Commencement Matters

Hospital Services

I ask the Minister for Health to address the need for a new inpatient cystic fibrosis unit at Beaumont Hospital. A unit for cystic fibrosis was promised in the programme for Government but, to date, there has been no progress and I fear it may have fallen off the agenda. This matter affects at least 180 adults in the immediate area who have cystic fibrosis and who are in need of such a unit. I have been contacted by a number of people about it and the daughter of one of them has cystic fibrosis. Is the unit still being considered and is any progress being made on it?

The Cystic Fibrosis Hopesource Foundation, which successfully lobbied for a part-funded cystic fibrosis outpatient unit at Temple Street Hospital, set up the first multidisciplinary teams for cystic fibrosis and seed-funded all related salaries for three years. There will be a press conference at Beaumont Hospital on 6 November to address the urgent need for an inpatient unit and I would love to be able to communicate some progress on that date. I will save time for the moment, if that is possible, until I hear the Minister of State's response.

Ireland has the world’s highest incidence of cystic fibrosis. There are over 1,100

people registered as having cystic fibrosis in Ireland. Life expectancy for people with the disease and the complexity of cystic fibrosis care have both increased progressively in recent years. This has resulted in an increase in the number of adults with cystic fibrosis being treated in adult centres. In addition, there has been an increase in average disease severity. The existing cystic fibrosis centre at Beaumont Hospital is one of the largest in Ireland. It provides specialist treatment and services to adults with cystic fibrosis. Beaumont Hospital conducts a significant amount of research into cystic fibrosis and this contributes to the body of research and understanding of the condition.

As the Senator noted, A Programme for a Partnership Government includes a commitment to the development of a dedicated cystic fibrosis unit at Beaumont Hospital. This unit will be underpinned by the model of care for people with cystic fibrosis in Ireland, which is being developed by the national clinical programme for cystic fibrosis. The model of care will set out standards and requirements for the physical and human resources to be provided for treatment of cystic fibrosis patients from a national perspective.

This model of care is undergoing the final stages of approval. It states that adult cystic fibrosis units must have dedicated single inpatient isolation rooms with ensuite facilities and the number of rooms will depend on the number of patients. There should be five inpatient rooms for every 50 adults with cystic fibrosis attending a unit. Cross-infection poses extremely dangerous problems for people with cystic fibrosis, therefore single rooms are critical for their safe care.

The national clinical programme for cystic fibrosis asked the cystic fibrosis registry of Ireland to carry out a census of people with cystic fibrosis in early 2017. The census results indicated the number of people with cystic fibrosis attending Beaumont Hospital at that time was between 135 and 150, indicating the need for approximately 13 to 15 inpatient rooms for the hospital. My Department, the HSE and the RCSI hospital group are supportive of the development of a new cystic fibrosis unit and recognise the need for capital development in supporting the delivery of key services to patients of Beaumont Hospital. The RCSI hospital group's operational plan for 2018 includes a capital requirement of €11 million for the unit. In terms of the progression of the cystic fibrosis unit, I am happy to confirm it has been included in the national planning framework under Project Ireland 2040, as well as being recommended for inclusion in the capital plan by the HSE national capital steering committee.

I thank the Minister of State. It is a very satisfactory answer in the sense that the Minister of State has outlined the position regarding the incidence of cystic fibrosis in the country and the ideal model of care. He has acknowledged that 13 to 15 inpatient rooms are necessary for Beaumont Hospital. That is very satisfactory. The RCSI hospital group's operational plan for 2018 includes a capital requirement of €11 million for the unit. What does that mean exactly, in terms of when we will realise an inpatient unit in Beaumont Hospital? There are a lot of other things I could say to make the case for this unit. The Minister of State has acknowledged it needs to be there and will be there. I would like to know what that means. When are we likely to see a unit in Beaumont Hospital?

This is a six marker.

I thank the Cathaoirleach for flagging it. As the Cathaoirleach said, it is a six marker. There is difficulty with the capital side of the budget, as the Senator will appreciate at this moment in time. It is one of the challenges. I am in a struggle in my area trying to secure funding for something that is very close to the Cathaoirleach's heart, which is Bantry General Hospital. I do not mean to take from the Senator's struggle to get funding for Beaumont Hospital. I appreciate it because I have a family member working there and understand the challenges faced by cystic fibrosis patients and their families, most importantly, and the staff working there. There are a number of national projects going on at the moment and that is the challenge we have in the health capital budget. We have the national children's hospital, the national maternity hospital and the national forensic hospital out in Portrane. As they are swallowing up hundreds of millions of euro, it is very difficult to get to all the capital projects. It is in the 2040 plan, as I have said. It has also been cleared by the HSE steering committee, which is an important step to get by. Hopefully increased funding will become available over the years. The model of care has almost been agreed for it. We are a long way towards it but I cannot give the Senator the answer she would like to hear.

