Skip to main content
Normal View

Dáil Éireann debate -
Tuesday, 12 Dec 1995

Vol. 459 No. 6

Private Members' Business. - Hepatitis C Victims: Motion.

I move:

That Dáil Éireann, mindful of the commitment given in the policy document A Government of Renewal to pay fair compensation to those infected with hepatitis C, condemns the Government for its failure to establish a statutory tribunal to deal with hepatitis C; recognises that the ad hoc tribunal falls short of meeting the needs of those infected, has been rejected by the groups acting on behalf of victims and fails to deal with serious issues such as the right of appeal and the loss of medical records; and calls on the Government to introduce legislation as a matter of urgency to establish a tribunal on a statutory basis.

I wish to share my time with Deputy Kenneally.

I am sure that is satisfactory. Agreed.

Níl aon aimhreas orm ach gur bí an chúis atá á phlé anseo anocht ceann dena scanaill sláinte is mó a bhuail an tír seo le fada an lá. Tá ceist hepatitis C a'deineadh buartha dóibh siúd atá tinn dá bharr ach freisin dá gclann, dá gcáirde agus den phobal tré chéile. Tá gealltanaisí tugtha ag dhá Rialtas, ag dhá Airé Sláinte agus níl le déanamh anois ach na gealltanaisí sin a chomhlíonadh go hionraic.

Tá chuile dheis tugtha don Rialtas theacht ar réiteach chothrom sa gcás agus tá deis eile fós a tabhairt anseo anocht. B'fhiú go mór dhá dtiocfaí ar réiteach a bheadh cóir agus inghlactha ag na grúpaí a bhfuil de chúiram ortha feidhmiú mar thaca agus mar fhoinse treorach dóibh siúd a bhfuil an galar ortha.

The Department of Health and the agencies operating under its aegis, such as the Blood Transfusion Service Board, have a task like no other Department or agency. If the Department of Health or any of its agencies were to get it wrong, lives would be put at risk. Unfortunately, that is what happened in the hepatitis C controversy. A State agency operating under the control of the Minister for Health made a fundamental error: it ignored its own procedures and about 1,500 people are now paying the price.

The Blood Transfusion Service Board did not just get it slightly wrong, it got it alarmingly wrong and many thousands of lives were put at risk. Instead of being held liable, senior management received golden handshakes to leave. The staff who remained had to face the public, take the flak and deal with the consequences of the controversy. They received no compensation even though they had to stand in the firing line.

The lump sums and generous terms to the two executives who left were granted by the Minister, Deputy Noonan. Given that he showed such generosity, one would have expected him to show even greater consideration for those whose lives have been destroyed by the affair, but the strange thing is that the only ones being punished by the State for this scandal are those who received the contaminated blood and blood products.

At every turn in this controversy they have been double crossed by the State. The Minister has sought to minimise the compensation they will receive by blocking their right of appeal. He has strung them out in negotiations and after making promises to get them back into talks he failed to deliver on those commitments. He is now forcing a flawed strategy on these vulnerable people.

For those who are not familiar with this controversy let me trace the background to it so that they can see the injustice which has been done. This scandal began for most of those infected with anti-D immunoglobulin, a blood product which is routinely administered and given without consent to rhesus negative blood group mothers. This product has been administered in Irish maternity hospitals since the early 1970s to prevent rhesus incompatibility in new born infants. It is an extremely important product which has prevented death and serious illness in thousands of infants in Ireland since its introduction in 1970. It is ironic that a product which was designed to save infants is the one which had led to so many lives being put under threat now.

Anti-D was manufactured from 1970 to 1994 in Ireland by the Blood Transfusion Service Board which is under the control of the Minister for Health. Women receiving plasma exchange treatment during pregnancy were a particularly rich source of antibodies for the production of anti-D. Plasma from one such women was used to produce anti-D between September and November 1976. She then became jaundiced and the board ceased using her plasma. She tested negative for hepatitis B and appeared to make a full recovery after a few weeks. The board then decided to recommence using her plasma in the anti-D programme.

In 1977, the board was notified of six women who had developed clinical jaundice some weeks after receiving anti-D immunoglobulin. Samples from these cases were sent, as we now know, to Middlesex Hospital Medical School where they tested negative for hepatitis B. In accordance with normal practice, Middlesex Hospital retained samples for further testing should additional tests become available at a later stage.

Hepatitis C was first described in 1989. Previously it had been described as hepatitis non-A, non-B because its characteristics had not been adequately identified. An internationally accepted test for hepatitis C was developed in 1991 at which time the board commenced testing all blood and plasma donations for the virus.

In December 1991, Middlesex Hospital used the new test for hepatitis C on the archived samples from the 1977 cases of jaundice. It tested samples from one plasma donor and three recipients of anti-D. It also tested archived samples of batches of anti-D which had been used in 1977. Evidence of hepatitis C was found in some of the samples and in December 1991 the hospital wrote to the board alerting it to the problem. The letter was acknowledged but no further action was taken until 1994, nearly three years later.

Early that year a research study found a disproportionately high incidence of hepatitis C in female rhesus negative blood donors. Further investigation found that these women had given birth in 1977 and were given anti-D at the time. More samples from 1977 were sent to Middlesex for testing and found to contain hepatitis C. The board than withdrew its anti-D product.

The report by the expert group investigating the board concludes that the probable source of the infection was the plasma exchange patient who developed jaundice in 1976 and whose plasma was used as a source of anti-D in the period immediately preceding the onset of her jaundice and again after she had recovered.

The expert group further notes that the board had clear standards governing the selection of ordinary blood donors and the male donor panel for anti-D production. In both cases the board's standards prohibited the use of donors with a history of infectious hepatitis or jaundice of unknown origin, but it did not apply those same standards to the 1976-77 female plasma exchange patient. Her plasma would not have been accepted if the rules had been adhered to. The board broke its own rules with devastating results.

The board also committed a serious omission when it failed to act upon the Middlesex Hospital letter of 1991. Had it acted then the infected product could have been withdrawn two and a half years earlier. Over 1,000 mothers contracted hepatitis C from contaminated blood products, a serious and potentially life threatening virus for which there is no effective cure. Half of these women have the full virus while more than a dozen children of the mothers and some partners have also been infected. More than 500 others have been infected with hepatitis C through blood transfusions — people who thought they were getting a new burst of life with a transfusion of blood were being infected with a serious virus. These include women at childbirth, children who received transfusions, car accident victims, those who received transfusions during serious operations and those with rare blood diseases. Haemophiliacs and Kidney dialysis patients have also been victims of this virus.

According to the virus reference laboratory at University College Dublin, up to 75 per cent of those infected with hepatitis C develop chronic hepatitis. Hepatitis C is a most uncertain disease for which there is no known treatment available. The type of hepatitis C contracted by most of those affected through anti-D is the least responsive to te standard interferon treatment. About one in five patients with chronic hepatitis C virus infection develops cirrhosis of the liver. Those with hepatitis C antibodies continue to undergo testing and it is not known how many of these have a hidden virus which current tests cannot discover.

