancers. Achieving the goals set out in Healthy Ireland requires composite solutions. The banning of the use of sunbeds for children under 18 years of age and regulating their use for those over 18 is an important initiative. Targeted interventions such as these will, in the long term, reap rewards and foster healthier living. Healthy Ireland will help to raise awareness on issues, such as the dangers associated with sunbed use, and will help promote healthy lifestyle choices by building on this legislation and by supporting and monitoring collaboration between areas such as primary care, hospitals, cancer screening and clinical programmes. Prevention is always better than cure, and a lot less painful.

The primary purpose of this Bill is to protect children by prohibiting the use of sunbeds on sunbed premises by those under 18 years of age and to regulate the use of sunbeds by those over 18 years of age. Our aim is to contribute to the long-term goal of reducing skin cancer rates. The Bill makes the following provisions. It makes it an offence to sell or hire a sunbed to a person aged under the age of 18 or to allow them to use a sunbed on a sunbed premises.

It promotes greater public awareness about the risks of sunbed use across all ages and prohibits unsupervised use of sunbeds in commercial premises. It provides for an exemption to allow the use of ultraviolet radiation for the medical treatment of specific skin conditions such as dermatitis and psoriasis in both children and adults. This exemption is limited to treatment involving phototherapy provided under the supervision or direction of a relevant registered medical specialist such as a dermatologist. The treatment must be provided by a health care establishment.

The Bill sets out mandatory requirements for protective eyewear. This is an important provision, as the eyes are particularly vulnerable to damage from ultraviolet radiation exposure. The Bill also sets out certain hygiene requirements for sunbeds and sunbed premises.

To protect public health, the Bill prohibits certain marketing practices such as allowing a customer who rents a sunbed for four weeks to get one week free, or offering early-bird deals. These offers are commonplace and incentivise clients to opt for a greater number of sessions than they might have originally intended.

The Bill prohibits the use of health claims other than those that may be prescribed by way of regulations. It has been common for sunbed operators to claim certain health benefits for sunbed use. Some claim an increase in the production of vitamin D as a result of sunbed use. The World Health Organization states "incidental exposure to the sun, combined with normal dietary intake of vitamin D, provides adequate vitamin D for a healthy body throughout the year". Overall, the serious health risks associated with sunbed use significantly outweigh any claimed benefits.

This Bill is also aimed at raising awareness and helping sunbed users to make more informed choices. As I have said many times, this is not a nanny State and we do not intend to forbid or ban adults from using the devices. We will, however, ensure clients are fully informed of the risks involved in using sunbeds so that they can make an informed choice. To this end, the Bill requires sunbed operators to display warning signs on sunbed premises and social media sites. The mandatory warning signs will inform the public of the health risks associated with sunbed use. The operator of a sunbed business will be required to provide information on the risks of sunbed use to potential sunbed users. This information will be required to be in written form. The operator must also ensure the potential client has read and considered the information and has signed the form before using the sunbed.

The Bill requires that those supervising the operation, sale or hire of sunbeds should be trained. Training will cover issues such as the risks of sunbed use, proper screening for potentially exposure-limiting conditions and emergency procedures in case of overexposure to ultraviolet radiation. To ensure the Bill affords the protection we intend, we have provided for an effective enforcement regime. To this end, all sunbed operators, including sellers and hirers, will be required to notify the Health Service Executive or its successor stating they provide sunbeds for use, sale or hire. The notification fee will also be provided for. To underpin the effective enforcement of this important public health legislation, comprehensive powers are set out in the Bill. Environmental health officers who have a proven record in enforcement of food safety and tobacco control legislation will be appointed as authorised officers by the HSE. They will have appropriate enforcement powers to carry out inspections and investigations to verify compliance with this legislation.

A regime for fixed payment notices - on-the-spot fines - for certain offences will be introduced. This sanction will allow environmental health officers to deal quickly and effectively with non-compliance with the legislation. It is important that the penalties for failure to comply with the legislation are both proportionate and sufficient to encourage compliance. The Bill provides for fines of up to €5,000 and terms of imprisonment of up to 12 months. The HSE may also publish a sunbed non-compliance list that will, in effect, name and shame offenders.

The Government is committed to reforming the health service to focus more proactively on promoting health and well-being. This Bill represents an important step in that direction by ensuring our children are protected from the harmful effects of sunbeds and by supporting adults in making better-informed decisions about sunbed use.

Prevention is better than cure. Approximately 150 Irish citizens pass away each year from melanoma alone, 7,000 people are living with melanoma, and there are many thousands who have other forms of skin cancer. This represents a heavy burden on those individuals and their families and also on the health service. If we are to begin to address the spiralling increase in skin cancer rates, we must act now. The statistics I have provided are on what we do currently. We can alter the future by taking action now to ensure future statistics are nothing like those of today. I commend this Bill to the House as a real sign of our collective commitment to ensuring prevention rather than just paying lip service to it.

