Tuesday, 7 February 2017
Health (Miscellaneous Provisions) Bill 2016: Committee and Remaining Stages
I wish to discuss my amendments. I am disappointed that they were not ruled out of order. They were designed to address the situation of mandatory retirement for critical health professionals in the public health system.These are senior decision makers in our system, who are forced to retire for no reason other than their age. As Professor Crown stated during the 2015 debate, we are not so flush with trained experienced staff that we can afford to offload them voluntarily. The Longer Healthy Living Bill 2015 received cross-party support. The Oireachtas Joint Committee on Justice, Defence and Equality examined in detail the broader issue of mandatory retirement in the context of the Employment Equality (Abolition of Mandatory Retirement Age) Bill tabled by the then Labour Party Deputy, Anne Ferris. One of the submissions was from Dr. Enda Shanahan, who helped me formulate some of my amendments. He stated that two years prior to coming before the committee he was compelled to retire from the health service, where he worked as a specialist hospital doctor. He wrote to the management, and the then Ministers, Deputy Howlin and Senator Reilly, indicating he was able and willing to keep working in the public health sector after the age of 65. He explained he was physically fit, still running all distances up to and including marathons, and medically fit for purpose as certified by the Medical Council's continuous professional development process. The answer was that retirement was mandatory on reaching the age of 65. At no point was any objective effort made to assess his suitability to continue working. He was retired purely because of a date in the calendar.
The health service is on life support. It is in dire need of resuscitation and reform. As a doctor and a Senator who is trying to be constructive, pragmatic and solution driven, I am bitterly disappointed the amendments have been ruled out of order on a technicality. The amendments would have helped in a small way to ameliorate the staff shortages which plague our health system. Last night, we saw the "RTE Investigates" programme which highlighted the shambles and cover-up that has become the norm in our health system. A simple "Sorry" does not cut it any more for the Irish people. We are embattled by staff shortages, a shortage of senior consultants, not enough GPs and a dearth of highly qualified specialist nursing staff. We have an ailing and failing health service. I intend to introduce to the House a new Bill comprising these amendments.
I remind Senators and the Minister of State that at present 250 consultant posts are unoccupied and 25% of all vacancies received no applications. I welcome Dr. Enda Shanahan, who contributed to the Oireachtas Joint Committee on Justice, Defence and Equality and who is in the Gallery.
I welcome the Minister of State, Deputy Corcoran Kennedy, to the House. I compliment my colleague, Senator Swanick, on tabling these very worthwhile amendments. While I fully accept the ruling of the Leas-Chathaoirleach that they are out of order on the grounds they would be a charge on the Exchequer, I fail to see how they could be a charge on the Exchequer. As Senator Swanick has pointed out, we have more than 200 vacancies for consultants. When Professor Crown was colleague of ours in the House, he brought forward legislation in this regard. At the time it was well received but nothing was done about it. While the House may not have a role in bringing forward legislation with financial consequences for the State, I urge colleagues on both sides of the Lower House to bring forward such legislation. I welcome the fact that Senator Swanick has said he intends to initiate such legislation in the House but I fear it will be knocked down for the same reasons as his amendments have been ruled out of order this afternoon.
At a time when we are discussing extending the retirement age to 68, 69 and even 70 in the years to come, I fail to see why it is not feasible, given the vacancies to which we have referred, to extend the retirement age for consultants.It is not a charge on the Exchequer because we have nobody to fill their vacancies when they occur. Until the pay and conditions are realistically tackled we will continue to have a shortage of consultants.
I compliment Senator Reilly on the work he put into the health service and was ridiculed for doing so, not only by the Opposition, but also by some of his colleagues at the time. When the commentator took over, who is now potentially looking for the leadership of the Fine Gael Party, he did very little.
I want to finish the point. People such as Senator Reilly, who tried to introduce initiatives to benefit the health service, were ridiculed, not only by some Opposition Deputies and Senators, but also by colleagues in his own party, including a recent former Minister for Health.
We have to stand up and say it as it is. We do not have the consultants to service our health service. Until we consider realistic proposals, such as those made by Senator Swanick, to extend the retirement age of consultants who want to continue in their practices and until we realistically tackle the pay and conditions of consultants who have been forced to leave the country to work under better circumstances elsewhere in the world, we will continue to have a crisis in our health service. However, I welcome the Bill that has just passed and I look forward to the Minister of State, Deputy Corcoran Kennedy, introducing legislation to tackle the amendments proposed by Senator Swanick.
I welcome Dr. Enda Shanahan to the House.
I wish to address two issues, the first being the point alluded to by Senators Swanick and Wilson. I thank the Senator for his kind comments. I support what the Senators are trying to achieve here. In addition to the consultant shortage and the difficulty in filling posts, a much broader issue is at play, namely, ageism.
