Vol. 599 No. 6
2 Dr. Twomey asked the Tánaiste and Minister for Health and Children the cost of adopting a policy involving the repayment in full of all illegal charges to patients who are still alive and invoking the Statute of Limitations in regard to the estates of patients who are deceased, in relation to the illegal charging of long stay patients; if she has received legal advice that such a course of action is sustainable; and if she will make a statement on the matter. [9717/05]
3 Ms McManus asked the Tánaiste and Minister for Health and Children the number of calls received to date by the national repayments scheme helpline; the information available to her Department regarding the extent of the potential cost to the Exchequer of the illegal charges; the progress made to date by the Government committee considering the question of repayments; if a decision has been made regarding whether the Statute of Limitations will apply; when the committee will produce a report; and if she will make a statement on the matter. [9542/05]
I propose to take Questions Nos. 2 and 3 together.
My Department is currently studying the Supreme Court judgment with regard to repayment of charges for publicly-funded long term residential care in detail and will take on board all the consequences for policy and law arising from the judgment. A special Cabinet sub-committee comprising the Taoiseach, Deputy Bertie Ahern, the Minister for Finance, Deputy Cowen, the Attorney General, Mr. Brady, and me, has been established to consider the issue of repayment in light of the judgment. Full details of a repayment scheme will be announced as soon as possible and it is the intention to make repayments as automatic as possible.
The Department is currently in discussions with the Health Service Executive, which assumed responsibility for the delivery of health and personal social services on 1 January 2005 regarding the appropriate mechanism of repayment that is efficient and non-contentious and without the requirement for going through a legal process.
The HSE has now provided an estimate of €532 million for the total overall cost of repayments for the six year period 1999-2004. The cost of repayment in full to patients who are still alive and invoking the Statute of Limitations in regard to the estates of patients who are deceased is currently the subject of discussions with the HSE regarding the potential costs to the Exchequer. The HSE has also now provided an estimate of 299,249 persons as being eligible for a refund for the period 1976-2004.
The total number of calls the national repayment scheme helpline dealt with up to 21 March 2005 was 7,044. The national repayment scheme also received 4,263 written correspondences as well as 514 e-mails.
The Supreme Court decision indicated that the State has available to it the Statute of Limitations defence, i.e. a six year limit. The Attorney General has been in touch with me regarding the issue of the Statute of Limitations and I am in continuous discussions with him in this regard.
Will the Government return to the Supreme Court to test the legality of invoking the Statute of Limitations? Has the Government considered doing so? The Supreme Court judgment takes into account the rights of the State's limited liabilities by reliance on the Statute of Limitations. Has the Tánaiste received definitive legal advice from the Attorney General on this matter?
The Tánaiste quoted a figure of €532 million to cover all repayments for the six year period. The 2001 legislation was pivotal in reactivating this issue within the Department of Health and Children. Can the Tánaiste give us some idea of how much of the €532 million relates to the 2001 legislation? That is pivotal to what the former Minister for Health and Children, Deputy Martin, said he knew nothing about. Ministers of State in his Department considered it very serious but we were not made aware of the substantial political importance involved until the Tánaiste made her announcement in the Dáil Chamber.
What is so important about the South Eastern Health Board legal advice that the Tánaiste is now attempting to cover up? Does this cover-up relate to court cases taken by patients in that health board area or does the legal advice relate to court cases pending from health board officials or other State employees in that area? We need clear answers because this issue is quite substantial and the Tánaiste is fudging on it every time we ask about it.
I would also like the Tánaiste to point out from where the figure of €1.15 billion came. This figure was given to the Supreme Court by counsel for the State and relates to charges going back to 1976. The Tánaiste has not given a breakdown of the figures. A Cabinet sub-committee must surely at this stage have some better working figures than merely the figure of €532 million. Can the Tánaiste supply a breakdown of these figures? How much of it relates to public nursing home charges, to long term psychiatric patients, to patients with intellectual disabilities, to patients who cannot represent their own interests? Can the Tánaiste give a more detailed breakdown of the figure of €532 million, which covers the six year period?
Before the Tánaiste leaves the Chamber today, can she clarify the issue regarding the Statute of Limitations and how far the Government has gone in considering invoking it?