I will make a slight response. While the 2040 plan is a really good plan and I am totally on board with it, the danger when the 2040 plan is mentioned is that people get the notion it will not materialise until 2040. Will the Minister of State give me a brief response on that point?

I am bending the rules to allow the Minister of State to respond.

I will be brief.

The Minister of State was very brief at the beginning.

I will be really brief.

I am replacing the Cathaoirleach in the Chair next.

Every politician in the House appreciates what the Senator has just said. When we talk about a 2040 plan, it suggests to people it will not happen until 2040. The 2040 plan, as the Senator said, is the way forward because it gives a long-term view and approach rather than doing it on a year-to-year basis. The 2040 plan starts today and that is an absolute fact. There are developments under way.

The next matter was raised by Senator Murnane O'Connor who has four minutes. In fairness to Senator Noone and the Minister of State, they both complied with the eight-minute rule. I acknowledge they were within their time.

Assisted Human Reproduction

I thank the Minister of State for coming in. In October last year, the Government approved the drafting of a Bill on assisted human reproduction and associated areas of research. A commitment was given that to support the commencement of the legislation, officials in the Department would work during 2018 with the HSE to develop a model of care for infertility to ensure the provision of safe, effective and accessible services through the public health system as part of the full range of services available in obstetrics and gynaecology. Part of this work was to include identifying policy options for a potential public funding model for assisted human reproduction treatment. Professor Simon Fishel, former chair in human reproduction at the University of Nottingham and founder of CARE Fertility in Britain, has predicted that increasing numbers of young women will freeze their eggs or ovarian tissues to have babies later in life. Fertility treatment is not available to public patients in Ireland although the tax relief for medical expenses scheme can be availed of. An attempt at in vitro fertilisation, IVF, costs up to €5,000. There is not usually just one attempt, which means poor people cannot avail of it.

Fertility preservation services for cancer patients whose treatment is likely to impact on their future fertility are provided by the Rotunda IVF clinic based on the grounds of the Rotunda Hospital. Funding for fertility preservation services for those with a diagnosis of cancer is €259,000. This has been in place since 2003 without increase despite a growing demand for the service. The funding comes to the clinic via the hospital. It sees 160 to 180 men for sperm freezing and 60 women for egg or embryo freezing. While the number of men has stayed roughly the same, there has been a more than 50% increase in the demand for egg or embryo freezing. It froze gametes for 35 women in 2015 and for over 55 women in 2017.

In 2015, the clinic engaged with the HSE and the national cancer control programme, NCCP, to look at additional funding and to perhaps look at improving the service with a view to considering the introduction of ovarian tissue freezing. In January 2017, a pre-tender interest form was submitted by the clinic to potential stakeholders who were interested in offering the service. In September 2017, they were advised that work was being done on a specification document and that engagement with all parties would commence within weeks. It is now more than one year later. If there was a real possibility for State funding for fertility treatment, which is important in order that there is an equal chance for all families to try fertility solutions that suit their circumstances despite the odds, the provision of fertility preservation needs to be seen as part of these services. They are not the same and due consideration should be given to fertility treatment and preservation. The funding for the Rotunda IVF clinic covers fertility preservation for men and woman with a recent diagnosis of cancer. It does not cover fertility treatment itself. As such, it needs to be managed separately and regulation needs to be structured into any funding models introduced. In the past two weeks, the clinic has had requests from a 15 year old and a 16 year old with recent diagnoses of cancer who are looking to the future. The only real option for these girls is ovarian tissue freezing and unfortunately this is not an option in Ireland at this time. One of the first things that will be talked about to a female up to the age of about 45 in the event of diagnosis of cancer will be future fertility particularly for those who do not already have children. More and more women and men are surviving cancer and having their own biological children should not be denied to them if the possibility of preservation is available to them. The HSE has continued to fund this programme and it is very important for those who have needed to avail of the service. We must not ignore the continuing and growing needs of our society and neither should we force families to put off fertility treatment because they do not have the money.

It is an issue I am very interested in.

I am nearly finished. Children born through fertility treatment or preservation are children who are wanted, loved and longed for before they are born and will grow up to contribute to society. What are the Government's plans to assist families seeking fertility treatment or preservation? Is there some timescale for those plans? I thank the Minister of State. This is a very serious issue and I look forward to his answer.

