Seanad Éireann debate -
Thursday, 13 Jun 1996

Vol. 147 No. 16

Health (Amendment) Bill, 1995: Second Stage.

Question proposed: "That the Bill be now read a Second Time."

Minister of State at the Department of Health (Mr. O'Shea)

The purpose of this Bill is to make provision for primary health care services without charge for persons who have contracted hepatitis C directly or indirectly from the use of human immunoglobulin — anti-D — or the receipt within the State of another blood product or a blood transfusion. The services to be provided include: general practitioner services, including prescribed drugs and medicines; dental, ophthalmic and aural services; counselling services; home help services; and home nursing services.

When the possible link between the anti-D product and hepatitis C was brought to the attention of the Department of Health in February 1994 the immediate concerns were the protection of all future recipients of anti-D and the identification of any risk for any mother who had received the anti-D product in the past. The first objective was met by the immediate introduction of a new virally inactivated anti-D product to all maternity hospitals and units. The second objective was met by the national screening programme for anti-D recipients, launched by the Blood Transfusion Services Board (BTSB), which offered screening for hepatitis C for anti-D recipients.

Some 60,316 women who received anti-D between 1970 and February 1994 have been screened under the national blood screening programme and 994 have tested positive for hepatitis C antibodies, of whom 472 have tested positive for the virus.

A targeted lookback programme was also undertaken by the BTSB to identify persons who had contracted hepatitis C from a blood transfusion. Some 266 living recipients of medium/high risk donations have been traced to date under this programme. Testing for hepatitis C antibodies has been carried out on 208 persons and 122 of these 208 are antibody positive. Testing for hepatitis C virus has been carried out on 183 persons. Some 73 of these persons have evidence of continuing hepatitis C infection.

The optional testing programme commenced in early September 1995 to trace a small number of persons who may have contracted hepatitis C from a blood transfusion and who would not be traced under the targeted lookback programme. Some 10,439 persons have come forward for testing to date and 34 of these persons have been confirmed positive for hepatitis C antibodies and 19 of 21 tested, are positive for hepatitis C virus.

The Government is committed to providing a high quality health service for all persons who have contracted hepatitis C from a blood transfusion or a blood product. Substantial progress has already been made over the last two years in meeting the many complex and varied health care needs of those persons who have contracted hepatitis C. This has been made possible by a process of consultation between the Department of Health and Positive Action, a support group for Anti-D women and their families, Transfusion Positive, a support group for blood transfusion recipients and their families, the Irish Kidney Association and the Irish Haemophilia Society. Many of the concerns expressed by these groups in relation to future health care arrangements have been addressed.

The special health care programme involves an extensive range of services in the following areas: secondary health care services, primary health care services, special research programme and a statutory monitoring body. Secondary health care treatment for those persons who have contracted hepatitis C from a blood product or blood transfusion is being provided since early 1994 at special consultant staffed clinics at six designated hospitals — St James's Hospital, Dublin, Beaumont Hospital, Dublin, Mater Hospital, Dublin, St, Vincent's Hospital, Dublin, Cork University Hospital and University College Hospital, Galway.

Specific funding has been provided in the Book of Estimates each year to ensure the consolidation and maintenance into the future of a high quality hospital in-patient and out-patient service, including prescribed medication for persons who have contracted hepatitis C from a blood transfusion or blood product. The secondary care element of the health care services programme includes provision for access to in-patient and out-patient treatment; non-payment of hospital charges; appropriate staffing levels and arrangements for staff training; equipment for hepatitis C units; anti-viral therapies and therapy initiation programmes; liver transplantation; treatment outside of Ireland where necessary; liaison between the hospital service providers; and prompt referral to clinicians for conditions associated with hepatitis C. The treatment services are also available to children and partners who are hepatitis C positive. The Health Act, 1970, is the statutory basis for the provision of these services.

The Government recognises the need for specific research in relation to hepatitis C, particularly in view of the fact that hepatitis C was described for the first time in 1989 and that a reliable screening test had only become available in 1991. My colleague, Deputy Noonan, Minister for Health, has arranged with the Health Research Board for the establishment of a special programme of research on hepatitis C and has provided special funding of £100,000 to enable this programme to commence this year.

To ensure that the health service as it relates to persons who have contracted hepatitis C from a blood product or blood transfusion is responsive to the changing needs of such patients, the Minister for Health is establishing a statutory consultative council which will advise him on matters relating to hepatitis C. The functions of the consultative council will include the monitoring of health and counselling services for persons with hepatitis C; the making of recommendations on the organisation and delivery of services for persons with hepatitis C; publication of information on hepatitis C; and liaison with the Health Research Board in relation to the special programme of hepatitis C research projects.

The Minister for Health has circulated a draft establishment order to interested groups for their views. Following this consultation process, amendments to the draft establishment order are being considered to take into account the views expressed by these groups. The Minister will again consult with the interested groups at an early date and following such consultation will formally establish the council. The secondary health care services, the consultative council and the research programme do not require new legislation as there is already statutory provision for these initiatives.

As I have already indicated, the purpose of the Health (Amendment) Bill, 1995, is to make provision for primary health care services without charge to persons who have contracted hepatitis C directly or indirectly from the use of human immunoglobulin anti-D or the receipt within the State of another blood product or a blood transfusion. The primary health care services to be provided by the Bill free of charge and without a means test are general practitioner services; drugs, medicines and medical and surgical appliances; dental, ophthalmic and aural services and dental, optical and aural appliances; counselling services in respect of hepatitis C; home help services; home nursing services; and such other services as may be prescribed.

In relation to the general practitioner services, eligible persons may attend the general practitioner of their choice for all medical conditions. Drugs, medicines and medical and surgical appliances will be provided to them free of charge for all medical conditions. The Bill also proposes that dental, ophthalmic and aural services will be provided without charge for eligible persons. Counselling services, as described in the health care package which was published in December 1995, will be made available to eligible persons.