Regarding the Statute of Limitations, the period is six years. While I have not got definitive legal advice from the Attorney General, we are still in the process of drawing up a memorandum for Government that I hope to take to the Cabinet meeting on 6 April so that we can make a decision on how to proceed. Trying to assemble all the information and thereby get a definitive opinion from the Attorney General has been a mammoth task. However, I have already put on the record the preliminary advice from the Attorney General that we cannot use the Statute of Limitations against anyone of unsound mind. Furthermore, for anyone now alive to seek to prove that he or she was of unsound mind would be an impossible task, as the Deputies can imagine, and a very unfair task to ask anyone to undertake.
I have been told that there are 22,000 people alive whose estates are affected, so that most of those affected have passed away. Regarding those still alive, the breakdown between those people in what I might call mental health institutions and those in the category of the elderly seems to be 50-50. That is my understanding.
The figure of €1.15 billion was the Department's estimate before the Supreme Court of what we raised since 1976. That seems to be the approximate figure for what was raised by way of charges for the people involved in publicly funded beds, whether in county homes or in psychiatric or mental health institutions. However, when it comes to repayment, the issue of interest arises. That is why some of the figures we are now discussing are somewhat higher than the figure of €1.15 billion. One has to consider interest and what someone could have earned if he or she had put the money in the post office or somewhere else. They are some of the issues that arise.
I assure Deputy Twomey that from the time I became aware of this matter, the last thing I have done is to fudge. I appointed John Travers because I was not satisfied with the report given to me, which I brought to the Cabinet. I only became aware of the deficiencies in that report 48 hours after I received it. I asked John Travers to look at all the issues and documents and give me a report so that I could establish what has happened and why this matter had not been dealt with in the past. That is what his report sought to do.
I have made many documents available, which were not even in the Travers report. Last week I made available some documents including those from the line division in the Department. I also gave an undertaking to make other documents available. Is is very rare for governments to release the legal advice they are given, but I can supply documents of a legal nature only if they do not prejudice any upcoming court cases. There are a number of cases pending. Most of them relate to the nursing home issue, private institutions and nursing home subventions, and they are intertwined in the legal advice the South Eastern Health Board had. That is why the Attorney General has strongly advised me that I could jeopardise the proceedings of this State if I were to put that advice into the public domain. As a responsible Minister I must take that advice.
What about the legal advice?
I must call Deputy McManus.
Perhaps the question Deputy Twomey wanted to ask is the same as mine. To what cases is the Minister referring? The suspicion is that the legal advice is deliberately being kept hidden, even from the Oireachtas committee charged with the duty of examining the issue in terms of administrative and legislative change. The Minister is giving us a job of work to do without providing the tools to do the job when she refuses to release this information. Will the Minister specify the cases about which she is talking that lead to this difficulty? Until we hear those details she will not convince us 100%.
The Minister knows who these people are because they are in public institutions. Will she describe for us the mechanism for payment? Will she discriminate in favour of people who are alive rather than those who have passed on? Will she publish the legal advices relating to the scheme when it is prepared and has passed through Cabinet? It would be helpful if she provided the details of the legal back-up. We have had to argue the case about the unconstitutionality of a previous Bill. The Minister must accept that it is important that anything done now is put to the test by publication so that we may all have confidence in it.
With regard to what is available to us in the Travers report, the legal advice of the then South Eastern Health Board is censored and delivered to us in a very truncated form. However, according to the report, that advice clearly states the only conclusive solution is the introduction of a comprehensive legislative framework etc. We know that two Ministers knew what was going on and that the Taoiseach was informed about it. The current cost is considerably higher because the Minister responsible did not live up to his responsibilities.
Does the Minister agree there is a major question mark over her predecessor? What the Travers report said about the legal advice of the then South Eastern Health Board cannot be gainsaid. No Minister could stand over total ignorance when such information is available to him and when advisers, civil servants and Ministers of State were at the meeting. Has this not added to the costs in a manner that raises a question mark over his competence to be in Cabinet?
With regard to the cases to which I referred, there was a lawyer from Cork on the radio a few weeks ago, who may be associated with one of the parties in the House, who has taken on a number of cases on the nursing home and private nursing home issue. That matter was also dealt with in this advice. He is not the only one, but he is on public record as indicating that he was taking cases. I have been told by the Attorney General that there are a large number of other cases pending.