Hepatitis C infection is associated with several diseases not directly related to the liver. Side effects experienced include rheumatoid arthritis, extreme fatigue, eye problems and auto-immune diseases. Hepatitis C is often a silent disease and many patients do not know they are sick until faced with possibly irreversible liver damage. Hepatitis C infection almost universally recurs in a newly transplanted liver.

The hepatitis C nightmare is one of the worst in the history of the State. It is a nightmare because it was the health system that caused the disease which infected healthy people. The State's negligence in the affair takes many forms. Through the Minister for Health, it granted to the Blood Transfusion Service Board a manufacturer's licence for the production of anti-D. Such a licence should be granted only if the Minister is satisfied with the suitability of premises, equipment, staff, manufacturing operations and arrangements for quality control, record keeping, handling, storage and distribution. There are many reasons to believe that some of these requirements were not met by the Blood Transfusion Service Board between 1975 and 1994. Earlier this year the Bains report was published on the questionable storage conditions at the Blood Transfusion Service Board, yet no Minister for Health in that time revoked the licence or ordered an investigation into conditions at the Blood Transfusion Service Board.

Given that fact and that the State was directly responsible for this nightmare through its negligence, one would have expected it would have made every effort to be fair to the people who endured much suffering and trauma. However despite the commitment in the programme for renewal to give them fair treatment, these people have been treated with contempt by the State and at every turn have been double-crossed by the Department of Health.

There is a catalogue of mistreatment in this case. The Government insisted on carrying out only a limited look-back study to discover who had the virus. As I said last week, that was the minimalist approach. It seems the Department of Health's agenda was to find as few victims as possible. The Minister for Health ignored all the calls for a full study involving doctors until he was forced by public political pressure to undertake such a study. In the look-back study and the later full research project, the Department of Health identified people who possibly received infected blood or blood products but have since died. The cause of their death was probably the medical condition for which they were hospitalised, but the Department of Health did not even contact their relatives to check whether that was the case.

The catalogue of mistreatment does not stop there. When negotiations were still ongoing the Minister for Health unilaterally announced the setting up of an ad hoc tribunal to hear applications, even though that was the last thing the representative groups wanted. The Minister for Health promised to put in place a comprehensive counselling programme, but as many as ten counties still have no such service. Even where the service was provided it met with strong criticism: some people were questioned about their lifestyle, ear piercing, tattoos and so on. The Minister put forward a comprehensive health package, which I welcomed personally and on behalf of my party. I hope that will result in a significant improvement in the counselling service. It took months of tough talking to eventually persuade the Department of Health to commit to pay for the promises of quality health care, which is no more than the victims justly deserve.

The Government's failure to provide a statutory tribunal to hear cases is unacceptable. The ad hoc tribunal has been criticised by the gropus acting on behalf of victims. Both groups have serious reservations about the Minister's proposals. In recent days the Minister has been on the hard sell for his proposals. He and his officials made a number of questionable statements — for example, they have likened this tribunal to the Stardust tribunal. I think the Minister will agree there is a massive difference between those two cases. First, the Stardust ballroom was not a State agency and the State was not the negligent party. Second, there were fewer people involved in the Stardust tragedy and the number of deaths and injuries could be determined relatively quickly. On the other hand hepatitis C can be a silent killer, with many years elapsing before the full effects are felt.

The Minister tried to present the demand for a statutory hepatitis C tribunal as an attempt to have a second beef tribunal but that is way off the mark. Nobody wants a re-run of the beef tribunal, least of all hepatitis C victims. The groups representing victims have agreed to set all legal fees and define procedures in advance of a statutory hepatitis C tribunal. The Attorney General must surely have a role to play in this regard. In that way there could be no slippage or dragging out of cases. The evidence with hepatitis C is relatively cut and dried compared with the beef tribunal. An expert group has examined the issues and given its findings. At any tribunal there would not be a major re-run of all matters with each case.

The Minister claimed during his hard sell of the proposals that no Government could back out of the tribunal. The document I have simply states that it will continue indefinitely. I do not know what idefinitely means in legal terms but I am sure it is not a watertight expression. There is nothing in the proposals to stop a Government ending the ad hoc tribunal. The Minister claimed the courts would prevent a Government from abolishing it. How can he be so certain the courts would make such a decision? How can one Government commit future administrations to spending programmes? In 30 years time how many of us will be sitting around the Cabinet table or will even be Members of the House? The tribunal should be established by statute. As proposed by the Minister it has no permanence in law. The only commitment is that it will continue indefinitely until a Government decides otherwise.

There are many other problems relating to this matter. On the surface a key attraction of the Minister's proposal is that it entitles victims to a provisional award. That is a payment scheme which would allow a victim to receive compensation in the event of deterioration of his or her health. Because hepatitis C is so unpredictable, a provisional awards scheme is vital. On more careful examination of the proposed tribunal one discovers that the gloss quickly loses its shine. Under the scheme a person may opt for a provisional award but it may be denied to him or her. The tribunal may, at its discretion, give a final lump sum and the claimant has no means of appeal against the tribunal decision.

Another major problem with the tribunal relates to the presentation of medical evidence. Under the scheme a claimant may seek to have his or her doctor give evidence at the tribunal, but there is no guarantee the tribunal will agree to that. Given that hepatitis C is such a terrible condition with many different side effects, claimants must have the right to bring their doctors to the tribunal and be confident the doctor will be heard — the tribunal should have power to compel doctors to atttend.

The Minister told the groups they have the right to judicial review. That is not stated in the document. I do not know if a right of judicial review always exists in law even under an ad hoc system. It is a point of law and perhaps the Minister would clarify it? It would be better if a member of the Government did not present as absolute something that may be uncertain. It is misleading and some could interpret it as the Minister trying to trick the victims of this State disaster into accepting a half measure.

There are other major difficulties with the proposals put forward by the Minister. In his document on health care he proposes to establish special hospital wards for those with hepatitis C. While I see some merit in that proposal, it creates great difficulties for those who have contracted hepatitis C but have not told their employers of their condition and want their plight to remain confidential. What would happen to confidentiality if an employer visits an employee in hospital and finds her in a special ward named "Hepatitis C"? The person will be stigmatised and her right to confidentiality will surely be breached.

In the tribunal document the Minister puts those who contracted hepatitis C from blood transfusions at a major disadvantage in making claims. He requires those making claims to prove on the balance of probabilities that they contracted hepatitis C from a blood transfusion. That is relatively easy to prove in the case of mothers who can produce their children or birth records, but it is far more difficult to prove for those who had blood transfusions. Their medical records in hospitals or in the Blood Transfusion Service Board may be incomplete, they could be lost or destroyed. I gather some hospital records were lost when some Dublin hospitals amalgamated. I gather also that some hospitals have a policy of destroying records after 25 years.