Home help services within the meaning of section 61 of the Health Act, 1970, and home nursing services within the meaning of section 60 of the Health Act, 1970, will also be provided free of charge to persons who have contracted hepatitis C from a blood transfusion or a blood product. These arrangements will also apply to the children and partners of persons who have contracted hepatitis C from a blood product or a blood transfusion if such children and partners have also been diagnosed positive for hepatitis C.

Arrangements will also be made with each of the health boards to designate a specific officer to act as a contact points for individuals and also as a liaison officer with each of the various interest groups whose members will be availing of the services set out in the Bill.

The Bill provides at section 2 that health boards shall make available certain health services without charge to persons who have contracted hepatitis C directly from the use of human immunoglobulin anti-D or the receipt within the State of another blood product or blood transfusion. The chief executive officer of the relevant health board will determine eligibility at his discretion. It is envisaged that his decision will involve inter alia, consideration of medical opinion submitted by the applicant's treating physician and also that of the board's director of public health. This provision is intended to allay fears of some members of Transfusion Positive who expressed concern about possible difficulties in the acquisition of past medical records and the determination of proof of contraction of hepatitis C from a blood transfusion.

As I have already outlined, a range of services will be provided under the Act and preliminary discussions have already taken place with some of the relevant bodies. Detailed negotiations cannot commence until the necessary legislation is in place. As soon as the Bill has passed all Stages in both Houses, it is hoped that discussions with health boards and negotiations with appropriate professional groups will be finalised to ensure the services to be provided under the Act for persons who have been diagnosed positive for hepatitis C will be available to them at an early date. The commencement order provision in section 1 (3) will allow time to finalise the necessary arrangements to ensure the provision of a high quality primary health care service. Undue delays in the regard are not anticipated.

In addition to providing for the health care needs of these persons, the Government, as the Senators are aware, is fully committed to fair compensation for persons who have contracted hepatitis C from a blood product or blood transfusion. The Minister for Health established the compensation tribunal on 15 December 1995 and the closing date for receipt of applications is Monday next, 17 June.

For the information of the Seanad, the total number of persons with hepatitis C who received a blood transfusion or blood product who have been identified to date is 1,356. The compensation tribunal has up to yesterday evening received 817 applications and I have been informed by the tribunal that a substantial additional number of applications is expected before the closing date. Since its commencement the tribunal has heard 70 cases. The awards made to date by the tribunal range from £15,500 to £324,321. A sum of approximately £7.5 million has been awarded to date by the compensation tribunal and no tribunal award has been rejected. Payment of an award is made within 28 days of receipt by the tribunal of notification of acceptance of an award. The tribunal is running smoothly, fairly and efficiently, as had been envisaged, and at this stage it has hearing dates arranged until 31 July 1996.

The Health (Amendment) Bill, 1995, will copperfasten the Government's commitment to meeting the future health care needs of persons who have contracted hepatitis C from a blood transfusion or blood product. The health care services at primary and secondary care levels will meet the genuine concerns in relation to the continued provision of high quality health care into the future for those who have contracted hepatitis C. I commend the Bill to the House.

Mr. Finneran

This is important legislation which will be welcomed not only by the House, but by many women who have contracted hepatitis C because of negligence by the State. This Bill would not have been necessary had the Blood Transfusion Service Board not given out faulty products which resulted in people becoming infected. The Government must introduce legislation to provide hospital, nursing and backup health care, while at the same time provide a mechanism by which people will be compensated.

There are two issues of concern to the thousand or so women who have been infected. As regards the method of compensation, we now know that the procedure or mechanism set up by the Minister is totally inadequate as far as the women are concerned. They disagree with its makeup and they want a tribunal to be established on a statutory basis to give them the opportunity to have their cases heard and to provide them with proper compensation. The Minister refused to do that and he has set up an ad hoc tribunal which is in most cases ineffective. The opportunity for fair proceedings which people expect will not be available.

This Bill to provide health care is welcome, but belated. It was only after massive protests and pressure by the groups involved, including Positive Action, and the two Opposition parties, that the Minister introduced this legislation. There are a number of issues about which I am worried, in particular the situation in relation to relatives of those who have died as a result of being infected by bad blood. The Minister said in the other House that these people would be dealt with by the tribunal in the normal way. I have been informed that may not be the case and that they may be treated in the same way as car crash victims and the amount of compensation might be a few thousand pounds. That would be totally inadequate as far as those families are concerned. I would like the Minister to comment on that when replying.

Many people with liver complaints were given infected blood which contributed to their death. Their families are at a loss as a result of that action by the Blood Transfusion Service Board and the State. They are not sure if proper compensation will be available under the ad hoc tribunal. I am not convinced about that either and I would like the Minister to clarify the situation.

On the question of who should be liable, the Minister said there was civil negligence in relation to this matter but I am not sure the public accepts such a statement. The public would say there was criminal negligence and that people were subjected to treatment which contributed to illness and, in some cases, death. Nobody has been brought to book, which is extraordinary. Although we are told the Director of Public Prosecutions is independent and that the Minister cannot interfere, somebody should be made to answer. If this occurred in the private sector, I am sure somebody would have had to answer. Because it happened in the State sector, there seems to be a coverup, a closing of ranks and an unwillingness to take the sector on. I believe there was criminal negligence and that the public is still not satisfied with the Government's response.

I welcome the actions of the Department of Health which has responded by introducing this legislation, albeit under pressure, and setting up a compensation mechanism. However, my party disagrees with the compensation mechanism because it was not set up on a statutory basis and it is not to the best advantage of those infected. The groups involved have been very responsible over the past six or eight months and they have presented positive and straightforward proposals. Had it not been for the way in which they put their case to the public and the political parties, we would not be in this situation. I compliment the two groups involved. A few months back there was no question that the Minister would respond positively to people who contracted hepatitis C through blood transfusions. That group seemed to had been left aside but that has now been rectified, and rightly so. However, nothing seems to have been done for the relatives of people who died because of this.