I will abide by and respect the decision of the Supreme Court in the manner in which we will set about making the repayments. However, I must be honest and admit that I am keen to use the statute of limitations if possible because this is an enormous bill. As the Travers report made clear, there was broad support for the concept of charging for shelter and maintenance going back to 1947 and no Government in office since then saw fit to remove the capacity to charge for shelter and maintenance. The tragedy is that this was not legislated for.
On the issue of legal advices, as the report indicates, in 1978 there was clear legal advice from Ronan Keane and Thomas McCann to the then Eastern Health Board which said that legislation was necessary. Even going back that far, it was clear legislation was necessary. It is a shame that the legislation was never passed to make legal a very good principle, which is what we are talking about here.
The meeting in December 2003 made the right decision and the people who attended that meeting cannot carry the can for anything wrong that happened. The issue was raised by the CEO of the then South Eastern Health Board. Note was taken of his concerns and a commitment was given that legal advice would be sought from the Attorney General. Subsequent to the meeting a group was put together and it drew up a document and a letter to be sent to the Attorney General. That letter never issued. The minutes of the meeting of the following March — when the next meeting took place with the CEOs and the management committee — state that legal advice was being sought, which was untrue. The next meeting was in October 2004 where it was stated that legal options were being explored, which again was untrue. To be honest, the situation is rather bizarre.
If we could have legislated for this matter a number of years ago, the mess we are now in would never have happened. We will seek to make it as easy as possible for people to go through the scheme we will establish rather than pursue the legal route. I want the taxpayers' moneys that we will pay to go to the elderly and their needs, not to the interests of the legal profession, with all due respect to that profession. I want to make it as easy as possible for people to access the scheme. Now that some of the issues are becoming clearer, I hope to be in a position to bring that memorandum to the Government for 6 April so that we can make a decision and a subsequent public announcement.
Why is this legal document being withheld from Members when it was widely circulated among the health boards in 2003? It is not Government legal advice but legal advice sought by a health board on an issue with which it was dealing and subsequently circulated to all health boards. The Minister tells us we cannot have this information. With regard to the Minister, Deputy Martin, and the Department of Health and Children, we have seen no political responsibility. We feel we have some political responsibility and that we should have that information if it is so widely available to everybody else.
It is not widely available, but available under privilege. They were all at the same meeting and all facing the same cases. The advice they were getting from the Department for many years, going back to 1978, was that they should not contest. Therefore, if one long-term bed occupant had a lawyer who could help him or her to take a case, he or she would no longer be charged while somebody not so fortunate in the bed beside him or her was charged in all those years. Besides the legal issues involved here, there are significant inequality issues that are unacceptable.
There is no doubt on the reading of the legal advice that the long-term charges issue should have been put on a statutory legal footing. The report makes that clear. However, the legal advice Governments must follow is the legal advice of the Attorney General. It is remarkable that his advice was never sought over almost 30 years. There is no evidence anywhere to suggest, as can be seen from the Travers report and even going back to 1976 when the famous circular was issued, that the Office of the Attorney General was consulted. This is what I find extraordinary. It was almost in the ether that this was fine and the attitude was that because we had always done it, we should continue to do it. If there is a lesson to be learned, it is that we should not ignore legal advice or the need to seek it to cover areas where one is raising substantial amounts of money, as we are doing through this route.
Surely that is not true. If former Minister, John Boland, was able to bring forward a proposal to Cabinet, presumably he had taken advice from the Attorney General in some shape or form. Has the Minister asked the person who took over from John Boland as Minister, the Ceann Comhairle, Deputy O'Hanlon, why the battle was not resolved at that point as the Minister states it should have been?
The Minister mentioned people suffering from mental illness. Are people in long-term care with physical disabilities included in the provisions?
The people included in these provisions are the people to whom the Health Act 1970 applies, people regarded as fully eligible, namely, medical card holders. That is the first time the concept of full eligibility was introduced. Those with physical disabilities may well be included. I am not certain that everybody with a physical disability would incur a maintenance-shelter charge.
