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Joint Committee on Health and Children debate -
Tuesday, 20 Nov 2012

Forthcoming Health Council: Discussion with Minister for Health

I thank everyone for attending. I remind members, officials and those in the public Gallery that mobile phones should be switched off so that the sound quality for broadcasting purposes will not be interfered with.

I welcome the Minister for Health, Deputy James Reilly, and the Ministers of State at the Department of Health, Deputies Alex White and Kathleen Lynch. This is Deputy White's first visit to the committee as Minister of State and I congratulate him on his appointment. I welcome Mr. Tony O'Brien, director general designate of the Health Service Executive and thank him for being here on his first visit to our quarterly meeting. I also welcome Ms Laverne McGuinness from the HSE, Ms Bairbre Nic Aongusa from the Department of Health and other officials.

I remind members that 20 members have submitted questions to the committee and members will be afforded the opportunity to ask a supplementary question to the written question they have submitted. There will not be an opportunity to ask a different question, but I will allow members to contribute.

The meeting will consist of two parts. In the first part, the Minister will brief the committee on the European Council meeting. Deputies Ó Caoláin and Kelleher and the spokesperson for the technical group will each have two minutes to respond and other members will have one minute each to respond. The second part will be our quarterly update meeting when the Minister and Mr. O'Brien will each have ten minutes to speak. Members of the Opposition may also speak for ten minutes.

I welcome the Minister and thank him for being here. On behalf of the Joint Committee on Health and Children, I express our sympathy to the husband and wider family of the late Ms Savita Halappanavar who died in tragic circumstances in University Hospital Galway last month. I am sure the Minister and Mr. O'Brien will want to comment on this tragedy in their opening remarks. It is important that the committee express its deepest sympathy to the family on their tragic loss.

I thank members who spoke on the issue in private session last week.

By virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of the evidence they are to give this committee. If a witness is directed by the committee to cease giving evidence in relation to a particular matter and the witness continues to so do, the witness is entitled thereafter only to a qualified privilege in respect of his or her evidence. Witnesses are directed that only evidence connected with the subject matter of these proceedings is to be given and witnesses are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise nor make charges against any person or persons or entity by name or in such a way as to make him, her or it identifiable.

Members are reminded of the long-standing parliamentary practice that they should not comment on, criticise or make charges against a person outside the House or an official by name in such a way as to make him or her identifiable.

Before we commence our quarterly discussion of health issues, I invite the Minister, Deputy Reilly, to make an opening statement regarding his attendance at the forthcoming European Council meeting.

I wish to extend my deepest sympathy to the family of the late Savita Halappanavar. It is on the record that we want to have this tragic case fully investigated as quickly as possible and that remains our intention.

I wish to address the situation relating to the Irish Presidency. Ireland's engagement with its European colleagues has been brought into focus by the rapid onset of Ireland’s Presidency of the Council of the European Union. In just 42 days, Ireland will take over the Presidency from its Cypriot colleagues. Preparations are well under way and work is intensifying at all levels. My Department’s main objective will be to progress the EU legislative agenda. Ireland will be responsible for advancing legislation critically important to promoting public health as well as innovation and research. This is a very important agenda for Ireland as many of the world's top medical devices companies and pharmaceutical companies are located in this country. Europe is losing opportunities to conduct clinical trials and further research and development. It is envisaged that the key legislative proposals for Ireland to progress will be in the areas of clinical trials, medical devices, serious cross-border threats to health, and tobacco.

Two themes, namely, health and well-being, and innovation and research will inform the Presidency health programme. In addition to progressing legislative priorities, the Presidency will hold two high-level conferences in Dublin. The first conference will deal with e-health and will run in parallel with the World of Health IT conference and exhibition and which will coincide with e-health week. The second conference will deal with the future of brain research.

