Health (Amendment) Bill, 1995: Report and Final Stages.

As there are no amendments on Report Stage we proceed to Fifth Stage in accordance with the order of the House today.

Limerick East): I move: “That the Bill do now pass.”

The purpose of the Health (Amendment) Bill, 1995, is to make provision for making available, without charge, certain services to persons who have contracted hepatitis C. Eligible persons are those who have contracted the hepatitis C virus directly or indirectly from the use of human anti-D product on receipt within the State of another blood product or a blood transfusion. The Bill is a concrete expression of the Government's commitment to provide a high quality health care service to such individuals and is the product of consultations with representatives of the various support groups, Positive Action, Transfusion Positive, the Irish Kidney Association and the Irish Haemophilia Society. As soon as the Bill has passed all Stages in both Houses I hope to finalise negotiations with professional groupings representing doctors and pharmacists to put in place the necessary administrative arrangements for the delivery of the health services set out in this Bill.

I take this opportunity to thank Members on both sides of the House for their support in the passage of the Bill. I also thank the chairman of the committee, Deputy Pattison, who was helpful in carrying the Bill through Committee Stage. I thank in particular the many Deputies who contributed to the debate on the Bill.

I renew my thanks to the Minister for responding with this legislation to a very difficult and sensitive issue. I was extremely concerned at the Minister's reply to a written parliamentary question from me this week in which he indicated that only 490 persons applied to the tribunal for compensation, yet the Department spent almost £1,000 per application in advertising — the total figure amounts to £412,000. That is a phenomenal amount of money for any Department to spend in trying to pressurise victims of hepatitis C into a tribunal which they consider — I am aware the Minister disagrees with this — to be flawed and incomplete.

I urge the Minister, before the passage of this Bill, to accede to the requests by Deputies in all Government parties and both Opposition parties — a unanimous decision was made in this regard by all parties represented on the Select Committee on Social Affairs — to seriously consider the extension of the deadline from next month on the basis that there are outstanding concerns that must be met by the Minister. I am aware that he is sympathetic and has been from the beginning, but that sympathy needs to be shown in a very concrete way. To defer the deadline date until after a court decision would be very welcome and would show the Minister's bona fides in the matter.

I am glad the Minister said he will enter negotiations. I presume negotiations have already taken place with general practitioners, other health care professionals and health boards on how the regulations under the Bill will be implemented. It is important that there is uniform application of the regulations. Sometimes a measure may work very well in one health board or a number of health boards while there may be the odd blip in the service in a specific health board area or small part of a health board area, particularly in rural areas. There are many victims of hepatitis C in rural areas, male and female, young and middle-aged, and it is very important that the level of service extended to their urban counterparts is available to them.

When will the regulations which accompany this legislation be prepared and published? I think it was in reply to Second Stage a commitment was given that the Minister could discuss the contents of the regulations with the representative groups of hepatitis C victims. It is important that is done and I am anxious to know whether the Minister still intends to discuss and, I hope, agree the contents of the regulations. What additional level of funding does the Minister propose to make available to the various health boards to implement this legislation?

The health boards which contacted me said there is no way they can provide the extra medical services required under the legislation from within their existing budgets and that to provide them they will have to cut back severly on services in other areas. We are all aware of the difficulties experienced by health boards and I would not like to see them exacerbated by this very worthy legislation. The services which will come under most pressure are home nursing-help services and dental, aural and ophthalmic services. Will the Minister say how he, in co-operation with the health boards, intends to resolve any difficulties which arise in this area?

There was a reference, during earlier Stages, to counselling services. The Select Committee on Social Affairs discussed this issue with the Department's adviser. It is important that the independent counselling providers and support groups are consulted by the Minister's officials on the best way of providing this essential service for the victims of hepatitis C. It is very important to remember that the spouses and families of the victims have also been very much affected. Many victims have not told their wider family, friends or employers that they have hepatitis C. The continuation of independent counselling services for the victims and co-operation between departmental officials and the groups which provide these services is essential.

I hesitate to interrupt the Deputy but I wish to remind her that we are on Fifth Stage. I have shown her much latitude but there is a long standing precedent in the House that the Fifth Stage debate is confined solely to the Bill and not to what should be in it, which, of course, is the subject matter of the Second and Third Stage debates. I have given the Deputy much latitude but I do not want to allow a situation to arise where Deputies make what are tantamount to Second Reading speeches.

My comments are on section 2 which provides for health services without charge to certain persons who have contracted hepatitis C. I am simply pointing out that those services should concentrate also on counselling services which go hand in glove with the health services.

It was proposed to establish a consultative council which would deal with hepatitis C and an order was to be made to establish it. This was part of the health agreement between the Department and the representative groups. Will the Minister say when this council will be established?