I understand that when a memorandum came to John Boland, he stated in his own handwriting that he wanted to include the charges issue. There is no evidence in the Department or elsewhere that advice was given to him to do that. The view was taken that perhaps because of his legal background or his experience on a health board, he was aware there was a problem around this issue. He was only a caretaker Minister for a couple of weeks, which is remarkable. The same memorandum went to the subsequent Government and it made a decision to introduce the elements of the budget which introduced charges for outpatient and inpatient services.
With regard to this issue, which was part of the decision sought, that Government said it would be done as relevant and that the Taoiseach, and the Ministers for Finance and Health and Children would meet to discuss the matter. There is no record of that ever happening but I have not spoken to anyone about that.
4 Caoimhghín Ó Caoláin asked the Tánaiste and Minister for Health and Children if she will initiate a State-wide cervical pre-cancer screening programme; and if she will make a statement on the matter. [9543/05]
I am committed to the national roll-out of a cervical screening programme in line with international best practice. International evidence demonstrates the proven efficacy of programmes that are effectively managed and meet quality assurance standards. Careful planning and consultation with relevant professional and advocacy stakeholders is required before I make policy decisions on a national roll-out.
The former Health Board Executive commissioned an international expert in cervical screening to examine the feasibility and implications of a national roll-out of a cervical screening programme. The examination included an evaluation of the current pilot programme in the mid-western area, quality assurance, laboratory capacity and organisation and the establishment of national governance arrangements. The expert's report was published on 14 December 2004. My Department is consulting the Irish College of General Practitioners, An Bord Altranais, the Academy of Medical Laboratory Science, the Institute of Obstetricians and Gynaecologists of the Royal College of Physicians of Ireland, the faculty of pathology of the Royal College of Physicians of Ireland, the Women's Health Council and the Irish Cancer Society. Consultation with these key stakeholders is well advanced and will be completed shortly.
Approximately 230,000 smear tests are carried out annually which represents an increase of almost 20% in recent years. To meet this increased demand, additional cumulative funding of approximately €14.5 million has been provided by my Department since 2002 to enhance the laboratory and colposcopy services.
The pilot cervical screening programme commenced in October 2000 and is available to eligible women resident in counties Limerick, Clare and Tipperary. Under the programme, cervical screening is offered free of charge at five-year intervals to approximately 74,000 women in the 25 to 60 age group. In addition, my Department allocated a further €1.1 million to the programme on an ongoing basis to complete the transition of the remaining laboratories to new and more effective testing and to support the development of quality assurance and training programmes. These are essential preparatory elements in a national roll-out.
Will the Minister support and act on the unanimous call of the Irish Cancer Society and 24 other organisations, including trade unions, professional bodies and women's networks, on 24 February for a State-wide pre-cancer screening programme? The latest figures I have relate to 2000. There were 1,019 new cases of in situ cervical cancer, that is, a pre-cancerous state, 193 cases of invasive cancer and 65 deaths. Does the Minister agree comprehensive screening leading to early detection and treatment can and will dramatically reduce the incidence and development of cervical cancer and the resulting all too terrible death toll? Will she therefore roll out a screening programme as soon as possible? Will she offer screening free of charge to all women aged between 25 and 60? Will she prepare a register of all such women to facilitate the roll-out of such a programme?
I would like to have a national roll-out. Professor Prendeville, who is one of our leading experts in this area, recently said an organised roll-out would be more effective than opportunistic screening, which is currently the case, in reducing the incidence of cervical cancer and he believes it could be reduced by 80%. I would like to discuss this issue in the context of the renewal of the contact under the GMS. This programme is being implemented by general practitioners and I would like it to be included as part of a new contract with them.
I do not have current figures on the number of women who die from cervical cancer in Ireland but I have no reason to dispute the figures given by the Deputy. However, population screening in certain areas is successful. Cervical and breast screening highlight that early detection has significant positive effects in preventing the illness or deaths and reducing the seriousness of the illness.
I thank the Minister for her reply. I am obliged to interpret it in the most positive way I can and if it is her wish that such a programme should be included in the programme of work she is undertaking, I welcome and encourage it. Will she take on board that a comprehensive screening programme will save massive resources? There can be no argument on cost in this instance because the health service will save resources through early detection and prevention and, above all, the lives of women will be saved. I hope the Minister will move the project forward with some alacrity.