1:30 pm

Photo of Marc MacSharryMarc MacSharry (Fianna Fail)
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I welcome the Minister to the House. I will stick to the issue under discussion, although there are a few others I could discuss. We welcome this Bill, which was on the programme for Government. Obviously, the last Administration came to an abrupt end, so its legislation on this matter was not dealt with. The Prohibition on Use by Children of Sunbeds and Tanning Devices Bill 2012 proposed much of what we are doing today. We might have amended that instead of waiting two years to go ahead with the one before us. That is one moan.

Another moan is the one the Irish Cancer Society would have articulated to the Minister directly. While the society welcomes the Bill as a step forward in cancer prevention and dealing with cancer generally, it has raised a clear issue concerning skin types. I refer not only to young people under 18, the argument in respect of whom goes without saying, but also to all people with skin types I and II on the Fitzpatrick scale, who have fairer skin. Most people in Ireland have these skin types. I contend that they should be prohibited from using sunbeds because they are more susceptible to skin cancer.

The increase in the incidence in cancer in recent years is such that it is clearly not attributable to the amount of sunshine we get in Ireland or the number of foreign holidays we take. The rate has increased by approximately 70% over the past ten years. I am sure the Minister covered some of these statistics himself. There were 8,145 new cases in 2009, and the number has risen since then. The global incidence of cancer is predicted to increase from 14.1 million cases per annum in 2012 to 25 million per annum in two decades. Some 70% of cases will be in African, Central American and South American countries, because they are as not as far up the curve on prevention as countries such as Ireland. That is not to say, however, that we do not have a very long distance to go to beat the scourge of cancer, which is what we all yearn to do. Perhaps on Committee Stage the Minister could revisit this issue to ensure those with skin types I and II do not use sunbeds, because they are in greater danger. I am sure the tanning shops and others in the business will have a vested interest in arguing against my proposal. That is fine - let them argue against it - but it should be remembered the Irish Cancer Society’s vested interest is not in any way related to profit or lifestyle but to saving lives. We ought to take this on board.

I am sure there is regular contact between the relevant officials in the Department and the Irish Cancer Society. I suggest that the Minister do as I propose. If he were to come forward with an amendment along the lines proposed by the society, he would certainly have the support of this side of the House and, I am sure, the other.

On the subject of dealing with the many different forms of cancer, sporadic news reports state that a cure for cancer is so many years away and getting closer all the time. More people are surviving with the right treatment. How is it that we are so close to a cure, considering the incidence is increasing to the point at which it is to reach 25 million per annum over the next two decades, as opposed to 14 million per year at present? The number of deaths is predicted to increase from 8 million to 15 million in the same period.

We all hear about the number of young people getting cancer. A young person in their 40s in my community has primary colon cancer with secondaries in the liver and lung. We have all heard such stories in our communities. People ask whether there is something in our water or air, or whether living close to a mountain has an influence, not to mention mobile phones and pylons. Are we investing sufficiently in research in the first instance? While we acknowledge that there is a link between cancer and lifestyle and that there are certain steps we can take, there is really no explanation in some instances. We hear about people who lead model lives in terms of diet and aerobic exercise but who are cut down by cancer.

The Minister went through the issues in the Bill, all of which we welcome. I would ask him to examine just that one issue concerning skin types.

The national cancer control programme is much celebrated as a successful clinical programme by the Minister and the HSE following the previous Government's work on cancer. I am from the north west where there is an issue in that regard. We are all for centres of expertise and excellence, and are not looking for the Mayo Clinic on every street corner or anything like that. People like the Minister, speech writers and officials take solace in the old cross-Border line, that "We are co-operating with our colleagues across the Border on this, that or the other." However, the absence of radiotherapy in the broader north-west region is an issue.

In the old regime, people could be treated in the Beacon Clinic for a form of cancer and the scans were shared with their colleagues in Pittsburgh. They determined together what the diagnosis and treatment might be. The national cancer control programme was established by Professor Tom Keane, who did the same work in northern Canada. They had centres of expertise there but further north in St. George - with a similar catchment to Sligo of about 260,000 - they put in a satellite radiotherapy centre. That would surely present challenges here. It cost about €10 million to put in place and €2 million annually to run it, not to mention the challenge of getting health professionals to run it. Nevertheless, at some stage, some Government will acknowledge this and set it as an aspiration that we ought to put in place. It could be the Minister's decision and it would be a good thing to do. It might go some way towards healing the divide, the pain and all of the lies from the pre-election promises on cancer.

It has been done in northern Canada. Professor Tom Keane said there was a gaping hole up there with no radiotherapy. They kept the centres of expertise for those requiring surgery who could then return home to convalesce. If they subsequently needed eight minutes of radium per day that could be delivered locally. The national cancer control programme has the motto "Centrally developed but locally delivered". The Minister might consider those points.

As the Minister has done, we commend the Bill to the House. Perhaps he might consider that one amendment on Committee Stage.