Records may not exist in the case of people in their mid-30s who received blood transfusions as children but who have not received any since. A problem may also arise regarding the chain of evidence. A person who contracted hepatitis C from a blood transfusion may identify the batch of blood received and pass on that information to the Blood Transfusion Service Board which, in turn, may identify the donor. However, it may transpire that the donor did not give blood after 1991 when testing for hepatitis C was introduced. The Blood Transfusion Service Board cannot say conclusively that the donor in question was the source of the infection. That donor cannot be ordered to have a test so the chain of evidence is broken.

The group representing those victims of blood transfusions have sought that the term "balance of probabilities" be dropped and replaced by more acceptable terminology. If possible, that should be done, especially if the Minister is committed, and I believe he is, to giving equal treatment to all those infected, whether through blood transfusions or through anti-D treatment. From an initial glance many of these points may appear minor in the overall framework, but taken together as the sum of the parts, they indicate the Minister's scheme is flawed. He would be better to go the statutory route. He should introduce legislation as a matter of urgency to achieve this. If he continues to refuse to go that route, I would like him to say hence why a statutory tribunal cannot be established. If his argument relates to legal costs, that, is not an issue as they can be agreed in advance. I accept there is not a simple solution to this problem and that the Minister has made considerable headway. I also accept that it will be a very expensive controversy, but given that he has gone such a long way down the road with the groups, would it not be better for the Minister to go the last mile?

The groups feel they have been treated in a patently unfair manner, especially given the Government's commitment in A Government of Renewal to pay fair compensation. If the Minister continues to reject the groups' concerns, this affair could end up being a case of penny-wise and pound-foolish for the State.

If the Minister maintains his position — and given the level of opposition to his ad hoc tribunal — there is a danger that all these cases will end up going to the High Court. Once there, there will not be agreed fees and the State will be liable for all the costs. A hepatitis C case is already before the High Court. I am sure no one will process a case through the ad hoc tribunal until the outcome of the High Court case is known as the ruling there will be a benchmark. The ad hoc tribunal may be set up by the Minister, but it is likely to be idle until there is a ruling on that High Court case.

I seek clarification from the Minister on the number of claims he expects will go before the ad hoc tribunal by the end of this month and on how many he expects the tribunal will have made a determination by the end of this year. From earlier discussions in this House today, the impression was given that £60 million is required in this financial year to pay claims. I understand from the Minister and I believe he told me the truth in response to parliamentary questions tabled last month, that he did not expect any claims to come before the tribunal because it would not be fully functional before the end of this year and, therefore, no payments would be made until 1996. That was my understanding of the position when we discussed this matter in the debate on Estimates last week. As the Minister is aware Government and Opposition parties were prepared to pass any Estimates necessary to compensate these women this year.

In an effort to get the groups back into negotiations the Minister promised to give the groups representing victims everything they wanted, but not on a statutory basis. The groups stepped aside from their demand for a statutory tribunal in an attempt to find a solution, but is now appears the Minister deliberately strung out Positive Action and Transfusion Positive which acted in good faith by stepping aside from their demands and did not show the same good faith in the negotiations. Even though the groups stepped aside from the demand for a statutory tribunal during the negotiations, they still believe that is the way to proceed in the absence of an overall agreement.

The Minister raised the political stakes in this controversy by proceeding without the agreement of victims. It is a rash decision, especially given the commitments by various members of Government parties to the groups representing the victims. It must be recognised that all the victims have been infected due to the negligence of the State. The Government could pay a high price for the Minister's intransigence in this affair and his unwillingness to go the extra distance. I appeal to the Minister at this late stage to carefully examine the possibility of taking the statutory route to ensure that in 30 years' time whoever will have succeeded him, will not have an opportunity to lay aside the ad hoc tribunal now on offer, without the matter coming before this House. I commend the motion to the House.

I am pleased to have an opportunity to speak on this motion. I commend our spokesperson, Deputy Geoghegan-Quinn, for bringing it before us. While it has been established that many women have been infected by blood products and realise they may face grave problems in the future, it is unfortunate that the number of women who have an uncertain future has not yet been established. At least 60,000 women have been given anti-D products by the Blood Transfusion Service Board. This problem is a new experience and tests which establish the type of infections transmitted are also new. We do not know if hepatitis C is the only infection involved or what new virus, of which we are presently unaware, may be detected in time.

The physical problems are greatly compounded by the uncertainty of the future and the Minister has an onerous duty to ensure that the future of these women is protected in the best way possible. That is why the sentiments expressed in the motion are so important to women, not only in a practical sense but in a psychological sense. Not only must we give medical help and every support to those affected, we must also reassure women that their health in this context will not be sacrificed for a paltry few pounds or because a Minister will not go the extra mile to give them what they need and want.

These demands are made by the people most affected. While I congratulate the Minister in going as far as he has, I am extremely disappointed that he has not seen fit to concede the statutory tribunal being sought by Positive Action. This seems to be the classic "Yes Minister" case of establishing priorities which suggest that people should not be given what they want but what the Minister feels they should have. I cannot see the Minister's logic in his approach to this problem. While on the one hand he gives the clear impression that he is anxious to do all that is necessary to relieve the distress of the women who have had major problems, not of their own making, thrust on them, he still baulks at the one guarantee that these women desperately want and need: continuing security.

Is the Minister for Health suggesting he will still be around in ten or 20 years' time to look after them? Even the Minister cannot be this optimistic. While he may be willing to give guarantees, the women who face an uncertain future would like, and are entitled to, better guarantees.

(Limerick East): Will Fianna Fáil tear it up?

I am afraid the Minister or one of his successors might tear it up at some stage.

(Limerick East): If in Government would the Deputy's party give a guarantee to go ahead with it?

Now is the time to make provision for them. We and the group who represent the women consider that the best way to achieve this is through a statutory tribunal. I do not know why the Minister is dragging his feet on this. If it is an administrative difficulty he must slash through the red tape; if it is pure bloody-mindedness on the part of the Minister then those suffering women should be made aware of that. If, on the other hand, his reluctance is due to economics and penny pinching — which I believe it is — the Official Report of 13 March 1991, Volume 406, No. 4, column 1116 states:

The Minister must realise that further delays by the Government will rightly be seen as a cynical act. Not only will it deny these people the right to some comfort during this stressful time but it will significantly reduce the possibility of compensation being awarded to the families of those people who have died. The Minister must clearly demonstrate to the House that he is not making such a callous calculation as the potential for savings to the Exchequer.

That statement was not made about this problem or during this dispute. It was made by Deputy Richard Bruton, Minister for Enterprise and Employment, during the debate on compensation for haemophiliacs on 13 March 1991. If the principle was right then, it is right now. I ask the Minister to concede that these disadvantaged people need a statutory tribunal.

