Dáil Éireann debate -
Tuesday, 27 Feb 1996

Vol. 462 No. 2

Health (Amendment) Bill, 1995: Second Stage.

Minister for Health (Mr. Noonan,

Limerick East): I move: “That the Bill be now read a Second Time.”

The purpose of this Bill is to make provision for primary health care services free of charge for persons who have contracted hepatitis C from a blood product or blood transfusion.

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 immunoglobulin and the identification of any risk for mothers who received the anti-D product in the past. The first objective was met by the immediate introduction of a new virally inactivated anti-D product to all maternity hospital units and the second objective was met by the launch by the Blood Transfusion Service Board of the national screening programme for anti-D recipients.

The 58,905 women who received anti-D between 1970 and February 1994 have been screened under the national blood screening programme and 980 have screened positive for hepatitis C antibodies, of whom 466 have tested positive for the virus. A targeted lookback programme to identify persons who had contracted hepatitis C from a blood transfusion was also undertaken. To date 263 living recipients have been traced under this programme. Testing for hepatitis C antibodies has been carried out on 208 persons and testing for hepatitis C virus has been carried out on 176 persons, of whom 72 have evidence of continuing hepatitis C infection.

The optional screening programme commenced in early September 1995 to trace a small number of persons who may have contracted hepatitis C from a blood transfusion who would not be traced under the targeted lookback programme. Some 7,901 persons have come forward for testing to date, of whom 20 have been confirmed positive for hepatitis C antibodies and 15 are positive for hepatitis C virus. The Government is committed to providing a high quality health service for all persons who have contracted hepatitis C from a blood transfusion or a blood product. Substantial progress has already been made during the past year in meeting the many complex and varied health care 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, the Irish Kidney Association and the Irish Haemophilia Society.

Many of the concerns, particularly about future health care arrangements expressed by these groups have been addressed. The special health care programme involves an extensive range of services in the following areas: (i) secondary health care services; (ii) primary health care services; (iii) special research programme; (iv) statutory Monitoring Body.

Secondary health care treatment for those persons who have contracted hepatitis C from a blood product or blood transfusion has been provided since early 1994 at special consultant staffed clinics at six designated hospitals: St. James's Hospital, Dublin; Beaumont Hospital, Dublin; Mater Hospital, Dublin; St. Vincent's Hospital Dublin; Cork University Hospital and University College Hospital, Galway.

Specific funding will be provided in the Book of Estimates each year to ensure the consolidation and maintenance into the future of a high quality hospital in-patient and out-patient service including prescribed medication for persons who have contracted hepatitis C from a blood transfusion or blood product. The secondary care element of the health care services programme includes provision for: (i) access to in-patient and out-patient treatment; (ii) non-payment of hospital charges; (iii) appropriate staffing levels and arrangements for staff training; (iv) equipment for hepatitis C units; (v) anti-viral therapies and therapy initiation programmes; (vi) liver transplantation; (vii) treatment outside Ireland where necessary; (viii) liaison between the hospital service providers; and (ix) 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. These secondary care services are being provided for under the Health Act, 1970.

The Government recognises the need for specific research in relation to hepatitis C particularly in view of the fact that hepatitis C was described for the first time in 1989 and that a reliable screening test had only become available in 1991. I have, therefore, arranged with the Health Research Board, for the establishment of a special programme of reseach on hepatitis C including research projects into hepatitis C as it relates to persons infected through the use of anti-D product. I have provided special funding of £100,000 to the Health Research Board to enable this special research programme to commence this year.

To ensure that the health service as it relates to persons who have contracted hepatitis C from a blood product or blood transfusion is responsive to the changing needs of such patients, I am establishing a statutory consultative council which will advise me on matters relating to hepatitis C. I have circulated a draft establishment order to interested groups for their views. 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 in relation to the special programme of hepatitis C research projects.

Following consultation with interested groups, I am currently considering a number of amendments to the draft establishment order to take into account the views expressed by these groups. The secondary health care services, the consultative council and the research programme do not require new legislation as there is already statutory provision for these initiatives.

As I have already indicated, the purpose of the Health (Amendment) Bill, 1995, is to make provision for primary health care services free of charge for persons who have contracted hepatitis C from a blood product or blood transfusion. The primary health care services to be provided by the Bill, free of charge and without a means test, are: general practitioner services including prescribed drugs and medicines; dental, ophthalmic and aural services; independent counselling services; home help services; and home nursing services.

In relation to the general practitioner services, those persons entitled may attend the general practitioner of their choice for all medical conditions.

The dental, ophthalmic and aural services will be provided for these people within the meaning of section 67 of the Health Act, 1970. Home help services within the meaning of section 61 of the Health Act, 1970, and home nursing services within the meaning of section 60 of the Health Act, 1970, will also be provided free of charge to persons who have contracted hepatitis C from a blood transfusion or a blood product. These arrangements will also apply to the children and partners of persons who have contracted hepatitis C from a blood product or a blood transfusion if such children and partners have also been diagnosed positive for hepatitis C.

Following consultation with the interested groups I propose to introduce an amendment on Committee Stage to clarify the entitlement for these specific categories of patients to be treated by the general practitioner of their choice for all medical conditions.

The Bill provides at section 2 that a health board shall make available certain health services without charge to persons who have contracted hepatitis C directly or indirectly from the use of a human anti-D product. I propose to introduce an amendment to this section on Committee Stage to include persons who have contracted hepatitis C from a blood transfusion or other blood product. It was always my intention to include these additional categories of patients by way of regulation, as is clear from the health care package for hepatitis C patients which I published in December 1995. However, following consultation with the representative groups I now propose to include these specific categories in the substantive legislation to allay any concerns that their members may have.

I also propose to introduce an amendment on Committee Stage to allow the chief executive office of the relevant health board to determine eligibility for these services within his discretion. I am introducing this amendment following detailed discussions with Transfusion Positive to meet their genuine concerns regarding difficulties that might arise in acquiring past medical records for a number of their members.

In detailed discussion with Transfusion Positive over the last number of weeks officers of my Department offered to give all necessary assistance to their members who were meeting difficulties in locating past medical records. Transfusion Positive subsequently wrote to all their members and yesterday details of eight persons who were encountering difficulties were forwarded to my Department.

On Committee Stage, I also propose to bring forward an amendment to include a provision in relation to a commencement order. This will allow me time to finalise the necessary arrangements to ensure the provision of a high quality primary health care service.

In relation to the provision of the general practitioner services free of charge, I hope to commence negotiations with the general practitioner representative groups in the immediate future. I trust that the co-operation shown recently by these groups in working successfully with my Department in relation to launching the optional testing programme will carry forward into the provision of these services.

It will be necessary also to finalise arrangements in respect of the delivery of dental and other primary health care services outlined in the Bill. I am confident I will be in a position to make the commencement order at an early date to put the services provided for in this Bill into effect. I assure the House that whatever financial resources are necessary to meet the cost of these new services will be made available by me to the health boards.

In addition to providing for the health care needs of these persons, the Government is fully committed to fair compensation for those persons who contracted hepatitis C from a blood product or blood transfusion. I established the compensation tribunal on 15 December 1995 and three priority cases have been heard to date. I understand that the tribunal has also listed cases for hearing during the months of March and April. I have every confidence that the tribunal will operate smoothly, efficiently and fairly.

The Health (Amendment) Bill, 1995, will copperfasten the Government's commitment to meeting the future health care needs of persons who have contracted hepatitis C from a blood transfusion or a blood product. The health care services, both at primary care and secondary care levels, will meet the genuine concerns in relation to the continued provision of high quality health care into the future for those who have contracted hepatitis C.

I commend the Bill to the House.

Mrs. Geoghegan-Quinn

I move amendment No. 1:

To delete "now" and add at the end of the motion the following words:

"when the tribunal providing for the payment of compensation to persons who have contracted hepatitis C directly or indirectly from the use of human immunoglobulin-anti-D and to persons of such other classes (if any) as may be prescribed is placed on a statutory footing".