Will the Minister explore with her Northern counterpart the prospect of an island-wide roll-out of the screening programme because tremendous savings and benefits would be gained by adopting a cross-Border co-operative approach on such issues? I know from all the contact I have had north of the Border, there is no resistance to such co-operation on health matters. It is an area that can demonstrate the great value and importance of co-operation on many levels and in many matters. This is certainly one of them.
That is a good idea. There is potential to do more on an all-island basis in the health care area. Unfortunately, because of the current political vacuum, it has not been possible to have a number of the meetings that might have been held in a different context. Perhaps following the Westminster elections, we might be in a position to discuss this. A number of issues have been raised on which it would make sense to work on an all-island basis. For example, radiotherapy is another issue for people in the north west and Border counties. If there are health care initiatives on which we can work on an all-island basis, we would be irresponsible not to pursue those options.
5 Mr. Neville asked the Tánaiste and Minister for Health and Children her plans for introducing adequate child and adolescent psychiatric services consisting of multidisciplinary teams. [9716/05]
A working group on child and adolescent psychiatry was established by the Minister for Health and Children in June 2000 to make recommendations on how child and adolescent psychiatric services should be developed in the short, medium and long term to meet identified needs.
In its first report, the working group recommended the enhancement and expansion of the overall child and adolescent psychiatric services as the most effective means of providing the required service for children with mental illness. The group found that the internationally acknowledged best practice for the provision of child and adolescent psychiatric services is through the multidisciplinary team and the funding of this area has been a priority for my Department in recent years. Since 1997, additional funding of almost €19 million has been provided to allow for the appointment of additional consultants in child and adolescent psychiatry, the enhancement of existing consultant-led multidisciplinary teams and the establishment of further teams. This has resulted in the funding of a further 19 child and adolescent consultant psychiatrists. Nationally, 52 such psychiatrists are in our complement.
The first report of the working group on child and adolescent psychiatry also recommended that a total of seven child and adolescent inpatient psychiatric units for children ranging from six to 16 years should be developed throughout the country. Project teams have been established to develop child and adolescent inpatient psychiatric units in Cork, Limerick, Galway and the Health Service Executive eastern regional area at St Vincent's Hospital, Fairview. Approval to tender for design teams for the units in Cork, Limerick and Galway was given by my Department recently. Inpatient services for children and adolescents are provided at Warrenstown House, Dublin, and at St. Anne's in Galway.
The Health Act 2004 provided for the Health Service Executive which was established on 1 January 2005. Under the Act, the executive has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes responsibility for the provision of mental health services. An additional €15 million has been made available for the further development of mental health services in 2005, bringing the total spend on mental health to approximately €725 million. A portion of this funding, the details of which are yet to be finalised, will be allocated to child and adolescent mental health services.
The future direction and delivery of all aspects of our mental health services, including child and adolescent psychiatry, will be considered in the context of the work of the expert group on mental health policy, which is due to report this year.
Does the Minister of State agree there is an urgent need to ensure proper beds and facilities for children under 16? The Irish College of Psychiatrists recommends in the report that the Minister of State mentioned that there be 144 beds available for people under 16. However, at present there are approximately 20 in the country. When those between the ages of 16 and 18 are included, it is clear that an extra 80 beds are required, making a total of 224. There are very few or no dedicated services for those aged between 16 and 18. In my area, there are children as young as 13 in adult psychiatric hospitals.
Does the Minister agree that it is totally appropriate, since as many as 18% of children under 16 and 20% of those between 16 and 18 will experience serious psychological or psychiatric problems? One must bear in mind that 11,500 people, mainly young, attended accident and emergency departments having attempted suicide last year. Does the Minister agree that the lack of child and adolescent psychiatric services is a factor in that level of attempted suicide and in successful suicides among young people? It is accepted that early intervention of a psychiatric or psychoanalytical nature among children and adolescents prepares them for difficulties experienced later. The lack of intervention for those in crisis is a major risk factor in levels of suicide and attempted suicide.
The ongoing highlighting by the Irish College of Psychiatrists and others of the lack of services in the context of the level of attempted and successful suicides is a serious issue.
