Priority Questions.

On a point of order, my priority question was removed from the Order Paper at the instigation of the Ceann Comhairle's office. The excuse or reason given was that the Technical Group had submitted a Private Members' motion that would allow this question to be addressed. When I complained about this, I was told I could submit a substitute question. I could have done so but it would have been turned down for precisely the same reason.

Every aspect of health was covered by my question and I am very annoyed that it was refused. As the Minister will be aware, the health questions were moved today to facilitate him. I readily agreed to this but did not do so on the understanding that I would not be allowed a priority question this month. It is very strange that two questions of mine were disallowed while nobody else's were, although they all deal with health and could have been dealt with under the terms of the motion. I realise nothing can be done about this but I am very annoyed.

I assure the Deputy that it is in accordance with long-standing practice.

I appreciate that. I object to the fact that I was singled out for this treatment, whereas every other health question was permitted despite the fact that they could all have been covered under the terms of the motion.

There was nothing unusual in——

It would have been possible for the questions office to telephone my office with an explanation, particularly because health questions were moved with my agreement to facilitate the Minister. I realise it is not the Minister's fault. Nevertheless, I want to place on record my annoyance.

On a point of order, I strongly protest at this development, for which there is no precedent. If such a precedent were to be applied, all questions would have been ruled out of order and there would be no health questions. This has happened three or four times during my time in this House, but with increasing frequency recently. It is totally unacceptable. It cannot be accepted by the Opposition because it may be of benefit to one side today and to another side tomorrow. If this continues, we will have to seek other means of redress.

As I assured Deputy Olivia Mitchell, the decision on this matter was in accordance with long-standing practice. It probably can be raised in another forum. We should proceed. We cannot have a debate on the matter——

We could have a debate on it.

Already, some Member has lost the opportunity to ask a question because the Deputies are eating into the time allowed for doing so. The longer this discussion proceeds, the fewer the questions that can be dealt with today.

I support Deputy Olivia Mitchell. I have lost three questions as a result of this decision. It is grossly unfair.

Hear, hear.

It does not matter whether it happened before, it should not happen now. Deputy Olivia Mitchell in particular has a grievance because hers was a priority question. This problem must be sorted out. It is simply unfair.

The place to sort it out is the Sub-Committee on Dáil Reform, not on the floor of the House.

No, it is not.

It cannot be sorted out today. All the Members are accomplishing by prolonging the discussion is that fewer questions will be attended to today.

If this occurs again, we will reconsider the position of co-operation with the Government. It is as simple as that. It is not a matter for the Sub-Committee on Dáil Reform.

Suicide Incidence.

Dan Neville

Question:

90 Mr. Neville asked the Minister for Health and Children his strategy to reduce the number of attempted suicides —parasuicides —presenting at accident and emergency departments of hospitals from the 2003 figure of 10,537; and his views on whether the rate among 15 to 19 year old women at 626 per 100,000 and the rate among 20 to 24 year old males at 407 per 100,000 presents a serious public health crisis requiring immediate and urgent intervention by him. [7124/04]

The second annual report of the National Parasuicide Registry, which I launched last month, indicates that there were 10,537 presentations to hospitals due to deliberate self-harm in 2002. These presentations involved 8,421 individuals. The report provides a wealth of information on the general characteristics of people who attempt suicide and reveals, for example, that the parasuicide rate for females is approximately 40% higher than that for males. The report also highlights the high incidence of attempted suicide in young people, bearing in mind that 90% of all recorded self-harm presentations to hospital involve individuals under 50 years old.

The findings of this important report will help to identify groups which are particularly vulnerable to self-harm and will assist my Department and the health boards in evaluating the impact of the preventative and clinical services being provided. The analysis of the information it contains will be vital in the development of policies and the implementation of measures aimed at preventing suicide.

My Department has paid special attention over the past few years to the resourcing of suicide prevention initiatives. Since the publication of the report of the national task force on suicide in 1998, a cumulative total of more than €17.5 million has been provided for suicide prevention programmes and research. This year, more than €4.5 million is available to the various agencies to reduce the level of suicide and attempted suicide.

This includes funding to support the work of the health boards, the National Suicide Review Group, the Irish Association of Suicidology and the National Suicide Research Foundation for its work in the development of a national parasuicide register.

