Health (Miscellaneous Provisions) Bill 2016: Committee and Remaining Stages

I welcome the Minister of State.

Sections 1 to 6, inclusive, agreed to.

Amendment No. 1 involves a potential charge on the Exchequer and has been ruled out of order.

Amendment No. 1 not moved.
Section 7 agreed to.
Sections 8 to 17, inclusive, agreed to.

Amendment No. 2 which seeks the insertion of a new section has been ruled out of order, as it is not relevant to the subject matter of the Bill and involves a potential charge on the Exchequer.

Amendment No. 2 not moved.
Title agreed to.
Bill reported without amendment and received for final consideration.
Question proposed: "That the Bill do now pass."

I wish to discuss my amendments. I am disappointed that they were ruled out of order. They had been designed to address the issue of mandatory retirement for critical health professionals in the public health system.

These are senior decision makers in the system who are forced to retire for no reason other than their age. As Professor John Crown stated during the debate in 2015, we are not so flush with trained experienced staff that we can afford to offload them voluntarily. The Longer Healthy Living Bill 2015 received cross-party support. The Oireachtas Joint Committee on Justice, Defence and Equality examined in detail the broader issue of mandatory retirement in the context of the Employment Equality (Abolition of Mandatory Retirement Age) Bill tabled by the then Labour Party Deputy Anne Ferris. One of the submissions received was from Dr. Enda Shanahan who helped me to formulate some of my amendments. He stated two years prior to coming before the committee that he had been compelled to retire from the health service, in which he had worked as a specialist hospital doctor. He wrote to management and the then Ministers, Deputy Brendan Howlin and Senator James Reilly, indicating that he was able and willing to keep working in the public health sector after the age of 65 years. He explained that he was physically fit, still running all distances up to and including marathons and medically fit for purpose as certified by the Medical Council's continuous professional development process. The answer was that retirement was mandatory on reaching the age of 65 years. At no point was any objective effort made to assess his suitability to continue working. He was retired purely because of a date on the calendar.

The health service is on life support. It is in dire need of resuscitation and reform. As a doctor and a Senator who is trying to be constructive, pragmatic and solution driven, I am bitterly disappointed that the amendments have been ruled out of order on a technicality. They would have helped in a small way to ameliorate the staff shortages which plague the health system. Last night we saw the "RTE Investigates" programme which highlighted the shambles and cover-up that had become the norm in the health system. A simple "Sorry" does not cut it any more for the people. We are embattled by staff shortages, a shortage of senior consultants, not having enough GPs and a dearth of highly qualified specialist nursing staff. We have an ailing and failing health service. I intend to introduce to the House a new Bill comprising the amendments.

I remind Senators and the Minister of State that at 250 consultant posts are unoccupied and that no applications were received for 25% of all vacancies. I welcome Dr. Enda Shanahan who contributed to the debate at the Oireachtas Joint Committee on Justice, Defence and Equality and is in the Visitors Gallery.

I welcome the Minister of State, Deputy Marcella Corcoran Kennedy. I compliment my colleague, Senator Keith Swanick, on tabling these very worthwhile amendments. While I fully accept the ruling of the Leas-Chathaoirleach that they are out of order on the grounds that they involve a charge on the Exchequer, I fail to see how they could. As Senator Keith Swanick pointed out, there are more than 200 vacancies for consultants. When Professor John Crown was a colleague of ours in the House, he brought forward legislation in that regard. It was well received at the time but nothing was done about it. While the House may not have a role in bringing forward legislation with financial consequences for the State, I urge colleagues on both sides of the Lower House to bring forward such legislation. It is welcome that Senator Keith Swanick has said he intends to initiate such legislation in the House, but I fear that it will be knocked down for the same reasons as his amendments have been ruled out of order.

At a time when we are discussing extending the retirement age to 68, 69 and even 70 in the years to come, I fail to see why it is not feasible, given the number of vacancies to which we have referred, to extend the retirement age for consultants.

It is not a charge on the Exchequer because there is no one to fill the vacancies when they occur. Until pay and conditions are tackled realistically, there will continue to be a shortage of consultants.

I compliment Senator James Reilly on the work he put into the health service. He was ridiculed for doing so, not only by the Opposition but also by some of his colleagues at the time. When the commentator took over who is now potentially looking for the leadership of the Fine Gael Party, he did very little.

The Senator might be straying slightly.

Slightly, but to come back-----

I will allow the Senator to come back quickly.

It is a curveball.

We are not on Second Stage. The Bill has been agreed to.