I thank the Senator. I am taking this issue on behalf of the Minister, Deputy Harris. The Government approved the drafting of a Bill on assisted human reproduction and associated areas of research in October last year. The introduction of legislation on assisted human reproduction and associated research is a priority for the Minister for Health and the process of drafting this Bill will be completed in conjunction with the Office of the Attorney General.

The general scheme was published on the Department's website, and the Oireachtas Joint Committee on Health is conducting a review of the general scheme of the Assisted Human Reproduction Bill 2017 as part of the pre-legislative scrutiny process, which began in January of this year. However, it is not possible at this time to give a definitive timeline for the completion of the draft Bill and its subsequent passage through the Houses of the Oireachtas.

While the majority of assisted human reproduction, AHR, treatments and services available in Ireland are provided through private AHR clinics, there is a limited specialist AHR service available through the HSE, which provides funding for fertility preservation for cancer patients whose treatment is likely to impact on their fertility. Officials in the Department are working with representatives from the HSE to ensure that there is a coherent approach to the development of the AHR legislation, which is consistent with the existing publicly available cryopreservation service.

In order to support the commencement of the legislation, officials in the Department are working with the HSE to develop a model of care for infertility to ensure the provision of safe, effective and accessible services through the public health system as part of the full range of services available in obstetrics and gynaecology. Part of this work includes identifying policy options for a public funding model for AHR treatment. Once the Minister has had the opportunity to consider these policy options it is his intention to bring a memorandum to Government on a model of care for infertility, including public finding for AHR treatment, for the Government's consideration. No specific decision has been made at this time on the parameters of any potential public funding model. It is important to note that any funding model that may ultimately be introduced would need to operate within the broader regulatory framework set out in the AHR Bill and the model of care for infertility.

Currently, patients who access IVF treatment privately may claim tax relief on the costs involved under the tax relief for medical expenses scheme. In addition, a defined list of fertility medicines needed for fertility treatment is covered under the high-tech scheme administered by the Health Service Executive. Medicines covered by the high-tech scheme must be prescribed by a consultant-specialist and approved by the HSE high-tech liaison officers. The cost of the medicines is then covered, as appropriate, under the medical card or drugs payment scheme. Therefore, while IVF treatment is not currently provided by the Irish public health service, there is some support available for patients who access such treatment privately.

It is disappointing that the only annual funding for the scheme, which has been in place since 2003, is €259,000. Many cancer patients now live longer than they did in the past and fertility and preservation is a serious issue for them. I want the Minister of State to look into this because it is an area we need to address. I hope he will return soon with good information. It all boils down to funding. We need to get the funding into this area.

I thank Senator Murnane O'Connor for raising the issue and thereby providing the opportunity to discuss the matter in the House today. The Minister and the officials are acutely aware of how necessary the AHR Bill is and how eagerly some form of additional support for accessing AHR treatments is anticipated. Officials in the Department of Health will continue to work with the Office of the Attorney General and the HSE as required to ensure that the drafting of the AHR legislation, the preparation for the relevant service arrangements regarding the model of care for infertility and the development of specific eligibility arrangements can all proceed in line with each other to allow for the timely commencement of the legislation.

Blood Donations

My question is fairly straightforward. I asked it earlier in the year and was pleased to be informed at that stage that the Irish Blood Transfusion Service, IBTS, was set to carry out a review of the ban on blood donations from people who were resident in the North and in Britain during the variant Creutzfeldt-Jakob disease, vCJD, crisis, in July of this year. Having submitted this Commencement matter I received a very helpful response from the Minister for Health yesterday on the review. This morning provides an opportunity to reiterate the call for more blood donations. People should actively consider that as well as organ donation. While we have to be scientifically and medically sound to keep the system free of and safe from contamination, it has been quite a long time since the vCJD crisis emerged and there is merit in the review taking place. When will the review be concluded and is there any indication of what its findings might be?

I thank the Senator for his continued interest in this and his concise and direct approach to it. I am happy to have the opportunity to advise the Seanad further on this matter. The remit of the IBTS, is to provide a safe, reliable and robust blood service to the Irish health system. The IBTS constantly keeps all deferral polices under review.