Significant additional funding has also been made available in recent years to further develop liaison psychiatry, child and adolescent psychiatry, adult psychiatry and old age psychiatry services to assist in the early identification of suicidal behaviour and to provide the necessary support and treatment to individuals at risk. In this regard, figures recently published by Comhairle na nOspidéal indicate that 72 additional consultant psychiatric posts have been approved since 1998. My Department also supports the ongoing work of many organisations such as Mental Health Ireland, Grow, AWARE and Schizophrenia Ireland in raising public awareness of mental health issues. This year more than €3.8 million is available to the voluntary organisations for their work in this field.

Since the publication of the report of the National Task Force on Suicide in 1998, there has been a positive and committed response from both the statutory and voluntary sectors to finding ways of tackling this problem. In response to the recommendations of the task force, the National Suicide Review Group was established by the health boards and membership of the group includes experts in the areas of mental health, public health and research. Resource officers have been appointed in all the health boards with specific responsibility for implementing the task force's recommendations. The presence of a liaison psychiatric nurse in the accident and emergency departments of many general hospitals to deal with people who present following attempted suicide is also an important development.

Additional information not given on the floor of the House.

The provision of this service ensures that psychological problems in general hospital patients are dealt with promptly. This benefits the patient but also ensures a more efficient use of medical and surgical services. There are also numerous regional initiatives currently being run by the health boards in conjunction with non-statutory organisations, which focus on mental health issues like stress management, depression, stigma reduction and suicide-related matters. These are issues of paramount importance which require further attention to ensure that positive mental health and the well-being of people is promoted.

My Department also allocates funding, through the National Suicide Review Group, for voluntary and statutory groups engaged in suicide prevention initiatives, many of which are aimed at improving the mental health of the younger age groups. These projects include life-skills courses for high-risk youth, school-based personal development modules and mental health promotion campaigns.

With regard to the further development of suicide prevention programmes, the Health Boards Executive in partnership with the National Suicide Review Group, and supported by the Department of Health and Children, have commenced preparation of a new strategic action plan for suicide reduction. It is important to stress that this plan will be action-based from the outset, as it will build on existing policy as outlined in the national task force report in 1998. All measures aimed at reducing the number of deaths by suicide will be considered in the context of the preparation of this action plan.

I share the public concern about the level of parasuicides and suicides in this country. It is a worrying trend and I am fully committed to the further implementation of suicide prevention initiatives and the further development of our mental health services.

Bearing in mind that the figure of 10,537 for those who attempt to take their lives quoted by the Minister refers to those who present at accident and emergency departments, has he any proposals to identify the full extent of the problem and include attempted suicides who present at GPs only, and those who do not seek any help? Given that Irish parasuicide rates are 60% higher than the European average, would the Minister agree that there is urgent need for research into why this is happening and to develop effective suicide and parasuicide prevention programmes?

This is just the second report of the national parasuicide registry for which I provided funding. Of course there is a need for further research and this will be critical for our proper understanding of the causes of suicide, parasuicide and the various trends emerging. This exercise and project have been a fundamental intervention by the Department and the State in terms of funding the carrying out of a national parasuicide registry. The tools involved in the compilation of that registry will be expanded but one must proceed in a proper scientific way in terms of international comparisons. The figure indicating a 60% difference between Ireland and the rest of Europe was not mentioned in the context of the report's launch. We must be careful when establishing figures and so forth.

The resources of the National Suicide Research Foundation are my source.

In terms of the compilation of data we can go back 20 years. People could argue that the level of reporting of suicide cases then was different to what it is today.

No, it was not.

It has been the same since the High Court hearing in the 1960s with respect to the compilation of statistics.

With respect to the Deputy, a variety of factors can be considered but we get far more accurate reporting today than we did a decade ago. Others in the field support this view. The fact that we have established and helped to fund the research foundation and that we have funded and assisted the suicide registry provides us with the type of statistical data we did not have before to analyse this issue properly.

That is the case for parasuicide, but not for suicide.

I agree with the Deputy that research is particularly important for the future. We are anxious to work with the foundation and the parasuicide registry. At the launch I had discussions on how we can move on to research other aspects of the tragic issue of suicide.

Why does the Minister feel it necessary to establish a suicide strategy group in view of the fact that 86 recommendations of this national task force of 1998 is a strategy in itself and the National Suicide Review Group was the engine to introduce the strategy outlined by the task force? Why must he now establish a strategy to review suicide when the strategy has been waiting to be implemented since 1998?