This Bill gives a number of ways in which infected people will have the opportunity of being dealt with by the health boards, GPs etc. What final agreement has been reached with the general practitioners? Is there a structure in place and an agreement reached and signed by the Minister and the GPs for the provision of treatment through the GMS? What agreement has been reached between the Department of Health, the Minister and the health boards regarding the provision of services? We do not want to have a chief executive officer saying later that he cannot provide that service because the Minister did not provide him with adequate finance. If we cut back on our health services, certain areas included in this Bill may only wind up as aspirations. I would like the Minister to respond to both of these questions when he replies. The public and the people infected would also like to know that.

There seems to be an implied reasoning that if somebody had a liver transplant — they would be covered for this under the legislation — it would solve everything. That might not solve the problem. It may be as likely that the transplanted liver would develop the same symptoms and problems as the original. There is no guarantee that this would solve the problem. A Government representative laid great emphasis on this — I am not saying it was the Minister — but that statement does not stand up to proper medical scrutiny and it should not be made.

How these symptoms will develop over the next five, ten, 20 or more years is a grey area — we do not know what will happen down the road. That is the reason the tribunal as constituted is inadequate. People should have as a right the opportunity of a provisional settlement.

Mr. Doyle

They already have.

Mr. Finneran

They do not. They have it at the discretion of the tribunal but not as a full right. That is a major difference. Everybody infected should have the right to a provisional settlement; it should be part and parcel of the compensation package. In the event of their developing more severe symptoms, needing extra or costly treatment or becoming incapacitated, a final compensation settlement could then be agreed. However, giving a final settlement either now or in the next few months would mean there would not be a subsequent appeals system. That is unfair and it does not at all protect the women infected. They should have the right to accept a provisional settlement now and to negotiate their situation later to protect themselves and their families. This is currently at the discretion of the tribunal. That is not copperfastened enough for the women involved.

I welcome the legislation in so far as it is necessary to protect people who have been infected through the State's criminal negligence, for which nobody has been charged or brought to book. There has been a total closing of ranks by the State to protect itself and the people who delivered the service and that is not good enough.

When a counselling group was set up to help the infected people, the Blood Transfusion Service Board was put in charge of it. It was trying to limit the damage to itself. Any counselling group established should have been independent and totally removed from that board. It was responsible for inflicting this problem on our women. This was an insult to those who had been infected. That board has its own avenue to follow, to limit the damage to itself. Rather than charging the people on the board with negligence or finding them in any way responsible for what happened, they were able to retire with large golden handshakes. Surely this was not in the best interests of fair play to these women.

This is a most serious situation. The women involved have still not received their entitlements. They certainly do not have a tribunal to compensate them which has been set up in a proper manner and with a proper statutory background. It is an ad hoc situation and these women are not happy with that. This is not the last we will hear about it. The courts will have a say in the matter and the ad hoc tribunal put in place by the Government will not deliver what is necessary. I have asked a number of questions about the health care package brought forward in this legislation and I hope the Minister will indicate the current situation on these matters.

Mr. Doyle

As the Minister stated, the purpose of this Bill is to make provision for primary care services free of charge for persons who have contracted hepatitis C from a blood product or blood transfusions. The nature and the appalling repercussions of this problem have been described in great detail by people who have experience of this issue and no words of mine today will help to illuminate the problem any further.

When Deputy Howlin, the then Minister for Health, informed this House in February 1994 that a problem had been identified, both he and the present Minister moved commendably to respond to it. In September 1995 the Minister announced the appointment of members of the compensation tribunal to compensate people who contracted hepatitis C from the use of the anti-D product. At the same time the Minister for Health gave details of a package of health measures designed to ensure that the future health care needs of hepatitis C patients will continue to be met. These include hospital in-patient and out-patient services and counselling services, which will remain in place for as long as they are required.

The purpose of the Bill is to amend the Health Act, 1970, to provide for general practitioner services, without charge, for specific categories of persons suffering from hepatitis C the treatment and care they may require. The Minister for Health also announced the funding of a special programme of research on hepatitis C, which was arranged through the Health Research Board. A statutory consultative council was also established to advise the Minister on matters relating to hepatitis C. He gave an assurance that the needs of blood transfusion and blood product recipients who have contracted hepatitis C will be reassessed on an ongoing basis to ensure necessary services are provided for them. The Minister also initiated the look back programme, the aim of which is to identify blood donors who have tested positive for hepatitis C and who may be at risk of contracting the infection.

As part of the health package the Minister provided for an optional screening programme to trace patients who may have been infected with hepatitis C from blood transfusions. In this supplementary screening programme anyone who received blood or blood products may wish to discuss their concern with their general practitioner. If, following a full consultation, a blood test is considered appropriate, a blood sample will be taken by the general practitioner and forwarded to the Blood Transfusion Services Board. No fee is charged for any of these services.

Persons who had multiple blood transfusions or serious surgery accompanied by transfusion prior to 1991 and who may be at risk are invited to avail of these testing programmes. If the patient, or the general practitioner, is unsure whether a blood transfusion was given during a past procedure, information in that regard can be obtained from the appropriate hospital.

I mentioned a number of the measures put in place to provide a comprehensive response to the problem. The Bill makes statutory provision for the delivery of a series of services to the victims, and in some cases their partners and children, of this tragedy. More importantly, it puts funding and the provision of those services beyond doubt. In addition to providing for the health care needs of these people, the Government is fully committed to fair compensation for persons who contracted hepatitis C as a result of receiving a contaminated blood product.

To this end, in 1995, the Minister established a compensation tribunal as an alternative to court proceedings to provide fair compensation to such persons. I understand the tribunal is dealing with applications from persons who have been diagnosed positive for hepatitis C antibodies or the virus resulting from the use of human immunoglobulin/anti-D blood transfusion or blood products within the State. It is also dealing with the children and partners of such persons who have been diagnosed positive with hepatitis C antibodies or virus; any person responsible for the maintenance of such people who has incurred financial loss or expense as a direct result of providing such maintenance, and any dependant of such persons who have died as a result of contracting hepatitis C.