Let us be clear about this. The Blood Transfusion Service Board is an organ of the Department of Health. It would be shameful of the Minister to try to shirk his duty to women, whom this body failed. The Minister could as easily concede liability in a court of law as to a tribunal of his appointment which would make a trip to the court by claimants, who wish to go down that road, a great deal easier. There is ample precedent for that. However, the awards granted there would not be in accordance with what the Minister has in mind under this tribunal.

In clause 8 of the Minister's scheme of compensation headed "Awards of the tribunal", the Minister states:

In calculating an award the tribunal may take into account any statutory or non-statutory benefits which the claimant has, or will become entitled to, or has received, or will receive as a result of the condition which gives rise to the claimants claims.

It is difficult to work out what it means. I admit I am suspicious of it. I saw on a British television programme recently where claimants in another context came away with a net £1 after various clawbacks had been made. It would be dreadful if that hapened here. I am not suggesting the Minister would be guilty of such an action but it again underlines the necessity of having everything made clear at the beginning and providing as much permanence as possible.

If we look back to the thalidomide affair or any other crisis caused by a commercial concern, the Government, rightly, would pursue such companies to discharge their responsibilities fully. When the duty rests with the Minister to provide for the needs of these victims he must do so. In anything as important as the health of a sizeable number of the citizens of the State, we have an obligation to provide what is best for their need in the longer-term.

While I accept the bona fides of the Minister in what he has proposed, he has not convinced me that these women should settle for less than their due. Because of the long-term nature of this problem and not knowing how benign future Ministers or regimes may be, we have to give the solution to this problem as much permanence as possible.

Under the Minister's proposal, his arrangements could be terminated at any stage whereas the work of the statutory tribunal could only be terminated by the Oireachtas. I do not understand, much less accept, the Minister's arguments that a statutory tribunal would be "more formal, less flexible, unwieldy, subject to greater delays and with potentially substantial legal costs". There is no drawback in the Minister's list which he, as Minister, cannot solve. I can only conclude that his motives in denying these women their moral rights are based on financial considerations and choosing the easy way out.

The Minister has seen fit to cast the amount of compensation, or so it seems at £60 million. This is disgraceful and indicative of his cavalier attitude to the problem. If he has learned anything it should be that this scheme must be open-ended. This is the core of the problem. We do not know, and the Minister cannot know, what is down the line and he cannot close off any option in this regard.

A man came to me a couple of weeks ago and was distraught because his wife is suffering from complications as a result of contaminated blood products. She has had a reasonably lengthy history of hospitalisation since and this will continue for the foreseeable future. She is hospitalised at least every two weeks for varying periods. Can the Minister even begin to quantify the level of compensation to which this woman is entitled? I accept her medical expenses will be taken care of but what about the other elements of her suffering? There is the pain, trauma and inconvenience to herself and consequently to her family; the loss of time with her family and the psychological loss and deprivation involved. There is the uncertainty of the future with an unquantifiable sentence over her head and the complete destruction of all her expectations of life. In other words, her life has all but been ruined.

What financial value can the Minister put on that? What kind of award would a court make if such a case came before it in the normal way? Let us be penny-pinching about it and say it was a paltry £200,000. Take a simple mathematical example. As I said earlier, 60,000 women have been given suspect blood and are exposed to some degree of risk. If only 1 per cent of these women proved to have long-term difficulties that represents 600 women. If, on the other hand, the Minister has provided an absolute maximum of £60 million one does not need a degree in mathematics to work out that only 300 women will be compensated, and that is probably the least he could get away with. The Minister's calculations are flawed. His approach is shameful and his attitude to a very stressful and traumatic situation is lacking in compassion. Women deserve better.

While the Minister may appear wholly reasonable in holding out the carrot of relatively trouble free compensation, the price of acceptance, which is the waiver of any future right to claim, will be too high. This will have the inevitable consequence of forcing people to the superior courts for a vindication of their rights. It is not proper that the Minister should formally decide that the compensation he proposes to make should be on an ex gratia basis. If he was generously picking up the pieces from the actions of a third party his actions would be commendable but the responsibility rests clearly and solely with him and to designate his remedial action ex gratia is totally unacceptable.

The motion reflects the needs and the wishes of the victims represented by Positive Action, who have suffered enough as a result of short comings of the State and shows the way forward which the Minister should take. I commend the motion to the House.

, Limerick-East): I move amendment No. 1:

To delete all words after "That" and substitute the following:

"Dáil Éireann, being of the view that—

(i) the Amended Scheme of Compensation published by the Minister for Health on 1st December, 1995, which will continue indefinitely as an alternative to court proceedings will serve the best interests of persons who have contracted Hepatitis C from Human Immunoglobulin Anti-D, blood transfusion or other blood products; and

(ii) the proposals set out in the Health Care Document published by the Minister for Health on 1st December, 1995, in relation to the long-term health care needs of persons diagnosed positive for Hepatitis C provide statutory guarantees in respect of the future provision of health care services,

approves the Amended Scheme of Compensation and the Health Care Document published by the Minister for Health on 1st December, 1995, copies of which have been sent to each Deputy and placed in the Dáil Library on 11th December, 1995.".

I am pleased to have the opportunity to move the Government's amendment to the Fianna Fáil Private Members' motion on the scheme of compensation for certain persons who have contracted hepatitis C. I welcome the opportunity to outline to the House the Government's firm commitment to fair compensation and to meeting the long-term health care needs of those who have contracted hepatitis C from a blood transfusion or blood product. There is a serious responsibility on Members to ensure that people with hepatitis C listening to the debate do not have their anxieties and concerns increased by inexact information or statements which are not in accordance with the facts. I compliment Deputy Geoghegan-Quinn for sticking, by and large, to the facts but unfortunately I cannot pay the same compliment to her young colleague.

When the possible link between the anti-D product and hepatitis C was brought to the attention of my Department in February 1994 the immediate concerns were the protection of all future recipients of anti-D product, the identification of risks for mothers who received the anti-D product in the past and the provision of counselling and treatment for women who test positive for hepatitis C. The first objective was met by the immediate introduction of a new virally inactivated anti-D product to all maternity hospitals and units while the second objective was met by the launch by the BTSB of the national blood screening programme for anti-D recipients. The third objective was achieved by the provision of special consultant staffed clinics for those persons diagnosed positive for hepatitis C under the national blood screening programme.

A total of 57,764 women who received anti-D between 1970 and February 1994 have been screened under the national blood screening programme and 973 have screened positive for hepatitis C antibodies, of whom 463 have tested positive for the virus. Under the targeted look-back programme, 217 living recipients have been traced to date, 174 persons have been screened for hepatitis C antibodies and 146 of these have been screened for the hepatitis C virus. Sixty-three of these persons have evidence of continuing hepatitis C infection.