1:40 pm

Photo of Colm BurkeColm Burke (Fine Gael)
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I welcome the Minister to the House and thank him for bringing forward this legislation. It is extremely important that proper regulation be put in place to deal with sunbeds. The Minister said there were approximately 10,000 cases of skin cancer in 2011, which is a huge number.
In discussing the health service, people tend to focus on the issues that affect them directly, not realising that many people are affected in one way or another by other health issues. The number of skin cancer cases shows the scale of the problem and underlines the importance of having proper regulations for sunbeds.
The Bill before us will help to ensure that proper controls and regulations are put in place. The Minister referred to the 2009 report by the World Health Organisation's international agency for research on cancer. Due to that research, the WHO reclassified such skin cancers from 2A carcinogenic to group 1. As a result of that reclassification there was a greater focus on introducing proper regulations in that regard.
Section 4 is quite comprehensive and prohibits sunbeds from being offered to people under 18 years of age. As a result, people will have to produce an age card or passport to prove they are over 18 in order to avail of sunbed facilities. The Minister has dealt with that issue comprehensively in section 4.
Section 5 deals with the sale or hire of sunbed equipment to a person under 18.
Section 6 deals with another issue concerning the use of sunbeds which are unsupervised.
I am also concerned about the purchase of sunbeds online, although I am not sure whether this can be dealt with in the legislation before us. I have gone through the Bill to check that but perhaps we can re-examine the issue. Can the legislation deal with someone in Ireland who purchases a sunbed online from a seller outside the jurisdiction? A lot of online shopping goes on, so someone could purchase a sunbed online and have it delivered here from abroad. Therefore, is there anything further we can do in this Bill to deal with that matter? We should certainly examine that possibility.
The Bill also obliges sunbed owners to register with the HSE. When the Bill is enacted, the regulations will be put in place and sunbed owners will have six months in which to register with the HSE. It is fine to have such legislation in place but we must know exactly who is offering this service and what type of service it is. In addition, those offering the service must be familiar with the regulations.
When this subject was initially discussed 12 or 18 months ago, a number of people contacted me who were worried that their business would be affected by the proposed regulations. This is about the bigger issue of healthcare, however, and it is therefore extremely important that we do not have anyone operating a facility that is contributing to health problems. This legislation will provide the required comprehensive regulatory framework.
Given that the country's population is growing, we will also face increasing challenges concerning the medical care to be provided. We must ensure we are up to date with all other countries, and especially EU states, vis-à-visthe treatments that are available. We must do everything possible to reduce the incidence of skin cancer, which is what this legislation seeks to achieve.
The legislation is welcome and has been carefully examined by the Department of Health. I note that the Minister provided the European Commission with the required three months' notice in respect of the Bill.
While this may fall outside the ambit of the Bill, I would ask the Minister to examine scanning services that are being offered to the public. There is a growing problem with such scanning services. I know of cases where no adequate insurance is provided and, in addition, there are serious question marks over whether people offering such services have received adequate training. Perhaps the Minister could take note of that point and examine the matter in the not too distant future.
I thank the Minister again for introducing this legislation. I hope we will soon have all the procedures in place so that everyone offering sunbed facilities will be properly registered and compliant with the regulations.

Photo of Jillian van TurnhoutJillian van Turnhout (Independent)
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I warmly welcome the Minister to the House. This Bill is an important step towards protecting the public, and particularly children, from the extremely harmful effects of sunbed use.

I wish to acknowledge the comprehensive briefing note I received from the Irish Cancer Society, which I will be drawing on in my remarks. I have also undertaken my own research on this matter.

As the Minister has outlined, sunbeds have been linked to a variety of adverse health conditions, including eye damage, photodermatosis, photosensitivity and premature skin ageing.