A significant degree of that has been implemented but it would be remiss of any organisation not to continue to update recommendations and task forces. The task force of 1998 reported and the Department is working with the various parties to produce a strategic action plan to give greater effect to suicide reduction.

The National Suicide Review Group was supposed to do that.

The amount of money spent by successive Governments on suicide before 1999 was negligible.

The Minister is now quoting 7% for all ——

The Deputy is wrong. I am saying we have gone from €160,000 in 1999 to €4.3 million today.

The Minister is equating suicide prevention with——

There are many intersectoral issues which the Deputy would appreciate. The evidence that emerged from the registry is interesting, for example, in terms of the impact of alcohol consumption and the use of paracetamol. Our decision to restrict the sale of paracetamol in 2001 could have a beneficial impact and hopefully the register may pick that up in time.

Why does the Minister not restrict its sale to pharmacies?

Hospital Staff.

Liz McManus

Question:

91 Ms McManus asked the Minister for Health and Children the steps being taken to address the continuing serious shortage of nurses; the number of nursing positions unfilled at the latest date for which figures are available; the steps, in particular, being taken to ensure that qualified nurses remain in the hospital service; the steps being taken to reduce the over reliance on agency nurses; and if he will make a statement on the matter. [7164/04]

The Health Service Employers Agency undertakes quarterly surveys of nursing vacancies, the latest of which is for the year ending 31 December 2003, a copy of which will be forwarded directly to the Deputy. The survey shows that there were 994 extra nurses employed in the health service in the year ending 31 December 2003 and 788 nurses were recruited from abroad. The vacancy rate now stands at 1.73%, nationally.

While all sectors reported that recruitment was well ahead of resignations and retirements, employers reported that 675 vacancies existed at 31 December 2003, a decrease from 1,021 vacancies in December 2002. However, the combination of utilising agency nurses and overtime adequately compensates for this shortfall. Since the surveys began, the number of vacancies on 31 December 2003 is the lowest recorded. The highest was at the end of September 2000, when employers reported 1,388 vacancies. The latest figure represents a reduction of 51% on September 2000.

The current vacancy rate of 1.73% has been declining steadily in recent years and could be considered to be a normal frictional rate, given that there will always be some level of movement due to resignations, retirements and nurses availing of opportunities to change employment and locations. The recruitment and retention of adequate numbers of nursing staff has been a concern of this Government for some time and a number of substantial measures have been introduced in recent years. The number of nurse training places has been increased by 70% since 1998 to 1,640 from 2002 onwards. A comprehensive range of financial supports has been introduced to support nurses in pursuing part-time degrees and specialist courses, including back to practise courses. Since 1998 nurses have been paid for overtime. Previously they were given time off in lieu and the introduction of payment represents a further significant financial incentive for them.

I introduced a scheme of flexible working arrangements for nurses and midwives in February 2001. Under the scheme, individual nurses and midwives may apply to work between eight and 39 hours per week on a permanent, part-time basis. The figure of 33,442 whole-time equivalent nurses working in the health service translates into 39,119 individual nurses. Of these, some 28,366 work full time, and 10,753 work job-sharing or other atypical patterns. Thus, over one quarter of the nursing workforce avails of family-friendly work patterns.

There have been very substantial improvements in nursing pay since 1997. For example, a staff nurse on the maximum point of the scale has seen a 51% increase in basic pay up to 1 January 2004. There is an increase of over 8,200 during the period from 1997 to the present.

Additional information not given on the floor of the House.

It is clear from these figures that the recruitment and retention measures I introduced are proving very effective. The promotional structure within nursing, including the introduction of a clinical career pathway, has been substantially improved on foot of the recommendations of the Commission on Nursing and the 1999 nurses' pay settlement. The National Council for the Professional Development of Nursing and Midwifery has been especially active in this area and, to date, 1,522 clinical nurse specialist and advanced nurse practitioner posts have been created. Figures from An Bord Altranais for the same period indicate that there is a steady stream of new entrants into the profession, over and above those graduating from the Irish system, thus further increasing the potential recruitment pool. Since 1998, the total number of nurses newly registered by An Bord Altranais is 19,945. Of this number, 13,658 were overseas nurses.