I thank the Leas-Chathaoirleach.

We still have to deal with other Bills in the future.

No doubt the Senator will find plenty of other ways and means to deal with those matters.

I want to finish the point. People such as Senator James Reilly who tried to introduce initiatives to benefit the health service were ridiculed, not only by some Opposition Deputies and Senators but also by colleagues in his own party, including a recent former Minister for Health. We have to stand up and say it as it is. We do not have the consultants we need to service the health service. Until we consider realistic proposals such as those made by Senator Keith Swanick to extend the retirement age of consultants who want to continue in their practices and until we tackle realistically the pay and conditions of consultants who have been forced to leave the country to work under better circumstances elsewhere in the world, we will continue to have a crisis in the health service. However, I welcome the Bill that has just passed and look forward to the Minister of State, Deputy Marcella Corcoran Kennedy, introducing legislation to tackle the amendments proposed by Senator Keith Swanick.

I welcome Dr. Enda Shanahan to the House.

I wish to address two issues, the first being the one alluded to by Senators Keith Swanick and Diarmuid Wilson. I thank Senator Diarmuid Wilson for his kind comments. I support what the Senators are trying to achieve. In addition to the shortage of consultants and the difficulty in filling posts, a much broader issue is at play, namely, ageism.

I cannot open up a debate on something that is not-----

I am not going to do so, but I will speak to the proposed amendment, even though it has been ruled out on financial grounds, which I fully accept. However, I am not quite sure if a Bill of that nature could be ruled out on such grounds-----

The Senator can take up that matter with the Cathaoirleach.

If you will allow me to speak without interruption, I will finish expeditiously.

I thank the Senator.

Otherwise I am quite capable of shouting back.

I will allow the Senator to be expeditious.

I thank the Leas-Chathaoirleach. The bottom line is performance in doing one's duty. Someone's suitability to perform his or her duties should be based on competence, not age. Thankfully, people, although not everybody obviously, are living longer. They are healthy. We heard statements at the Global Economic Forum in which it was pointed out that we had a host of individuals aged between 65 and 80 years who were healthy, wealthy and looking for something to do as an opportunity for tourism in this country. I fully support the concept that people should be adjudicated on on their ability and competence to carry out their job, not age. To complement the point, under the new under-sixes contract, GPs can work until they reach 72 years of age if they wish. I do not suggest people should be forced to work beyond 65 years if that is not their desire, but they certainly should not be prevented from doing so when they have built up expertise over many years that is very hard to replace.

I welcome very much the amendments on plain packaging. It is something I know that we all understand is critically important in preventing the next generation from taking up this killer habit which kills 6,000 people every year. That is a statistic that falls off the lips, but it is 6,000 partners, parents and families who are ripped asunder because they have lost a loved one and an income. It is horrendous, not to mention the tens of thousands who suffer from chest diseases, heart attacks, strokes, peripheral vascular disease and all of the other cancers this heinous killer product causes.

I commend the Minister of State for bringing forward this really important legislation. I look forward to the merry month of May when children will be safe from the subtleties and the evils of the tobacco industry which seeks to addict them before the age of 18 years and before they are in a position to make a decision as an adult on whether they wish to smoke.

I call Senator Máire Devine.

I am sorry, Senator, but I am calling speakers in order. Senator Maire Devine will be followed by the Senator and then Senator Rose Conway-Walsh. The Chair has ruled and I have called Senators in the order indicated.

I thank the Leas-Chathaoirleach. Is there a problem we need to sort out first?

No, the Senator is in order.

Am I? That makes a change. I thank the Leas-Chathaoirleach.

The Senator is expected to be brief. The Bill has been passed.

I will be really brief. I am happy to outline my broad support for Senator Keith Swanick's amendment. We have a serious problem in attracting health professionals and I am talking on behalf of my nursing colleagues. There are thousands of nursing vacancies, as well as for other healthcare staff workers. We are trying to bridge the gap in expertise and the mentoring of new recruits. We have lost a lot of expertise. This measure will do enough to safeguard the employer and the employee and ensure fairness and choice. It is about choice. I do not want to see it as mandatory. Some of us are having our day on a Zimmer frame earlier than we had expected because we have been worked so hard. As we are all living longer, we are promoting lifelong learning, of which this measure is part.

I raise a couple of concerns. I know of a situation where nurses, in particular, were employed post-retirement age. I presume they are temporary contracts, but there are problems with them. They require clarification on the matter of pension contributions in that the people in question are already pensioners. There is also the issue of senior staff, or a senior nurse in the instance about which I am thinking, being paid based on seniority they had reached in their careers, yet they will not be the senior staff responsible in a ward or the delivery of a health service. It is someone who is being paid significantly less

The Senator should direct her gaze this way.

