Health (Amendment) Bill 2017: Committee and Remaining Stages

Does Deputy Sherlock wish to speak on section 1?

I wish to speak to section 5, le do thoil.

I will give the Deputy the opportunity to do that.

Sections 1 to 4, inclusive agreed to.
Question proposed: "That section 5 stand part of the Bill."

I received correspondence from the Ceann Comhairle. I had proposed an amendment to section 70 of the Health Act 1970 and I will refer specifically to that section. My proposed amendment related to screening tests for foetal anomalies. The original wording going back to 1970 was that "A health board shall make arrangements for carrying out tests on persons without charge, for the purpose of ascertaining the presence of a particular disease, defect or condition that may be prescribed". I had proposed an amendment to that which stated that "Without prejudice to the generality of section 70, arrangements made under that section shall include arrangements for carrying out without charge ultrasound and other standardised prenatal foetal diagnostic tests, to accurately date the pregnancy and to assess the foetus for diagnosable anomalies or defects, during the antenatal period".

I was very surprised to receive correspondence from the Ceann Comhairle which stated that he regretted to inform me that my amendment tabled at this Stage had been ruled out of order as it involves a potential charge on the Exchequer. All I sought to do was to make an amendment to ensure that the language of the 1970 Act was updated to ensure that, as of right, every woman will have access to the foetal anomaly scan in pregnancy and to make sure there was some degree of universality around that. I do not understand why that is deemed to be a charge on the Exchequer. I spoke very briefly to the Minister, Deputy Harris, about this today and I am hopeful this can be addressed. I refer specifically to the HSE's national women and infants health programme and the issue around the recruitment of ultrasonographers in the State. I refer specifically to Cork University Maternity Hospital where not every woman has access to that vital scan. If we are talking about positive outcomes for babies and mothers, it is vitally important that we have these scans so we can ensure the best outcomes for both mother and child.

I fail to understand how my amendment could be deemed to potentially put a charge on the Exchequer when the 1970 Act already states that the health board "shall make arrangements for carrying out tests on persons without charge, for the purpose of ascertaining the presence of a particular disease, defect or condition that may be prescribed". I am hopeful at this late hour, even though the amendment was tabled in good time, that the Minister of State will address the issue and, on the basis of common sense, ensure that women who do not have access to these scans at present will have access to them and that there will be adequate resources deployed through the national maternity strategy. It is the language of the national maternity strategy I am using here. We need to ensure that access is not denied to women and that the resources are deployed.

I take some solace from the fact that, with the restructuring of hospital groups, a new clinical director of the women and children services directorate for the South/South West hospital group was appointed on 27 February 2017. I understand an order has been made under section 16 of the Health Act subdelegating certain functions in maternity services to a person. I understand that those functions having been delegated is a positive move. The question is whether that delegated function will result in a budget line that will ensure every woman in the region I serve will have access to the scans. We cannot have a situation in this country where some women are denied access to scans by dint of geography. We know what the import of these scans is in terms of the best outcomes for mothers and babies. It is a public health issue and I am hopeful the Minister of State will address the point I make in a non-partisan way. It is something that affects all of us. It is a positive move. If the Minister of State was inclined to accept my amendment, I would be very grateful. If the Minister of State was inclined to address the issue before us it would be very beneficial to the women and children of the Munster region.

I will clarify the Chair's position. Deputy Sherlock was advised that his amendment was ruled out of order because amendment No. 1 seeks to insert a section after section 70 of the principal Act to provide for ultrasound and other standardised pre-natal foetal diagnostic tests without charge. The amendment is not relevant to the provisions and therefore must be ruled out of order in accordance with Standing Order 154(1). I am advised the amendment could impose a charge on the Exchequer and therefore must also be ruled out of order in accordance with Standing Order 179(3). However, the Minister of State might wish to address this and consider it before Report Stage.