The IBTS currently has a permanent deferral policy in place for individuals who have resided for more than one year, cumulative, in the United Kingdom, including Northern Ireland and the Channel Islands, between the years 1980 and 1996. This deferral policy was introduced in 2004 following the first confirmed case of vCJD transmission via blood transfusion in the UK. There is no test for vCJD and confirmation that someone had the disease is only possible post mortem. In July, a special meeting of the medical advisory committee of the board of the IBTS was held to review the IBTS deferral policy in relation to vCJD and to consider the current scientific and medical evidence on vCJD transmission. It was decided at the meeting not to change the donor deferral policy at this time. It was agreed that a full risk assessment was warranted and the medical and scientific director of the IBTS has since commenced this assessment. The assessment will consider the current medical and scientific evidence available, involving a systematic examination of all relevant literature, studies and reports. Once this is complete a further meeting of the medical advisory committee will review the decisions made at the July meeting. This review is expected to be completed by mid-2019.

If the outcome of the risk assessment indicates that the IBTS could safely relax the current deferral polices in regard to vCJD, then a case for such changes will be made to the board of the IBTS and subsequently to the Department of Health. The focus of my Department will at all times be to ensure the provision of a quality supply of blood to the Irish health system. Decisions on changes to deferral policies for blood donation must always be supported by rigorous scientific and medical evidence.

I thank the Minister of State. That is pretty clear. This is not a question of running ramstam into this or seeking to compromise or jeopardise the scientific and medical soundness of the blood supply. This emanates from people who may have been working in England or Scotland during this period and now want to donate blood, to heed the call from the Department of Health and from the IBTS. It is a question of trying to find a balanced and safe, medical and scientific basis for allowing more people to donate blood. I reiterate the call to the Department and the IBTS not to lose sight of this issue and keep it under review. If God spares us all, it might be something I will come back to in mid-2019.

I again thank the Senator for his consistent and continued interest in this issue and for continuing to keep it to the fore. He has been very responsible in his approach and response to it. His focus is to be welcomed because while it is important to get the balance right it is also important to get a timely balance right. That is where his contribution is most helpful.

Rental Sector

I welcome the pupils from St. Vincent's school in Marino, who are in the Visitors Gallery. We are talking about an issue that affects every family in the city, if not the country, the housing crisis.

I have addressed the Minister of State, Deputy English, on this matter on several occasions. When the Tánaiste and Minister for Foreign Affairs and Trade, Deputy Coveney, had responsibility for housing, he formed a cross-departmental group to examine short-term letting and he promised us action and policy. In November 2017, the current Minister, Deputy Eoghan Murphy, said in this House that short-term letting and the rental market need policy development, ignoring the cross-departmental committee. In May 2018, he said that policy was being finalised in the Department. In June 2018, he promised that regulations would be published shortly. In August 2018, he said that he would bring plans to regulate short-term letting to Government in September. On 28 September 2018, he promised to publish proposals "next week". Just as tomorrow never comes, there is still no regulation in this area .

According to the figures provided by the Minister, Deputy Eoghan Murphy, regulation in this area would generate 1,000 additional units for rent. We are continually promised that action will be taken tomorrow. Why have we not had action? In Dublin 2, in one apartment block in Christchurch, there are only seven apartments for long-term rent to people working in the city who want to pay their way. I can give the Minister of State, Deputy English, the details in this regard. While researching the Airbnb website, I came across 60 units being let by seven hosts, all of them short-term lets, ranging from €2,100 per month for a one bedroom apartment to €4,300 per month. I could find no units with planning permission for change of use. We are in the middle of a housing crisis. The Minister of State has been in this House several times on this issue and he promised action "tomorrow" but as of yet we have seen no action. We still have a crisis. I am sure the Minister of State will respond to the effect that we need to address the supply issue. I have been raising this issue for two years and while there have been many promises of action tomorrow, there has been no action. This is not good enough. What I want to hear from the Minister of State is that the regulations are to be published immediately.

I thank the Senator for raising this important matter. I have been in the House to address the matter, which I know is dear to his heart, on at least five occasions to date. He is correct that short-term letting affects supply. The Minister, Deputy Eoghan Murphy, is focused on addressing the issue as quickly as possible.

I welcome the opportunity to outline the progress the Government has made to date regarding short-term lettings and to outline the plans to bring forward further legislation in this area. Under action 18 of the strategy for the rental sector, my Department established a working group comprising representatives of all Departments and agencies with a policy interest in short-term lettings to develop guidance on planning applications and changes of use relating to short-term lettings and to examine the need for new regulatory arrangements. The proposals considered by the working group, which met on six occasions, were aimed at facilitating short-term letting of accommodation within permanent residences, known as home-sharing, while seeking to protect the existing stock of residential property in areas of high demand, safeguarding neighbourhood amenity and consumer protection and generating revenue to address any negative externalities of short-term letting. The working group completed guidance for local authorities on planning applications relating to short-term lettings and my Department issued a circular on the matter this time last year. The group has since been focused on developing proposals for an appropriate comprehensive regulatory approach for short-term tourism-related lettings.