I am not going to, but I will speak to the proposed amendment even though it has been ruled out on financial grounds, which I fully accept. However, I am not quite sure if a Bill of that nature could be ruled out on such grounds-----
I thank the Leas-Chathaoirleach. The bottom like here is the performance of one's duty. One's suitability to perform those duties should be based on competence and not age. Everybody is living longer, thankfully - not everybody, obviously. As a group, humanity is living longer. People are healthy. We have already had statements at the Global Economic Forum, pointing out that we have this host of individuals aged between 65 and 80 who are healthy, wealthy and looking for something to do, as an opportunity for tourism in this country.
I fully support the concept that people should be adjudicated upon in terms of their ability to carry out their job on competence and not age. To complement the point, with the new under-sixes contract, GPs can work until 72 years of age if they wish. I do not suggest that people should be forced to work beyond 65 if that is not their desire, but they certainly should not be prevented from doing so when they have built up an expertise over many years that is very hard to replace. I welcome very much the amendments on plain packaging. It is something I know we all understand is critically important in preventing the next generation from taking up this killer habit, which kills 6,000 people every year in this country. That is a statistic that falls off the lips, but that is 6,000 partners, parents and families who are rent asunder because they have lost a loved one and an income. It is horrendous, not to mention the tens of thousands who suffer because of chest diseases, heart attacks, strokes, peripheral vascular disease and all the other cancers that this heinous killer product causes.
I commend the Minister of State on passing this really important legislation. I look forward to the merry month of May, when our children will be safe from the subtleties and the evils of the tobacco industry, which seeks to addict them before the age of 18 and before they are in a position to make a decision as an adult as to whether they wish to smoke. I commend the Minister of State.
I will be really brief. I am happy to outline briefly my broad support for Senator Swanick's amendment. We have a serious problem attracting health professionals, and I am talking on behalf of my nursing colleagues. There are thousands of vacancies in that area and among other healthcare staff workers. We are trying to bridge the gap of expertise and mentoring of new recruits that come in. We have lost a lot of that in our time. This measure does enough to safeguard the employer and the employee and to ensure fairness and choice. It is about choice. I do not want to see it as mandatory. Some of us are having our day on our Zimmer frames earlier than we expected because we have been worked so hard. We are all living longer and subsequently we are promoting lifelong learning of which this is part.
I want to raise a couple of concerns. I know of a situation where nurses in particular were employed post-retirement age. I presume these are temporary contracts, but there are problems with temporary contracts. They require a clarification on pension contributions in that these people are already pensioners. There is also the issue that senior staff, or a senior nurse in the instance I am thinking about, are paid in terms of the seniority they have reached in their careers, yet they will not be the senior staff responsible in a ward or health service delivery. That is someone who is paid significantly less
I support Senator Swanick's excellent amendment even though it was ruled out of order. Senator Crown spoke about this issue in the last Seanad. Why, on a certain date when one is 65, if one is, as Senator Reilly said, experienced, knowledgeable, resilient, full of health and competence, does one have to give up one's job? It can be ruled out of order all one likes, and it was ruled out of order on financial grounds if I am correct, due to financial burdens on the State-----
It is one of the most relevant amendments here. If one looks at the financial burden or emotional trauma that has happened to people on waiting lists, the cost to the State and the people is unimaginable-----
I really think ruling this amendment out of order is ageist. Some 25% of us are going to be over 65 in 2020. What are we thinking about? It is outrageous. It is one of the best and most creative amendments that has come in here and I would like to know why it was ruled out of order and on what grounds.
I would just like to support Senator Swanick. He should pursue it against all odds. Perhaps this Seanad could actually bring it about that people do not have to leave their work if they are competent, able or resilient, and with all of that experience, on a certain day when they are 65. I never heard anything as ridiculous if they want to stay.
I, too, support that amendment on the basis that ruling it out of order is hiding behind a cloak that there may be some financial liability in the future, without quantifying that in any way, shape or form. I do not think it is right. I agree with my colleague here that it should be brought forward.
Common sense is not all that common and the more time I spend here, the more I realise that.
I also want to talk about the amendment that was also ruled out of order on the case of working farmland being a total of 90% of farm assets for the fair deal scheme and that it should be exempted from any valuations or means assessment. This amendment was an attempt to correct a significant anomaly in the fair deal scheme which unfairly discriminates against farm families. My office in County Mayo, and indeed Senator Ó Clochartaigh and Senator Mac Lochlainn and I am sure many other rural Senators and Deputies, has received many requests about this issue. Farm families should be concentrating on the health of their loved ones rather than worrying about the potential sale of part of their farming homestead. Working farmland is not a financial asset for farming people. It is their main means of production and it is required to continue living in rural Ireland.
I will make it very briefly. It is disgraceful that the main means of production that farm families have around this country should be used as an excuse to penalise them. People should think this through. Where will it end up? Will people lose their farms because of it? It is absolutely crazy. The amendment is very simple in that it would allow fairness. It is called a fair deal scheme and it needs to be fair for farm families as well as anybody else. The accusation of senior people within the HSE that farm families and families are leaving their loved ones in hospital beds just because they do not want to give up their farms and livelihoods is despicable. I certainly will not be letting this amendment go away. We will present it again.