That is about it - simple and easy-peasy.

The Senator should be very brief.

I will be very brief. I thank the Leas-Chathaoirleach.

My apologies to the Senator. I thought we were on Committee Stage.

The Bill has been passed.

I know that. My apologies for thinking I was ahead of the Senator. I was not.

Not at all. The Senator is grand.

I support Senator Keith Swanick's excellent amendment, even though it has been ruled out of order. Former Senator John Crown spoke about this issue in the last Seanad. Why, on a certain date when someone reaches 65 years, if he or she is, as Senator James Reilly said, experienced, knowledgeable, resilient, full of health and competence, does he or she have to give up his or her job? The amendment can be ruled out of order all one likes - if I am correct, it has been ruled out of order on financial grounds, due to a financial burden being imposed on the State-----

No; I am sorry, it was, apparently, also related to relevance, but that is a matter the Senator will have to pursue with the Cathaoirleach.

It is one of the most relevant amendments. If one looks at the financial burden imposed or the emotional trauma caused for people on waiting lists, the cost to the State and people is unimaginable-----

Not waiting lists.

I really think ruling the amendment out of order is ageist. In 2020 some 25% of us will be be over the age of 65 years. What are we thinking about? It is outrageous. It is one of the best and most creative amendments that has been tabled here and I would like to know why and on what grounds it has been ruled out of order.

The Senator will have to pursue that matter with the Cathaoirleach. I am sure she will be able to have a discussion with him.

That is all very well, but I would like to support the amendment because it is excellent.

I understand. He explained-----

It was explained to the Member who tabled it.

I support Senator Keith Swanick who should pursue the amendment against all odds. Perhaps this Seanad might actually bring it about that people will not have to leave their place of work if they are competent, able and resilient, given all of their experience, on the day when reach 65 years. I never heard anything as ridiculous, if they want to stay on.

I, too, support the amendment on the basis that in ruling it out of order one is hiding behind a cloak that there may be a financial liability in the future, without quantifying it in any way, shape or form. I do not think that is right. I agree with my colleague that it should be brought forward.

The position was explained to the Member who tabled it. I will leave it at that.

That is appreciated.

I have to leave it at that.

Common sense is not all that common and the more time I spend here, the more I realise it.

I also want to talk about the amendment that has also been ruled out of order on working farmland accounting for a total of 90% of farm assets under the fair deal scheme. It should be exempt in any valuation or means assessment. The amendment was an attempt to correct a significant anomaly under the fair deal scheme, which discriminates unfairly against farm families. My office in County Mayo, Senators Trevor Ó Clochartaigh and Pádraig Mac Lochlainn and I am sure many other rural Senators and Deputies have received many requests about this issue. Farm families should be concentrating on the health of their loved ones, rather than having to worry about the potential sale of part of the farming homestead. Working farmland is not a financial asset for farm families. It is their main means of production and required to continue living in rural Ireland.

I will not allow a lengthy speech.

I will not do so, but I really have to say this.

The Senator can make a brief point.

I will make it very briefly. It is disgraceful that the main means of production of farm families should be used as an excuse to penalise them. We should think this through. Where will it end up? Will people lose their farms because of it? It is absolutely crazy. The amendment is very simple and would allow fairness. It is called the fair deal scheme and needs to be fair for farm families, as well as anybody else. The accusation of senior personnel within the HSE that farm families and others are leaving their loved ones in hospital beds just because they do not want to give up their farms and livelihoods is despicable. I certainly will not be letting this amendment to go away. We will present it again.

I am sure the Senator will pursue it further.

The farm organisations which are depending on us to put proper legislation in place will be severely disappointed that the amendment has not been accepted.

I ask Senator Colm Burke to be brief.

I welcome the Minister of State and thank her for bringing forward this legislation. It covers a number of important areas, particularly ex gratia compensation payments under a number of schemes, including for women who were subject to symphysiotomies. Over 600 people who benefit from ex gratia payments will not have them included in calculations under the fair deal scheme.

