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Seanad Éireann debate -
Wednesday, 12 Feb 2014

Health Identifiers Bill 2013: Committee and Remaining Stages

I welcome the Minister to the House.

Section 1 agreed to.

Amendments Nos. 1 to 4, inclusive, are related and may be discussed together. Is that agreed? Agreed.

Government amendment No. 1:
In page 9, line 7, after “such” to insert “and who falls within a class of such agents prescribed for the purposes of this paragraph”.

Amendments Nos. 1 to 4, inclusive, concern changes to the definition of relevant employees and relevant agents. As the changes are similar in nature it is proposed to discuss the four amendments together. The Bill allows the Minister for Health to assign unique identifiers to health service providers. Providers must use their unique identifiers in health records they make and their communications relating to the provision of health services. Under the Bill, health service providers include health practitioners and health service bodies. Relevant employees and agents of these practitioners and bodies are also included as health service providers under the Bill. The proposed amendments are designed to facilitate a phased approach regarding assigning identifiers to these employees and agents. Amendments Nos. 1 and 2 provide for the Minister to prescribe classes of agents for the purposes of the definition of a relevant agent and amendments Nos. 3 and 4 provide for the Minister to prescribe classes of employees for the purpose of the definition of a relevant employee.

Amendment agreed to.
Government amendment No. 2:
In page 9, line 10, after “such” to insert “and who falls within a class of such agents prescribed for the purposes of this paragraph”.
Amendment agreed to.
Government amendment No. 3:
In page 9, line 20, after “such” to insert “and who falls within a class of such employees prescribed for the purposes of this paragraph”.
Amendment agreed to.
Government amendment No. 4:
In page 9, line 23, after “such” to insert “and who falls within a class of such employees prescribed for the purposes of this paragraph”.
Amendment agreed to.
Government amendment No. 5:
In page 10, between lines 8 and 9, to insert the following:
“(b) the identification or prevention of a threat to public health,”.

The Bill provides that the individual health identifier, IHI, can be used for relevant purposes. These are the primary and secondary purposes set out in the Bill. Primary purpose means the present, past or future provision of health services to an individual. Secondary purpose relates to the wider health service matters, such as health service management and patient safety. This amendment proposes that there be a specific reference in the definition of secondary purpose to the "identification or prevention of a threat to public health" to ensure that this area is expressly captured in the Bill. Subject to legal advice, the Government may propose other amendments to the definition of "secondary purpose" in due course in the passage of this legislation.

Amendment agreed to.
Section 2, as amended, agreed to.
Sections 3 and 4 agreed to.

I move amendment No. 6:

In page 11, to delete lines 35 to 37.

On Second Stage I spoke in favour of the Bill and I am still in favour of the Bill. It is necessary and will join up services across hospital care and health care generally. I am very much in favour of this. It has been far too long coming. The previous Government should have done this a long time ago but I welcome this Government's commitment to moving this on.

I have tabled this amendment, which is to remove section 5, because in the Bill itself we have a statement that possession of an identifier does not necessarily qualify a person for health services. We have a lack of clarity in this State about exactly what people are qualified and eligible for and, I would say, entitled to from our health services.

We had many promises from previous Fianna Fáil-led Governments to publish the eligibility for health and personal social services Bill. At the time, we had calls from the Opposition, both from the Minister of State's party and that of the current Minister, Deputy Reilly, for the publication of this Bill along with other Opposition spokespersons. It has been reported that this issue will be addressed in the Minister's draft White Paper on universal health insurance. The problem is we have not seen that. Maybe it is in the White Paper and it will become a reality at some point but because of the statement in this Bill about people not qualifying for health care simply because of having an identifier, I cannot support this section, so I am tabling this amendment.

I guess the Minister will not accept the amendment. I will support the Bill and I am tabling this amendment on a point of principle more than anything. I hope the Minister will be able to take on board this constructive contribution and that in due course people will have a legal entitlement to health care in this State.

Amendment No. 6, as the Senator has indicated, would delete section 5(3) of the Bill. The purpose of the Health Identifiers Bill is to put in place a legislative framework for individual health identifiers. This is primarily a patient safety issue. Eligibility for health services is a separate, although important, issue and is provided for in other legislation as the Senator and the House will be aware. Section 5(3) was included in the Bill to make it clear that the assigning of an IHI to an individual shall not be regarded in any way as indicating an entitlement to or eligibility for the provision of health service to the individual.

In this context we must bear in mind that the IHI is an identifier which will apply throughout the health service, public and private. An IHI can also be assigned to anyone receiving a health service, whether or not the person is ordinarily resident in the State. I do not propose to accept the amendment in view of the purpose of the Bill and the intended use of the IHI across the health service. I hear what the Senator has said and I thank him for the support he, along with colleagues across the House, expressed for the Bill and its purpose on Second Stage. Senator Cullinane used the word "entitlement" which does not mean the same thing as eligibility, but I understand where he is coming from. He will accept that the questions of eligibility for health services, how they should be managed, how a resource should be distributed, and funding the health services through health insurance or by the Exchequer directly are all enormously important issues. The Senator rightly pointed to these issues in his contribution.