This is the fifth occasion in the House in the past number of months that there has been an opportunity to discuss hepatitis C. One would have expected that in the time between debates and question times some headway would have been made on the issues involved. That is not the case and most of the issues remain as they were six months ago. The only progress that has been made relates to the legislation before the House. However, the Bill has been brought forward only after intensive efforts by Fianna Fáil and the Progressive Democrats and groups representing the victims of hepatitis C. The demands of victims were resisted every step of the way by the Minister until eventually he had to take some action. Even when he did agree to publish a Bill he broke his commitment to consult the groups representing victims prior to publication.

When the Bill was published on 18 December 1995 it had all the signs of being rushed. For example, it failed to make any reference to those who were infected with hepatitis C through blood transfusions. If this was an oversight then it was a most serious one as those infected through transfusions are a most vulnerable group. Many of them have life threatening conditions as a consequence of hepatitis C. Many of these victims have not let their employers know they have hepatitis C so they are bearing their condition in silence and in private.

If the Minister was hoping to get one over on them, because they do not wish to go public, it was a cheap political manoeuvre. It has also backfired. Public pressure has forced the Minister to consider amendments to his Bill. If those amendments are not adequate — while I welcome them as announced in the House today — I will table, on behalf of Fianna Fáil, more inclusive amendments.

As far as the Health (Amendment) Bill goes it rightfully puts on the Statute Book the Government's commitment to provide, without charge, certain health services to a category of persons who have contracted hepatitis C. Their need for quality health care is compelling.

Hepatitis C is a serious and potentially life threatening virus for which there is no effective cure. According to the virus reference laboratory at University College, Dublin, up to 75 per cent of those infected with hepatitis C develop chronic hepatitis. About one in five patients with chronic hepatitis C virus infection develops cirrhosis of the liver. Hepatitis C is a most uncertain disease. The type which most of those infected through anti-D have is the least responsive to the standard interferon treatment. Those with hepatitis C antibodies are continuing 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 which are 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 they are faced with possible irreversible liver damage. While some might feel a liver transplant would be the solution, hepatitis C infection almost universally recurs in a newly transplanted liver.

Those who have hepatitis C include over 1,000 mothers who caught it from contaminated blood products administered when they were giving birth. 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. Renal transplant patients and haemophiliacs have also been infected. All these people believed they were getting something which would save their lives and possibly that of their children. Instead, through the negligence of the State, they were administered a deadly virus.

The responsibility of the State in this matter was accepted by the Fianna Fáil/Labour Government once the tragedy and consequences became apparent. A quality health care commitment was given by that Government in 1994 and, to copperfasten it, a promise was made to introduce legislation. The then Minister for Health, Deputy Howlin, was asked to bring forward a health care package and legislation. The Government was briefed on a regular basis and told this was progressing. When the new Government took office in December 1994, we heard regularly after that from the Minister for Health about the promises of quality health care. However, the package and the legislation were slow to materialise.

In June 1995, when the Minister announced his flawed, ad hoc hepatitis C compensation tribunal, he made no reference whatsoever to the health care needs of the victims. He no doubt believed foolishly that money would solve all his problems and that this was all the victims wanted. In fact, of greater concern to the groups representing victims is whether ongoing treatment will be available in ten, 20 or even 30 years. This is why they are so concerned about the ad hoc nature of the tribunal. They are not primarily concerned about compensation but rather about their health. They want to know how they will be treated today, tomorrow and in the future.

Their concern about health care spurred them into tough and lengthy negotiations with the Government and the Minister for Health. The Minister eventually gave a commitment to produce a health care package and to put it in statute. Two years after the promise was made the package and Bill emerged. The Bill represents part of the package and, provided the correct amendments are brought forward, it will eventually be sufficient to deal with the matters involved. The other part of the package spells out in detail the hospital, general practitioner and other services which will be provided to the victims. It includes reference to counselling services and allows for the establishment of a consultative council which will have a role in monitoring the services.

The Health (Amendment) Bill and the health care package will only be as effective as the resources provided for it. The health care package must not end up as a collection of aspirations which are never delivered. Adequate funding for primary health care must be provided. Funding of £2 million was included in the 1996 Health Estimate to cover hospital in-patient, out-patient and counselling services. This strikes me as a rather inadequate allocation given that a recent study found it costs approximately £5,000 a year to treat each person who develops chronic hepatitis. Three-quarters of those with hepatitis C will reach this chronic stage. Based on these figures the drug treatment bill alone could be over £4 million a year.

What does the £2 million Health Estimate allocation represent? Will next year's allocation be more and at what rate will it increase over time? Is this £2 million in 1996 just to cover the six clinics and will health boards provide further money for primary health care? Other questions also arise in relation to the health care elements of the Minister's proposals. Has the Minister undertaken and completed discussions with representatives of general practitioners in relation to hepatitis C patients? Has the Minister negotiated a package so these patients will now be able to attend surgeries free of charge for all conditions?

Up to now, infected victims had to pay for visits to their GP from their own pockets. However, some general practitioners have refused to take money for such visits because of the tragedy and how it has affected their patients. I commend such general practitioners. However, given that this was a tragedy caused by the State, doctors should not have to pick up the tab for the negligence of the Blood Transfusion Service Board.

Will the Minister outline the fee which has been negotiated with doctors and will he state for what period that fee agreement will apply? Has the Minister addressed the concerns raised by some of the groups representing victims in relation to the failure of the General Medical Service payments scheme to meet the cost of some services required by individuals? Will the Minister also explain if the agreement involving doctors and the Department of Health will allow for the time which will be needed for doctors to deal adequately with hepatitis C victims? For example, will it allow for the time envisaged in the health care document for the provision of counselling services?

The Bill places an onus on health boards to make services available to victims. Will the Minister outline the negotiations which took place with each health board? Will the health boards receive additional funding to provide these services? If so, will the Minister outline the amounts in detail in each case? Has the Minister told the health boards what extra provision will be made in the budget for these new programmes? In addition, how will the delivery of these services impact on waiting lists in each health board area?

In the health care document there is provision for dental, oral and counselling services. These services are stretched and overcrowded; there are already long waiting lists and they are longer now then they were a year ago. Will hepatitis C victims have to join the queue? If they do not, does it mean the queues will get longer or will the resources be provided to health boards to keep the queues moving and the hepatitis C victims looked after? In addition, will the Minister outline how the public service embargo will apply in relation to hepatitis C? Will staff numbers be increased in health boards? Will in-patient and out-patient access be fully available all the time? Will all charges be waived and will they stay waived?

Will somebody ensure the services provided by each health board are up to a national standard as one health board — as we have often discovered — may offer a good service, another may offer an adequate one and more perhaps may provide a poor one? Who will provide the extra resources to ensure a health board's services come up to scratch? The intention behind the legislation is to provide the hepatitis C victims with the guarantees they deserve in relation to health care. They do not deserve a health care agreement which is not properly funded. Fianna Fáil will demand answers in the debate and on Committee Stage on the specifics of what will be provided and how it will be funded.

The Bill provides for a number of other services in addition to general practitioner attendances and drugs. As the Minister said, it provides for dental, ophthalmic and oral treatment and home care and counselling services. These may appear generous terms, but the reality is that, unless statutory provision is made for them, those infected could be refused access. Already some of the victims have been refused treatment by their local dentist. The dentists say they can no longer give them a simple filling because they do not accept the risk of treating a person they know to have hepatitis C.

Dentists who treat victims have altered appointments so that victims are taken at the end of the day. Such stigmatisation is difficult for many victims to bear. Victims have also had to meet the cost of additional sterilisation requirements. The humiliation of refusal and being singled out, as lepers were in the past, has created enormous hurt among victims. It is also right that the provision of a range of medical services, including dental services, is included in the Bill as at least it ensures treatment and an end to discrimination of victims.

Another medical service covered in the Bill relates to ophthalmic services as eye problems have been identified as a side effect of hepatitis C. The individuals who are infected had to bear the cost of additional medical attention they required. Home help and nursing services will also be provided under the terms of the Bill. As there is no cure at present for hepatitis C, the health of many victims has already deteriorated while the health of others will worsen over time. They may experience general ill health and liver damage ranging from chronic to a complete breakdown of the liver system. The provision of nursing services means families will not be forced to take upon themselves the total burden of care. Not all of those infected will require a service of this nature but it is essential that all health boards operate this provision where and when it is required. That must be done with generosity; victims cannot be made to feel they are under a compliment to the particular health board.