Senator Finneran misunderstands that no person is compelled to apply to the tribunal for compensation. It is a matter for each person to decide whether he or she wishes to pursue their claim in the court or through the compensation tribunal. I understand 17 compensation cases are before the court at present and it must be pointed out that making a claim to the tribunal does not involve a waiver of any right of action. It is only if the claim is accepted as an award by the tribunal that the claimant is required to agree to waive any rights of action he or she may otherwise have had. If a claimant receives an award, they have one month in which to decide to accept or reject it.

An applicant has the choice of going through the tribunal or the courts. A person is not compelled to apply to the tribunal. I understand, following discussions between the Department of Health and interested groups, including Positive Action, that a number of changes have been made to the scheme. It was agreed during the course of the negotiations in November 1995 that the time within which a claimant could apply to the tribunal would be extended from three to six months. This is now the case.

I understand the tribunal is working well and hearing approximately 12 cases a week. As the Minister said, since its commencement the tribunal has heard 70 cases and awards totalling approximately £7.5 million have been made. No tribunal award has been rejected and this is a firm indication of the confidence not only of the applicants, but of the legal profession supporting the cases.

The scheme of compensation offers numerous advantages as opposed to court proceedings. It is speedy and informal and negligence is not required to be proved. The right of court action by the applicant is preserved unless and until the award is accepted.

Mr. Finneran

Every case is contested by the Government.

Mr. Doyle

The scheme is entirely optional. The concept of a provisional award, which is not available in Irish law and therefore could not be available if one went through the courts, allows the claimant to return to the tribunal if it is of the view that a claimant, as a result of the hepatitis C virus, may suffer a serious consequence or consequences in the future. This is a particularly important option for claimants, given the uncertain nature of the infection.

I find it difficult to understand the sustained criticism of the tribunal, given that the Government has done its utmost to facilitate victims of the problem. A number of people making these criticisms are the same people who failed to support motions in this and the other House in 1989 in relation to compensation for haemophiliacs who contracted AIDS through an infected blood product. The Minister of State was a Member of the House at that time and it was a most sad occasion for me because the motion was in my name. It sought compensation for a finite number of people who were dying, but the Minister for Health of the day refused to accept it. When the motion was rejected in the other House, a general election followed. In view of the attitudes of certain people then, their current criticisms carry no weight with me. I fail to understand their total inconsistency on this matter.

Given the criticism levelled at the Minister of State, Deputy O'Shea, that he misled the other House, I am thankful to Dr. Miriam Hederman O'Brien for publishing a letter which made it clear that the allegations against the Minister of State were without foundation. I am sure Members on both sides will agree the Minister for Health and his predecessors have acted with commendable and proper thoroughness in addressing this problem.

The Bill and the other measures taken are comprehensive in that they seek to address all aspects of the problem. It is a great source of sadness that the measures to address this problem have been marred by argument about the method of compensation. More recently these arguments have continued in efforts to extend the deadline of 17 June 1996 for claimants at the compensation tribunal.

It is also a great pity that the trauma of the victims of this awful event has been added to by this uncertainty and argument. I hope that these arguments and criticisms will come to an end and that the Bill before the House will greatly assist those who have hepatitis C and give them confidence and with the assistance of long life health care and ancillary services which the Bill provides, they will lead a happy, full and productive life.

Ms Honan

I welcome the Bill which puts in place a package of health measures for victims of hepatitis C. The legislation is being brought forward following detailed negotiations with groups representing the people who have contracted the disease — Transfusion Positive and Positive Action. These people have been infected with a potentially life threatening virus because of the negligence of a State board.

The Health (Amendment) Bill gives a statutory commitment to provide without charge health services to people who have contracted hepatitis C. It provides for the delivery of services to match a commitment given in February 1994 by the Coalition Government when this scandal was first uncovered to provide free health services to the victims of this tragedy. Negotiations with the Government and the Department of Health and two years of tough campaigning by the victims have led to this Bill.

The Minister has brought legislation before this House which reflects that agreement and gives guarantees to the victims. The Progressive Democrats welcome this. Originally, Transfusion Positive felt that there was a lack of clarity about who would get medical treatment and they also had difficulties in relation to obstacles that may be put in their way from receiving this treatment because of the lack of availability of their medical files. Amendments were brought in as the Bill was going through the other House to ensure that the chief executive officer in the relevant health board would have the power to determine eligibility for the proposed services at their discretion. This was welcome because it followed discussions with representatives of Transfusion Positive who were concerned that a small number of their members would experience difficulty in acquiring their past medical records and thereby qualifying for the health benefits provided in the Bill.

In determining eligibility, the chief executive officer's decision would involve consideration of medical opinion submitted by the applicant's physician and also the relevant health board's director of public health. To become eligible for the services you do not require a determination by a court or the compensation tribunal. Some individuals might not have a claim with the courts or the compensation tribunal, but would be eligible for the services provided under this Bill. The amendment is welcome in this regard.

The Bill details part of the health care agreement which the Department of Health negotiated with the victims. It is detailed because the complexity of the health problems for the victims of hepatitis C require it. The Bill outlines GP, hospital and other services that will be provided for the victims. It refers to counselling services and the health care agreement allows for the establishment of a consultative council which will have a role in monitoring the services provided. All this is welcome.

The Minister and his officials have taken on board the genuine concerns of the victims, but there are questions which have to be asked to clarify the health package. Discussions have taken place, for instance, with the GP bodies regarding the services that would be provided to the victims but as the Minister of State has said, a detailed agreement has not been reached with the GP's. It is very important, particularly when cases are being settled in the tribunal, that that is done quickly. Preliminary discussions have taken place but it is necessary that agreement would be reached quickly. Some negotiations have been completed with the health boards but a final agreement on their role in the provision of services has not been reached either. It is important to reassure people who have become infected with hepatitis C.

Some of the groups representing these people are not happy with the current counselling services. For instance, Positive Action believe that counselling is a vitally important element of the health services which the women need. Under the Bill the health boards will be asked to provide this service. What assurances can the Minister give that each health board will provide an independent quality counselling service that will be accessible for every woman who needs it? For instance, there is no independent counselling service available to women in Limerick, which is the Minister's constituency.