I will address the issues raised. The proposed amendment being submitted has been ruled out of order by the Clerk due to it being irrelevant to this legislation. The Ceann Comhairle contacted Deputy Sherlock on this issue. The current legislation provides for women to receive medical, surgical and midwifery services in pregnancy free of charge. Therefore, where screening services are required and available, these are provided free of charge. While ultrasonography services are not available consistently throughout the country, foetal anomaly scans are available in all hospital groups. Those hospitals maternity units currently providing anomaly scans accept referrals from other maternity units if requested.

This occurs where the medical team in the referring maternity unit considers that an anomaly scan is clinically indicated. The national maternity strategy is very clear that all women must have equal access to standardised ultrasound services. Consequently, anomaly scanning is a priority issue for the newly established HSE national women and infants health programme, NWIHP. An early priority for the programme will be to develop clinical guidance regarding routine detailed scans at 20 weeks. In the meantime, the NWIHP will continue to work with the six hospital groups to assist in increasing access to anomaly scans for those units with limited availability.

One of the current challenges in terms of increasing access to scans is the recruitment of ultrasonographers. It is expected that the establishment of maternity networks across both hospital groups will assist in developing a sustainable model that ensures that every woman within each group can have access to scans.

Before calling Deputy O'Reilly, I remind her that the amendment has been ruled out of order and we are only addressing section 5.

I wish to correct the Minister of State. He mentioned that tests were offered where clinically indicated, but they are screening tests. There cannot be a clinical indication before a woman has had the screening test. The tests are not being offered to women. Along with other Deputies, I would like to hear a commitment from the Minister of State on a timeframe.

The Minister of State's position is contradictory. I tabled Parliamentary Question No. 254 on 2 February. Effectively, I asked whether all pregnant women in Ireland had access to a foetal anomaly scan and for the number of foetal anomaly scans relative to actual births for every individual maternity unit in the State for the years 2015 and 2016 in tabular form. I will cite the HSE's response for the record, so I hope the departmental officials and the Minister of State are taking note. According to the response, foetal anomaly scanning is not available to all pregnant women in the public health system. The three maternity hospitals in Dublin and the units in Galway and Waterford provide 100% access, but most of the remaining units only provide some access to scanning, usually where it is clinically indicated or based on other agreed criteria.

In the context of the 1970 Act, every woman as of right should have the scan available to her regardless of whether it is clinically indicated. Also according to the response, the NWIHP does not currently collect the information that I had requested. We do not even have proper data on the number of scans performed in Ireland. Finding out took some work by OBGYNs and consultants across the State. Figures show that approximately 23,000 women, accounting for 36% of all births each year, are not able to access publicly funded anomaly scans. The consultants were happy to share these data. This is a matter of record within the Houses of the Oireachtas through the health committee.

The Minister of State's answer contradicts what the HSE and, based on their data analysis, the consultants are telling me. As a matter of urgency, we must reach the point whereby women in the regions in question - particularly in Cork, but not just there - have access to these scans, not in the third quarter of the NWIHP, but now.

I would like the Minister of State to reply to the effect that the Government, of which he is a part, will do its utmost to ensure that a process is put in place to recruit sonographers within the first or, at the latest, second quarter of this year. We are discussing public health. Were I the Minister of State, I would not rely on the Fine Gael Minister for an answer. I accept the Minister of State's point about taking this debate, but I am sure that he has a position on the matter as a member of the Government through the Independent Alliance. He has a responsibility for this issue as well, if I may put it so bluntly. It is not just a Fine Gael responsibility.

I feel strongly about this matter. If we are to be equal in our treatment of patients, every woman and child must, as a right and a public health issue, have access to this scan.

I accept some of Deputy Sherlock's points. For example, the Independent Alliance's priority is to build and develop services using the public health model. However, I do not accept his other points.

I will revert to Deputy O'Reilly regarding the timeline issue after I have clarified it with the Minister, Deputy Harris.

Deputy Sherlock referred to the 23,000 women and the recruitment process. I will push the latter issue further with a view to putting the process in place as quickly as possible.

Question put and agreed to.
Title agreed to.
Bill reported without amendment, received for final consideration and passed.