The December EU Council will take place in Brussels on 6 and 7 December 2012. I plan to attend on day 2 when health issues will be discussed. The agenda for the Council will be presented to the committee of permanent representatives on 21 November 2012. Therefore, it is not possible to be absolutely sure of what will be included on the agenda. It is expected that the Cypriot Presidency will outline its achievements in the health area, including: progress made on dossiers on the health for growth programme; serious cross-border threats to health; medical devices; clinical trials; the transparency directive; food intended for infants and young children; and food intended for special medical purposes.

At the December meeting I hope to meet with the new Commissioner, Mr. Tonio Borg, from Malta, if his appointment is confirmed. I also plan to meet ministerial colleagues from the other trio-partners, Lithuania and Greece, and to meet fellow Ministers from other member states. I am very concerned that the tobacco directive be progressed. I will do my utmost to garner support for that measure, notwithstanding the recent changes in the Commission. The Council will provide an opportunity to outline Ireland’s Presidency plans which I have outlined to the committee. Ireland has held the Presidency very successfully on a number of occasions in the past. Ireland will not hold the Presidency for another 14 years so this coming Presidency is crucial. We must aim to make it a good opportunity for the good of our own citizens and for the citizens of the EU in general.

I have had many opportunities to engage with my ministerial counterparts, including most recently at the June Council under the Danish Presidency which I attended. This was a productive meeting. We had a useful orientation debate on the serious cross-border threats to health and a lunchtime discussion on the joint procurement of vaccines.

The European Union is at its most effective when it moves forward, with all member states working together, to deliver results for Europe’s citizens. I am looking forward to the opportunity the Presidency presents to drive forward the EU health agenda.

I call Deputy Kelleher and Deputy Ó Caoláin who have two minutes each on European Union matters only, please.

I wish to be associated with the expressions of sympathy to the family of the late Savita Halappanavar. I will revisit that matter at a later stage in this discussion.

I wish the Minister well for the Irish Presidency. It is a very important responsibility for the country and for the promotion of health in the European Union. A few issues arise. This committee discussed medical devices, the issue of PIP implants and the need for a quality control system to be in place across the EU to ensure strong oversight of the licensing of such medical devices. This is an area where it will be necessary to take action to reassure people. This is a key area for strong oversight to ensure that devices are scrutinised and licensed. There needs to be a mechanism to allow consumers to vindicate their rights and to apply for compensation.

I refer to the issue of the threat to health from tobacco. Last week, Senator Professor Crown's motion that this should be a smoking-free Parliament received some support. The issue of tobacco is a key area for this Presidency. The Minister said that the subject of food intended for infants will be on the agenda of the Council meeting. Will obesity be discussed? I ask for clarification on those issues. I wish the Minister well and I hope it will be a successful Presidency from the point of view of legislation and the position of Ireland in Europe.

I welcome the Minister and his team and the representatives of the HSE. I join with earlier speakers in hoping that the six-month period of the Presidency will be beneficial to Ireland on many levels. I note from the Minister's comments that he expects the priorities under the health heading will include clinical trials, medical devices, serious cross-border threats to health and tobacco. All of those, with the exception of the latter, will certainly be reported on at the conclusion of the Cypriot Presidency. They are all part of ongoing work being handed on to the Irish Presidency. Has the Minister given consideration to initiating a particular focus on any given area during the course of the six-month Irish Presidency? I commend to the Minister the whole area of rare diseases. This is invariably an area that is not addressed because of the small numbers directly affected by any disease. However, the collective impact of all the recorded rare diseases demonstrates that it is an area that needs to have urgent and particular address.

We would serve those individuals, their families and the wider community - not only in Ireland but also across the European Union - well if we were to take such an initiative.

I again wish to express my approval of the decision to alter the membership of the investigative committee.

We will leave that matter until later. We are dealing with EU affairs at present.