The continuing attractiveness of nursing as a career for school leavers and mature code applicants alike is clearly evident from the number of applicants for such courses. For example, there were 7,507 applications for 1,640 places in the autumn 2003 intake. This means that applications for courses were oversubscribed by a factor of 4.6. This is most encouraging, given that our third level education system provides an ever-increasing array of attractive alternatives. My Department recently gave approval to the roll-out, on a national basis, of the health care assistant training programme. This fulfils a key recommendation of the Commission on Nursing. The main objective of the programme is to upskill health care assistants so that, working under the supervision of nurses, they are enabled to take on a wider range of duties, thereby freeing up nursing resources to concentrate on exclusively nursing tasks.

The HSEA surveys to which I have referred also contain data on the use of agency nurses. The average number of agency nurses used per day in 2001, 2002 and 2003 was 434, 401 and 312, respectively. These figures demonstrate a continuous and substantial downward trend in the use of agency nurses. I am confident that the extensive range of measures I have outlined, including the substantial increase in training places, the recruitment of overseas nurses, the more effective utilisation of the professional skills of nurses and midwives, in addition to close monitoring and assessment of the situation on an ongoing basis, will continue to prove effective in addressing the nursing workforce needs of the health services.

Would the Minister not accept, despite the spin he is applying to make the figures look good, that there are approximately 700 vacancies in nursing posts? Is it not true that by 2005 the 1,500 nurses will not be qualifying yet the Minister is not preparing for or making changes to meet that shortfall next year? Does he not accept that we are not going to be able to depend on overseas nurses coming here? In the Philippines, Ireland is no longer seen as an attractive option. It does not compare well with other countries now who are effectively attracting overseas nurses much more than we are. Would he not accept that the employment ceiling on health boards is having a negative effect on filling nursing posts and that because of it, health boards are being forced to use much more costly agency nurses? Would he not also accept that the promise to open more than 190 beds to deal with the accident and emergency crisis has not been fulfilled partly if not solely because there are no nurses to look after patients in these beds, particularly elderly ones, and therefore beds remain closed?

I am not applying spin. I am stating the facts. These can be ascertained objectively and independently —they are not my figures. Since 2000 there has been a dramatic improvement with a reduction in the nursing vacancies. There has been a dramatic increase in the numbers of nurses in the service by 8,200. In addition there are now only 675 vacancies, or less than 2%.

The Minister should answer my question.

All the partners were anxious to have a degree programme for which we provided substantial funding. While we will work to prevent problems, if such a problem occurs, it should manifest itself in spring 2006. The window of difficulty will occur between spring 2006 and autumn 2006. Under the new degree programme nursing students will be employed in the health service for a 12-month period during their training and will receive a salary. They will commence their rostered service from spring 2005 until spring 2006. They will make a significant contribution to the health services and will help to address some of the difficulties. In addition there will be a cohort of graduates available by autumn 2006. We are working with the Health Service Employers Agency and the employers to ensure that we make provision for that period.

The Deputy is incorrect in suggesting we are not competitive in attracting nurses from abroad particularly from the Philippines. We have attracted substantial numbers of overseas nurses last year and will do so again this year, mainly from other countries.

It is unreal for the Minister to think that is the case. Everybody knows there are difficulties concerning Filipino nurses and that those problems will increase. Is the Minister aware that the nurses qualifying this year are not being given guarantees of work even though the vacancies exist and even though hospital beds remain closed? Due to the employment ceiling, health boards and hospitals are not able to offer any guarantee of work to people who are soon to qualify and who we want to retain in the system despite the great need that exists even though the Minister does not seem to be fully aware of the shortage in meeting the needs of patients in hospitals.

The facts do not bear that out. Almost 1,000 extra nurses were appointed last year alone.

How many extra beds have opened?

The ERHA is working to commitments it has made in this regard. For example the Dublin teaching hospitals recently succeeded in recruiting 135 nurses from India.

We had to go the Philippines and now we have to go to India.

The Deputy is wrong in what she said about the Philippines.

They cannot do without nurses in India.

It is completely unethical.

That has been checked with the Indian authorities and the Deputy is wrong in that regard.

While there has been considerable polemic, comment and campaigning, nursing in this country has been transformed in the past five years because of the implementation of the recommendations of the commission on nursing and because of new practices that have been introduced. We have worked with the partners to achieve this. We have made it a profession by introducing a degree programme and have committed in excess of €250 million towards it.

However we have no nurses.

It is time some of this was acknowledged by all concerned. Back in the early 1990s when Fine Gael and Labour were in power they did not provide adequately in their nursing manpower policies.

The Minister always wants to blame somebody else.

The Government should just open the beds and employ the nurses.