Another issue raised was the promise of funding for the Health Research Board for special projects on hepatitis. I was pleased to hear the Minister of State tell us that the Minister for Health had arranged with the Health Research Board for the establishment of a special programme and had provided funding of £100,000 to enable the programme to commence this year. That is welcome news.

The Minister of State said that a monitoring body is urgently needed. A draft establishment order was circulated to interested groups for their views, and following the consultation process, amendments were being considered to take the views being expressed by these groups into account and the Minister will consult again with these groups at an early date. Does the Minister for Health have a date for this order which will formally establish the consultative council?

The women are concerned about the services available from some hospitals. There is no consultant hepatologist in Beaumont Hospital which has one of six special anti-D units. Members of Positive Action have gone to the clinic recently and found it closed. This has been very upsetting as they do not know what are the future plans for the unit and fear that the services which have been provided up to now may not be available in the future.

The people who have contracted hepatitis C have had to face up to a litany of facts. The most shocking was that the Blood Transfusion Services Board knew as far back as 1976 that the main donor they used for the manufacture of anti-D was infected with hepatitis. That has been very difficult for the victims to accept. It is also difficult for them to have faith in the institutions of the State. They quickly lose faith when promises to provide health services etc., for them are not kept. It is necessary to reassure them that the services that have been provided will be available in the future and that any shortfall in these services will be made good immediately.

Members of Positive Action have also reported that, despite the promises made by the Minister, they have found themselves in mixed wards when admitted to hospitals for biopsy procedures. In the health agreement which the Minister negotiated with Positive Action, each unit was to have a designated ward area for patients who were admitted to hospital for testing, treatment or for biopsy. Why is this not happening in all centres?

I would also like to ask if the special units have been granted the funding they requested to provide the services which were agreed by the Minister. It is important to raise this issue as this Bill is providing these services. We need to ensure that this funding is in place. Otherwise, it just adds to the fears and concerns of these people and none of us wants to see that.

In producing the health care package, the Minister and the Department listened to the concerns of the people involved who had contracted hepatitis C. That is to be welcomed. However, irrespective of whatever has been said with regard to the ad hoc tribunal which was set up, the Minister was not listening fully. I accept that he went a long way down the road in providing what the victims required. But there were a few small measures which I believe would not have been costly to the State, could have been provided and would have given these people a tribunal they would have seen as fair and acceptable. In fairness to the groups, it must be said that they have always accepted that a tribunal was the best way to deal with their cases rather than going through the lengthy legal procedures of the courts. It is unfortunate that a few items of concern to them could not have been adjusted by the Minister when he was setting up the ad hoc tribunal, and which he has the power to change at any time.

I listened to the Minister for Health, Deputy Noonan, when he spoke in the other House on this matter on Tuesday last. He gave assurances on many of the issues which were of concern to women. Unfortunately, because of the whole background to this tragedy, the women do not have great confidence in the institutions of this State. They want to see everything copperfastened and written into the order which set up the tribunal. I know, for instance, that the Minister on that occasion assured the other House and the women that he had been assured by the tribunal that no applicant would be compelled to have his or her case heard without agreement to the date fixed by the tribunal for the hearing. He also gave assurances in the House that he had been advised by the Attorney General that the terms of any award made by the tribunal would be enforceable before the courts.

The Minister also informed the other House that all claimants to date who had sought a provisional award have been granted a provisional award, but that is not the point. The women want to know that down the line no woman who wants a provisional award will be refused. I know that anybody who has asked for one so far has been given it, but it is not given by right. The tribunal could still refuse any person a provisional award because that decision is to be made by the tribunal; it is not a decision which is left for the individual going before the tribunal. These assurances can be given by the Minister; but if it is not copperfastened in the tribunal, it is not fully acceptable to the victims.

The Minister stated in the other House on Tuesday that he had been advised by the Attorney General that proceedings before the compensation tribunal will be subject to judicial review. This is another matter which the victims believe could have been stitched into the tribunal and not stated verbally by the Minister. They feel that the tribunal was set up by the Minister and he could have attached these guarantees.

The Minister stated in the other House that oral evidence of the claimants had been heard in all cases by the tribunal and that the tribunal had advised the legal profession and other interested parties that claimants shall be entitled to give oral evidence. This statement is welcome, but the parties who negotiated the tribunal on behalf of the victims last November were not given this guarantee by the Minister at the time. The victims feel that all of these matters have had to be dragged out of the Government only because there have been continuous debates, Opposition motions and Adjournment Matters in this and the other House. It is unfortunate that there is such a low level of trust——

Mr. Sherlock

To be honest, that is hardly a fair comment.

Ms Honan

——between the victims and the Government, which is a pity. However, it is understandable, given the circumstances in which they contracted hepatitis C.

I must disagree with the contention that when it was discovered by the court in the Bridget Roe case that donor X, who caused 90 per cent of the infection, had a clinical diagnosis of infective hepatitis, this was obvious. I must disagree. It was not obvious to me and I do not think it was obvious to many of the victims. That was another setback to them. It was something they discovered when the case was before the High Court and it was another shock for them. We, fortunately, have not contracted hepatitis C and it is a different scenario to us looking at it from the outside rather than from the victim's point of view.

As the tribunal is dealing with a group of people, it is difficult for some individuals to cope with all of this. It is difficult for us to understand the effect it has on individuals, the stresses it causes and the victims' ability to deal with that stress. There is a backlog of bitterness and disappointment among many of them and this adds to their demands. This is why we should try to listen to them and ensure their concerns are taken on board.

I pay tribute to the fact that the medical services which are being provided are what the women wanted, but the issue of compensation is their main concern. The fact that if they go to the tribunal they need not prove medical negligence in itself removes a burden of proof; but in this case the State board was clearly negligent, so it suits the State to wave proof of negligence. Otherwise, the State would probably be held liable to a greater degree of negligence.