It is not true that the targeted look-back programme is minimalist or was introduced in response to public pressure. Several of the statements put on the record by me indicated that we would follow this strategy and the hepatitis look-back programme being currently undertaken targets recipients of blood transfusions prior to 1991 by tracing the past donations of donors now identified with evidence of hepatitis C virus following the administration of anti-D and who subsequently became blood donors. The look-back programme also included donations given prior to 1991 by donors identified as hepatitis C positive following the introduction of routine screening of blood donations in 1991. In addition, the Blood Transfusion Service Board has asked a pathologist and other medical practitioners to advise it of patients with a diagnosis of hepatitis C where blood transfusion may have been the source of the infection. When a potentially infectious donor is identified by this route their previous donations are also included in the look-back programme.

The targeted look-back programme has two phases. The first phase has identified, and will continue to identify, donors who have tested positive for hepatitis C, the product, whole blood, red blood cells, platelets or plasma, the hospital to which the product was issued and the recipients. The second phase will trace the recipients with a view to offering tests. Phase two of the programme is well under way and contact is being made with recipients through their general practitioners with a view to assessment and obtaining blood samples for testing for hepatitis C. The programme will identify those people who are known to have received a potentially infected blood transfusion. It, therefore, offers a screening test for hepatitis C to any individual who has received blood or blood products from donors who are potentially infected with the hepatitis C virus.

This is not a minimalist programme, rather it is unprecedented in its scope. Even though similar problems have arisen in other countries, no similar programme has reached this stage of advancement. Deputy Geoghegan-Quinn was incorrect to say a minimalist approach was adopted, it was slip shod or forced on us. This programme was always part of the strategy and it was introduced as soon as possible on the basis of the information available to us. I know the Deputy did not intend to mislead the House by saying it is minimalist but it is very important to ensure that the facts are put on the record. We do not want to raise anxieties based on wrong information.

Under the optional screening programme which I announced in early September, 6,024 persons have come forward for testing. To date 30 of these persons have tested positive for hepatitis C antibodies while 12 have tested positive for the hepatitis C virus. I wish to express the Government's deep concern and compassion for recipients of anti-D and other blood products who have been infected with hepatitis C by virtue of exposure to the blood product. I wish to state clearly that my Government colleagues and I are committed to ensuring the ongoing availability of the highest quality health care for these people. I assure them that I fully appreciate their anxieties and concerns for their future well-being. I hope the Dáil will agree that the open and generous way the Government has addressed this issue is evidenced in the health care services programme and the amended compensation scheme.

I wish to outline the health care services I am putting in place through my Department, the health boards and the acute hospitals and which, as Deputy Geoghegan-Quinn said, have been welcomed by Members on all sides of the House and the two organisations negotiating on behalf of affected people. Substantial progress has been made during the past year in meeting the many complex and varied needs of those persons who have contracted hepatitis C. This has been made possible by a process of consultation between my Department and Positive Action, a support group for anti-D women and their families, and Transfusion Positive, a support group for blood transfusion recipients and their families. Many of the concerns about future health care arrangements expressed by Positive Action and Transfusion Positive have been addressed and these are now reflected in the health care document and the amended compensation scheme forwarded to both groups on 1 December last which I have circulated to all Members. The special health care programme involves an extensive range of services in the following areas: primary health care services, secondary health care services, a special research programme and a statutory monitoring body.

Enabling legislation which will be published on 31 December next will allow for the following services to be provided free of charge and without a means test for certain persons who have contracted hepatitis C: general practitioner services, including prescribed drugs and medicines; dental, ophthalmic and aural services; independent counselling services; home help services and home nursing services. Today the Government cleared the text of the legislation which will be published as soon as the printing arrangements are made. The legislation will be brought before the House as early as possible after the Christmas recess. I hope all parties will give these arrangements the kind of parliamentary permanence they have requested by supporting the legislation.

On the question of secondary health care services, treatment for those who test positive for hepatitis C is provided at special consultant staffed clinics at the following six designated hospitals: St. James's Hospital, Dublin; Beaumont Hospital, Dublin; Mater Hospital, Dublin; St. Vincent's Hospital, Dublin; Cork University Hospital and University Hospital, Galway. The treatment involves both out-patient and in-patient services as required. On Committee Stage Deputy Flood asked why the services were confined to these hospitals. The expertise available dictates the locations. I would like a facility in Limerick but unfortunately the expertise is not there at present. The above hospitals have provided the services and will continue to do so.

The treatment, including prescribed medication, is provided by the public hospital service free of charge. In 1994 a sum of £1.8 million was allocated to the six designated hospitals for the provision of these services and £1.98 million was allocated for them this year. It has now been agreed that specific funding will be provided in the Book of Estimates each year to ensure the consolidation and maintenance into the future of high quality hospital in-patient and out-patient services for persons who have contracted hepatitis C from a blood transfusion or blood product, including the anti-D product.

The secondary care element of the health care services includes provision for access to in-patient and out-patient treatment, non-payment of hospital charges, appropriate staffing levels and arrangements for staff training, equipment for hepatitis C units, anti-viral therapies and therapy initiation programmes, liver transplantation, treatment outside of Ireland where necessary, liaison between the hospital service providers and prompt referral to clinicians for conditions associated with hepatitis C. The treatment services will also be available to children and partners who are hepatitis C positive.

I am arranging with the Health Research Board for the establishment and funding of a special programme of research on hepatitis C, including research projects into hepatitis C as it relates to persons infected through the use of anti-D. Funding will be provided to enable this special research programme to commence early in 1996.

Under the powers conferred on me by the Health Acts 1947 and 1953, I will by order before 31 December 1995, establish a statutory consultative council to advise me on matters relating to hepatitis C. The functions of the consultative council will include the monitoring of health and counselling services for persons with hepatitis C; the making of recommendations on the organisation and delivery of services for persons with hepatitis C; publication of information on hepatitis C; and liaison with the Health Research Board on the special programme of hepatitis C research projects. The membership of the council, which I will be appointing, will include representation from Positive Action and Transfusion Positive.

The health care programme which I outlined was specifically designed to further copperfasten the Government's commitment to meeting the future health care needs of persons who have contracted hepatitis C from a blood transfusion or blood product. I am sure that Deputies will agree that the Government's proposals are fair and generous and will meet the genuine concerns of those who have contracted hepatitis C in relation to the continued provision of high quality health care in the future.

Deputies will have noticed also that they are either being enacted in statute with the Bill to which I referred which will be published shortly or already covered by statute under the health Acts, such as public provision in hospitals, or covered under regulations or orders statutorily based on sections of the health Acts. The arrangements for the ongoing health care needs of persons with hepatitis C are being put on a permanent basis, which is a major issue in this House.

Deputies referred to the compensation scheme in detail. The Government in its policy document —A Government of Renewal— included a commitment to fair compensation for women infected by the hepatitis C virus from anti-D. Earlier this year, the Government decided to establish, as a matter of urgency, a tribunal which will assess compensation on an ex-gratia basis in respect of anti-D recipients who are infected with hepatitis C antibodies-virus and the partners and children of these women who are also infected with hepatitis C antibodies-virus.