Most worryingly, there is clear evidence of a link between sunbed use and skin cancer. Research published in 2009 by the World Health Organization's International Agency for Research on Cancer, IARC, found a 75% increase in the risk of cutaneous melanoma when people began tanning regularly before the age of 30 years.
Skin cancer is the most common cancer in Ireland. In 2010, 9,450 people were diagnosed here. Of these, 896 were diagnosed with melanoma, which is the most serious form of skin cancer. We know that there were 158 deaths from skin cancer in 2011. The incidence of melanoma in Ireland is increasing, having risen by a phenomenal 137% between 1994 and 2010. In nine out of ten cases, skin cancer is caused by ultraviolet rays from the sun or from sunbeds and, as such, it can be prevented. Reducing exposure to UV rays from the sun and sunbeds will significantly reduce the risk of developing skin cancer. According to research conducted by the Irish Cancer Society in June 2010, 140,000 people in Ireland use sunbeds on a regular basis; 88% of those who use sunbeds are women and 20% are between the ages of 15 and 24 years. It is vitally important that as legislators we do everything in our power to protect people from preventable skin cancer by legislating for and regulating the use of sunbeds. As such, I welcome many elements of this Bill, such as prohibiting operators of sunbed premises from allowing anyone under 18
years of age to use a sunbed on their premises, prohibiting the use of sunbeds in unsupervised premises, requiring sunbed operators to make users fully aware through the dissemination of prescribed information of the risks involved and requiring warning signs to be in place in the premises of all sunbed operators.
To be honest, I would have liked to see a Bill before us that completely bans the use of sunbeds. I say that after doing my research, but I understand that the Minister must try to find a balanced way of dealing with the matter. I can try to push for more, and that is my role. Sunbeds have been banned in a number of states in Australia - New South Wales, Victoria, Tasmania and South Australia - with the ban being phased in over the coming years. Sunbeds were also banned in 2009 in Brazil, where, to the best of my knowledge, there have been no successful claims that the ban is an undue interference with people's individual freedom.
An Australian study previously published in the Journal of Cancershowed that the risk of developing melanoma under the age of 30 increases by a factor of six for people who use sunbeds more than ten times. What really got to me was the finding that a single visit to a solarium could increase the risk of melanoma by 41%. A study of people diagnosed with early-onset melanoma shockingly recorded sunbed use in people as young as 14 years of age. I suppose the accepted logic in Australia, which has one of the highest skin cancer rates in the world, is that because 80% of all newly diagnosed cancers are skin cancers, and sunbeds are clearly linked to increased incidence of skin cancer, ipso facto, sunbeds will be banned in the interests of the common good. Unfortunately, the Bill before us does not do this, but I hope we soon arrive at a similar conclusion as people become more educated and informed, because preparing for this debate has been educational and informative for me. I will flag at this juncture that I will be coming back on Committee Stage with two amendments drawn up by the Irish Cancer Society and tabled in the Dáil by Deputies Billy Kelleher and Caoimhghín Ó Caoláin. The amendments seek to introduce an additional layer of protection for those over the age of 18 who are physiologically at greater risk of developing skin cancer from sunbed use. It is important to note skin types I and II on the Fitzpatrick scale are the most common skin types in Ireland. According to a medical study in 2010, in comparison with people with skin type IV - the fourth out of six skin types on the scale - people with skin type I are 2.27 times more likely to be at risk of malignant melanoma, while people with skin type II are at double the risk. In Australia, a number of states, including Victoria, while gearing towards an all-out ban, prohibit people with very fair skin - type I - from using a sunbed and require a skin assessment prior to use. The amendments I will table seek to prohibit those with skin types I and II from using sunbeds and will extend the capacity of the Bill to save more lives.
The enjoyment of personal freedoms and the right to engage in risky behaviour can be subject to limitation. For example, I will argue that the common good is proportionately served by dramatically reducing the number of people dying from or being treated for skin cancer in Ireland. In respect of the dissemination of prescribed information to people looking to use sunbeds, I note in the explanatory memorandum to the Bill that this measure aims "to promote a greater public awareness across all age groups of the dangers of developing skin cancer". I wonder whether it is too late for a person to receive the information when they are already in the solarium because they have already made the decision to use a sunbed. Surely we need to disseminate this information as part of a broad public health campaign, particularly in schools, with a view to de-normalising the use of sunbeds in the same way as the Minister is succeeding in de-normalising smoking. We need to look at other outlets such as magazines and bring together that information on sunbed use. Preparing for this debate has been hugely informative for me, so we should share this knowledge.

1:50 pm

Photo of John GilroyJohn Gilroy (Labour)
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I welcome the Minister to the Chamber. What seems to be the strangest thing about this legislation is that it is not already on the Statute Book. The Minister's figures about the incidence and increasing rates of skin cancer make it self-evident that this legislation is necessary and overdue. The link between the use of sunbeds and skin cancer is well established and I do not think anybody would argue against it with conviction. Knowing this risk, I find amazing that people would willingly put themselves in harm's way. If I am amazed that adults would do it, I am incredulous that people would pay to put their children in harm's way. Unfortunately, we might see that in the coming weeks, with confirmations and first holy communions coming up, and we will probably find children as young as seven years of age walking around with grand tans from sunbeds. It is mind-boggling. I do not intend to say too much about the generality or necessity of this legislation, because the Minister has made the case strongly enough. It is, of course, important to re-emphasise that sunbeds are a group one carcinogen. That alone should be enough to deter any responsible person from exposing children or those under 18 to sunbeds.

I want to ask the Minister one or two questions about the legislation. Section 3 points to the difference between the cosmetic use of sunbeds and the use of sunbeds for necessary phototherapy. Do conditions exist that can be treated at a cosmetic studio that has a medical intent? We will hear people making that case in defence of sunbeds, but surely if it is a medical treatment it would be delivered in a medical suite as opposed to a high street beauty salon.

Section 6 states that a person who supervises the use of sunbeds must be over the age of 18. Is there is a risk of exposure for someone supervising, as opposed to using, a sunbed? I am a bit concerned that we are closing off career paths and opportunities for younger people who might choose to work in the beauty trade. I will accept the Minister's guidance on this, but are we really saying that the risk of exposure for someone supervising a sunbed is greater than the risk involved in actually using it?