It is only because of pressure from the women and the Opposition that certain matters have been clarified. The fact that no applicant will be compelled to have his or her case heard without agreement to the date was, as I said, clarified by the Minister the other night and it was welcomed. The fact that oral evidence has been heard in all cases to date, that this has been confirmed by the lawyers to the tribunal and that the proceedings will be subject to judicial review are matters that are also welcome. The fact that all claimants so far who have sought a provisional award is welcome but there is no absolute right for that to happen to anybody. Since the Minister stated in the other House on Tuesday that the hearing of cases before the tribunal will go on into next year, I cannot understand why there is an insistence on the deadline of 17 June and why the Minister cannot wait until after the court case, which will clarify the matter and show the details of what the blood bank did or did not know. I cannot understand why this cannot be conceded. We must remember from where the women come, the lack of trust they have in the institutions of this State and try to think about it from their perspective rather than from that of a Minister of Government who is a defendant in this particular case.

Mr. Maloney

I am pleased to have the opportunity to contribute to this debate. At the best of times, hepatitis C is a dreadful condition, but to have contacted the disease from services provided by the State must be frustrating in the extreme. As public representatives, we must understand the hurt and despair felt by the victims, their families and friends in this case. Any of us who worked in the health services and met people suffering from hepatitis C understand the stress and hurt involved. Every effort must be made to ensure that what happened in these cases does not reoccur.

I must commend the work done by the representative groups of hepatitis C sufferers in keeping this issue high on the public agenda and for the positive way they have worked with the Minister for Health. I want to see that kind of co-operation continue and I ask the Minister to make every possible effort to ensure the resolution of any remaining issues between his Department and these groups. I am sure no Member of this House can find fault with this Bill. It seeks to confer on the victims of hepatitis C rights to which they would not otherwise have been entitled, such as the provision of full GMS services. I welcome the Bill and I congratulate the Minister for bringing it to this House.

This is not the only measure being taken by the Department of Health. The hepatitis C tribunal is already up and running, although it has been a source of controversy. A case is now being made to extend the closing date for applications. I support the concept of the tribunal and I note that none of the awards it has offered so far has been refused. Tribunals are more flexible, personal and, perhaps more importantly, less costly than formal court proceedings.

I am pleased with the way the Minister has chosen to operate this tribunal. Many women who have applied to the tribunal are keen to see the outcome of court cases currently pending. The arrangements for the tribunal do not preclude women from doing so. An application submitted can be withdrawn. Awards, if deemed unsatisfactory, can be turned down without affecting somebody's right to legal action. Medical evidence is not required with an application form, so there should be no reason why the 600 or so unfortunate sufferers of hepatitis C who have not yet made their applications to the tribunal should not do so. I am satisfied that the Department, through its advertising campaign, has made every effort to bring the closing date for applications to people's attention.

I apologise if I am not speaking to the Bill, but these matters cannot be separated as they form part of the Government's response to this tragedy. This response has been flexible and sympathetic. A mean spirited response would have been to force these women into court where it would have been onerous and costly to prove their case. Had the State adopted this stance it would have committed a great wrong against these women. Such an approach would have been morally reprehensible and the Minister is to be congratulated for refusing to do that. I hope the State continues in this vein. While I understand the Minister's position vis-á-vis the closing date for applications to the tribunal, I urge him to ensure that any person who for some legitimate reason has not applied in time should be given recourse to the tribunal.

Section 2 gives the chief executive officers of the health boards powers to confer the entitlements established in this Bill on individual applicants. I urge them to approach this problem with the same flexibility and understanding as the Government. I commend the Bill to the House.

Mr. Sherlock

May I discuss other issues apart from hepatitis C, or are there two Health (Amendment) Bills?

An Leas-Chathaoirleach

I am sure the Senator will succeed in discussing any matter he wishes.

Mr. Sherlock

There is no question of the Minister or the Government being unfair in their treatment or recognition of the people who suffer from hepatitis C. I have had many discussions with people who represent themselves in this regard. However, the legal profession wants to have a say in this matter. We heard the other day that the State is about to pay £1.4 million to solicitors who represented women in the recent equal treatment payment cases. Under the previous Government, people who were legally entitled to get those payments from the Department had to get solicitors to make representations on their behalf. It is outrageous that they will now be paid in excess of £1 million.

I want to speak about the health strategy to make health boards more accountable and to improve and define management structures. The Bill succeeds to some extent in doing that. Am I in order to speak about such matters?

Mr. Doyle

On a point of information, there are two Health (Amendment) Bills — the Health (Amendment) Bill, 1995, and the Health (Amendment) Bill, 1996. We are discussing the 1995 Bill today. The Senator is discussing matters which relate to the 1996 Bill.

Mr. Sherlock

I will confine my remarks to one Bill.

Mr. Doyle

The Minister's office was also under a misunderstanding.

An Leas-Chathaoirleach

This Bill relates to hepatitis C.

Mr. Sherlock

I bow to Senator Doyle's superior knowledge in this matter.

General practitioners prescribe drugs and medicines, provide dental and ophthalmic services and counsel those involved in home help. If the State decides to provide such services, it must clearly state how they will be provided and what amount of money will be allocated to them. So many services are being withdrawn from the health system that it is hardly worthwhile for people to have a medical card. We are prepared to extend that service now, but I am sure general practitioners will have a big say in that matter.

Is it stated clearly and unambiguously in this Bill that people suffering from hepatitis C will be fully eligible? There should not be restrictions which make it impossible to implement and we should not have to fight general practitioners. We pay a grant of £35,000 or £40,000 to general practitioners per annum and people are fully eligible to avail of the health services. If the State does not want to increase the capitation grant payable to general practitioners, it should keep the number on medical cards below a certain level. If we want to extend that service to this category of people, we should ensure there are no restrictions. That is happening at present.

We must seriously examine the paltry sum being paid to people who provide home care or home help services for people with disabilities. The home care allowance is reasonable but the home help payment is a derisory sum for people who go far beyond the bounds of duty to provide a service. That has to be looked at as well. I am sure that at the end of the day everybody will be satisfied; that is only as it should be. To suffer from hepatitis C is a tragedy. Every effort must be made to ensure that these people are adequately compensated and to provide adequate health services for them.

