Adjournment Debate

Sunbed Usage

Senator John Crown

I urge the Government to introduce legislation regulating the sunbed sector at the earliest opportunity. I am pleased to say the Minister of State at the Department of Health, Deputy Kathleen Lynch, has graciously informed me that such legislation will be introduced very shortly. I will be taking a non-controversial stance because I regard myself as a partner with the Government and Ministers on this topic. I will, however, take advantage of the debate to emphasise why it is important to regulate the sector.

The updated figures on the incidence of malignant melanoma in this country are frightening. I have previously quoted figures for this potentially lethal skin cancer. I must stress that most skin cancers are cured by the simple expedient of being recognised at an early stage and removed before they can spread. Of the three major kinds of skin cancer the least common, malignant melanoma, is potentially the most fatal and it also has the greatest potential for secondary spread, dissemination and lethality. The incidence of this cancer doubled between 1998 to 2008, from 400 to 800 cases, and the most recent figures indicate that its incidence has increased to nearly 1,000 since 2008. A bitter fruit is being harvested from the unhealthy habits we have developed in respect of both the real sun and sun beds. Worryingly, the sector is largely unregulated. It is still legal for children under the age of 18 years to partake in sunbed bathing. This activity is recognised as presenting a defined incremental risk in the incidence of malignant melanoma. The figures show that one sunbed session increases an individual's lifetime chance of developing melanoma by 20% compared to someone who never used one. Each additional session during the same year may increase the risk by a further 2% to 3%. The average risk of skin cancer from sunbeds is more than double that of spending the same length of time in the midday Mediterranean sun. People who regularly use high pressure sunlamps may be exposed to as much as 12 times the annual ultraviolet A dose than they would get from sun exposure.

A number of jurisdictions have already introduced legislation to ban sunbed use by those who are under age. These include Austria, Belgium, Finland, France, Germany, Italy, Norway, Portugal, Spain, Sweden, England, Northern Ireland, Scotland, Wales, British Columbia, Newfoundland and Labrador, Nova Scotia, Quebec, California, New York, Vermont and Iceland. Brazil has banned all commercial tanning beds. Australia, where the biggest demographic presenting with skin cancer is of Irish extraction, plans to introduce a similar ban from 2014 onwards. New Zealand is also introducing stringent regulations.

Three attempts to have been made to introduce legislation in this area over the years. I laud my colleagues in this House and the Dáil for their efforts in this regard and, without missing any opportunity to launch a save the Seanad campaign, it should be noted that one of these Bills was introduced in the last Seanad by Senators Healy Eames, Cummins, Bradford and Paul Coghlan. Unfortunately, the Bill ran out of steam with the 2011 elections. More recently, a Bill was introduced in the other House by my friend and colleague, Deputy Kelleher, and another Bill was introduced by the now Minister of State at the Department of the Environment, Community and Local Government, Deputy Jan O'Sullivan. I am not sure what will happen to Deputy Kelleher's Bill and whether it will be supplanted by other legislation but we must remain committed to putting legislation on the Statute Book at the earliest opportunity. Every year, 28,000 young people use sunbeds, which means 28,000 more young people are being exposed to skin cancer every year we delay legislating.

I would also take this opportunity to ask the Minister of State, separate from the subject matter of this Adjournment debate, to find out what is happening to the Protection of Children's Health from Tobacco Smoke Bill 2012, which deals with smoking in cars. It was supposed to be in place to protect children during last year's summer holidays, but that did not happen. I am getting very nervous about whether it will happen in 2013.

Minister of State at the Department of Health (Deputy Kathleen Lynch)

I am responding to Senator Crown on behalf of my colleague, the Minister for Health, Deputy Reilly. I should mention that my script refers to the Senator as "Deputy Crown".

Senator John Crown

I have been promoted.

Deputy Kathleen Lynch

I was about to say I do not know whether it is a promotion or a demotion. I thank the Senator for raising this matter and giving me an opportunity to outline to the House the current state of play with regard to the proposed public health legislation governing the use of sunbeds. There has been a growing body of evidence over recent years that the use of sunbeds, especially by children, should be restricted because of the associated increased risk of skin cancer and other health problems. In 2009, the International Agency for Research on Cancer, which is an expert body under the World Health Organization, reclassified sunbed use as a group 1 carcinogenic. This higher-risk classification now places sunbed use on a par with cigarette smoking.