In respect of section 8, is it necessary to legislate that a sunbed clinic should be clean and hygienic? Surely that should be the most basic requirement of any premises or business offering a public service. I wonder why we are singling out sunbeds in respect of legislating for hygiene. I have a suspicion as to the reason why, which I will come to in a minute.

Section 13 deals with the requirement of the HSE to maintain a sunbed business notification list and outlines the powers of the HSE and Minister in this regard. Senator van Turnhout's concerns might be addressed in this area, and I suspect that this might be part of its intent. The legislation might place such an onerous burden on the providers of sunbed services that it is economically unviable to provide them in the first place. If that was the intent, the Minister could not really say it. If that is the case, why do we not seek to have a fully licensed service, as opposed to just maintaining a register, or go even further and ban the provision of sunbed services outright, which Senator van Turnhout is in favour of, as indeed am I?

That said, I do not believe either of us would find much use for sunbeds.

The Minister spoke about the qualifications and training of the people providing services. What does he think these might be, given that it seems a rather simple service to provide in terms of qualifications and training? Under section 15, there is a requirement that the clinic ensure that the instructions on the use of sunbeds are read and understood, and that this form is maintained for two years. Is this a mechanism whereby the provision of the service is made so burdensome that people might not be bothered doing it?

Section 17 refers to the authorised officer and how such an authorised officer may enter a private dwelling. It is noted in the Bill that a warrant from a District Court would be required in order to enter a private dwelling. Is it an oversight on the Minister's behalf that he excludes a peace commissioner from providing the warrant? In most other legislation the provision of a warrant can be by either a District Court judge or a peace commissioner, who can step in to sign the warrant if a District Court judge is not available. As a peace commissioner myself, I do this all the time for gardaí when a District Court judge is not available, particularly on weekends, when the use of sunbed services would be at its greatest.

We recently passed in the House some stages of the legislation that prohibits smoking in cars, under which the onus of responsibility and the penalty would apply to the person who is actually doing the smoking in the car. Is there any scope to have an additional level of liability for parents who expose their children to the use of sunbeds, in addition to penalising the premises itself? Does the Minister believe class 1 and class 2 fines are sufficient in this area, given that they are limited to €4,000 and €5,000 respectively?

As far as I can see, there is no provision in the legislation for action to be taken against a consistent breaker of the rules in order to close the premises entirely. The Minister might give me his opinion on that.

2:00 pm

Photo of David CullinaneDavid Cullinane (Sinn Fein)
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I welcome the Minister to the Chamber. On behalf of the Sinn Féin party, I welcome the publication of this Bill and commend it to the House and to all Senators. It is, in our view, a vital protection of public health. I will refrain from taking the opportunity to discuss cancer services in the south-east, including Waterford, because I believe the Minister is going to be in Waterford city on Friday. I am glad to see he is back to full health and I look forward to seeing him both inside and outside Waterford Regional Hospital on Friday when he visits.

This is an important Bill. It is very simple: sunbeds cause cancer. It should not go any further than that when people make up their minds on whether they support this Bill. If the Bill is passed and implemented, then lives will be saved, fewer people will get cancer and less taxpayers' money will be spent treating people with cancer. Therefore, there will obviously be huge benefits to having the Bill passed.

Senator van Turnhout has already articulated areas in which some in the Opposition, including my own party, would like the Minister to go further and would support him in his efforts if that were the path he chose. While he may not take the opportunity here, I have no doubt that if this Bill is implemented in its current form we will be back here at some point in order to take it further, because it just makes sense and is logical to do so. Anything that makes sense and is logical is something we should do.

I understand that it is difficult to strike a balance between what might be seen as coercion and the use of legislation to encourage a modification or a change in social behaviour. With the smoking ban, we have seen that we can meet with resistance and that we sometimes try to strike a balance where we should not. In my view, we should come down on the side of the simple principle that should underpin our approach to this issue - it saves lives. It is as simple as that, and this is what should guide us.

The ban on smoking in public premises and in the workplace has been a clear success in public health terms, but it would not have been possible without the years of widespread education of the public about the reality of lung cancer and the many other illnesses caused by smoking. A long battle was fought against the massive resources of the tobacco industry. That battle is not yet over and the Minister is still implementing positive measures in this area, which my party supports. While we do not have the same lobby on the issue of sunbeds, because the numbers are smaller, I am sure the Minister has been lobbied, as we all have been.

Smoking has both a social and a physical aspect. For some, there is a perceived social or peer pressure to smoke, although that has greatly diminished. Far more important is the physical addiction to tobacco that is so difficult for people to overcome. In contrast, the attraction of tanning with sunbeds is purely a product of social and cultural attitudes. It is about the body image favoured by many in our society, which is where we now need to focus our attention. Education on this issue is hugely important and should go hand in glove with the passing of this legislation. There is almost a compulsion for sections of our population to have a permanent tan because of the widespread perception that a tan is necessary in order to appear attractive and even healthy. I am sure if any of us were to take a walk down to a hotel in the city where a wedding was taking place, we would find many people with fake tans, including people under the age of 18, and this is not just the case at weddings but also at confirmations and communions. I would certainly not allow my child to use a sunbed, although if they reached the age of 18, they could make up their own mind. Hopefully, we will have moved to an outright ban before my children reach the age of 18. It is incredible to think that some people would allow their young children to lie on sunbeds, given the inherent and real dangers this poses to their health. It is obvious that education has to be part of this and that we have to educate the adults as well the children.