Since this controversy began three years ago the provision of counselling services has been a great weakness in the State's response; I would go so far as to say it has been a disgrace. It was a disgrace that the Blood Transfusion Service Board, the guilty party in this affair, was given the job of counselling. What the board undertook was a damage limitation exercise. Women were asked questions about their lifestyle, ear piercing, tattoos and so on. The counselling did not offer any comfort; the women even felt worse after it. Those who availed of the service were treated coldly, callously and without respect. They felt isolated and that they had been dismissed.

The expert group, which produced a fine report on the hepatitis C controversy, stated that the board should have no future role in counselling. That was a correct recommendation but the Minister was slow to make changes and political and support group pressure again had to be applied. A detailed counselling scheme has not yet been agreed and the services currently in place are far from adequate. Independent professional counselling services are not available nationwide. I am using this opportunity to ask the Minister for Health to specify the funding he is allocating for counselling services. I also want him to outline how he plans to expand the services to meet the current demand which will continue well into the future.

Regulations are to accompany this legislation. When will these be published and will they be discussed with the groups representing victims before their introduction? These regulations are an important feature of the legislation and they should reflect fully the intention of the Government to provide quality health care services to the hepatitis C victims.

Considerable concern has been expressed about this Bill because it did not make any mention of those who contracted hepatitis C from blood transfusions. There was also a difficulty in relation to the health care document because it provided for special hepatitis C wards in hospitals. Those who wished to maintain privacy would be immediately identified as victims if they were corralled into these special wards. I understand negotiations have been continuing for some time on these difficulties and amendments and changes are to be brought forward by the Minister. There will be a guarantee opt-out on the designated wards and letters are to be provided by hospitals which will be made available to the victims. I am happy enough with this compromise but I remain concerned about the qualification for health care of those who contracted hepatitis C from transfusions and other sources. I understand the new arrangement is that if a victim gets a medical consultant to write a letter saying that person has hepatitis C and had a blood transfusion, the chief executive officer of a health board can allocate them a hepatitis C card and health care. I am concerned in that if a medical consultant refused to give such a letter because there was some other factor involved, how would the hepatitis C victim obtain health care? What if the health board chief executive officer disagreed?

As I have said many times in this House, I am extremely concerned at the ad hoc nature of the compensation tribunal and the rules and regulations applying to it. These difficulties could eventually spill over into the health care element, particularly if a person is refused compensation by the tribunal. Will that person then be entitled to quality health care?

The Minister for Health's handling of the hepatitis C controversy has been a matter of some comment in the media and in the House. It is no secret that I have been critical of his handling of the issue. I thought my concern would abate with time but unfortunately this has not happened. The latest matter to set the alarm bells ringing concerns the Minister's treatment of the funding for the groups representing victims. As I understand it — perhaps the Minister would clarify this when responding — their lottery funding has been stopped and they are now dependent on funding from the Department of Health. I detect — perhaps I am wrong — a distinct element of muzzling of the support groups in this regard. The implication seems to be that unless they tone down their public comments and play the Minister's game, they could find themselves short of funds.

The Minister is holding rigidly to his position on the tribunal despite all the apparent difficulties. Those claiming at the tribunal do not have the right to appear before it or indeed the right to have oral medical evidence heard. There is not any right to a provisional award even though hepatitis C is such an uncertain disease. The flawed, ad hoc nature of the tribunal has not yet been resolved. The most serious difficulty has been the failure of the Minister for Health to make any concession on the balance of probability requirement. This heavy onus of proof that is put on the victims is likely to result in many of them failing to meet the criteria for the tribunal. That could happen because medical records are lost or because it is impossible to prove conclusively the link between the blood or blood product they received and hepatitis C contamination.

A number of other matters continue to concern me. The Minister for Health said on a radio show recently that he would make contact with the tribunal. The tribunal subsequently made very small awards to two people. Following that, the Minister said in the Dáil that the tribunal "will hand down awards and as soon as some of the very large awards are made, there will be a rush of applicants". How does the Minister know that large awards will be made? Is this a strategy he is expounding? How is it that even though the tribunal makes the award, the cheques come from the Department of Health? Why is the tribunal so sensitive to public comment and why does it want to silence anyone who criticises it?

The Minister is most naïve to believe that the lure of big money will somehow make the problem disappear. It is insulting to the groups representing victims to accuse them of simply being interested in the money. I can tell the Minister they are much more interested in health care than compensation and I call on him to apologise for the remarks he made in this House about compensation.

Mr. Noonan (Limerick East)

Rubbish.

Mrs. Geoghegan-Quinn

The Government has tried to minimise the State's responsibility in this affair at every turn. It is making the tribunal appear as charity. The application forms for the tribunal could lead to information about the individuals concerned being disclosed to their employers and to various Departments, including the Revenue Commissioners. The Government is trying to force victims to go before the tribunal rather than going to court with a legal challenge being mounted to one women's court application. Heavy handed letters are being issued by the Chief State Solicitor's office to those who decide to go the court route.

The Minister for Health has given information to try to lure others into the tribunal. Prior to Christmas, for example, the Minister said that 500 cases were ready to go but during Question Time at the beginning of this month he conceded that the tribunal had received only 72 applications. What happens, for example, in the case of victims who have died? No consideration is given, either at tribunal level or in the Department of Health, to such victims, their spouses, their partners, their children or their extended families. It would be important for the Minister to let us know what exactly the Government proposes to do for the families of such victims.

The Minister had denied that he circulated application forms for the tribunal to victims. Will he confirm that a personal message was sent by him to victims with individual application forms for the tribunal? In the past I called on the Director of Public Prosecutions to investigate whether a criminal prosecution should be brought in regard to this whole affair and in the past ten days I received a rather threatening letter in my mail as a result of that call. As this debate shows, this scandal has serious health implications. The Director of Public Prosecutions should investigate this issue because of the seriousness of the findings of the expert group which investigated the blood bank and found that it breached its own rules.

The events that occurred at the Blood Transfusion Service Board will hopefully never be repeated but the confidence of the public in the blood bank continues to be low. We all heard about a recent blood scare following the infection of an individual who had received a transfusion. An inquiry was ordered but its findings were inconclusive. I find it most surprising that no organisation, company or individual was found to be responsible, that the inquiry drew a blank but that would not convince me that much has changed at the blood bank since the expert group compiled its report. I intend, at the Select Committee on Social Affairs meeting later this week, to ask my colleagues to agree to issue an invitation to the management of the Blood Transfusion Service Board to appear before the committee at an early date. Above all, in relation to the board, there is a need for openness, transparency and, definitely, accountability.

I hope the Minister responds to my questions and I appeal, once again, to Government backbench Deputies in Fine Gael, Labour and Democratic Left, all of whom have given personal commitments to hepatitis C victims and their families, to support the establishment of a statutory tribunal. These Members have such opportunity now by voting for our amendment. Victims and their families will no doubt be watching with interest.

Ms O'Donnell

The welcome health care provisions the Minister is proposing in this Bill for hepatitis C victims form an integral part of a composite package which, regrettably, is still most unsatisfactory and with which the women concerned are very unhappy.

This legislation is being introduced following detailed negotiations with the groups, Positive Action and Transfusion Positive, which represent the victims of the hepatitis C scandal, the people who have been infected with a potentially life threatening virus due to the negligence of a State board in the manufacture of Anti-D immunoglobulin. The Bill provides for a statutory commitment to make available, without charge, certain health services to certain persons who have contracted hepatitis C. This is in line with a commitment given to the House in February 1994 by the then Coalition Government to provide free health services for the victims of this tragedy. The Bill is the result of two years of tough and protracted campaigning by the victims who have had to fight very hard to get the Government to agree to a health package which meets their needs. It reflects that agreement and gives guarantees to the victims. To that extent I welcome the provisions announced by the Minister.

The Minister and the Department had found it difficult to acknowledge that detailed health care guarantees were needed for the victims. When, in June 1995, the Minister first gave details of the ad hoc compensation tribunal there was no reference to health care. After the predictable strong reaction from the women infected with the disease he realised he could not ignore their strong and genuine concerns, but it was only after months of hard negotiations that the Department finally agreed to a health package.