Dr. Henry

I will not delay the Minister as I have spoken on this subject before. This was a very serious episode in the lives of all those who received contaminated blood, be they the women who received anti-D serum, patients with renal disease who were infected from dialysis, or patients who were given other blood products for very serious blood diseases. The Blood Transfusion Services Board has been criticised very strongly about what happened. It was a terrible episode for all those working in the blood bank as well as for the recipients. The concern this episode caused for staff within the Blood Transfusion Services Board should not be underestimated.

The Department of Health has got off lightly. Between 1989 and 1991 the Blood Transfusion Services Board sought further funding for testing, but on reading the debates on this issue in the Official Report it seems to me that the Blood Transfusion Services Board was run on a very tight budget. We cannot afford not to allow the latest steps in technology to be brought forward immediately when dealing with such services. Although it can be argued that tests in these areas are not 100 per cent accurate when they are first introduced, is it better to bring in the test which is 80 per cent accurate immediately and possibly have to deal with false positives, rather than to have no knowledge at all? I have a certain amount of sympathy for those working in the Blood Transfusion Services Board, particularly at that time, who sought money and received a very poor response from the Department of Health.

I am very glad the Department of Health has made all those who were infected with the hepatitis C virus eligible for primary health care; this is very important for them. The dreadful thing about this condition is that the treatment is not very satisfactory. We still do not really understand the natural history of the disease. There has been a considerable amount of criticism about the tribunal, but at least when dealing with the tribunal people do not have to deal with the stress caused by court cases. I am glad to be able to tell the Minister I have only had to go to court as a witness in my professional capacity, but it is important not to underestimate the stress caused by court cases, which can have a range of psychological and physical effects.

It has been said that some of those who have settled their cases at the tribunal are already dead. While two patients are dead, I can tell the House that one of them died from causes completely unrelated to hepatitis C. It is very important not to give the impression to other sufferers that patients who have received compensation have died of hepatitis C, because it paints a particularly gloomy picture for others who are infected. It is important to remember that people can die of other conditions even when they are infected with hepatitis C.

People ask for categorical assurances that this kind of crisis will not happen again. It is impossible to give such assurances. I noticed how careful those from the blood bank were, when before the Joint Oireachtas Committee on the Family, not to reassure the committee that this could not happen again. We can do our very best to ensure it does not happen again, and in this context it is important not to starve the service of money so that tests can be updated.

These are biological problems and we do not have total control over them. There is already a problem with hepatitis G in Germany. This has almost certainly been imported from the far East. These viruses may be sexually transmitted or they may be transmitted through the blood; we do not know. No one can give categorical assurances, but they can do their absolute utmost and any new tests must be made available immediately. We must have state of the art testing in this country. Huge efforts have been made by Professor McCann and by Mr. Dunbar — I compliment them on the work they have done — but we can only do what is humanly possible within these areas and that is all that can be promised to the public.

It is interesting to note that because of the greatly increased vigilance in the Blood Transfusion Services Board, a far higher proportion of those offering to donate blood are now being refused. The generosity of the Irish public is exceptional. A friend of mine needed 25 pints of blood the other day following an operation. Some 25 people helped that man. He would not be here without their help and it is important to remember this. This is an effort, not just by the Blood Transfusion Services Board, but by society in general. When I was a young doctor I first went to work in America and I will never forget how when a patient was admitted, the first thing they were asked for was a list of their donors. This has never had to happen in this country. All that is necessary is to put out an appeal for donors — the specific blood group can even be mentioned — for donors to offer blood.

There has not been a drop in the number of donors coming forward but unfortunately more donors have had to be refused so as to be absolutely sure that every possible effort has been made to exclude every condition, known and unknown. It is very difficult to exclude conditions we know nothing about at the moment. We are trying to deal with conditions and diseases of which we do not know the natural history and for which we know there is no treatment. This is a very testing time for the medical services in this country and the efforts which have been made to try to make sure that this could not happen again should be recognised. We should try to go forward with confidence that Irish society will continue to run a service for people who need blood which will be second to none.

I am very glad that the Minister for Health has also said that during the Irish Presidency of the European Union we will make further efforts to standardise the various tests and regulations pertaining to blood and blood products within the European Union. Ours are some of the tightest; but an overall approach would be better, because blood all over the world is much the same. It is important to address this urgent problem systematically with the knowledge that we have to provide finance for this service if we wish to ensure that it is of the highest level.

Mr. Cotter

I am glad to have this opportunity to say a few words on this issue. I will not keep the House very long. I speak mainly because a few people from my constituency have contacted me about it to express their concerns. I imagine that the people who discussed the matter with me are typical and that many of the people are worried because of the publicity this issue has received for the last number of months.

Having discussed it privately people seem to get their confidence back when they realise that what is going on is basically political tomfoolery. I have every confidence in the Minister of State and the Minister in their handling of this matter. They are doing a marvellous job. It is important to put it in context for people who, through no fault of their own, are suffering from hepatitis C. The context is simple; it is that those who are opposing and trying to blacken the efforts of the Government would do exactly the same if the Government had decided to opt for a court based procedure. They would then, rightly, say it is correct to set up a tribunal.

They are playing with people's lives. Those people do not need additional worries, they have enough on their plates. They need to feel confident that the Government is doing its utmost to help, which it is. When you contrast the courts system, where they would get a payment and that would be the end of it, with how the tribunal is operating — where people have recourse to the tribunal again at a later date if their conditions deteriorate to such an extent that that is required — it is a fair system.

I compliment the Government on introducing this measure. This has been a tragic drama from beginning to end. A huge exercise to screen people has been carried out. Those involved deserve better treatment from Opposition parties that are trying to smear the Government. Toying with people's lives in such tragic circumstances degrades politicians.

Mr. Finneran

What about the action groups?