I welcome the Minister of State and thank her for bringing forward this legislation. It covers a number of areas which are important, particularly in relation to ex gratiacompensation payments under a number of schemes, such as to people who went through symphysiotomies. Over 600 people who will benefit from ex gratiapayments will not have these included in calculations under the fair deal scheme.
The wording of the amendment put forward by Sinn Féin is probably not correct in the sense that a proposal is being considered at the moment by the Minister of State, Deputy Helen McEntee. We have been dealing with this proposal over the past three years. I have worked very hard on trying to get that amendment included because I am very much aware of farming families where a sudden illness arises and they need full-time nursing home care. I speak as someone who was involved in forcing the creation of the fair deal scheme. My own legal office in fact identified a discrepancy in legislation, where moneys were being illegally deducted from people in nursing homes, and that subsequently led to the creation of the fair deal scheme. One of the parts relating to farming families was not appropriately dealt with and instead of ignoring 90% of the assets of the farm, the idea is that under the same point in relation to inheritance tax, the value of the assets is reduced by 90%. The proposal that is currently being considered is about reducing the valuation of land by 90%, but the house would still be taken into account.In fairness, most farm families do plan for the future. I have seen very comprehensive planning being done by farm families, and any legal practitioner will highlight the issue of making sure that there is forward planning in this area. I accept that there is a need for an amendment to legislation dealing with farm families, and I feel that it is appropriate that it would be dealt with at a very early date. It would certainly be very welcome.
The amendments brought forward by Senator Swanick should be brought forward via the introduction of a Bill which could then be dealt with through both Houses in the appropriate manner. It is not just about amending the entitlement to work. There are many other amendments that have to be legislated for if we go through that process. It is not enough to simply amend the current entitlements. There are many other areas that would have to be dealt with in any legislation, and it requires a separate Bill.
I thank the Minister for bringing forward this legislation. It is important that it is put in place and becomes operational at the earliest possible date.
I thank Senators for their contributions on Committee Stage of the Health (Miscellaneous Provisions) Bill 2016. The provisions of this Bill will allay the fears of recipients of ex gratiaawards which have been approved by the Government. It would be most unfair if people who received an ex gratiaaward were then to be disadvantaged regarding their financial assessment for support under the nursing homes support scheme as a result of receiving an award. I hope this Bill will give peace of mind to the individuals concerned and their families.
This Bill contains some very important measures regarding tobacco control and I am delighted to see Senator Reilly here as he is a champion of this issue. Once this Bill is enacted arrangements will be made to introduce standardised packaging of tobacco. It is my intention to allow adequate preparation time before the commencement of the new packaging measures. As we know, 23% of Irish people are daily or occasional smokers. Some 8% of our ten to 17 year olds smoke. While the reduction in these figures over the past number of years is significant and welcome, we are a long way from reaching our 5% prevalence rate set out in our Tobacco Free Ireland policy.
Almost 6,000 Irish people are killed annually by smoking. The human cost of smoking in Ireland today is overwhelming. Less important but still significant is the economic cost of smoking in Ireland. The annual health care bill amounts to €506 million, lost productivity costs €1 billion and the cost of litter associated with smoking is €69 million. These costs are very significant, and show us how reducing smoking can improve not only the health and well-being of the Irish people, but can also reduce the cost to the taxpayer in dealing with the impacts of smoking in the long term.
We can be proud of what we have achieved over the last couple of decades regarding tobacco control, but work must continue on reducing the numbers who smoke, and in particular the number of young people starting to smoke. Standardised packaging is just one of a number of recommendations set out in Tobacco Free Ireland. I am committed to ensuring that we continue to implement this policy to ensure that our children and our children's children get to experience a tobacco free Ireland. I ask all Senators to continue their support, not only for the standardised packaging measure being discussed here today but for all future public health measures to be implemented by my colleague, Deputy Harris, and me.
The provision in the Bill to amend the Health (Pricing and Supply of Medical Goods) Act 2013 is also intended to benefit the health of the population. It provides that when considered appropriate in the interests of patient safety or public health, over-the-counter medicines can continue to be reimbursed to medical card holders after May 2018. This means that products such as nicotine replacement products and emergency contraception can continue to be provided under the medical card scheme. The proposed amendment to the Irish Medicines Board Act 1995 will allow the payment of fees to members of the Health Products Regulatory Authority in line with the arrangements of other boards, in order to continue to attract the highest calibre of expertise to apply for board membership at no additional cost to the taxpayer.
I thank everyone who contributed to the debate. I want to thank Senators Swanick and Ó Clochartaigh for the genuine intentions of their amendments, and I regret that due to Standing Orders it was impossible to accept them. I think everyone will agree that getting this Bill enacted as quickly as possible is a primary aim. The Bill aims to make important changes to the four Acts in the interests of equity, and in some cases patient safety, and of course the tobacco legislation is to help protect public health. Again, I thank all of the Senators for their contributions.