Transfusion Positive, the group which represents those victims who contracted hepatitis C from blood transfusions, argues that there is a lack of clarity about who may receive free medical treatment. These people, who were excluded under the original Bill, believe that there is no certainty. The difficulty is that obstacles could be put in their way. Transfusion victims are encountering difficulties in recovering medical files which in many cases have been destroyed. If there case is rejected at the tribunal, a health board could then refuse to provide free treatment. The health board could also refuse if the person concerned decided not to apply to the tribunal. If they do not qualify for a tribunal hearing because they are unable to satisfy the burden of proof, who will satisfy the health board? These victims could find themselves in a difficult situation seeking desperately needed health care.

This Bill details part of the health care agreement negotiated with Positive Action. It is a detailed agreement because of the complexity of the health problems associated with this illness. It outlines the general practitioner, hospital and other services that will be provided for the victims. It refers to counselling services and allows for the establishment of a consultative council which will have a role in monitoring services. These proposals are welcome.

The members of Positive Action and Transfusion Positive welcome the health care package. In this instance, the Minister and the officials of his Department have recognised their genuine concerns. Will the Minister outline the detailed agreement reached with general practitioners regarding the services that will be provided? Will he outline the negotiations that have been completed with the health boards with regard to their role in the provision of services and detail the way in which applications will be made for services by hepatitis C victims? It would be useful if he could detail what funding has been provided by the Department specifically for these services.

My party welcomes the proposals set out in the Bill by the Minister to meet the long-term health care needs of the women who have been infected. It is a shame that these measures must be debated against a background of bad relations between the victims and the Government in relation to the tribunal. There has been a spectacular failure, in regard to the ad hoc tribunal, to recognise the equally genuine concerns of the women who have been infected. The Minister continues to promote a tribunal which the largest group of hepatitis C victims continues to argue is unfair and flawed. It is heartening that he recognised, as his officials did, the concerns of the victims about their health needs, but the failure to recognise the concerns of Positive Action and Transfusion Positive in relation to the ad hoc compensation tribunal shows they have been listened to with one ear only.

The tribunal is flawed because it is unfair in that it falls short of the commitment given in the policy document, A Government of Renewal, to provide fair compensation. The scheme should be acceptable to the women who have been infected with a potentially life threatening virus for which there is no cure. What they have been offered is inadequate. They received contaminated blood from a State board and everything possible should be done to ensure they are happy with the deal negotiated on their behalf.

In addition to the physical injuries, all the women in question face an uncertain and unpredictable future. The full extent of the damage to their health will only manifest itself in time. Perhaps the most frightening aspect is that many of them suffer from cirhosis of the liver and may have to undergo a transplant. They face a panorama of uncertainty.

I wish to outline the reasons Positive Action believe the tribunal is flawed. It does not give women the right to have oral medical evidence heard in individual cases. The position now is that all medical and other evidence has to be submitted in writing in advance of a hearing. The tribunal decides whether it will hear oral evidence. There is a right of appeal to the tribunal members, the people who first refused to allow oral evidence to be heard. Women wish to ensure that their cases are presented fairly and want the right to have their doctors heard, if warranted. They also want the tribunal to have the right to compel witnesses to attend. It does not have the power to direct or order any witness to appear before it, no matter how essential it may view that witness.

Women want the right to receive a provisional award which is a key feature of the tribunal. This allows a claimant to return again if her condition worsens, but a provisional award is only allowed at the discretion of the tribunal. Therefore, a women may opt for a provisional award for personal or health reasons, but find that she is denied it and given a lump sum against which she has no appeal. If a women, or an infected child, accepts a provisional award, they have no guarantee that the tribunal will still be in existence if they return to have their condition and compensation claim reassessed. Positive Action is seeking a limited form of contract between the individual and the State which would provide such a guarantee. These demands are reasonable.

When debating legislation on Second Stage we usually deal with academic points and what might happen. However, we are here addressing a situation involving real people with real needs. When people express their demands in negotiating what they need and what will make them happy we hear what they require. However, in terms of the tribunal, we should move towards making concessions to give them what they want. We have all met these women and they are not unreasonable. Their health has suffered greatly and their lives, and the lives of their families have been terribly affected by this illness. Some of them are 40 years of age, suffer from cirrhosis of the liver and face a liver transplant operation. It is reasonable for them to request that these outstanding matters be addressed. It is their view that the Minister has gone a long way towards meeting their health requirements, but they urge him to go the extra mile and make changes to the tribunal to render it acceptable.

Those who contracted hepatitis C from blood transfusions believe they are at a major disadvantage in making claims under the tribunal. Their medical records at hospitals or at the Blood Transfusion Service Board, may be incomplete, lost or destroyed. It was said some hospital records were lost when Dublin hospitals amalgamated and I understand some hospitals have a policy of destroying records after two years. Records may not exist for people in their middle thirties who received blood transfusions as children but who have not since received any.

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, the donor may not have given blood after 1991 when testing for hepatitis C was introduced so the board cannot say conclusively that the donor in question was the source of the infection and the donor cannot be ordered to have a test, so the chain of evidence is broken.

The group representing these victims of blood transfusions has sought that the term "balance of probabilities" be dropped and replaced by more acceptable terminology. Perhaps the Minister would indicate if this is possible, especially if he is committed to giving equal treatment to all of those infected, whether through blood transfusion or anti-D.

Under the tribunal scheme, the Minister has power to make changes at any time. These small number of changes should be conceded to make the tribunal satisfactory to all. Promises were made to the women of Positive Action last November that the Minister would give them everything they wanted under the tribunal's structure, provided it was not a statutory tribunal, which was initially demanded. Positive Action has always said that an ad hoc tribunal would be considered acceptable if important changes were made; the quid pro quo for their agreeing to the ad hoc tribunal has been negated by the failure to concede the required outstanding matters.

The members of Positive Action will not apply to the tribunal as it stands. According to the Minister's recent advice to the House, thus far the tribunal has received only 72 applications out of 1,800 potential claimants. That shows the appalling and regrettable level of confidence the victims have in the tribunal. It is sad that the goodwill between the Minister and the women involved has evaporated.

The members of Positive Action had two general meetings since the tribunal was announced and have overwhelmingly rejected it. They have no confidence in it. Providing what is needed would give them the confidence and I appeal for some flexibility from the Department in this regard. Only the Minister can resolve the difficulties. To date he chose to turn his face against their requests and in consequence, the State has been left open to a vast number of legal cases in the courts, cases which will not be settled as cheaply as by a tribunal. Because of what has happened to these women and their experience in dealing with a State board, they have very little confidence in any public administration. This loss of confidence is central to their relationship with the Minister and his Department. Given that they have been seriously damaged by maladministration at the hands of the State, is it surprising that they distrust proposals and have no confidence in guarantees given with regard to the operations of the tribunal? It is understandable that they are fearful.

Apart from the obvious lack of transparency, one of the recent features of public administration in this State is the lack of accountability for action and inaction. Deputy O'Malley addressed this matter in the House in the recent debate on the budget. According to the Official Report, 1 February 1996; Column 2128, he stated:

...the most easily understandable and glaring example of the lack of public accountability...lies in what has now come to light about the activities of the Blood Transfusion Service Board. Its negligence in regard to contaminated anti-D immunoglobulin almost defies belief. The ordinary civil negligence is, in effect, admitted by the Government...

The more sinister aspect, however, arises when one considers the question of criminal negligence. The degree of negligence, wilful neglect and failure in this instance is so great that it is difficult to see how it can be less than a criminal offence, but what accountability have we had in that sphere? Who is responsible? Not alone are there no prosecutions, but there were golden handshakes for some officials of the board.

Not for the first time, golden handshakes are accommodated and presented to public servants who deserve to be fired and, in this case, prosecuted. Resignations were not sought or given in this case. There were voluntary retirements; a deal was done in private with those involved in this maladministration. There has been failure to hold accountable those responsible. In other jurisdictions they would be prosecuted.