The World Health Organization, the Irish Cancer Society, the Environmental Health Officers Association and other bodies have expressed growing concern about the use of sunbeds. The Department of Health has taken these developments fully into account in its consideration of the measures in the proposed legislation. The Department has conducted two public consultations on the matter and has met a number of interested parties, including the Sunbed Association of Ireland, Quality and Qualifications Ireland, the Health Service Executive, the National Consumer Agency, the National Standards Authority of Ireland and the Irish Cancer Society. The Department has also consulted the Department of Jobs, Enterprise and Innovation, which has responsibility for safety matters relating to sunbeds and other types of tanning equipment.

The Government has approved the drafting of legislation. I can confirm that the Bill has been accorded priority status in the Office of the Attorney General. Officials from the Department are working closely with the Office of the Parliamentary Counsel to complete the drafting of this important public health legislation. The Minister's key priority in the legislation is to prohibit people under the age of 18 from using sunbeds on a sunbed premises and from purchasing or hiring sunbeds. The Bill will also set out a comprehensive range of measures to promote greater public awareness across all age groups of the dangers of skin cancer, premature ageing and eye damage caused by exposure to ultraviolet radiation. The Bill will require those involved in this sector to supervise sunbed use, issue notifications to the HSE, train staff, provide protective eyewear to sunbed users and display warning signs. Sunbed businesses will be required to provide comprehensive information setting out the health risks associated with sunbed use to anyone over the age of 18 who is considering sunbed use. Those who choose to use sunbeds despite the risks involved will be required to sign a form indicating they have been made fully aware of the potential dangers of sunbed use. In addition, there will be a prohibition on certain promotional and marketing practices. Comprehensive enforcement provisions will also be included in the Bill.

The drafting of the public health (sunbeds) Bill will be finalised in the next six to eight weeks. Thereafter, the legislation must be notified to the EU Commission under the EU transparency directive prior to its publication and introduction in the Oireachtas. This EU notification requirement will take a minimum of three months to complete. I hope my reply has been of some help to the Senator. I will make inquiries about the Protection of Children's Health from Tobacco Smoke Bill 2012.

Senator John Crown

I thank the Minister of State. I am tremendously grateful for the effort that has been made in this regard by the Minister and the Ministers of State and their officials in the Department of Health. We will raise the question again in approximately three months' time to see what the status of the legislation is at that stage.

Hospital Services

Senator Jimmy Harte

I thank the Minister of State for coming to the House for this debate on the future of three community hospitals in County Donegal, in Stranorlar, Carndonagh and Dungloe. They are as geographically spread out as any three hospitals in the county could be. This issue, which affects every corner of County Donegal, was brought into focus recently when HIQA reports found that the hospitals in question were not 100% satisfactory. Many of these problems stem from the staffing of the hospitals. The communities served by these hospitals and the families of the hospitals' patients need to get some clarity. That would be better than certain individuals going on the airwaves to say that the hospitals will close, or that there will be a reduction in services. Older people would rather have clarity. Many of them would regard the community hospital in the same way as their sitting room or kitchen. That is where they spend their time and where their families visit them.

County Donegal may be unique in how its community hospital service is structured. Lifford Community Hospital, which is roughly in the same boat, provides a useful step-down service to those treated at Letterkenny General Hospital. The local community and the local doctors came together when that hospital was under threat to speak to the Minister and draw up a plan to help the hospital improve structurally. It has been suggested recently that the three hospitals I mentioned at the outset could lose beds and never get them back. Older people find it difficult to accept that possibility. A local councillor, Martin Farren, has attended some meetings about the future of Carndonagh Community Hospital. Another councillor, Frank McBrearty, has been dealing with St. Joseph's Community Hospital in Stranorlar. I have also spoken to people who have attended meetings in Dungloe.

The HSE has a communications problem. Its management should play a more proactive role and say exactly what is happening here. When rumours are spread about hospitals - this seems to be a regular occurrence - politicians from all parties have to find out what is happening and go on the airwaves to explain the position before someone from the HSE eventually issues a statement. The HSE should be more proactive in explaining what is actually happening to the public, the community and the patients in our community hospitals and thereby providing reassurance. The worst thing for a hospital is for a rumour to get legs. In such circumstances, everyone believes the rumours rather than the facts. Maybe that should be considered in the overall context of how the HSE communicates. These rumours should be nipped in the bud more quickly. Perhaps the Minister of State can provide some clarity on the future of these three hospitals.

Deputy Kathleen Lynch

I do not need to tell anyone in this country, and definitely not anyone involved in politics, that we are facing challenging times as we try to keep the finances, the services and the infrastructure of our community units in place. These challenges relate to finances, to staffing and to the ageing structures in which these units are housed. All developments have to be addressed in light of current economic and budgetary pressures. Any decisions taken by the HSE must have regard to these pressures and to the current recruitment moratorium.