However, it is wrong to in any way seek to change this Bill, the purpose of which is a narrower objective which has to do with patient safety and which will give us an enormous resource - and I can see this in primary care - regarding the management of the health services properly for the whole population, across the board. It would be a pity if we were to try to import into this Bill the broader debate about eligibility which is covered in legislation such as the Health Act 1970, which we have discussed several times here regarding eligibility for medical cards. There is a broader debate to be had here. There is a draft White Paper on universal health insurance which is being discussed by the Government. It is intended to publish that White Paper in early course. It will give us an opportunity to have this broader debate that the Senator regards as important, and on which I agree with him. It would be a pity if we were to interfere with any of the provisions of this Bill which are somewhat more narrowly focused and which have a particular intent in mind. I ask the Senator to consider those observations.

I fully support the Minister and I do not support the amendment. I have raised this matter in the House previously. A 1976 High Court decision decided that nursing home care came under the definition of medical care.

As a result people received an entitlement that was not intended when medical cards were introduced. Likewise, this section states that having an identifier number does not give the person an entitlement. That is an important clarification in the Bill. I support fully what the Minister of State says on this matter. It is an important section.

Amendment, by leave, withdrawn.
Section 5 agreed to.
Sections 6 to 10, inclusive, agreed to.
Government amendment No. 7:
In page 14, to delete lines 21 and 22 and substitute the following:
“or after the coming into operation of this subsection—
(a) subject to paragraph (b), request the individual to provide his or her individual health identifier (if any) to the provider, or
(b) in the case of an individual who may require the assistance of another person to provide the individual’s individual health identifier (if any) to the provider (whether due to the age or lack of capacity of the individual or for any other reason), request the other person to provide the individual’s individual health identifier to the provider.”.

One of the provisions of section 11 of the Bill is that a health care provider, when providing a health service, can request an individual to give his or her IHI to the provider so that it can be associated with the patient record. It is proposed in amendment No. 7 to amend this provision to encompass a situation where the individual concerned cannot give his or her IHI because of age or capacity and someone else, for example, an accompanying parent, guardian or friend is allowed to do so on his or her behalf.

Does the Bill adequately cover the situation of someone with dementia, particularly if there is no court order or enduring power of attorney in place? Have we adequately covered all the problems that might arise? While the amendment is welcome it is also important that those situations are adequately catered for, particularly enduring power of attorney, and even powers of attorney, because there are circumstances in which a person may not have dementia or a health problem has signed a power of attorney for the management of his or her affairs, following legal advice. Is the Minister of State satisfied that we have covered all those angles?

The legislation seems to me to be safe in respect of what Senator Burke has said. To some extent the Senator’s concerns are being dealt with, belt and braces, in this amendment. To the extent that there might be such concerns, it seems to me that this resolves them. Existing law and provisions in respect of power of attorney, or enduring power of attorney, have their own legal substance and content and would have an impact by their nature. I do not think that anything in this Bill reduces or undermines that. This amendment covers whatever residual concerns there might be. That is one of its purposes.

As the Senator is aware, the Minister for Justice and Equality is preparing legislation to deal with assisted decision-making which will be dealt with elsewhere.

Amendment agreed to.
Government amendment No. 8:
In page 15, line 10, after “purpose” to insert “or for the purpose of performing a function conferred on him or her by this Act or another enactment”.

Amendment No. 8 is essentially a drafting amendment. Section 11 currently allows the Minister for Health to process an individual’s IHI and other identifying particulars in the register for a relevant purpose. Amendment No. 8 brings section 11 into line with section 10 which provides that the Minister may access the national IHI register for a relevant purpose or for the purpose of performing a function conferred by the Minister under the Bill or other enactment.

Amendment agreed to.
Government amendment No. 9:
In page 15, line 22, to delete “disclose” and substitute “provide”.

Amendment No. 9 is a drafting amendment and relates to substituting the word “provide” for the word “disclose” in section 11(6)(d) for consistency.

Amendment agreed to.
Section 11, as amended, agreed to.
Sections 12 to 29, inclusive, agreed to.
Government amendment No. 10:
In page 27, line 4, after “Act” to insert “other than information provided under section 8 or 9”.

Section 30 allows the Minister for Health to carry out measures to verify any information provided to the Minister under the Bill or to establish the efficient and effective operation of the registers. Amendment No. 10 clarifies that verification arrangements under section 30 would not apply to information given by An tArd Chláraitheoir on births and deaths or information given by other Ministers.

Amendment agreed to.

Section 30, as amended, agreed to.
Government amendment No. 11:
In page 27, line 12, to delete “equivalent person” and substitute “person who falls within paragraph (b) or (c) of the definition of “specified person” in section 2(1)”.