When the package of £60 million was set aside in the budget great passions were aroused in the House on the question of budgetary irregularities, but no such passions were displayed regarding the substance of the matter to which the allocation was made. Nobody expressed outrage at what happened to these women. The Government's deliberate intention was to minimise the enormity of what happened with regard to the hepatitis C scandal. Public confidence has been severely damaged regarding the blood supply generally. That is very worrying. All steps should be taken to renew confidence in our blood products.

When asked if the DPP would take a prosecution against those involved in the scandal, the Minister said it was none of his business because the DPP is independent. The DPP is also unaccountable. If I ask why the DPP is not proceeding to prosecute those involved in the scandal I will not get an answer because the DPP's decisions are exercised independently and he does not have to account for his decisions.

This is the kind of circuitous and fruitless debate on accountability that takes place in the House. It represents a permanent flight from accountability and is something I have become accustomed to with regard to the DPP and other office holders, health boards and so on. There is also failure to publish reports ordered by the Minister on the maladministration in health boards because of legal difficulties. There are many reasons nobody is ever held accountable for maladministration.

The women infected with hepatitis C have been fighting for their rights for the past two years and they deserve the generosity shown to the public servants who were given golden handshakes. The women concerned are being punished by the State for a second time. At the outset the State did not have a leg to stand on in regard to this matter. Every inch of territory conceded has been negotiated by the women and great credit is due to them. Their continuing persistence must be admired, they have been empowered by this tragedy and many of them have been politicised because of the need to fight for justice.

The health services and the tribunal form a composite package. Despite the women's satisfaction with the medical service proposed in the Bill, the entire package is diminished and compromised by the serious deficiencies of the tribunal. One would have to be a woman to understand how badly this tragedy affected those concerned. It flowed from one of their happiest moments, that of pregnancy and childbirth. The fact that this tragedy is linked to such happiness must be distressing for them. Dr. Hederman O'Brien's report, which was damning in its criticism of the Blood Transfusion Service Board, should be debated by a committee of this House. I agree with Deputy Geoghegan-Quinn that we need to examine the criminality of this matter and if the DPP does not do so, a committee of this House should pursue the matter. We have tried to increase the Dáil's inquiring, as distinct from the legislative, role. We have a role to play in inquiring into the maladministration of the Blood Transfusion Service Board at that time and since.

The inadequacies of the scheme are clear and the Minister is well aware of them. Why is it so difficult to make these concessions? The Minister did not explain why he is standing firm against the women's concerns. This Bill provides an opportunity to introduce flexibility and for the Minister, in consultation with the women, to go back to the drawing board in regard to the tribunal. This should be possible given the goodwill of the Minister and the women who want to settle their differences with the State by getting reasonable compensation in a satisfactory tribunal.

In December last Positive Action members rejected the tribunal because it was unfair. The women concerned should not settle for half measures, they should keep up the fight. They want justice, not charity, and they have every right to be furious. They have been treated deplorably and the Minister must explain the intransigence on the matters about which they are still unhappy. Months of negotiations by the women and others have failed to impress on the Department that the women will not give up on this matter. They are determined not to walk into an unfair tribunal on the promise of big money. For that reason many of them are determined to pursue actions in the High Court. I was surprised to learn that individual women have received letters from the Chief State Solicitor stating that if they ignore the tribunal and proceed through the courts "the resulting litigation will be fully defended by the State, if necessary to the Supreme Court". That type of State bullying of vulnerable women who seek to vindicate their constitutional rights in the courts is unacceptable. I am sure the public would not agree with that being done in the name of the State and the people. How does that type of attitude from the Chief State Solicitor's office and the State fit with the twin track approach to which the Minister referred on Question Time? He referred to a twin track strategy, in other words, if the women did not like the tribunal they could go to the court. If the matter were defended to the teeth in the court, surely this is not a twin track strategy. There is no parity between the two options. This inflexible response to the needs of women infected as a result of State negligence demonstrates a lack of understanding and empathy for the subjective needs of the women concerned. I hope moves can be made to get the parties back to the negotiating table on the outstanding issues.

Mr. Dukes

I deplore the outrageous carry-on of limiting time on Second Stage as it goes against proper debate in the House.

The nature and appalling repercussions of this problem have been described in detail by people inside and outside the House. I do not intend to deal with this any further except to take it as read. I could not say anything more to illuminate the problem. When the problem was identified the Minister and his predecessor moved commendably to respond to it. This Minister, in particular, gave the matter priority during 1995 and held extensive consultations on the issue. He worked with great sincerity to deal with the repercussions of the matter. I am sure both previous speakers agree that the package he announced last December, with the additions announced in the meantime, provide a comprehensive response to the problem. For that reason, some of Deputy Geoghegan-Quinn's remarks about the Minister's intentions and his approach are unwarranted and unworthy of her stature as a leading Member of the House. In case she may have forgotten, the Government of which she was a member did not do anything about a tribunal. She may say it had not got that far and she would be correct to say that because it would vitiate many of her remarks.

The Bill makes statutory provision for the delivery of a series of services to the victims, and in some cases their partners and children, of this tragedy. It puts the funding and the provision of those services beyond doubt. When passed none of its provisions can be changed or affected by any transient approach or difficulty in regard to public finances without a change in legislation. That is why the Minister has put this provision on a statutory basis. It is only fair to point out to the public that a report today in The Irish Times which attributes certain views to the Positive Action group in relation to funding is out of date. It should be recognised that this Bill meets any concern that could be legitimately voiced about these matters.

We must bring as much certainty as possible into the assistance and treatment that will be available to the victims of this appalling tragedy. They, their partners and their children have to deal with enough uncertainty because of the nature of the problem. Therefore, anything we can do in this Bill or in any other way to bring more certainty into the response they can expect would be welcome. The part of the series of measures provided for in the Bill will be put on a statutory basis. However, I fail to understand why the rest of the series is not being put on a statutory basis as the need for certainty in regard to the other parts of the response is just as great, if not greater. Why is it not possible to set up the tribunal on a statutory basis? I have made inquiries and have been told that a statutory tribunal would experience a number of technical difficulties in delivering the kind of things the tribunal is intended to deliver. I have been told that by its nature a statutory tribunal would be more formal, less flexible, unwieldy, subject to greater delays and have potentially substantial legal costs. Some of this might be the case but it is not inevitably the case. It is not obvious to me that this would be the case and if that danger exists then a necessary part of the design of any statute is that it would avoid those problems. I cannot see any prima facie reason it should be beyond the wit of the people who design the scheme and draft the legislation to produce a scheme which would have the flexibility, convenience etc., of the tribunal now in place and to establish a tribunal on a statutory basis. I have not heard any convincing explanation of why there are these differences between a statutory and non-statutory tribunal and I would like to hear them. I am sceptical at present and I would like to be conviced one way or the other.

Some of the legal advice shown to me and given to the groups who discussed the matter with the Minister seems to be not only flawed but rather political in nature. For example, it has been alleged to me that legal advice includes the suggestion that the method adopted to deal with this problem is designed to put the problem behind us as quickly as possible. I cannot find any basis, even from my sceptical standpoint, for making that allegation about this action. If anything, the attempt has been to ensure that the system continues for as long as it is needed and on as wide a basis as is needed. That should be our approach when dealing with this legislation and when we come to deal in whatever manner is appropriate with the other measures.

The suspicions and fears seem to be founded. Deputy O'Donnell quoted responses alleged to have been made by the Chief State Solicitor's office to people who say they will not choose the tribunal route, that if they ignore the tribunal and proceed through the courts the resulting litigation will be fully defended by the State, if necessary, to the Supreme Court. I do not know — and I cannot be bothered spending the time trying to find out — the legal formalities of the relationship between the Chief State Solicitor's office and a Department and Minister but it seems that common sense and humanity should prevail and that nobody in the Chief State Solicitors's office should be allowed even to think of communicating in those terms with anyone facing the kind of problems faced by the victims in this case. This is outrageous and deplorable and if it happened it should be stopped immediately.