I thank the Minister and his officials for talking on board some Committee Stage amendments tabled by Fianna Fáil. The implementation of the provisions of the Bill is vitally important and I hope the necessary financial resources will be made available for them to be implemented in a uniform way.

Given the way in which these people were infected with hepatitis C we must, at a minimum, guarantee the best possible health services for them. Much consultation was required before it was agreed to put these health services on a statutory framework. I agree with Deputy Geoghegan-Quinn that the psychological injury inflicted on these women is as great as their physical injuries. The relationship between the support groups and the Minister on the question of the tribunal is fractured and I hope it can be improved by the extension of the date before which the victims can apply to have their case heard by the tribunal.

I welcome the Bill. The women infected by hepatitis C had to fight very hard to get a package which suited their unique needs. I hope the Minister will ensure the highest level of service possible for these women who have been so damaged through no fault of their own. They have unique needs and I hope the Bill will go a long way towards ensuring the very high level of service they deserve.

(Limerick East): I thank Deputies Geoghegan-Quinn and O'Donnell for their help and co-operation in dealing with the Bill. We all appreciate that this issue has been fraught with difficulties. This is understandable as the persons who contracted hepatitis C, their families and immediate social circle are concerned about these events. I will continue to take all measures necessary to resolve any outstanding difficulties.

On the question of the consultative council, I consulted the interested groups and circulated a draft establishment order to them. I am currently considering a number of amendments to the order to take account of the views expressed. On the question of regulations, it was proposed in the original draft to extend the Bill by way of regulation to cover groups other than the women who had contracted hepatitis from an anti-D product. On further consideration, including examination of the amendments tabled by Deputy Geoghegan-Quinn, it was decided to make the extension part of the primary legislation; in other words, to include people who had contracted hepatitis C from blood transfusions. It may be necessary at a later date to extend the Bill to cover unspecified persons who have not been fully identified.

The counselling services will continue. On Committee Stage I indicated that each health board would be asked to designate an officer who would act as co-ordinator, ensure that the whole range of services would be made available without delay and that any difficulties which might arise would be brought to our attention very quickly. We will pay whatever costs are necessary. In terms of the health services as a whole, we are talking about a small cohort of between 1,400-1,600 people and there are no huge additional costs involved in terms of the overall budget. Even though this will give them extended services, some people will already be covered by a general medical card and the GP service will be available to them. The cost of this initiative is not huge but if it necessitates additional funds, and it will, they will be provided.

The tribunal is working very well at present, hearing about 12 cases per week, and its procedures are in line with those requested by the interest groups. They requested changes in its terms of reference to ensure that certain procedures would be followed as a matter of course by the tribunal. In my view, confidence is building in the tribunal. To date 62 awards have been made and none has been turned down. That is a fair indication of the confidence, not only of applicants but of the legal profession supporting them, in the fairness and adequacy of the compensation awards being made.

Of course, there is a huge range of compensation awards because cases differ enormously. To date, the smallest award was approximately £15,500 and the largest approximately £324,000. When we last ran the averages, the figure was £106,000. For example, yesterday 511 applications were submitted. From our contact with the secretary of the tribunal we know that solicitors have indicated to him they will be submitting a large number of applications in coming weeks.

The matter of advertising is a difficult one because we have an absolute obligation to draw the attention of all potential applicants to the fact that the tribunal is available to them. If we did not do so, we would be leaving ourselves open to legal confrontation.

On initial calculations, aggregating persons who received antibodies or full-blown hepatitis from the anti-D product, in respect of whom we have a defined number arising from the national screening programme in the course of which 58,000 persons approximately were screened, persons represented by the Irish Haemophilia Society, in respect of whom we have an absolute number, persons represented by the Irish Kidney Association in respect of whom we have virtually ascertained an absolute number, and those persons for whom we do not have an absolute number who contracted hepatitis resulting from a blood transfusion and for whom we have look-back programmes and a national screening programme, which is the variable within the overall numbers, we are still below the estimated cohort. Based on a certain premise I suggested that the whole cohort may be approximately 1,600. The figure may be somewhat lower but, if we add letters received from solicitors, which would indicate proceedings being opened in the courts, letters to me, to the BTSB and so on and, without trying to cross-match those applications with those submitted to the tribunal, we are still significantly short of the total cohort.

There is a need to continue our advertising. The House would be amazed at the numbers of people who telephone my Department saying they never knew anything about this tribunal, even though it has been a matter of controversy for almost 12 months. I stand over the amount of money being expended on advertising because it is very important, in so far as we can, to get the information to the last person, and certainly to the last solicitor.