The 11 community hospitals in County Donegal provide 400 public beds, of which 238 are short-stay beds and 162 are long-stay beds. They are supported by a wide range of community-based services. Primary care centres are attached to six units, which means there is access to services including public health nurse services, community psychiatric nursing, home help services and old age psychiatry. These services are available to residents of the units as need requires. The use of short-stay beds has enabled older people to access the services and supports they need to maximise their independence and remain at home for longer. This is demonstrated by the fact that just 2.7% of older people in County Donegal are in long-term care, compared to a figure of 4% nationally. There is an emphasis in the county on supporting acute services to discharge older people in a timely manner to step-down facilities in community hospitals. Some 976, or 29%, of the 3,353 admissions to community hospitals were from acute hospitals in 2012. The availability and use of short-stay beds in community hospitals minimises acute hospital admissions as it allows general practitioners to admit patients to community hospitals directly.

Dungloe Community Hospital, like Carndonagh and Stranorlar community hospitals, was registered with the Health Information and Quality Authority on 22 June 2012.

The registration period is three years and the current capacity is 35 beds. In addition to long-term care, there is a day hospital, outpatient clinics, X-ray and other specialist services. The hospital has recently experienced an increased number of staff retirements, long-term sick leave and maternity leave. In order to maintain a safe level of care to patients the HSE decided temporarily to reduce the number of short-stay beds by ten. Long-stay beds are unaffected. The decision to close the beds temporarily was taken to ensure that there is an adequate number of staff to meet all of the needs of the residents safely. The hospital will continue to provide respite and rehab care within its current capacity.

Carndonagh Community Hospital is the focal point for health care delivery in north Inishowen, delivering a comprehensive service to meet a wide range of patient needs. Services include long-term care, respite, rehabilitation, palliative and dementia-specific care. There is a wide catchment area with 14% of the population over 65, many of whom live in isolated areas and alone. This places greater demands on services, particularly inpatient services. The current bed capacity in Carndonagh Community Hospital is 38. The recent decision to reduce capacity from 42 to 38 beds was also taken to maintain safe and appropriate levels of care to patients. The situation will be kept under review and as sick leave resolves the beds will re-open.

The current capacity of St.Joseph's Community Hospital is 75 beds. Services include respite, rehabilitation, palliative and intermediate care and there are 27 beds available for long-term residential care. When the hospital was last inspected by HIQA in April 2013, inspectors observed that while staff provided care in a knowledgeable, competent and respectful manner, there was a concern that this complex mix of residents can make it more difficult for the staff to meet the needs of long-term residents. In order to address this issue one ward, with a dedicated staff, has now been designated for long-stay residents only. The changes mean St. Joseph's will now have an operational capacity of 67 beds. I am confident that this response will facilitate improved compliance with residential standards. Residents and their families can be assured that management and staff will continue to work to provide the highest standards of care in all the community hospitals in Donegal. The HSE has asked me to assure the House that the residents at all these facilities are receiving a safe and quality service. Bed capacity across community hospitals in Donegal will be kept under on-going review. However, there are no current plans to further reduce bed capacity. I hope this is of some help to the Senator.

Tobacco Control Measures

Senator Martin Conway

I would like to share time with Senator Crown if that is acceptable.

An Cathaoirleach

Is that agreed? Agreed.

Senator Martin Conway

I have raised the issue of the sale of tobacco in this House previously and this Government has demonstrated its dedication to dealing with the scourge of tobacco smoking. The Minister for Health and the Minister of State, Deputy Lynch, whom I welcome to the House, are committed to dealing with this. As part of my other profession I run a shop and I tend to know what the cigarette companies are up to, probably sooner than everybody else. I highlighted in this House how these companies were offering financial incentives to young staff in shops to promote branded cigarettes. I have discovered that this has not been happening since I highlighted it.

I am, however, greatly troubled by promotional material from one of the major cigarette companies offering packs of 25 cigarettes. Originally they were sold in tens and 20s until the ten packs were banned. The cigarette companies have very cleverly developed a 23 pack and now a 25 pack which they sell for less than €10. Per cigarette the price has been reduced. This is a very clever tactic for reducing the price of cigarettes. I want the Government immediately to ban the 25 and 23 packs or else ban 20 packs and introduce one pack with a single quantity, whether 20 or 25. I do not want the Government to wait to do this. It is within the Minister's power to ban this immediately, to issue a directive to the cigarette companies that they can sell only one packet of cigarettes with a particular dedicated quantity.