Those who represent the victims have shown a commendable level of ability, expertise and persistence. Given the problem they face they are to be applauded. I understand they have said that they are willing to consider proceeding on the basis of a non-statutory tribunal if certain conditions and concerns they have expressed are met. I will not detail these as it would be tedious to do so. The Minister, Deputy Geoghegan-Quinn, Deputy O'Donnell and many other Deputies are fairly well acquainted with these matters but I ask the Minister to consider these conditions in the light of what he has said so far about the tribunal. We owe it to the victims in this case to give them as much assurance as we can. They need assurance and certainty and to know what exactly will be done to help them. None of them will ever be cured or feel that this problem has been rectified so that they can close the page and move on to a new chapter. In the nature of the problem, no one will every feel that but at least they should be able to feel that if anything more emerges after a period of years there will be a response to it and it can be met if it is traceable back to this event. I ask the Minister to consider the conditions on which agreement could be reached by a non-statutory tribunal in the light of the situation facing these victims.

I very much regret that before Christmas the Opposition chose to make something of a political football of the funding for the tribunal. I am sorry Deputy O'Donnell is not present as I would like to say this to her in the greatest of amity and directly to her, but undoubtedly she will read the record of my contribution with riveting interest. The part of her contribution which dealt with the argument about the £60 million was utterly glib and lacked any conviction or, to use her word, passion. I found it rather entertaining to hear her passionless denunciation of the lack of passion in the debate about this issue. We heard from her the standard issue identikit Progessive Democrats' text on accountability — and the alleged lack of accountability — of the Director of Public Prosecutions. I found this more than a bit amusing given that later on this evening we will start a debate on a Bill put forward by the same party which goes to considerable lengths to make it clear that it does not want or intend in its proposals on the criminal justice system to require the Director of Public Prosecutions to give an account in any particular case. Before Deputy O'Donnell starts trying to manufacture ersatz passion in the House, makes glib remarks about passionless debates or gives out the standard doctrine as unreflectedly as she did this evening, she should read some of the Bills produced by her party.

The Minister and his predecessor acted with commendable thoroughness on this issues. The Bill and the other measures which have been taken are comprehensive in that they seek to address all the aspects of the problem about which we know. It is a great pity that the debate so far has been marred by the argument about whether the tribunal should be a statutory one. It is also a great pity that the trauma to which the victims of this awful event have been subjected has been added to by this uncertainty and argument. I think Deputies on all sides of the House will agree that there is in prospect and near at hand the means of resolving this problem and of arriving at an agreement so that we will have a tribunal, statutory or non-statutory, which can meet the real concerns of the 1,800 people most directly affected and, is some cases, of their spouses, partners and children and which will properly translate into action the concern the Government and its predecessor have brought to bear on the problem. The means of resolving the problem are not far away from us and I urge the Minister to do everything in his power to ensure that we get to that point. The situation demands this and the sincerity the Minister has brought to it so far requires that to put the finishing touches to it.

Dr. Moffatt

I support Deputy Geoghegan-Quinn's amendment. There has been much talk about the hepatitis C problem but to date, everything has been done in a piecemeal fashion to try to provide an adequate response in regard to treatment of those affected. Much of what is contained in the Bill in regard to primary care is aspirational. A number of issues have been raised today, such as the Government's embargo on public sector appointments. Will this embargo affect primary care for these people? Will extra funding and personnel be made available to the general practitioner service, the dental service and the carer's service? People are experiencing difficulties in trying to see appropriate consultants and to get counselling. It is good to express a wish to provide counselling and dental services, but much of what is in the Bill is aspirational.

I understand the Minister has not yet entered into serious negotiations with general practitioners in regard to this service. He is depending on their goodwill and they have been flexible to date. It is to be hoped that in the final analysis the Minister will offer them adequate money to solve the problem, but does this amount to putting the cart before the horse. He should have entered negotiations earlier. Most people who have been affected by hepatitis C are worried primarily about their health, they are not worried about the money even though monetary compensation will always be a factor.

People in peripheral areas have difficulty getting to secondary treatment centres such as the major hospitals, and there has not been provision for this. Money has not been made available for transportation and so on. People have difficulties staying overnight in cities etc. prior to treatment and provision should be made for those patients. Treatment should not cause too much disruption to families. We must take account of those matters.

We do not know the long-term consequences of hepatitis C on patients. We do not know whether the condition is progressive. Not alone may it affect the liver but it may affect the eyes, the kidneys or other body systems and people are worried about this. They do not know what the outcome might be in regard to conditions such as rheumatoid arthritis and chronic fatigue. People are not primarily worried about the money aspect, they would like to see provision for long-term treatment and not just on an ad hoc basis.

The Minister has gone a long way to allay fears in regard to all aspects of this issue but it has been done in a piecemeal fashion. He has produced a rather good package, but we want all of it put on a statutory basis. Deputy Dukes said he does not see why this cannot be done. The Minister has defended his ground well but if we are intent on solving the problem we should not be getting caught up between the statutory and the ad hoc aspects of the tribunal.

We are primarily interested in the satisfactory outcome of the process because the Government, and its agencies, are responsible in one way or another. This was not intentional, it was accidental. Immunoglobulin has been beneficial through the years but, unfortunately, in this instance we have to take responsibility and we must deal with those affected in an amicable and straightforward manner. People must be dealt with as human beings and in such a manner that they or their families will not have undue fears in the future. This is part of the problem. If all aspects of this package were put on a statutory basis, those affected would have no undue fears for the future.

Deputy Geoghegan-Quinn, our spokesperson on Health, has adequately outlined the position and expressed the fears of those affected. I do not want to go over the ground she covered but I urge the Minister to do his best to treat the women in a manner commensurate with his portfolio as Minister for Health. His interest should be in the health of those affected, not in the compensation to be paid to them. In the future it will be remembered whether he treated the women as patients in a manner appropriate to the Minister for Health, whether he was interested in their health or in the compensation issue, which is the main difficulty we seem to be running into in regard to this tribunal.

Dr. McDaid

I wish to speak on a point I spoke to the Minister about recently. I am concerned about a group of people whom I do not believe are catered for in the Bill. While there is a great deal of help for those affected by hepatitis C, a certain group has been left out. I speak of the families of victims who have since died. They have not been taken into consideration. Two people whom I knew have since passed away. I am led to believe that the compensation provided for these people will be based on the compensation which would be paid had their deaths been the result of a car acccident. I have been in touch with a number of solicitors and they say that the families of these people will be entitled to something in the region of £7,500. That is not adequate. In such cases, compensation arises as a result of an accident in which the trauma dates from the time of the accident. The trauma suffered by these families dates from the time the patient was diagnosed as having contracted hepatitis C.

The people I refer to contracted hepatitis C through blood transfusions which they were given because they already had a chronic disease, and this hastened the deaths of these people. In that context the Minister should ask the tribunal to remove the standard clause, if that is what it is banking on.

Will the Minister say whether provision can be made through the tribunal for this type of case? There will be few such cases, but the families have suffered. Many husbands have given up their jobs. They have had to meet added medical costs over the years and unwonted and unnecessary costs up to now. I speak on behalf of a sector which has been left out, namely, the families of victims who have since passed away. I ask the Minister to consider granting them adequate compensation when they come before the tribunal. It would be helpful also if these cases could be given priority because the families have suffered the loss of a loved one but they have not been referred to in the deliberations to date.

Mr. Boylan

Knowing the grave trauma caused to the victims and their families, I thank the Minister sincerely for the manner in which he has moved to deal with this terrible tragedy in our generally excellent health care services which has resulted in many otherwise healthy women having to face an uncertain future. Some of them, unfortunately, have gone to their eternal reward.

A number of aspects of this Bill will have to be examined. The Minister's proposals will deal with the ongoing health care of people who were affected, and the compensation available from the tribunal will go some way to soften the blow. Let me deal with that aspect first. The medical profession is unsure of the long-term effects on victims and what their life span and quality of life will be. The Minister cannot, therefore, make a final settlement at this time. Money is not the solution to the problem but it does help, and no matter what the package of health care proposals — and what is proposed is comprehensive — there will be ongoing costs and difficulties. An interim settlement should, therefore, be part of the tribunal's brief, with the tribunal granting, say, £5,000 now and reviewing the person's health in a few years to see if there is a need for a further allocation.