A very interesting survey was carried out last year among 243 transition year students at five County Sligo post-primary schools on their attitudes to skin cancer, sunbed use and tanning. The results were quite alarming. Of most concern is the belief among 73% of those surveyed that a sunbed tan provides a so-called safe base for a holiday tan, and the persistence of the myth among some that it is a cure for acne. The clinical nurse specialist in dermatology who carried out the Sligo survey said that while the long-awaited ban on sunbeds for those under the age of 18, provided for in this Bill, is to be welcomed, a nationwide sun awareness campaign is essential. I would certainly echo that call.

Legislation, to be effective, must go hand in hand with public education and awareness. In this regard, I commend the work of the Irish Cancer Society, which has done a great deal to expose the reality of what sunbeds mean for public health in Ireland. The statistics are grim. Up to nine out of ten cases of skin cancer are caused by ultraviolet radiation from the sun or from sunbeds. In 2009, the International Agency for Research on Cancer placed sunbeds in the highest category of cancer risk - as carcinogenic as tobacco and plutonium. The most common cancer in this country is skin cancer. More than 9,000 people were diagnosed with skin cancer in this State in 2010, nearly 900 of them with melanoma. There were more than 150 deaths from skin cancer in 2011. Obviously, all of these figures should be of great concern to us. Indeed, the incidence of melanoma is rising every year and the current rate is over 130% higher than that recorded in 1994. The risk of developing cancer as a result of sunbed use is greater among young people, yet the Irish Cancer Society researchers found that, in 2010, some 28,000 young people under the age of 25 used sunbeds in this State, many on a weekly basis.

To come back to the social attitudes which lead to sunbed use, 88% of those who use them are women, as Senator van Turnhout said earlier, and 20% are between the ages of 15 and 24. It is very clear that parents as well as children need to be educated about the dangers. No responsible parents who are properly informed of the high risk of cancer to which they are exposing their children would allow them to use sunbeds. It is appropriate, therefore, that a special focus of this Bill is the protection of children. I welcome the outright ban on the use of sunbeds by people under the age of 18. Welcome also is the new regulatory regime for a sector that has been unregulated up to now. I look forward to seeing these regulations put in place and implemented comprehensively, and I urge the Minister to ensure the necessary resources are in place to do so.

I am not certain of the wording of section 14(1) which enables the Minister to prescribe training leading to a qualification in the safe use of sunbeds - I believe that is the terminology used - which is recognised within the National Framework of Qualifications, or an equivalent qualification. Apart from the exempted area of phototherapy, surely the whole thrust of the Bill is that there is no safe use of sunbeds.

I had intended to say more, and I did not get to the discuss the amendments proposed by my colleague in the Dáil, Deputy Caoimhghín Ó Caoláin. We hope the Minister will accept them in good faith because they were proposed in order to enhance the Bill. We should move a step further and ensure that we do our best to save as many lives as possible, reduce the incidence of cancer and push down the figures and, crucially, save the taxpayer money as well as save lives. The Bill is to be welcomed and I commend the Minister on its introduction.

2:10 pm

Photo of Feargal QuinnFeargal Quinn (Independent)
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I welcome the Minister, and the legislation is welcome as well. About 40 years ago my wife and I bought a sunbed in order to use it at home. Within weeks my wife discovered that using sunbeds was not a healthy thing to do and the sunbed disappeared somewhere else. That is a reminder of how quickly attitudes change. Sunbeds are a bit like smoking, because we have known for years that smoking is dangerous. I shiver whenever I see somebody smoking on the street, and the same applies to sunbeds.
We should look closely at legislation that could have a negative effect on legitimate businesses, but at the same time we must remember that health concerns take precedence. It has been interesting to get some idea of how harmful sunbeds are. I have not been here all day but I am sure the dangers have all been covered. In 2009, the World Health Organization categorised tanning devices as a high-level carcinogen, which puts tanning on a par with tobacco use. The same legislation called on all Governments to regulate sunbed use, which is what the Minister for Health is doing now. The WHO says that the use of sunbeds before the age of 35 increases the risk of melanoma by 75%. Some countries have banned sunbeds altogether. As all health implications become clearer with the passage of time, will Ireland eventually go down the same route? My colleague Senator Crown wants to make Ireland the first smoke-free country in the world and I hope we will take steps in that direction.
I note that section 6 of the Bill prohibits the unsupervised use of sunbeds. Should we include something exclusively in the Bill to effect a ban on self-service automated or coin-operated sunbeds? We have such machines here and they pose a danger because there may be no staff around to help the person using the sunbed if something goes wrong. The inclusion of the section means that supervision is required, but automated sunbeds are still permitted. In Wales, which is part of the UK, coin-operated sunbeds are banned, but we do not have the same reference in the Bill. Should a reference be included to clear up any confusion? Perhaps the Minister will comment on the issue.
I note that the legislation does not apply to medical treatment. The Bill states:

This Act does not apply to the use of a source of artificial ultra-violet radiation used for phototherapy is provided under the supervision or direction of a relevant medical practitioner in a healthcare establishment, or provided elsewhere by that establishment under such supervision or direction.
The UK legislation, applicable to England and Wales, states that a sunbed can be used by a person under 18 for the following reasons:
(a) the use is for the purpose of medical treatment provided under the supervision or direction of a registered medical practitioner, and
(b) the sunbed is a dedicated sunbed in, or provided by, a healthcare establishment.
... “dedicated sunbed” means a sunbed that is made available only for use for the purpose of medical treatment[.]
Where the conditions for the exemption are met, a person under 18 years may be allowed to use or be offered the use of a sunbed, or to be present in a restricted zone containing a sunbed, without an offence being committed. Should we open Irish legislation in order to give doctors a little bit more flexibility to use sunbeds? Should we allow them to make a judgment on whether a person under 18 years can use them? I for one would trust a doctor's judgment on this matter and it seems the UK has adopted the same view. We should seriously consider allowing the power to remain in the hands of medical professionals in this regard. Some doctors support the use of sunbeds for specific ailments. Professor Tim Oliver, a consultant oncologist at St. Bartholomew's Hospital, London, has expressed this view, and I know other experts in dermatology and related fields support this. We should take their expertise into account when considering the Bill.
I am interested in hearing the Minister's comments on my specific questions on automated sunbeds and letting doctors have more flexibility in the use of sunbeds. In overall terms, the Bill is something we must approve of, and the sooner it becomes law the better.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I thank the Senators for their support for the Bill and for the many contributions they made. I will address the issues in the order in which they were raised.

By way of general comment I wish to reiterate that skin cancer is the most common type of cancer in Ireland. It represents a major public health challenge in both the short and long term. We cannot ignore the frightening figures and projections provided by the National Cancer Registry. I can repeat the figures for anyone who thinks this proposed legislation is frivolous or indicative of a nanny state approach, although I acknowledge that nobody in the Chamber thinks so. More than 850 new cases of melanoma are diagnosed in Ireland each year, and more than 150 Irish people die each year from melanoma. More than 7,000 people were living with this type of cancer in Ireland as per the last statistics in 2011.

As others have pointed out, the sad reality is that we know the disease is totally avoidable. As I have already said, this is a true case of prevention being better than a cure that is often very painful. We must legislate now to put measures in place to protect our children and allow adults to make better-informed choices. We must do all we can to discourage the use of sunbeds and encourage a healthier attitude to protecting ourselves and our children from ultraviolet radiation. I am convinced that the Bill will contribute to a reduction in the incidence of skin cancers in the long term. It is a comprehensive response to a serious public health issue. The Government's key objective in the Bill is to protect young people. Therefore, we propose to make it an offence to sell or hire a sunbed to a person under the age of 18 or allow such a person to use a sunbed on a sunbed premises.

Through the Bill, and the wider Healthy Ireland agenda, we will create awareness of the dangers of using sunbeds. We will promote healthy lifestyle choices among the public by building on this legislation and by supporting and monitoring collaboration in areas such as primary care, hospitals, cancer screening and clinical programmes.

I have no intention of passing the Bill only for it to be left on the shelf. Environmental health officers have a proven track record in the enforcement of a broad range of environmental health legislation. They play a lead role in the enforcement of food safety and tobacco control legislation. The impact of their efforts can be seen in the consistently high compliance rates - above 90% - with non-smoking legislation.

I shall now address some of the questions raised. Senator MacSharry mentioned at the outset, as did several others, that he supported the Irish Cancer Society's amendment providing for a total ban on the use of sunbeds by people with skin types I and II. I wish to put on the record of the House that I am the number one supporter of the Irish Cancer Society and the great work it does in raising awareness and funds to help with treatment and research, as well as the colorectal cancer screening project that was rolled out at the beginning of this week. None the less, this legislation is very much a political decision. As a Minister for Health who was a practising doctor in the past, I do not believe I can impose my will on other people. I believe that one should give people the information and let them make an informed decision. We are not a nanny state. We allow people freedom of expression and the right to make their own decisions. On the one hand people think we are too liberal, and on the other they think we are not liberal enough. We have a duty of care to children, which we take very seriously; hence the banning of the use of sunbeds by children under 18 years. I do not propose, on a policy principle basis, to accept the proposed amendment. In any case, there is a real difficulty regarding the enforcement of such a measure because doctors differ over the skin type categorisation of individuals. I can see real issues with such a measure.