Section 31 provides that for the purposes of the Bill a data exchange agreement may be entered into between the Minister and other persons, including professional regulatory bodies and health service providers. Amendment No. 11 extends section 31 to include all specified persons and not just health service providers as the section currently provides. The amendment also deletes the reference to equivalent persons as data exchange agreements involving them would be addressed under a section 12 agreement entered into between them and the Minister.

Amendment agreed to.
Section 31, as amended, agreed to.
Sections 32 to 39, inclusive, agreed to.

Amendments Nos. 12 to 14, inclusive, are related and may be discussed together by agreement. Is that agreed? Agreed.

Government amendment No. 12:

In page 32, to delete line 6.

These amendments relate to the lists of persons in Schedules 1 and 2. Schedule 1 lists the authorised disclosees. Schedule 2 lists specified persons. Specified persons may access the IHI register and process the IHI and other identifying data on it for a relevant purpose. Authorised disclosees do not have access to the IHI register but they are persons to whom a specified person may disclose an individual health identifier and other identifying particulars for a particular secondary purpose. Following further consideration by the Department of Social Protection it is not considered necessary for An tArd Chláraitheoir to be an authorised disclosee. Amendment No. 12 therefore removes An tArd Chláraitheoir from Schedule 1.

Amendments Nos 13 and 14 are concerned with moving the Health Research Board from Schedule 1 to Schedule 2 since the Health Research Board operates the national drugs-related death index and other national health databases.

Amendment No. 14 also includes the Child and Family Agency as a specified person in Schedule 2. It was not possible to do this in the Bill when published as the legislation establishing the Child and Family Agency had not yet been enacted. Specified persons can access the IHI register and process identifying data for a relevant purpose. Subject to legal advice, there may an amendment to section 10 which provides for this matter to clarify access to data.

Amendment agreed to.
Government amendment No. 13:
In page 32, to delete line 13.
Amendment agreed to.
Schedule 1, as amended, agreed to.
Government amendment No. 14:
In page 33, between lines 5 and 6, to insert the following:
"2. Child and Family Agency.
3. Health Research Board.".
Amendment agreed to.
Schedule 2, as amended, agreed to.
Title agreed to.
Bill reported with amendments and received for final consideration.
Question proposed: "That the Bill do now pass."

I thank Senators for the constructive and very useful debate on Second Stage and today. This Bill gives us the enabling legal framework for a unique identifier system for individuals and health service providers right across the public and private health system. It is worth saying again that first and foremost, a unique identifier system is an important component of a safe health service, helping to ensure that the right information is associated with the right individual at the point of care. An identifier system will also support health service management and delivery systems and facilitate the e-health agenda.

The Second Stage debate and our discussion today demonstrates that we share a common view of the benefits of an identifier system. I thank Senators for the positive approach taken across the House and for their useful and productive debate on the issues concerned during the consideration of the Bill.

We support this Bill. As I noted on Second Stage, there are some variables to consider with regard to cost and technology required to back this up. Is what we have sufficient and how much will it cost to run this process? Will the appropriate resources be available? There must be a cross-departmental approach to these issues, taking in social welfare, health and justice, as data protection can be a barrier to the success or the aspirations of a Bill like this. We all agree in principle with the identifier system but there is a question of how best to take it forward. That does not detract from the amendment forwarded by Sinn Féin on eligibility and entitlement of people to gain the appropriate treatment, which is an old chestnut of mine. For now at least, we welcome this as a small step in the right direction.

I thank the Minister of State and the officials in all the Departments involved with the matter. It is an important step. We have much catching up to do, as I mentioned in a previous debate on the matter. In Denmark, the computerisation process began in 1994. We have 1,700 different computer systems in the health area but in Denmark they have 27 and are working to a target of five or six systems for the entire country. This is an important step in creating efficiency and saving money and it cannot be taken without having the appropriate legislation in place. This is the appropriate legislation and it will set up proper structures.

There is one advantage as we know the mistakes made by other countries and health systems. It is important that we learn from that and put in place a safe system both in respect of the protection of data and in ensuring data can be accessed in an efficient and proper manner by health care personnel. It is an important step but we have much work to do. This is just one of the many areas where we must create efficiency in the health service.

I thank the Minister of State for bringing forward this Bill. It passed through the Seanad very quickly but that is not a reflection of the importance of the Bill; the cross-party support is an indication of the Bill's importance. It seeks to make the health services more efficient - which we all want - and make them more effective for patients and patient care. That is essentially what this is about. It is a step in the right direction. We will return to the wider debate about how we fund health services, including matters of entitlement and eligibility and cutbacks in health care. We have debated those matters several times in this House and we will do so again. As a step forward, this is a good one, and although it is long overdue, it is more than welcome.

I thank the Minister of State for bringing this Bill through the House. Senator Cullinane has summed up succinctly what I wanted to say. The expeditious progress of the Bill through the House shows the necessity for it, as evidenced by the all-party support it has had.

I thank the officials in the Department of Health for their assiduous attention to the legislation. It has been extremely helpful. I also thank the Members.

Question put and agreed to.
Sitting suspended at 1 p.m. and resumed at 2 p.m.