I published the scheme of the compensation tribunal on 20 June 1995, a copy of which was circulated to every Member of the Oireachtas. On 12 September 1995 I announced the Government's decision to extend access to the tribunal to include those who had contracted hepatitis C from a blood transfusion or blood product.

The Supplementary Estimate of £60 million which was discussed in committee and which is before the House is in relation to the estimated 1996 cost of meeting the compensation awards likely to be made by the tribunal. It is, of course, accepted that all awards made by the tribunal will be funded from the Exchequer.

There was never any doubt about what we were doing in committee last week — we were making a provision for the estimated costs of compensation through the tribunal in 1996. I also made it quite clear that I was setting up the tribunal immediately and that the £60 million would cover the administrative costs in 1996. Certainly, some of the administrative costs have already been incurred in 1995 on salaries, premises and so on. I do not think the tribunal, which we will set up next Friday, will have handed down any awards by the end of the year, but I made that point clearly last week on committee. However, it is true that if we had reached agreement on the tribunal when it was published during the summer, significant awards would have been made this autumn because much less lead-in time is needed for a tribunal rather than the High Court to make awards. In response to Deputy Kenneally, it is on record that there is no question of a cap on £60 million. The £60 million is an estimate of what we may spend next year but the liability, no matter what it is, will have to be met next year, the year after and if it costs more than £60 million next year, I will be coming into the House with a Supplementary Estimate to cover the extra costs.

At the end of September, Postive Action published a draft Bill which encompassed many issues relating to compensation and health care issues. The Government's position on a statutory scheme and the question of an admission of liability by the State was made clear by me on a number of occasions to Positive Action and in this House. The Government's position was set out in detail by me also in a letter I sent to all Members on 13 October and at the end of October, Positive Action agreed to my request to enter further discussions.

During November further extensive consultations and negotiation with Positive Action and Transfusion Positive took place with my Department and many of the concerns expressed during the negotiations have been addressed and are reflected in the amended compensation scheme, a copy of which has been circulated to all Members. It is not true that there was foot dragging by the officials of my Department. My Department's senior officials worked late into-the night and at weekends and members of Positive Action and Transfusion Positive can vouch for several meetings held outside normal office hours. At the risk of embarrassing my officials it is worth noting that the Civil Services grades entitled to overtime are limited and all senior officials do not get anything extra even if they work all night. There is no recompense for civil servants at the senior level involved in this work for working weekends or at nights and a small bit of appreciation is appropriate now and again.

The scheme of compensation approved by the Government offers numerous advantages as opposed to court proceedings. The advantages for tribunal applicants include speed, informality, flexibility and privacy; negligence need not be proved; the right of court action is preserved unless and until an award is accepted; proceedings before the tribunal are not excluded from judicial review. I reiterate that proceedings before the tribunal are not excluded from judicial review. As I said in reply to a question from Deputy Geoghegan-Quinn, the proceedings of the tribunal may be reviewed judicially if we want them in a positive rather than a negative way. The concept of a provisional award, which is not available in Irish law, allows a claimant to return to the tribunal for future specified, unexpected consequences of the hepatitis C infection. This is a particularly important option for claimants given the uncertain nature of the infection; the scheme is optional and imposes no disadvantage.

There is nothing in the tribunal which prevents persons from taking their case to the High Court. There is nothing in the tribunal which prevents persons from rejecting an award if they think it is inadequate and then proceeding to the High Court. The intention in setting up a tribunal was to provide an alternative to the High Court. The High Court provides a statutory way in which to process compensation claims. It was as clear as crystal at the start that the alternative would be informal and non-statutory. We did not need a statutory scheme because the statutory route to dealing with compensation claims is through the High Court. It is important to stress the concept of a provisional award as this is not available in Irish law, it is in English law, and is not available in the High Court. I repeat it would not be possible for me either legally or politically to bring in a statutory scheme to provide for provisional awards in respect of persons to whom the tribunal will apply as I would be forced into extending it across the range of compensation claims. Members know the length of time it takes to draft legislation and then to secure its passage through this House. Deputies will appreciate that if we had to extend a statutory tribunal that can make provisional awards and payments by instalments, it would apply to every case of compensation that goes through the courts whether as a result of a motor car accident or falling into a pothole. Deputies will appreciate that one of the primary reasons I am not going the statutory route is that I can provide a much better facility to those who are claiming compensation by going the non-statutory route. It is very difficult when acting in the best interests of persons involved to be accused of being slipshod, penny-pinching, uncaring and not taking people's views into account. There is none of that; I have no doubt that this is the direction to follow and it is in the interests of applicants.

I should say also that I have a responsibility to members of Positive Action and Transfusion Positive. My primary responsibility is not to members of any particular group but rather to individuals who have hepatitis C or antibodies. It must be left to individual choice whether to take one route or another; I must offer individuals that choice after the conclusion of appropriate negotiations. I cannot hold up a scheme indefinitely which is to the benefit of so many individuals who must also be given a right to process their claims.

As I said, a tribunal based on a statute would present many technical difficulties — I mentioned one — if it were to encompass many of the benefits I highlighted. Of its very nature a statutory tribunal would also be more formal, less flexible, unwieldy, subject to greater delays and would carry potentially substantial legal costs. We are all familiar with the issue of costs vis-à-vis the Tribunal of Inquiry into the Beef Processing Industry. I am not contending that this tribunal would be a replica of that body. I am saying that the legal profession, above all others, knows how to charge and how to devise schemes carrying legitimate charges if it can render them complicated. Being aware of the amount of money being claimed for the production of a Private Members' Bill, I would advise Deputy Geoghegan-Quinn that, based on her work as Opposition spokesperson on Health, she is worth approximately £250,000 annually if she were paid the same rates. Let us call a spade a spade. I am not going to be placed in the position in which a proportion of taxpayers' money — which we are dedicating to process legitimate claims, through which we want fair compensation to be paid to persons involved — may be frittered away, with several millions of pounds expended on many totally unnecessary processes. That is the cost issue and there is no saving to be had by following the compensation or High Court route in terms of compensation. This compensation cannot work unless the tribunal pays the equivalent High Court rate because, if they attempt to pay a lesser rate, people will be advised that that rate is not on a par with that of the High Court, awards will be refused and claimants will resort to the High Court. That is why we are taking this route.

With regard to the permanence of the Government's compensation scheme, Positive Action has sought a statutory tribunal on the basis that a statute would guarantee the permanence of such a tribunal. A statutory scheme offers no such absolute guarantee of the permanence of a tribunal, as every Member knows, because any Government can change any statute drawn up by itself or any of its predecessors.

However, there are a number of safeguards against the abolition or future amendment of the Government's scheme to diminish the rights of applicants to the tribunal. These include: the terms of any award made under the Government's scheme would be enforceable before the courts; and any abolition or future amendment of the Government's scheme to the effect of diminishing the rights of applicants to the tribunal would be subject to judicial review.