Fine. At the recent meeting of the British-Irish Parliamentary Assembly and again in the Minister's presence in the Seanad, I stated that there is much merit to the idea of the European Union committing to a long-term strategic goal of eradicating all commerce for profit in tobacco. It is a given that if tobacco were discovered for the first time tomorrow, it would not be legal. Chemicals which are far less dangerous to people's health are routinely banned in a way that tobacco has not been. It has become socially acceptable because it has been available, in Europe at least, for 400 to 500 years.

There is no doubt that the principal driver behind the tobacco addiction epidemic which still sweeps Europe is the huge profits which can be obtained. These profits are used to fund attempts by public relations companies to influence public policy and into various forms of advertising which are legislated for differently in the many jurisdictions that comprise the European Union. It is obvious that the screw is turning with regard to such advertising but the reality is that it should not be acceptable or possible to sell a cancer-causing, addictive toxin to anyone. We have already created a website by means of which we are collecting support for the notion that tobacco should no longer be legal by the year 2030. We picked a date so far in the future because it will give tobacco farmers an opportunity to learn how to grow other crops. They will be growing such crops in a world which will be increasingly short of food. Investment houses, hedge funds and pensions funds will also have an opportunity to diversify their investments out of tobacco. In addition, tobacco companies will have a chance to learn to repurpose their factories and make new products. Given that the bully pulpit afforded by the Presidency of the European Union will be at our disposal next year, we will have a great opportunity to advance this matter.

I ask the Minister to pay attention to the potential collateral damage to which the forthcoming data protection regulations could give rise in respect of cancer research. I will be delighted to brief him in greater detail on these regulations. Although clearly not the aim of those who drafted them, the regulations to which I refer could have a very negative impact on cancer and other forms of research. I wish the Minister well during the six months of our Presidency.

I am very concerned with regard to matters relating to quality assurance in respect of medical devices. Patient safety is a major issue, as is that relating to people being in a position to vindicate their rights. I am in absolute agreement with Deputy Kelleher in this regard. The point regarding food for infants actually relates to regulations to make such food safer. I believe our Cypriot colleagues may guide the relevant legislation through the Parliament prior to the end of their Presidency. This is not certain but if they do so, the onus will no longer be on us to have it passed.

Deputy Ó Caoláin referred to our initiating debate on matters that are of concern to us. There are two issues on which I wish to focus in this regard, namely, autism and the effect of the economic downturn on health services across the EU. I am of the view that these issues warrant debate. With all the economies of Europe under pressure, we must try to protect health services. By doing this, we will hasten the economic upturn. It is necessary to have a healthy workforce in order to have a healthy economy.

In respect of Senator Crown's points, from a professional point of view I would love to see a complete ban on tobacco sales in the EU by 2030. I will certainly explore whether such a goal is achievable with the Senator and others during our Presidency. The data protection proposal to which he alluded will also be examined in the first half of next year. Europe is very aware of the fact that we are losing out in terms of clinical trials as a result of the red tape which obtains. This legislation does not just relate to economic benefits, it also relates to reducing the level of red tape while improving and enhancing patient safety. I always welcome the opportunity to highlight the benefits of being involved in clinical trials from the patient's perspective. Not only does one obtain access to cutting-edge medicines, one is also subjected to a level of supervision not normally associated with course of treatment in the general health services of any country. These are two benefits which we should promote, particularly in the context of people's willingness to become involved in such trials.

I welcome the Minister, the Ministers of State and the officials. On the Minister's priorities for Europe and specifically that which relates to the provision of health services in the current economic climate, I am of the view that it would be useful to include the abuse of alcohol in this regard. If there was less abuse of alcohol, there would be less pressure on our hospitals. I do not know whether the Minister will be able to fit this into his programme of work.