I agree in general terms with the Deputy's suggestion that imbalance in mental health can be a factor in the cause of suicide, though it is clear that many factors are involved, and I am not able, as Minister of State with responsibility for policy in the area, to give a diagnosis or clinical assessment, since I do not have the same expertise as the Deputy. However, regarding the general question of the mental health services for children and adolescents, it has been recognised for several years that there are difficulties; that is why the reports were commissioned. On foot of those reports, the decision was recently taken to allow the design teams to go to tender.
The project teams have been established to develop child and adolescent inpatient psychiatric units in Cork, Limerick and Galway. That has now been sanctioned, and that is the key point. The proposed unit in Cork will consist of 20 in-patient beds, the unit at Dooradoyle, County Limerick, will have 14 in-patient beds, and the child and adolescent unit in Merlin Park Hospital, Galway, will have 20 in-patient beds. There will clearly be an increase in capacity when those plans are implemented.
The Minister of State announced again that €15 million has been made available for the development of psychiatric services. Bearing in mind that this serious issue will affect one in five people at some stage of their lives and that the development of psychiatric services has been neglected for decades, that €15 million, which is less than the cost of the Punchestown project and only 25% of that of electronic voting, is absolutely unacceptable. It is an absolute disgrace to announce that for the development of psychiatric services when they need a multiple of that sum each year to bring them into line with the standards of the 21st century.
As I pointed out, approval has recently been given to tender for the design teams for the units. Regarding the units in Cork, Limerick and Galway, tender for design work does not require that much money. The Deputy rightly identified in his question that there is a lack of capacity in this sector, and we are addressing that.
I was referring to the €15 million.
We have gone on with the expert working group, which has made certain recommendations. On foot of that, we have given approval to tender for design team. One cannot simply double or treble allocations if one does not have the capacity to deliver the service. One must plan for a service, and that is what we are doing on the basis of the report. We are planning an increase in the service's capacity. As the Deputy rightly said, existing in-patient services are inadequate. There is insufficient capacity in Warrenstown House and St. Anne's in Galway for national cohorts. Therefore, we are increasing the capacity. I will not enter into a discussion about expenditure tables, Punchestown or voting machines in this context. I am describing to the Deputy what is being done on this issue. The Government is aware of the problem and is dealing with it.
The €15 million is intended to cover all psychiatric services rather than simply those for children and adolescents. Is that not inadequate?
We must move on.
6 Mr. Gormley asked the Tánaiste and Minister for Health and Children the action her Department is taking in response to warnings from the World Health Organisation of the danger of a flu pandemic; if there are plans to increase the supply of anti-viral drugs here, which are now only adequate for approximately 45,000 persons; if a meeting has been called of the expert group tasked with updating Ireland’s emergency plan and stockpiling anti-viral drugs; and if she will make a statement on the matter. [9541/05]
The influenza pandemic expert group is reviewing and updating Ireland's 2002 influenza pandemic preparedness plan. Once finalised, the updated plan will be published. The 2002 plan was based on the World Health Organisation, or WHO, blueprint for an influenza pandemic plan, published in 1999. It addresses a range of issues, including prevention strategies, scientific and medical issues, and communications. The WHO plan is currently being updated to incorporate new scientific data and experience obtained during recent outbreaks. Our pandemic plan will be modified in line with those recommendations once they are agreed and published by the World Health Organisation.
Vaccination is the principal measure for preventing influenza and reducing the impact of epidemics. It will be the primary public health intervention in the event of an influenza pandemic. However, the production of a vaccine tailored to a pandemic influenza strain could take six to nine months. Developments are under way at international level seeking to expedite that process.
Pending the availability of virus-specific vaccines, anti-viral drugs will be the only influenza-specific medical intervention available for use in the event of a pandemic. Anti-virals can be used for prevention and treatment. The Government has decided that anti-viral drugs should be stockpiled. The expert group reviewed recommendations for the use of anti-virals in line with best international practice at its meeting on 24 February 2005. Following consideration of the expert group's advice, I have directed that 1 million treatment packs of Tamiflu should be stockpiled. That quantity is sufficient to treat 25% of the population and is in line with best international practice. The Health Service Executive has been so advised, and procurement arrangements have been put in train. I am confident that 600,000 packs will have been delivered by the end of this year — sufficient to treat 15% of the population. The remaining 400,000 packs will be delivered in 2006.