Hospital Services.

Liam Twomey

Question:

92 Dr. Twomey asked the Minister for Health and Children his views on a report compiled by the ERHA detailing the use of elective beds in acute hospitals by patients who were not resident within the region; and if he will focus his views on the SEHB region. [7123/04]

I presume the Deputy is referring to a report compiled by the Eastern Regional Health Authority and presented to its board last year. The report dealt with the extent of referrals of elective patients resident outside of the region to hospitals in the eastern region. The report concluded that protocols were required in the referral of patients from other health board areas for elective services in hospitals in the eastern region.

Analysis also carried out in 2003 by the South Eastern Health Board found that approximately 60% of elective patients from the south-east who are referred to the eastern region each year come from the counties of Wexford and Carlow. Such use of eastern region facilities may reflect individual choice or perhaps the traditional referral patterns of local GPs. The case mix analysis carried out by the South Eastern Health Board demonstrates that the complexity of the South Eastern Health Board residents receiving treatment in the east is of a higher complexity than those of the ERHA.

The proportion of South Eastern Health Board residents being admitted to hospitals in the eastern region has decreased in recent years. This has come about as a result of the development of specialist regional services. This development of regional services in the south-east is reflected in the 30% increase in consultant posts in the period 1999 to 2004.

Successive Governments have pursued a policy of regional self-sufficiency in the provision of hospital services to ensure that patients are in a better position to access services locally. The benefits of this policy are evident through a series of major infrastructural developments in hospitals around the country, which has resulted in the availability of more services and new specialities on a regional basis. However, for reasons of complexity, a number of specialised services are concentrated in the eastern region. The ERHA has acknowledged that the referral of patients from outside the region to avail of tertiary and super-regional services in the eastern region remains appropriate given the range and specialised nature of the services provided.

In this regard, my Department has been informed by the authority that it intends to have discussions with hospitals in the eastern region and other health boards during 2004 with a view to the implementation of protocols regarding referral of patients from outside the region. The intention is to secure greater transparency, agreement and understanding of the referral process for utilisation of services in the east. The South Eastern Health Board will, therefore, have the opportunity of discussing and agreeing protocols for referral of patients from the south-east to specialist services in the eastern region. Having regard to the potential service and budgetary implications of any change in traditional referral patterns, my Department has requested the ERHA to inform the Department before any revised protocols are implemented.

The Minister indicated he believed there is a natural inclination for patients to go to the hospitals in the ERHA region. In some respects this is because the services are still not available in the south-east. The number of in-patient beds in the ERHA region occupied by patients from the South Eastern Health Board region reduced from 15% to 11%. There has been no corresponding increase in the South Eastern Health Board budget to reflect that it is doing more work in the south-east and it remains the second lowestper capita budget in the country.

Why are more than half the consultants appointed to the ERHA? There is a deficit in the services that need to be provided in the south-east. While the Minister said the number of consultants appointed to the south-east has increased there are considerable deficits in the service.

The Minister mentioned that some patients still go to Dublin. In the south-east it takes five years to get regional services such as an ENT or orthopaedic out-patient appointment. The South Eastern Health Board has the perfect structure with a regional hospital and a number of local hospitals working around it. It is not working as efficiently as we would like because of insufficient funding. It is not a question of the Hanly report and all the silly recommendations coming from that. For instance, the Hanly report did not refer to the tertiary services offered by Dublin hospitals to any great extent, considering the cost involved.

Does the Minister not believe we should start to appoint consultants in the south-east to embed these services in the south eastern region so that we have some hope of providing the services for the 400,000 patients in the region? I would like a commitment from the Minister to increase the funding to the South Eastern Health Board region. The presentation to the Oireachtas Joint Committee on Health and Children last Friday made it clear that the South Eastern Health Board is very efficient in dealing with the money it receives. However, it is also aware that huge capital expenditure will be required because its buildings are becoming run down. In the Dublin region there are too many consultants and not enough beds. Outside that major region there is a deficiency of consultant numbers. That is the problem with the Hanly report. Unfortunately there seems to be a sense that the best way of complying with the European Working Time Directive is not to bother with the consultants' contracts but instead to withdraw services from hospitals, such as the hospital I support, Wexford General Hospital. There should be a way around the directive which does not require the radical closing of services proposed by Hanly.

This is not the time to go into this. I am much more interested in hearing the Minister's views on why the South Eastern Health Board, no matter what it does, still seems to receive a poor share of resources, despite all the talk of equality.