It is not just alcohol abuse, we must also deal with tobacco addiction and with drug abuse generally. In so far as is possible, we will certainly discuss alcohol abuse as another matter which needs to be addressed. We may try to promote the idea of a uniform approach to this problem being taken across Europe. I must be careful and advise Deputy Dowds and other members that there is only so much one can achieve. If one seeks to dilute one's aims to a huge degree, the effectiveness of one's Presidency will become suspect. I am of the view, therefore, that we should focus on some of the major issues, while also dealing with a number of the smaller ones - accept that certain of these are hugely important to us - then we can make serious progress. From the public health perspective, the one about which I am really concerned is the tobacco directive. This was well advanced before the resignation of Commissioner Dalli and we want to ensure that it will be expedited by the new Commission. We want to create the opportunity to progress this matter in a serious fashion during our Presidency.

I wish to pose a question on the cost of prescribed drugs.

We are dealing with EU matters.

Yes, my question is relevant in that regard. I am aware that the Minister and his Department have made strides in this regard and that the saving for next year will be approximately €120 million. Is he of the view that we will be in a better position to make even greater savings in respect of prescription drugs during the six months of our Presidency?

I welcome the Minister. To what extent will the Minister be able to use the Presidency to advance his plans to deliver clinical programmes to the north-west region, in particular?

The Senator is straying outside EU matters.

I assure the Chairman that I am not. On many previous occasions, the Minister has heard me refer to the discriminatory nature of the national cancer control programme in the context of the north west. I have also referred to changes in cardiology, stenting procedures, etc.

We are dealing with EU matters.

Yes, this is such a matter. I hope the Minister will be able to use the Presidency of the EU to advance care in this country. When I have questioned him on this matter, he has suggested that cross-Border solutions will apply in respect of those in the north west - where there are no cardio-catheterisation facilities - who require stenting procedures. Radiology services are also absent from the north west. In my opinion, the Presidency will provide an opportunity to deal with these issues.

Each member state has 30 months in which to put in place legislation relating to the cross-border health care directive, which as passed in November 2011. Would it be possible to co-ordinate matters in order that such legislation would be passed in all 27 member states by the end of our Presidency?

Deputy Maloney inquired as to whether the Presidency will have an impact on our bill in respect of prescription drugs. I do not believe it will have an effect one way or the other. The agreements we have in place with the Irish Pharmaceutical Healthcare Association, IPHA, and the Association of Pharmaceutical Manufacturers of Ireland, APMI, which represents the generic producers, both last until 2015.

We have prescribing initiatives in place now which will involve six pharmacists in the General Medical Service payments board who will be examining general practitioners' prescribing habits and advising them on how to improve it. To put it bluntly, if a patient has a condition which is costing €400 per month to treat and an examination reveals that the same result can be achieved for €200 by prescribing similar but different drugs, obviously that is to the benefit of other patients who can then avail of that resource that is saved. In terms of the answer, I do not envisage the Presidency improving it but I see our costs in regard to pharmaceuticals improving over the period the Deputy mentioned.

Regarding Senator MacSharry's question, the more interaction there is, the more opportunity for interaction with the Northern Ireland Minister of Health, Social Services and Public Safety, Mr. Poots MLA, but the Minister and I have had several discussions on that. He is extremely open to it. He is a pragmatic individual and the two of us intend to take a tour of the cross-Border facilities, not just to see the big items such as the hospitals but the ones people might not think of, such as a community nursing unit in Lifford with the possibility of affording a service to people across the Border in Strabane, a GP who might be isolated in Blacklion availing of a roster across the Border, the issue of ambulances, and an air ambulance service stretching up the whole length of the coast whereby if they had an air ambulance they could cover the north west, we could move down the coast with our cover in a more concentrated fashion. There is a host of possibilities and all that will continue apace.

On whether the European Union affords us some increased activity around that, I would like to think it will but we will be looking to co-operate in every way we can, particularly in terms of some of the ones the Senator mentioned which are big ticket items such as cardiology, oncology and radiotherapy, but also on other issues which do not spring to mind immediately but which can make a huge difference to the populations either side of the Border.

Senator Colm Burke asked about the cross-Border initiative on health care. We will pursue that through the EU, as has been the case in the past.

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