Mr. Cotter

I heard it said in the House this morning that when a person goes before the tribunal the Government actually goes in to defend the case. The person who made that statement should give it a bit of thought. The Government is trying to ensure that people get fair and good treatment and it is only right that they should examine the situation. The Government should not allow a situation to develop where people get whatever they ask for. That is not the purpose of the tribunal.

Mr. Finneran

They are opposing it in the courts.

Mr. Cotter

The purpose of the tribunal is to try to establish their needs and, once they are established, to deal with them.

Mr. Doyle

And to give fair compensation.

Mr. Cotter

That is happening. People who are hyping it up are doing a disservice, particularly as their parties were in power when this debacle happened. I wish Opposition politicians would choose carefully the topics on which they go to town when they want to score against the Government, and that they would be more sensitive in their approach. People telephoned me because they were frightened out of their wits by politicians going over the top on this issue. However, once you have had a calm discussion with them they fully understand and enjoy some peace of mind. The difficulty, of course, is that we cannot talk to everybody.

I spoke to the Minister last night and suggested he should recontact every one of the people involved to explain the situation once again. He has already sent a personal letter to everybody explaining the position fully. I suggested, however, that he might have to do so again because people are being upset by fairy stories. I appeal to the Opposition to find some other way of crucifying the Government than by using the lives of these people.

I am confident the Government and future Administrations will honour the commitments made by the Department of Health, even though the Opposition is casting doubt on the issue by claiming it has not been legislated for and that the next Minister for Health could change his or her mind. I do not think so. Even the irresponsible people hyping this issue would act responsibly when in Government. They would handle the situation impeccably.

Mr. Finneran

That is a vote of confidence for us.

Mr. Cotter

Indeed, Fianna Fáil tend to be responsible when in Government but when in Opposition, they are anything but. Of all the parties in this House, the Senator's is responsible for giving politicians a bad name. This is another example of it.

Mr. Doyle

It is not Senator Finneran's day.

Mr. Cotter

The "slightly constitutional" Fianna Fáil Party has always been so in opposition.

An Leas-Chathaoirleach

The Senator should confine himself to the Bill, please.

Mr. Cotter

When they are in Government they put on the cloak of respectability, and we must be thankful for that.

Mr. Maloney

Not after the next election.

Mr. Cotter

I appeal to those politicians to stop playing with people's lives and to support the Government on this issue. People who have suffered so gravely should have confidence in the system. It would be better for Deputy Geoghegan-Quinn to declare that if her party came into Government tomorrow it would support the procedures put in place by this Government, instead of putting questions marks over them. People would be happier in the knowledge that no matter which Government is in power they will be looked after.

I welcome this Bill because it underlines the fact that the Government is serious about looking after these people. At enormous cost to the Government and to the people of Ireland who support it, the Bill is putting in place certain procedures through the health boards to offer services to these unfortunate people for the rest of their lives. I commend the Government on its handling of the issue and for holding its nerve in difficult circumstances. I hope Ministers will continue to deal with this matter as they have been doing. People should have confidence that they will be looked after.

Minister of State at the Department of Health (Mr. O'Shea)

I thank Senators who contributed to this constructive debate and who gave the Bill a general welcome.

The purpose the Health (Amendment) Bill, 1995 is to provide for making available, without charge, certain services to eligible persons who have contracted hepatitis C. Eligible persons are those who have contracted the hepatitis C virus directly or indirectly from the use of human immunoglobulin anti-D, or the receipt within the State of another blood product or a blood transfusion.

The Bill is a concrete expression of the Government's commitment to provide a high quality health service for such individuals. It is the product of consultation which has taken place with representative groups of various supporting areas including Positive Action, Transfusion Positive, the Irish Kidney Association and the Irish Haemophilia Society.

As soon as the Bill has passed all Stages in both Houses it is hoped to finalise negotiations with professional groupings representing doctors and pharmacists to put in place the necessary administrative arrangements for the delivery of health services set out in this Bill.

With regard to co-operation between the Department and these groups, I trust the co-operation shown by the groups in working successfully with the Department of Health in launching the optional testing programme last autumn will carry forward into the provision of these services.

I would like to deal with some of the items that arose during the debate. Senator Finneran gave the impression that no health care services have been put in place until now. The treatment for those who test positive for hepatitis C has been provided at special consultant staffed clinics at six hospitals since February 1994 free of charge, including prescribed medication. A counselling service was also immediately put in place. An ex-gratia expenses scheme was also administered by the BTSB to ensure that people could avail of services.

The tribunal scheme was mentioned by a number of Senators. Clause 4 (b) of the scheme provides that any person responsible for the maintenance of any persons who have been diagnosed positive for hepatitis C as a result of a blood product or a blood transfusion may claim. Clause 4 (c) provides that any dependant of a person who has died as a result of contracting hepatitis C may make a claim. Clause 8 provides that the awards of the tribunal will be calculated by reference to the principles which govern the measure of damages in the law of tort, in other words, the same means as would operate in a court.

The funding required by health boards to meet the costs of the new primary health care services set out in the Bill will be provided. In all cases where a claimant has requested a provisional award, the tribunal has made a provisional reward and that should be noted. Senator Honan raised the issue of counselling. Following the passage of the Bill, the health boards will be legally obliged to provide a counselling service and will be funded to do so. With regard to the consultative council, the Minister for Health will consult with the interested groups again and, following those consultations, will formally establish the council. However, I cannot give a definite date for when the council will be established.

Senator Honan also mentioned mixed wards. This took place in one hospital, St. James's, when it was under particular pressure. The hospital informed the Department that it had happened and the hospital was requested to ensure it would not happen in the future and must be mindful of the health care package at all times and comply with it.

I thank the Members for their support for this Bill and for their contributions in this debate.

Question put and agreed to.

An Leas-Chathaoirleach

When is it proposed to take Committee Stage?

Mr. Doyle

Next Wednesday, subject to the agreement of the Whips.

Committee Stage ordered for Wednesday, 19 June 1996.

Sitting suspended at 12.25 p.m. and resumed at 2 p.m.