I do not think there is any reason to extend the term of office of the tribunal and I will give some reasons for so saying. The tribunal, having received 511 applications this morning — if they did not receive any more — have 12 months' work on hands, sufficient to take them well beyond Easter next, probably until this time next year, on the basis of dealing with 12 applications per working week. The case made for the extension of the tribunal is that a court case has been set down for 8 October next and that applicants should have available to them all the facts of the outcome of that court case before taking a decision. Anybody who applies between now and the end of the month, within the normal scheduling, must expect that it will be well after the result of the court case has come to hand before they can possibly get a hearing before the tribunal anyway. In terms of practicalities the issue does not arise.

We are making it very clear — we put a little flier into the solicitors' gazette — that we are not seeking complete and final applications by 17 June. All we are seeking are completed application forms; the supporting evidence can be submitted subsequent to that date. We are not driving people up against a deadline they will find it difficult to meet. It is a question of completing the application form to the best of their ability.

When was that decision taken?

(Limerick East): It was always the case but this is the first time I have explained it in the House.

So the advertisement has been significantly changed.

(Limerick East): We wanted to signal, coming up to the end, that a completed application form is sufficient. Two things are necessary to the administration of the tribunal. As far as possible, we would like an indication of the total cohort to ascertain whether its term of office will last a year, 18 months, two years or three years. If it is to last for too long a period, we shall have to examine how we can obtain extra resources because we do not want applicants waiting too long. On the basis of a continuing tot and striking averages I need to be able to indicate to the Department of Finance the amount of money which might be necessary for this purpose. I will give the House an example of the manner in which we have proceeded to date. When I first discussed this with the Minister for Finance I said we might need £100 million in 1996. Subsequently we settled for a figure of £60 million which, as Members will recall, was the subject of some controversy before Christmas last. It now appears as if approximately half that amount will be expended in 1996 on the basis of the average compensation award and the caseload being dealt with each week. Because the tribunal is not a statutory one, it has a lot of discretion to allow applicants to have their applications considered even after the final date, which will be clear to anybody who examines its terms of reference.

The final matter is a problem I have experienced with Positive Action for some time. When issues are raised, we discuss them and agreements are reached, they are kept on my side but the ground changes on the other side. We had a discussion with Positive Action about the expiry date for applications to the tribunal. As Members will recall, its original terms of reference stipulated that applications should be submitted within three months of its establishment or within three months of the diagnosis of hepatitis C. Following full discussions with Positive Action we extended that period to six months and it was agreed that that was an adequate period. For the reasons I have outlined, I cannot see how the 17 June date will adversely affect anybody. There are many benefits, in the administration, establishment and financing of the tribunal, in adhering to that date. I suggest there are quite a number of benefits for applicants themselves, not least of which is the guarantee that solicitors will meet the deadline. We know we have a great legal profession but we also know that, at times, they can be slow enough if there is a fixed date for the submission of applications, that should help many applicants to ensure that their applications have been received by that date. Otherwise, we may well have a long-term drift.

I am prepared to consider anything said here because the general advice I have been receiving from my Opposition colleagues has been very helpful. However, I do not see any reason for moving from our present position.

I do not think any other matter has been raised but, if it has, I will deal with it privately. The position we are in today is that, once we establish the consultative council — and we are on the way to doing so — the overall health package agreed with all the representative groups and ourselves in the Department will have been finalised and delivered. In respect of the health issues on the one hand and compensation issues on the other, we have now delivered on the health commitments to the satisfaction of all the representative groups.

Two questions are raised constantly about compensation — what is the appropriate manner in which to pursue a claim and what is the appropriate compensatory amount in individual cases? Progress has been made by the representatives of the litigant who is proceeding to the High Court, that case having been set down for 8 October next. The tribunal is now settling down and the procedures it is following have inspired the confidence of applicants and the legal profession to the extent that nobody has turned down an award. I understand that a significant number of provisional awards have been made and that in no case has the tribunal refused any applicant who has applied for a provisional award rather than a full or final settlement. I do not want to exaggerate the position, but there is a limited number of outstanding issues and we will continue to try to reach agreement on them.

Progress towards reforming the Blood Transfusion Service Board is continuing. Significant progress has been made and donor confidence is still quite high. Procedures have changed significantly and management structures are being changed. Mr. Liam Dunbar, who acted in a temporary capacity on secondment from St. James's Hospital, will be the permanent appointed chief executive officer of the board. Professor Sean McCann, who has been appointed professor of haematology at Trinity College and retains his consultancies at St. Jame's Hospital, will leave. That creates a vacancy for the post of chief medical consultant of the board and it will be filled as quickly as possible by an appropriately qualified person. On looking back one sees the progress that has been made, but frequently when embroiled in the issues it may appear that progress is not being made as quickly as it might be.

I thank Members for their help on this Bill. It will greatly assist those who have hepatitis C and give them confidence that they will have lifelong free health care with ancillary services.

Question put and agreed to.