These were innocent victims who went into hospital, in most cases for the birth of a baby which should be a joyful time. The consequences turned out to be tragic. Somebody was negligent and it is not good enough to say that there was a mistake, that we were not fully aware vis-à-vis the quality of blood, etc. I do not accept that. The people involved were highly paid and had responsibilities. When something goes wrong they cannot simply run away and say they were not aware, that they did not expect or did not understand. The people who were affected put their trust in those people when they accepted a blood transfusion or whatever caused this infection. The people responsible will have to be held to account to ensure that this can never happen again because there is much concern among women about blood transfusions and about whether the quality of the blood they receive is of the highest standard and not contaminated.

The last thing I want to do is point the finger at officials who cannot come here to defend themselves. However, I have read accounts about the manner in which blood was stored which, if true, should result in people being sacked. I would like that matter addressed. Was it simply a story in our national papers or is it true that blood collected from donors was stored in sheds at the back of Pelican House? If it is not true, let us say so. If it is true let us admit that there was carelessness and negligence.

I want to speak on behalf of the women of rural Ireland because for them getting to a centre for treatment means travel costs and the disruption of a young family. There may be good will and help offered but that can easily wear thin if a woman has to make regular trips to a centre or hospital. Children cannot be left alone in the home. It is not good enough to say that the father should be there — that may not be easy or possible. Somebody will, therefore, have to look after the home while the woman travels to Dublin for treatment until she returns home. Overnight accommodation will have to be made available to her, and I do not mean an iron bed in a cold hospital ward. I want the best for these people who are the victims of a mistake on the part of the health services. The women of rural Ireland will have to have access to the same treatment as women from our larger cities where the hospitals are located. This should include overnight accommodation and a carer for the family while they are away.

I note that in the list of primary health care services the Minister mentions home help services which I welcome. That should be ongoing because the health of these women is weakened to the extent that they will need somebody to help them with their normal household duties until they build themselves up again. The State should provide such help.

A home nursing service should also be provided. This should consist of something more than an occasional visit by district nurses who, although they provide an excellent service, are simply run off their feet. A nurse should be designated to look after women infected with hepatitis C in a particular area. Their families need State support.

The family of a woman infected with hepatitis C who has gone to her eternal reward is entitled to financial compensation, irrespective of whether she died from it or some other ailment. If she was known to have received contaminated blood, that should be sufficient and the State should not try to discover the cause of death.

Some problems remain to be resolved but I welcome the Minister's programme of health care services.

Mr. Ring

I compliment the Minister on his work in this area. This is a serious problem and I hope life will be made easy for any woman who has been infected. Women have been mistreated for far too long and their health was not seen as an issue. My mother reared 13 children and she slaved for her family. The last person she thought about was herself. Health is wealth. People were infected through no fault of their own but as a result of bad management in the blood transfusion service. Those who are to blame for this should be behind bars. They got away with murder and walked away from this serious matter.

There are few women doctors in County Mayo. I tabled a question on the number of women doctors in Castlebar. Many women who come to my clinics tell me they have no choice but to attend a male doctor. We are all aware of the case where a male doctor videoed female patients in his surgery, that is disgraceful and I hope he is put behind bars. For too long women were degraded and mistreated in this country. I stated on a radio programme that they must be twice as good as men to get on in any profession. As far as their health is concerned they should be properly looked after.

One of my relatives in County Mayo had to attend St. Luke's Hospital. That is traumatic in itself because people know exactly why they are attending that hospital. Her husband was on the dole and we tried to get money for her from the health board. It was like extracting teeth from an ass.

A person living in Belmullet who needs treatment must travel 70 miles to Ballina before going on a four hour bus journey to Dublin. Such services should be available in Castlebar, Galway and elsewhere.

The Minister should do everything possible for those infected with this serious illness. Deputy Moffatt said this was not about money. That is true; it is about women's health. We must stop treating them as second class citizens. I am glad that we have a number of women Deputies in the House, one as able as the other. I hope the Minister will continue his good work and put the necessary funding in place.

It is time women were respected for the work they do. They are homemakers and look after children. In some cases they are breadwinners. They have not been treated properly. What recognition is given to women who stay at home? Those who serve on the Joint Committee on the Family realise how much they have been neglected. The Minister must do what is right for those women who have been infected.

Dr. McDaid

More than half the students entering the medical profession are women. That stems from the time Fianna Fáil introduced free education in 1968.

Mr. Ring

They do not get the jobs when they are called for interview.

Mr. Creed

What Deputy McDaid said is a welcome development. However, in rural areas the choice of a doctor under the GMS scheme is limited as far as the choice between male and female doctor is concerned. In many rural practices doctors are generally male.

Dr. McDaid

Times are changing.

Mr. Creed

I accept that but in advance of women doctors coming on stream the Minister might consider giving GMS patients access to doctors who may not be in the GMS scheme but who practise in the area.

I welcome the Bill and the Minister's efforts to tackle this difficult issue. Like most speakers in this debate, I am not a medical person and am not familiar with the intricacies involved. The Government is making an earnest effort to provide the necessary care for the women affected. While providing a medical card to all those identified as suffering from the infection is welcome, there are a number of shortcomings which the Minister may wish to address. These women put their faith in the health service and, like all of us who visit a GP's clinic or hospital, hoped the treatment they received would be beneficial to them. They are helpless victims of the systematic failure of the Blood Transfusion Service Board to identify and respond to problems that were evident at an early date.

The question needs to be raised as to why those responsible got off scot-free. They drew their lump sum payments, their fat "thank you" cheques, and were not held accountable. That gives rise to considerable anxiety and anger among the victims. It is important that public confidence in the Blood Transfusion Service Board be maintained so that blood reserves are not depleted — the event that gave rise to this Bill had the potential to eradicate public confidence in the Blood Transfusion Service Board — and I accept that the Government has made appropriate arrangements, but in a just society those responsible should pay the price. If we compare this incident with a similar incident in France some years ago, the people responsible for causing people to be infected with contaminated products were brought before the courts and paid a price.

When this controversy came to light it was essential to maintain public confidence, but that does not necessitate opening the escape routes for people who perpetrated injustice on a large section of the population. Public confidence in the Blood Transfusion Service Board would be best served by pursuing those people vigorously. In environmental law, the principle is that the polluter pays. That is a coarse analogy, but a very high price is being paid by the large number of women who, through no fault of their own, are infected as a result of the ineptitude of those responsible. I do not know if the legal options are closed, but the Minister should give serious consideration to pursuing this principle and holding accountable those responsible. If that means bringing them before the courts, so be it. The Government is committed to accountability, and rightly so, but we have been remiss in dealing with this problem.

There is a lack of support services for women living in rural areas. The hospitals designated to provide a service for those infected are Cork University Hospital, Galway University Hospital and four hospitals in Dublin. A large stretch of the country is uncovered in terms of providing the necessary care and attention for the women affected. I accept that the provision of a medical card will be of benefit, but there are associated expenses, such as travelling to and from hospitals and overnight stay, which are not covered. The Minister may suggest that people approach their local community welfare officer in that regard, but they are obliged to take into account people's means. As I understand it, the intention is to remove the necessity for a means test in providing services for affected people. Given that a person living on a peninsula in west Kerry who has to travel to Cork University Hospital or a person living in Donegal who has to travel to University Hospital Galway incurs considerable expense, provision should be made for that.

I do not bring medical expertise to this debate, but I have limited experience from my constituency, in terms of the number of people affected with whom I have had direct contact, and I am aware that the financial aspects are of concern to them. While the proposals go some way towards meeting the needs, they fall short in some respects, particularly in regard to the points I raised.

I pay tribute to the Minister for establishing the tribunal which, unlike a court, will respect the anonymity of these people. As I understand it, the tribunal's decision will be final. Medical opinion may suggest that it is not possible to predict with certainty the extent to which the problem will affect people's lives — for example, a person appearing before the tribunal with evidence of having been contaminated by infected blood product may not be in a state of critical ill-health and, on the evidence before it, the tribunal may decide that £X be given by way of compensation.

Two to five years hence a victim's illness may have advanced to a stage which warrants a much greater compensation award than she originally received. Is there a case to be made for interim compensation payments initially with a statutory provision for their review after five to ten years? The Minister may argue that such a proposal would open the floodgates in terms of compensation claims, but there is a moral obligation on the State to adequately compensate the victims, given that a State service was found to be inadequate and negligent and that the women affected are before a tribunal through no fault of their own.