The following are the amendments to the scheme which the Government has approved following on my consultation with Positive Action and Transfusion Positive: (i) the scheme has been extended to include transfusee claimants who have been diagnosed positive for hepatitis C antibodies/virus; (ii) the children and partners of transfusee claimants who have been diagnosed positive for hepatitis C antibodies/virus are also included; (iii) the purpose of the scheme has been extended to include that the scheme shall continue indefinitely; (iv) the State will not rely on the Statutes of Limitation so that no claimant by virtue of those statutes may lose their legal right to initiate proceedings against it because of making a claim to the tribunal; (v) the discretion of the tribunal to hear oral evidence has been extended; (vi) the making available of medical and other expert reports to claimants is explicitly incorporated in the scheme; (vii) a claimant to whom an award has been made by the tribunal shall be awarded the legal costs and expenses associated with the claim; (viii) the time within which claimants must apply to the tribunal has been extended from three months to six months; (ix) in the case of minors and persons of unsound mind, the claims can be made within six months of the cesser of their legal disability; and (x) the reports of the tribunal shall, in so far as is practicable, not identify any claimant.

On the preservation of legal rights the scheme to compensate certain persons who have contracted hepatitis C does not provide for an appeal against the award made by the tribunal. However, if a claimant is not satisfied with the award made, it can be rejected. It is open to such person to initiate proceedings or continue proceedings in the courts. By making an application to the compensation tribunal, a person's legal right to pursue a case arising from the same circumstances is not in any way diminished. In any event, if an appeal system from the award made by the tribunal was to be included in the scheme of compensation such would be an appeal to the High Court. As I stated, a person's legal right to pursue a claim in the courts is preserved in the event that a person rejects an award made by the tribunal. While not a formal appeal, whenever someone rejects an award, he or she will still have recourse to the High Court, which means it has the same effect.

On the question of oral evidence, the discretion of the tribunal to hear such has been extended beyond what was contained in the original scheme published by the Government in June last. While the tribunal will rely primarily on written medical reports, having considered such reports, it may notify the claimant that oral evidence of some or all of such reports will not be required. However, upon receipt of such notice, the claimant may inform the tribunal in writing of any reasons he or she considers that such evidence should be heard orally and the tribunal, having considered such reasons, shall notify the claimant of its decision to receive such evidence orally. If it refuses to hear such evidence orally, it will have to be sure that it acted in accordance with the rules of natural justice. If somebody does not like such a refusal, their legal representative can appeal it for judicial review. This means that a claimant's position is preserved in the manner in which we have structured this compensation scheme.

The discretion of the tribunal in relation to provisional awards was inserted in case an applicant chose a provisional award when a lump sum award clearly would be in his or her best interests. The Government considered this necessary, lawyers in Ireland not being familiar with the concept of provisional awards which are not available in Irish law. In English law, the courts have discretion in relation to making provisional awards when a claimant chooses to apply for such an award. The Government considered it to be of benefit to applicants that the tribunal should retain its discretion in this regard. That provision was incorporated deliberately, not in the interests of the Government, the Exchequer or the Department of Health but rather in those of the applicants in case that lawyers, unfamiliar with the provisional award system — as they all are in Ireland because it does not exist — would advise an applicant to proceed in a certain direction which would not be in his or her best interest. The tribunal will oversee that provision.

In the generality of cases, whenever somebody applies for a provisional award the tribunal will agree but a very small number of circumstances could arise in which somebody was badly advised to apply for a provisional award when they should have gone for full and final settlement. For example, if somebody is advised to opt for a provisional award in circumstances in which the medical prognosis shows that their state of health will not change, there is no point in opting for a provisional award because they would be cutting themselves short and would be much better obtaining a larger award in full and final settlement; that is all that is involved there.

The tribunal will be presided over by a very senior judge of the Supreme Court. It is not as if we were appointing people who did not understand compensation issues; that is the manner in which it will work in practice. It is very frustrating when some provision, included for the benefit of applicants, is turned around and used as a stick with which to beat me, as Minister, as if I were endeavouring to subtract from their rights whereas I am endeavouring to give them additional ones.

Notwithstanding the many concessions which I have outlined, Positive Action has in recent days reasserted its demand for a comprehensive statute dealing with compensation or, as a possible alternative, sought further concessions which have already been the subject of extensive negotiations. The Government considers that no further concessions can be made.

Many of the concerns expressed in relation to the Tribunal make it quite clear that there is a degree of misinformation and misunderstanding about the compensation scheme. A number of these concerns are misplaced. I would strongly suggest that individual claimants discuss their particular circumstances with their solicitor.

It is my intention to formally establish the compensation tribunal later this week. An announcement will be made in this regard and application forms will be made available to potential applicants. I have every confidence that the compensation scheme will operate successfully, thus ensuring that the Government's commitment to provide fair compensation for those persons who have contracted hepatitis C from blood products or blood transfusion will be honoured.

The House will agree that this has been a long and difficult process for everyone involved. I am sure that the House will also agree that the comprehensive health care package, taken together with the amended compensation scheme, represents a clear demonstration of the Government's commitment to providing an extensive range of high quality health care services into the future and fair compensation for these people.

I wish to share my time with Deputy Moffatt. I am very happy to support the motion. It is both sensible and timely and I fervently hope it receives the full support of all sides of this House. Before commenting on the specific proposal before us it is appropriate to briefly consider the nature of the current hepatitis C problem. A large number of people, mainly women, have become infected by the virus as an accidental consequence of receiving medical treatment. Some of the affected people have contracted the virus as a result of receiving contaminated anti-D vaccination which was administered to protect the health of the child. Most of the other victims of the use of contaminated blood products have been recipients of blood transfusions, usually received either as a consequence of surgery or as part of therapy for a blood related disorder. A much smaller group of victims consists of either partners or children of people directly affected through the anti-D vaccination or as a result of receiving contaminated blood products. While any episode of illness is unfortunate and to be regretted it is particularly upsetting when the problem occurs in the manner suffered by the vast majority of those currently presenting with hepatitis C infection.

It goes without saying that all those infected by the virus have the full sympathy of each Member of the House and the community at large. Sympathy alone, however, is neither sufficient nor adequate support for those people. In particular, we in this House must take every step to ensure that two further levels of support are provided. We must be sure that the most comprehensive and advanced possible level of treatment is made available to each person affected by that condition. This must involve support at both hospital and at community level where appropriate. All necessary diagnostic facilities must be proved to ensure that the medical condition of each patient is accurately assessed on a regular basis. If there is evidence of deterioration in a patient's condition, it is vital that all necessary treatment is immediately available. We must take all possible steps to ensure that the most recent reliable international findings regarding optimal patient therapy are immediately taken into account in this regard. The patients and their families have suffered enough already. It is vital that they now have the security and peace of mind which comes from knowing that the very highest possible level of care is automatically available to help them deal with their infection. As well as providing comprehensive medical assessment, monitoring and treatment facilities, it is equally important that the patients and their families receive the highest possible level of counselling support to help them deal with their situation.