There are elements of contradictory commentary in terms of what should happen in the south-east. Much of what the Deputy has said is what the Hanly report is about, namely, regional self-sufficiency and a dramatic increase in the number of consultants in the region. I support that. The essence of the Hanly report is to move from a consultant-led to a consultant-provided service. In the mid-west, for example, it is estimated that the number of consultants will be doubled. The same will probably happen in the south-east although the region has not been examined yet. That is ultimately the way to take a number of services back to the east.

At one level there has been a decrease in the traffic going to Dublin from the south-east, especially since the appointment of consultants in oncology, rheumatology haematology, nathology and dermatology. More cardiologists will be coming on board. All that has succeeded in bringing many services back within the geographic areas of the south-east which perhaps heretofore were located in Dublin. There has been an improvement.

That said, there is still evidence of high rates of referral to the east for routine treatments which are available in local health board areas as a result of significant development of services. I could give some statistics regarding the numbers of patients who are still travelling. Some people are still travelling for routine treatments which are available within the south-east. However, in the areas to which I referred, especially oncology, there has been a significant reduction in traffic to the east because of the appointment of additional consultants. Since 1999 about 35 additional consultants have been appointed to the south-east.

We should engage. We are not interested in downgrading services in the south-east. Leaving elections out of the equation, the issue is how to make the region as self-sufficient as possible in terms of consultant manpower, which means additional specialties and strong critical mass in those specialties. This will ultimately mean that the majority of people will be treated in their own region. That is what I am about.

I agree with those sentiments.

We have exceeded the allotted time.

The best way to implement Hanly is to recruit consultants and provide services because patients drift towards where the quality service is available.

We are way over the time limit.

Our argument throughout the debate since I was elected to this House and since the Hanly report was published in September has always been about the report's approach towards acute services, not towards what we are talking about here on which we are in agreement.

It is related. There will be no diminution of acute services.

Of course there will be. That is rubbish. The Hanly report spells it out and the Minister accepted it. The Minister is misleading the House.

There will not.

Tell it to the marines.

Allergies Incidence.

John Gormley

Question:

93 Mr. Gormley asked the Minister for Health and Children if his attention has been drawn to recent studies which show that Ireland has a very high rate of allergies; if his Department has undertaken studies to find the reasons for such a high rate; and if he will make a statement on the matter. [7126/04]

My Department has been aware in recent years of a number of references both in the general media and in the medical literature to an increase in the prevalence of conditions which may be related to allergies. These conditions affect a number of systems such as food allergies resulting in gastrointestinal symptoms, allergies to substances in the environment which may lead to a variety of skin conditions, and the one which has been most widely researched and reported, that of an apparent increase in the prevalence of asthma in both children and adults.

Some of these phenomena may be explained by more sophisticated diagnostic and investigative techniques which allow for the more frequent identification of conditions whose pathology and causation were previously unknown. However, it is generally accepted, not only in Ireland but in the Western world in general, that there appears to have been a real increase in the incidence of asthma which is not solely explained by reference to diagnostic techniques. This was confirmed in a study which was carried out on asthma in Ireland by Allen & Hanburys in conjunction with the Asthma Society of Ireland in 2001. This research extended a previous study which was carried out in seven countries in Europe in 1999 which confirmed that, among the European Union countries, there are also variations in asthma prevalence.

It is accepted that some of the factors which may influence this situation include environmental factors, not only smoking and workplace exposure to respiratory irritants, but also a more general level of exposure to environmental substances which cause allergies to occur. The Deputy may wish to note that the EU is developing an action plan on environment and health which is expected to be adopted later this year. The plan is intended to reduce the disease burden caused by environmental factors in the EU, with special emphasis on children and other vulnerable groups in society, to identify and to prevent new health threats caused by environmental factors and to strengthen EU capacity for policy-making in this area. Officials of my Department and of the Department of the Environment, Heritage and Local Government are involved in the preparation of this action plan.

Additionally, an expert workshop on childhood asthma organised by the Joint Research Centre of the European Commission will be held in Cork on 22 and 23 April 2004. This will examine approaches to research on childhood asthma from a genetic and environmental perspective, which is part of a major research initiative ongoing at EU level. It is hoped to agree Council conclusions on this issue at the June meeting of the Employment, Social Protection, Health and Consumer Affairs Council.