A national anti-viral stockpile would be used to treat priority groups. Prioritisation is essential if morbidity and mortality are to be reduced and essential services are to be maintained, thereby minimising as far as possible the disruption to society that might result from a pandemic. The priority groups include, for example, individuals hospitalised with influenza, people who may be more vulnerable to the virus, and key workers in essential services.
It should be noted, however, that pandemic planning is a dynamic process, and the definition of risk is likely to change over time. That means the recommendations for use of anti-virals must be kept under review and expert opinion always sought. In particular, the expert group will need to review the epidemiological data before final recommendations are decided in the setting of an imminent pandemic. The decision-making process will be guided at all times by relevant expert advice from the European Commission and the World Health Organisation.
The Tánaiste stated that the plan would be published once finalised. When does she expect that the document will be finalised, and what has been the delay? We have been told that the consultants refused to meet. Does that continue to hinder the progress of the pandemic expert group? Who are the priority groups? The Tánaiste mentioned those most vulnerable, but are we also talking about emergency staff, the gardaí and so on? Would it include Members and Ministers? How far does it go in the context of getting those extra doses of Tamiflu? Will the ordinary person have to go out and buy it? For what price is it retailing? Does the Tánaiste agree that we simply could not cope with a pandemic, given the major crisis in our accident and emergency units which look like a war zone? Does she agree with the assessment of the pandemic expert group that up to 26,000 people would need treatment and that 11,000 people in the Republic could die? Will she explain to the House the disparity between the figure that 11,000 people in the Republic could die and the statement yesterday by Dr. Lorraine Doherty, senior medical officer in the Northern Ireland health department, that 36,000 people could die in Northern Ireland? Does she agree with me that there is much confusion surrounding the figures we have been given? Does she agree also that co-operation between North and South is required on this issue? What measures has the Tánaiste taken to co-operate with our colleagues in Northern Ireland? If Ireland does not cope with this pandemic, will she consider that a resigning matter?
It is one thing to resign over events that have happened but the Deputy may be Minister for Health and Children by the time we have such a pandemic. I hope we will not have one soon.
I would not want the job.
I am surprised to hear that. At least the Deputy is being honest.
I am being honest with the Tánaiste.
I will remember that. Is it a case of all advice and no bottle?
I have got the bottle.
I will have to ask the other Deputies the same question. Perhaps I will have to stay in the post forever.
I would love the chance.
Just give me the opportunity.
On the expert group, it was delayed because of the dispute but that dispute is now settled. It is imminent. I have had a number of discussions with the chairman of the group and some of the members and it is imminent. It is the type of expertise that is almost constant in that it is difficult to say that this is the final report because events are changing rapidly, and there is a good deal of co-ordination and co-operation at international level, both at European Union and World Health Organisation level. A very good seminar on this matter was held recently in the O'Reilly Hall in University College Dublin and attended by many international speakers.
The Deputy said our accident and emergency units are like a war zone. I was in Sarajevo last Saturday and Sunday.
For the peace and quiet.
The Deputy should go there because he would see——
Is the Tánaiste comparing this country to a war zone?
——what a war zone is really like, unfortunately. On the priority groups, I will take advice from the experts on the make-up of those groups. I doubt if we would include politicians in a priority group. I would certainly not want to show any preference to myself or my ministerial colleagues but I am sure best international practice in this area will be followed. The groups include emergency workers and the more vulnerable groups in our society. This is something that has to be done purely on the basis of expertise and advice and not on any other basis. There is much debate about this issue internationally. I hope we do not have a pandemic soon.
What about the huge difference between the figures for Northern Ireland and those given for here?
I cannot account for that difference. The Deputy made a good suggestion about having an all-Ireland approach. That is a good idea.
We have to do that.
I cannot account for the difference in the figures. The figures did not come from politicians. They came from the experts and I have to accept what the experts say in this area. To be honest, with an issue as serious as this one it is probably difficult to get exact figures. All we can do is take best advice and approximate because one never knows, as with SARS and other unknown viruses, what might be the impact.