On a somewhat brighter note it must be acknowledged that much has been achieved to date in dealing with this unfortunate matter. A reasonably effective screening programme has been initiated to help identify to the greatest possible degree those directly affected by the use of contaminated anti-D vaccination. Similarly, a system has been put in place to identify possible victims of the use of contaminated products in blood transfusions. The Department of Health has invested significant resources in its treatment centres around the country. All these steps have made a positive contribution to the situation and it is important to acknowledge the wholehearted efforts of people from a range of sectors, including health care administrators, medical and nursing staff, laboratory personnel and counsellors. There is no room for complacency, however, and a sustained programme of planning, assessment and inmplementation is required if the matter is to be dealt with effectively.

There is another level of support which is equally vital to those affected by the accidental use of blood products contaminated with the hepatitis C virus. That involves the provision of a proper level of compensation to each and every person. It is vitally important that the process of providing such compensation be carried out in the most effective and considerate manner possible. It is only correct that the Minister should approach this matter in a deliberate and prudent manner on account of the major liability which has accrued to his Department because of this disaster, but most fair-minded people would have to agree that more than enough time has gone by to allow the Minister to develop a comprehensive and satisfactory compensation system to deal with the concerns of all those involved. The matter came into the public arena in February of 1994, yet we are still awaiting the conclusion of a fair and equitable agreement on compensation. This is simply not good enough for the many people whose lives have been turned upside down through no fault of their own.

The Minister now has an urgent moral duty to take all possible steps to remove any remaining blocks in the way of a full settlement. The patients and their representative groups are fully entitled to insist that any mechanism adopted to deal with the matter is both fair and secure. While substantial progress seems to have been made in relation to the fairness of the proposed tribunal, a further decisive step is required to ensure the security of any agreement. This requires that the proposed provision be placed on a full statutory basis. The motion before us is designed to provide such security.

At this stage it is imperative that the matter be brought to a final conclusion since delay in various forms has from the outset been a major source of aggravation to those involved. I sincerely hope the Minister and the Government parties take this opportunity to provide a satisfactory working environment for the tribunal which is to begin its proceedings at the earliest possible time.

I would again like to place on the record my full support for the concerns and needs of those affected by this unfortunate episode in the medical history of this country. While some may argue that the original use of infected anti-D vaccination could not reasonably have been avoided because of the simple fact that the hepatitis C virus was unknown at that time, it must be agreed that an early opportunity to react to the problem was missed. Consequently patients' treatment has started at a somewhat later date than would otherwise have been the case. Against such a background it is vital that this House acts energetically and decisively to assist the victims in every possible manner. A clear-cut opportunity in this regard is placed before the House tonight with this motion.

I compliment Deputy Geoghegan-Quinn on tabling this motion. Ever since the hepatitis C issue became a problem here, she has followed it up relentlessly. In doing that she has taken great care to look at how women, men and children have been affected by this problem. The Minister has also done his bit; he has looked at it continually and improved matters. Unfortunately, to date his best effort has not been good enough from the point of view of the people involved, especially people who have been infected and their representative groups, Transfusion Positive and Positive Action.

The main stumbling block at the moment is the question of an ad hoc tribunal versus a statutory one. Despite what the Minister has said, his reassurances have not been sufficient to placate those people who are still worried that the ad hoc tribunal is simply a tribunal for now. What will happen down the road? Hepatitis C is a peculiar problem. We think we know all about it, but we do not. Even the experts do not know what the end result of hepatitis C may be for quite a number of patients, some of whom were infected but cleared the virus out of their system, some of whom still have the virus in their system, and those whose livers are damaged.

The hepatitis C saga should never have happened. Mistakes were made at the Blood Transfusion Board and the State is liable for the consequences of those mistakes. Anti-D immunoglobulin was supposed to protect women in future pregnancies from rhesus disease, but unfortunately the product itself was infected and many of the women who were given it have since experienced problems with hepatitis C. The virus was also transmitted through contaminated blood. The first problem facing the Government was to get rid of the contaminated product, which was done speedily. The Minister initiated a programme of blood testing, etc., to discover how many people were infected. He moved the goal posts on a number of occasions and improved the programme. However, people were not happy with it and the programme was improved.

We know the extent of the problem but treatment is a different matter. Despite blood tests, liver biopsies, etc., it is not satisfactory. Interferon may help temporarily and stop the process for a time but it is not a cure. Those who are infected do not know what will happen to them. They may experience general ill-health, liver damage which may be chronic, chronically active, active or result in the complete breakdown of the liver system. In such cases the only treatment is a liver transplant. Even if one has a liver transplant hepatitis C may not be cleared out of the system and may affect the transplanted liver. That is why Positive Action is so worried about the long-term effects of hepatitis C and the ad hoc system the Minister has put in place.

Will ongoing treatment be available for such people in ten or 20 years' time? People are not concerned primarily about compensation but about their health. How will it be looked after today, tomorrow and in the future? The Minister has not answered that completely. He stated the ad hoc tribunal will look after those who are infected and ensure compensation is paid. However, they are not convinced and neither are we. If we were, we would not have tabled this motion.

The Minister stated he is setting a number of health services in train. He has broken it up into primary and secondary health care services, a special research programme and a statutory monetary body. Much of that is pious aspirations. Has he negotiated free treatment with general practitioners? Has he told the health boards what extra provision will be made in the budget for these new programmes? The Minister spoke about dental, aural and independent counselling services. These services are overcrowded and there is often a long waiting list. The Minister said he will guarantee these services will be available but no specific provisions have been made with the health boards to ensure that the programme will be in place when it is required. Home help and nursing homes are other areas that must be examined.

The Minister made provision for people in need of tertiary care in St. James's Hospital, Beaumont, St. Vincent's, Cork University Hospital and University College Hospital, Galway. Many people alluded to the fact that there is not anything available in Limerick. If it had been possible I am sure the Minister would have a programme fully operational in Limerick. However, there are not many hepaticologists and the service must be provided in the hospitals where they operate.

Will the services be available? One such service is access to in-patient and out-patient treatment. That is available if people are prepared to wait. Most people are exempted from hospital charges. As regards appropriate staffing levels and arrangements for staff training, how will staff numbers be increased if there is an embargo on staffing in health boards? There is a problem in the Midland Health Board. How will the Minister provide the extra funding? There is a great difference in the service provided by various health boards, one may provide a good service, another a mediocre one and a third a service I would rather not mention. Those are the problems facing the Minister.

Although he is making a great effort those infected with hepatitis C are not happy with the ad hoc tribunal. They want something in writing, on a statutory basis, that will outlive this and other Governments so that in 30 years' time children who are affected today by hepatitis C will have statutory rights. The Minister should explain a number of elements of the programme he has in train, especially in relation to liver transplantation treatment outside Ireland. This may not be a big factor because, fortunately, we have good hepatologists and liver transplant provisions.

Debate adjourned.
Top
Share