The Deputy may wish to note that, at the meeting of the Competitiveness (Internal Market, Industry and Research) Council on 22 September 2003, a directive was approved regarding the labelling of the ingredients present in foodstuffs. The new labelling rules in particular aim to ensure that consumers suffering from food allergies or who wish to avoid eating certain ingredients for any other reason are informed. They foresee that all ingredients in foodstuffs will have to be included on the label and abolish the 25% rule which up to now meant that it is was not obligatory to label the components of compound ingredients that make up less than 25% of the final food product. The new directive also establishes a list of ingredients liable to cause allergies or intolerances. It will also be obligatory to mention allergens on the labels on alcoholic beverages.

Additional information not given on the floor of the House.

At the forthcoming meeting of the European Union chief medical officers, the chief medical officer of my Department has placed the issues of food and asthma on the agenda so that we can share experiences, information and knowledge with our EU partners on this issue. In addition, my Department has contacted the Health Research Board to discuss the issue of research into the incidence of asthma in the Irish population, and the establishment of an asthma register is under discussion between professionals dealing with asthma and the Eastern Regional Health Authority. These initiatives should help to elucidate more clearly some of the causative factors relating to these conditions and, more specifically, to identify factors which contribute to the allergic component of this and other conditions. Thus, preventative and treatment strategies can be more effectively developed and implemented.

I thank the Minister for his comprehensive reply. I take it from the reply that he accepts that this is a serious problem in Ireland. The latest statistics available to me show the percentage of teenagers aged 13 to 14 years in Europe reported to be wheezing in a 12 month period. It was 30% for Irish children. In terms of the league table, does the Minister accept that the United Kingdom and Ireland come off worst? Can he explain why we come out so badly in the asthma league table? In 1983 only 4% of children suffered from asthma, so there has been a dramatic increase in the rates of asthma. There is evidence of this in my constituency. Schools in Ringsend, Sandymount and Rathgar have a box full of inhalers. Can the Minister identify or does he hope to identify why Ireland has such a poor record in this regard? Does he accept the hypothesis that the rise in allergies could be directly linked to the way we live now, in bacteria-free homes, eating semi-sterile food, and that all the evidence shows that children exposed to more infections in early life are less prone to allergies? Will research in this area focus on that?

I have a number of specific questions. There is no dedicated provision for the identification and treatment of allergies in the public health system in Ireland. When does the Minister intend to make provision to address the allergy epidemic and direct his Department or the Central Statistics Office to begin collecting data that will inform his decision-making on adequate service provision in this area? What guidelines are being issued to general practitioners and accident and emergency units where they are confronted with someone with an allergy? There are those who believe —and they are well-informed individuals —that people are not properly informed and that we could have fatalities as a consequence. Is the Department issuing guidelines to people at the coalface dealing with this and to people in schools? Many children have allergies to various foodstuffs and teachers do not know how to deal with them.

Having spoken to those involved in the area and to consultants, clinicians and researchers, I am aware that there are still a number of theories regarding the prevalence of asthma in developed countries such as Ireland. It is argued by some that it is a condition of the developed world and not one that affects those in the developing world. Many clinicians have articulated that explanation but it is yet not definitive in terms of evidence and some people question it.

I recently met the head of the European Union joint research centre and discussed his plans for a major European research study of which the workshop in Cork will be a part. This study will provide an opportunity for Irish researchers to tap into information from across the Continent. The individual who heads the centre happens to be Irish and he was anxious to involve the country in this medium-term project.

To whom is the Minister referring?

I do not want to name the individual involved. He is head of the joint research centre of the European Union. The project will be a substantial, multi-partner research initiative and we hope to put it forward at the June meeting in Budapest which will deal with children and environmental factors. The idea is to carry out genuine research on the linkage between environment exposure and genetic make-up. There could be an interplay between both factors and some may be more exposed and run higher risks in respect of certain environmental considerations than others.

In respect of the specific case of Ireland, I have been involved in discussions with certain professionals. My chief medical officer and his team are currently in discussions about the establishment of a specific asthmatic register so that we can obtain data about the prevalence of asthma in this country. The United Kingdom and other countries in Europe have rates similar to those which obtain here. I take the point that we have lacked infrastructure for development.

When will the register be ready?

It will take time to get it up and running. I hope that the discussions to which I refer will soon reach a conclusion. Dr. Manning has been a tireless advocate for the establishment of such a register. I hope I will be in a position to put in place the machinery to facilitate this.