Senator Crown has been very active in the anti-tobacco campaign and highlighting the health issues surrounding tobacco use. I am very grateful to him for participating in this debate and I am glad to give him some of my time.

Senator John Crown

I am very grateful to my friend and colleague, Senator Conway, for giving me a moment to speak. I am very supportive of his efforts and request. We must understand that on no level is the tobacco industry collectively our partner. It is on every level the adversary of good governance and good public policy. It is us versus them - we "ain’t" partners on this. Senator Conway deserves great credit for highlighting this really sneaky marketing effort on the industry's part to try to circumvent several regulations related to tobacco. I was not aware of this. I warmly commend his efforts and I hope that the Minister of State is able to follow his advice that there be one standard pack size. Ultimately, we are hoping that by 2030 there will no standard pack size legally available.

Deputy Kathleen Lynch

I thank the Senator for raising this issue. My Department, in consultation with the HSE, is continuously monitoring the ever-evolving market tactics of the tobacco industry. As these evolve so too must our legislation and policy framework. I appreciate the Senator's bringing this new development to our attention. As the Senator may be aware the European Court of Justice ruling has obliged us to cease the practice of placing a minimum price on tobacco products and to amend our legislation in this regard. The Public Health (Tobacco)(Amendment) Act 2013, however, allows for the regulation of various promotional devices used by the tobacco industry.

While the Senator is right to be concerned at the introduction of these new packs of 23 and 25 cigarettes, the main issue of concern to the Minister is preventing people and especially young people starting to smoke. The ban on the sale of packs containing fewer than 20 cigarettes was introduced as a measure to deter children and young people from smoking. A combination of measures is required in order to make an impact on the numbers smoking in Ireland. These include raising awareness, education, price increases, developing legislation related to tobacco products and to smoke-free measures. It also includes support and services for those who want to escape nicotine addiction. These measures are aimed at saving lives and not interfering with smokers' rights.

One in two of all long-term smokers will die from a smoking-related disease. A comprehensive range of tobacco legislation is in place in Ireland which places us in the top rank of countries internationally. Some of these significant initiatives include: a ban on in-store display and advertising; a ban on self-service vending machines except in licensed premises; a ban on the sale of tobacco to individuals under 18 years of age; cigarette price increases; social marketing and media campaigns and graphic warnings on cigarette packs. All these measures have the effect of denormalising tobacco use in our society which is the most effective way to prevent future generations from continuing the habit. More, however, needs to be done. My Department is finalising a new tobacco policy which sets out a range of measures to achieve a tobacco-free society. These measures include the development of legislation to ban smoking in cars where children are present and the development of legislation for the introduction of standardised packaging of tobacco products. The plain packaging of tobacco will ensure that cigarette packets are no longer a mobile advertisement for the tobacco industry. Evidence shows that young people in particular find plain packaging tobacco products less appealing. As almost 80% of smokers start when they are children it is important that many of our measures should be aimed at young people.

In conclusion I would like to confirm the Minister's and this Government's commitment to health promotion and the introduction of tobacco control measures. I can assure the Senator that the Department and the HSE will continue to monitor the tobacco industry promotion. The aim is to de-normalise smoking and ultimately move to a tobacco-free society. We will, with everyone's assistance, work constructively with all stakeholders to achieve this goal. We cannot but say that the type of packaging that we have been seeing lately, the smart, sleek, long packages are very clearly directed at young women.

The pink sleek packaging is not something that would appeal to young men. It is clearly directed towards young women. The criticism of that type of marketing which we must state loudly and clearly is that this is a clear attempt to get more young people as customers for the tobacco sector.

Senator Martin Conway

I thank the Minister of State for her reply. The Government banned ten packs of cigarettes because they were attractive to young people. Let us now ban 20 and 23 packs; let them have their 25 packs. While I take on board the reply, we need to be up-front and forward thinking and move quickly on this issue. They are sneaky and cheeky in the way they do business. We need to be as sneaky and cheeky as they are in dealing with them. I would prefer to see a packet of cigarettes priced at €20, which would definitely put it beyond the reach of many young people. We need to send a clear message to the cigarette companies that when they introduce a new sneaky product, we will deal with the issue head-on and, if necessary, use a sledgehammer in dealing with it. I was appalled when I saw the literature the other day. If there was any way to deal with this more urgently than having a review, I would urge the Minister to do it.

The Seanad adjourned at 6.50 p.m. until 10.30 a.m. on Thursday, 4 July 2013.

Seanad Éireann debate - Wednesday, 3 Jul 2013