Senator MacSharry raised the issue of why rates are increasing. There are a number of reasons, one of which is that people are living longer and, the longer one lives, the more likely one is to develop cancer. That is based on scientific fact. The longer one lives, the more the cells mutate and, with more mutations, the greater the chance of a mutation and ending up with cancer. Second, there is a long lead-in time from taking preventive action to seeing the results.

We are joined by a host of young ladies from some school in the Visitors Gallery. There are very welcome. We are discussing a Bill that has a direct impact on them. We are banning the use of sunbeds for people under 18 years of age because people who use sunbeds increase their risk of getting skin cancer. Some 150 people die in this country every year from skin cancer. Every Senator who has spoken is in favour of the Bill.

Prevention works and I have been very critical of my fellow politicians because for too long we have paid lip service to prevention but we do not pay for it. We must pay for it although it is not politically attractive because we will not see the results before the next general election. It will not win us any votes but in 20, 30 or 40 years' time, it will have saved thousands of lives and billions of euro in health care costs.

Senator Colm Burke spoke about scanning services. HIQA licensing legislation is being worked on in the Department to afford it the right to license premises. That includes the likes of services to which the Senator alludes and this ensures certain standards will be met. At the moment, no standard is applied and we are unsure about the training of individuals purporting to offer these services. I would be very wary of them.

The Senator also mentioned remote sales. Awareness raising was also mentioned. We must raise awareness of melanoma and skin cancer generally. We launched a melanoma awareness month on 1 May this year, as we did last year and the year before. It is organised with the support of a number of organisations and on that occasion I called on individuals to regularly protect themselves and their children. During melanoma awareness month, the Marie Keating Foundation held a skin cancer awareness seminar to launch the annual skin cancer awareness campaign. This was attended by my officials. Throughout the summer months, the foundation's nurses will be delivering a free skin cancer education roadshow to communities all over Ireland through the mobile information units. My Department recently met with the HSE, the Irish Cancer Society, the national cancer control programme and the Environmental Health Association of Ireland to agree a cohesive approach to awareness raising. The Department and I will continue to ensure there is a focus on awareness, particularly in respect of young people, of the dangers of sunbed and sun exposure.

Senator van Turnhout talked about banning sunbeds altogether and I have addressed that point. Senator John Gilroy wondered about the Bill allowing medical treatment but the Bill allows for medical treatment at a medical establishment. If there were travel issues for people with chronic conditions, arrangements can be made with a local facility. I am not aware of the risk to the supervisor. The Senator also referred to legislating for hygiene and asked why it was necessary. We can never have enough legislation in that regard, irrespective of where it appears in the legislative process. It is no harm to reassert that point. Currently, we do not have licensing but we are working towards licensing. The register is the first part of that.

Qualification and training is very important and the WHO is very clear that unqualified people create a greater danger to people using sunbeds. That is the result of research. The Senator raised the position of peace commissioners and the role in signing warrants in the absence of a judge. That is something we can look into and we can come back to it on Committee Stage. With regard to the recalcitrant offender, being in jail for 12 months means people will be unable to operate the salon, although this has not stopped some of our drug dealers.

Senator Cullinane talked about a total ban, as with tobacco, but tobacco is very different. Environmental tobacco smoke is involved and sidestream smoke affects people in the room whereas this is a different issue as it affects only the individual concerned. People have the right to make the decision once they are over 18 years of age. If they are old enough to decide to go and fight for this country and die for this country they have the right to make other decisions. I have already covered the point raised about a nationwide sun awareness campaign.

Senator Quinn talked about automated sunbeds and flexibility for doctors. We considered the use of the authorisation by doctors of the use of sunbeds for those under 18 years of age but, due to the risks, we decided that medical phototherapy should only be carried out under the supervision of a specialist in a health care setting. We could look at making provision for extraordinary circumstances but people need to be under the care of a specialist. We need that distance because family doctors can come under all sorts of pressure, stress and strain with no disrespect to them. They do fantastic work and are part of our health service working day in and day out and very few people have complaints about them.

The training and online aspects are covered. Section 12 provides that, once the machine is brought into the country from the point of sale, it is considered to come under the Bill. It does not matter whether it was purchased online. I thank Members for their contribution and I believe we have done some good work on prevention in the Seanad and in the other House. Prevention is always better than cure and it will not give us that warm political glow that we might like to feel but, more importantly, we will be able to look back in 20, 30 or 40 years if we are lucky enough to be alive and we will not have our granddaughter or grandson asking why we did not do something about this when we could have, in which case their friend would not be dying. I commend the Bill to the House.

Question put and agreed to.

2:20 pm

Photo of Paddy BurkePaddy Burke (Fine Gael)
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When is it proposed to take Committee Stage?

Photo of Colm BurkeColm Burke (Fine Gael)
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On Tuesday, 27 May 2014.

Photo of Paddy BurkePaddy Burke (Fine Gael)
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Is that agreed? Agreed.

Committee Stage ordered for Tuesday, 27 May 2014. Sitting suspended at 3.10 p.m and resumed at 3.30 p.m.