I compliment the Minister on the proposal before us which goes a long way towards meeting the concerns of those affected. However, the Minister should bear in mind the reservations I made to which I invite him to reply.

Miss Flaherty

I am pleased to have the opportunity to speak on this important legislation. I support the broad points made by the two previous speakers on two specific issues. Deputy Creed raised the issue of responsibility for this appalling tragedy resulting from errors made in the Blood Transfusion Service Board and he contrasted it with the experience in other countries. This issue is a matter of concern to Members and to the public. In dealing with problems, it is part of the Irish psyche that we are willing to let the past be the past and that when matters are being sorted out to leave it at that. That is good in some cases, but not in this one. The consequences of the mistakes made here were major for many people. They cannot be assessed at this point, perhaps that is an issue to which we should return. The consequences have been enormous for the women directly affected and for their families. When replying the Minister should comment on an issue of great concern to many Members, that such negligence could occur and that no element of responsibility has rested with anybody at any stage. Is that a good marker for any person charged with responsibility for the provision of similar vital services in the future?

A number of my colleagues, including Deputy Ring in his usual colourful fashion, made a case that has been put to us by Positive Action, that of the inadequacy of services in rural areas. I acknowledge it is difficult to provide all the speciality services in a wide range of areas. This is a practical issue and I am sure it is one the Minister will be able to resolve in future. Travelling long distances to gain access to treatment adds greatly to the stress of those coping with difficult medical problems.

We all welcome this Bill as it puts entitlement to long-term medical care for those infected with hepatitis C and their families on a statutory basis. That was one of the possible responses discussed by the Minister when a delegation from Positive Action appeared before the Select Committee on Social Affairs. While he considered it inappropriate to respond by way of a statutory tribunal, he considered he could respond by putting entitlements to many of the medical requirements on a statutory basis. This Bill removes an element of uncertainty in regard to medical attention that was a cause of concern for the women affected, and their families, in terms of their overall fears about the handling of compensation claims by the tribunal. This proposed package was welcomed and seen to respond in a transparent and reliable way to the needs of those women. They are confident about this measure as this Bill writes their entitlement into law. We welcome the measure and congratulate the Minister on introducing it.

We should also congratulate the Government on its commitment to pay compensation. In the opening statement of its most recent correspondence outlining its remaining concerns, Positive Action acknowledges that the Government is prepared to pay compensation. That is an important commitment. There have been other injustices to which there have not been as good a response. The Minister and his predecessor must be congratulated on their response. Given that we have travelled almost 99 per cent of the way in the meeting of minds, it is unfortunate that although all the necessary structures are in place, a large number of the women affected are unwilling to use the avenues currently open to them. The Minister has done his utmost to reach agreement on this. He has generously met the groups involved in recent months and is anxious to resolve this problem in the best interests of the women concerned and in the most efficient manner. Deputy Dukes covered some of the arguments about statutory and non-statutory tribunals. While the Minister's objective has been to provide a speedy and efficient service by way of a tribunal, if the current stand-off remains in place, we will have the worst of all worlds. A minority of those affected will use the tribunal and the majority will use the mechanism the Minister wished to avoid, a highly complex, expensive and slow-moving legal procedure. Neither the Minister nor, I am sure, the women concerned want to take that route.

Very few areas remain in respect of which there is a difference of opinion. The major issue is Positive Action's lack of confidence in a tribunal that does not give the women concerned the right to have oral medical evidence heard in their cases. Another critical issue, to which Deputy Creed referred, is the right of the tribunal to refuse the women concerned provisional awards. Those two critical issues were identified around December. If they were resolved, there could be a great meeting of minds. I would be interested to hear the Minister's thinking on those remaining issues of conflict.

I note the Minister indicated that he has established a compensation tribunal. It is not essentially the business of this Bill, but it is a related issue. Three priority cases have been heard to date and cases are listed for March and April. The Minister has every confidence that the tribunal will operate smoothly, efficiently and fairly. I invite the Minister to expand on that. Perhaps he would tie it in with the current impasse. I gather that up to last week only 72 applications had been received. Has that position changed? Does the Minister anticiapate it will change or is there anything further he can do to ensure the submission of at least another 1,000 applications to the tribunal? Those of us unaffected may find it difficult to understand the transformation wrought in the lives of in excess of 1,000 women and their families, who talk not only of their direct medical problems but of the enormous personal and social problems.

I suppose it is their deep hurt, tragedy and devastation that makes them so determined to fight their case, sometimes to the point at which many of us might be inclined to think they should be satisfied. They have an interest in this matter beyond the immediate. They are concerned about their future, about the next generation and who will look after them. Therefore, they must carry out this task thoroughly and ensure they do not accept anything less than a settlement that will provide the best possible security for themselves and their children.

While accepting the Minister has done everything possible and has bent over backwards to negotiate and renegotiate to devise the best possible proposals, there is perhaps one further step he could take which would lead to his desired result, which is that the majority of women will process their claims via the tribunal he has established.

If progress was made on the two issues to which I referred and another two highlighted in other contributions — reservations about the privacy and confidentiality of the tribunal proceedings and the right to compel witnesses — it could well constitute the kiss of peace on this very tragic episode in our medical history. Then at least we could be happy we had done our very best to address the huge damage done to these women. It is worth this last effort to achieve the Minister's objective. When replying, I hope he will be able to report some progress in this regard.

Miss Coughlan

I am very glad to have an opportunity of speaking on this matter again. I accept the very genuine efforts of the Minister, his predecessor and those of his departmental officials, all of whom are most anxious that this matter be thoroughly addressed. The sincerity of contributions made here and within committees exemplifies our deep concerns.

I do not want to see a situation evolve where this matter would be relegated to the archives of this House, without any guarantees being given that everything will be dealt with as thoroughly as possible in the passage of this legislation. Unfortunately, this is a problem of our time and it is up to all of us to ensure that this legislation is the best that can be devised. It is within our competence to ensure that everything possible is done, that we tease out every possible permutation, bearing in mind the nature of the problem and particularly the fact that many women have not yet come forward, despite the efforts of the Blood Transfusion Service and health boards. I hope those women affected by blood transfusions can be assured they will encounter no problems in coming forward, that they should make themselves available to the tribunal, when everything possible will be done to alleviate their fears and concerns.

I welcome the introduction of this Bill and the Minister's guarantees of access to proper primary and secondary health care services, in addition to the other equally if not more important programmes, in particular on research.

It was unfortunate that a mistake had to surface before we were really aware of the problem. Arising out of the special research programme to be undertaken guarantees should be given that anything necessary will be done to prevent this tragedy recurring.

I am not comfortable regarding access to counselling services. Within my general practitioner's area there are three or four women who have been affected. I must commend general practitioners nationwide who have done their utmost to ensure that everything possible is done to alleviate the damage, fears and concerns of those women. While the Minister may have tired of listening to me talk of distances, about access to proper services and facilities, we are aware that all health boards are overstretched, particularly in the matter of trained professional counsellors. I plead with him to ensure the availability of adequate qualified counsellors, particularly in the context of a more regionalised policy on access, with particular reference to secondary health care services.

While acknowledging that Dublin hospitals are expert in addressing such problems, there is a need to provide such facilities in the north-west, ensuring proper access to the necessary secondary health care services for those living in Border regions.

One or two of the Minister's comments leaped out at me, one being eligibility for private health care facilities. This decision, when left to a chief executive officer of a health board, does not inevitably result in equal access nationwide. For example, within the NorthWestern Health Board area, some service may be provided which may not be available within the Eastern Health Board area and so on. I am very concerned at the general lack of uniformity. Since the Minister proposes tabling an amendment for Committee Stage, I must emphasise the need for uniformity and proper guidelines. We are all aware that people interpret guidelines differently and so on. I look forward to teasing out the Minister's amendment and the provision of such guarantees.

I must ask also that the requisite resources be guaranteed for all of these services in order to deal with any problems arising, including those that may be encountered by the next generation.

Debate adjourned.