The wording of the amendment put forward by Sinn Féin is probably not correct in the sense that a proposal is being considered by the Minister of State, Deputy Helen McEntee. We have been dealing with it for the past three years. I have worked very hard to try to have it included because I am very much aware of the circumstances of farm families when there is a sudden illness and full-time nursing home care is needed. I speak as someone who was involved in forcing the creation of the fair deal scheme. In fact, my legal office identified a discrepancy in legislation, whereby moneys were being deducted illegally from people living in nursing homes. It subsequently led to the creation of the fair deal scheme. In the case of farm families, instead of ignoring 90% of the assets, they were not dealt with appropriately. As in the case of inheritance tax, the proposal being considered involves reducing the valuation of the land by 90%, but the value of the house would still be taken into account.

In fairness, most farm families do plan for the future. I have seen comprehensive planning engaged in by farm families and any legal practitioner will highlight the need to make sure there is forward planning in this regard. I accept that there is a need for an amendment to legislation for farm families and it is appropriate that it be dealt with at a very early date. It would certainly be very welcome.

The amendments brought forward by Senator Keith Swanick should be brought forward in a Bill to be dealt with in both Houses in the appropriate manner. It is not just about amending the entitlement to work. There are many other amendments that would have to be legislated for if we were to go through that process. It is not enough to simply amend current entitlements. There are many other areas that would have to be dealt with in legislation. That is why a separate Bill is required.

I thank the Minister of State for bringing forward this legislation. It is important that it be put in place and operational at the earliest possible date.

I thank Senators for their contributions on Committee and Remaining Stages of the Health (Miscellaneous Provisions) Bill 2016. Its provisions will allay the fears of recipients of ex gratia awards which have been approved by the Government. It would be most unfair if people who received an ex gratia award were then to be disadvantaged in a financial assessment for support under the nursing homes support scheme as a result of having received an award. I hope the Bill will give the individuals concerned and their families peace of mind.

The Bill contains some very important measures in the area of tobacco control. I am delighted to see Senator James Reilly present as he is a champion of this issue. Once the Bill has been enacted, arrangements will be made to introduce standardised packaging of tobacco. It is my intention to allow adequate preparation time before the commencement of the new packaging measures. As we know, 23% of Irish people are daily or occasional smokers. Some 8% of ten to 17 year olds smoke. While the reductions in the figures in the past few years are significant and welcome, we are a long way from reaching the 5% prevalence rate set out in the Tobacco Free Ireland policy. Almost 6,000 people are killed annually by smoking. The human cost of smoking is overwhelming. Less important but still significant is the economic cost of smoking. The annual health care bill amounts to €506 million; lost productivity amounts to €1 billion, while the cost of litter associated with smoking is €69 million. These costs are very significant and show how reducing the incidence of smoking can improve not only the health and well-being of Irish people but can also reduce the cost to the taxpayer in dealing with the impact of smoking in the long term.

We can be proud of what we have achieved in the last couple of decades in the area of tobacco control, but work must continue to reduce the numbers who smoke and, in particular, the number of young people who smoke. Standardised packaging is just one of a number of recommendations set out in the policy Tobacco Free Ireland. I am committed to ensuring we will continue to implement this policy to ensure our children and their children will get to experience a tobacco-free Ireland. I ask all Senators to continue their support, not only for the standardised packaging measure being discussed but for all future public health measures to be implemented by my colleague, the Minister for Health, Deputy Simon Harris, and me.

The provision in the Bill to amend the Health (Pricing and Supply of Medical Goods) Act 2013 is also intended to benefit the health of the population. It provides that, when considered appropriate in the interests of patient safety or public health, over-the-counter medicines can continue to be reimbursed for medical card holders after May 2018. This means that products such as nicotine replacement therapy and emergency contraception can continue to be provided under the medical card scheme. The proposed amendment to the Irish Medicines Board Act 1995 will allow the payment of fees to members of the Health Products Regulatory Authority in line with the arrangements made in other boards in order to continue to attract experts of the highest calibre to apply for board membership at no additional cost to the taxpayer.

I thank everyone who contributed to the debate. I thank Senators Keith Swanick and Trevor Ó Clochartaigh for the genuine intentions behind their amendments. I regret that, owing to Standing Orders, it was impossible to accept them. I think everyone will agree that having the Bill enacted as quickly as possible is the primary aim. It aims to make important changes to the four Acts mentioned in the interests of equity and, in some cases, patient safety. Of course, the changes to tobacco legislation are to help to protect public health. I again thank all of the Senators who spoke for their contributions.

I add my words of welcome to Dr. Enda Shanahan who is in the Visitors Gallery.

Question put and agreed to.

When is it proposed to sit again?

At 10.30 a.m. tomorrow.

The Seanad adjourned at 5.15 p.m. until 10.30 a.m. on Wednesday, 8 February 2017.