Having considered the group’s report, as well as the recommendations of the Oireachtas committee’s report on short-term lettings, the Minister and I are currently engaging with relevant Ministers on the appropriate next steps in taking the proposed regulatory regime forward. Among the options under consideration is the development of a new licensing regime for short-term letting platforms and homeowners who rent out rooms or entire properties to tourists to facilitate a more managed approach to short-term tourist lettings, and thus protect the existing stock of residential property, in particular, long-term rental accommodation, in areas of high demand, which, again, was rightly referred to by the Senator. He also gave some good examples of areas where this provision is being abused.

Recognising that the introduction of such a regulatory regime will take time, the Minister and I are also considering what other measures might, in the interim, support the recommendations and objectives set down in the working group’s report and the Oireachtas committee’s report. I understand that the Minister intends to set out his proposed actions, including specific reforms to relevant legislation, in the near future to address the issues raised in these reports. I am sure Senators will understand that I am not in a position to elaborate further at this time. However, once these proposals are announced, I expect there will be opportunities for both Houses to consider and discuss them in advance of their coming into effect. I can give the Senator a commitment that the Minister and I will be available to come to the House for that debate.

In regard to the timeline issue, the Minister has on a number of occasions tried to prioritise the regulations but it is a complicated legal process. When he appeared before the committee towards the end of September last, he said that the regulations would be published in a week's time. It was hoped to have this done before the budget but owing to a legal issue, publication was delayed. The regulations are almost complete and the Minister hopes to be in a position to announce the changes in the next week or two. It is hoped he will be in a position to announce them this week but it may be the next week or two. It will not be done tomorrow, but it will be done soon. I am confident in that I will be back in the House soon to debate the changes. It was genuinely the Minister's desire to do this prior to budget week but the events of the budget took over. Hopefully, the Minister or I will be in the Seanad next week to discuss the new arrangements.

I thank the Minister of State for his reply. We have moved now from "tomorrow" to "next week". On 28 September, the Minister, Deputy Eoghan Murphy, told Ms Marie O'Halloran that he would publish proposals the following week. In the interim, the situation has worsened. In one apartment block off Mount Street in Dublin 2, more than 50% of the apartments are available for short-term letting. Recently, one of those apartments was used a pop-up brothel. Short-term letting is leading to security issues for residents throughout Dublin. Short-term letting affects not only the housing crisis but people who bought homes, who owing to the constant re-let of apartments and the passing on of apartment codes etc, do not feel secure in their homes. This is not good enough. The cross-departmental and committee recommendations were not published, which is unacceptable. This issue has been raised on an almost weekly basis over the past two years.

For that reason, the Minister of State is familiar with it and he has said that the proposals will be published in the next two weeks.

Sorry, Acting Chairman-----

The Senator's point is well made.

-----that has been the constant statement since 14 November 2017. It never happens. The Minister of State mentioned that a legal issue has arisen. I do not understand why the Department did not foresee that issue. I have published legislation in this area, which the Minister of State, Deputy English, said is flawed. I am open to amendments being made to that Bill to progress it. The Government has been given many opportunities to deal with this issue but it has failed to do so and that is not acceptable. I regret that the Minister of State, present today because this matter does not come within his remit and it is being passed between the Departments of Transport, Tourism and Sport and Housing, Planning and Local Government. I am rightly angered. There are people contacting me and my office on a daily basis because they are unable to access housing in this city owing to short-term letting.

The Senator's point is well made. In fairness, he has raised the issue many times. We have to take the Minister of State at his word.

As I have outlined a number of times, action has been promised tomorrow, next week and next months.

The Senator has made his case. I ask the Minister of State to conclude.

I discussed this issue yesterday with the Minister, Deputy Eoghan Murphy. He is aware of the issue raised by the Senator and he understands the need for urgent address of it. In fairness, the Minister, Deputy Eoghan Murphy, has never said that he will do it "tomorrow". Rather, that is Senator Humphreys's interpretation of what the Minister said. In September, he said that he hoped to do it the next week. As I said, there is a delay owing to a legal issue arising and there was also a delay owing to the budget. The aim is to do next week or the week after at the latest. I can give the Senator a commitment that the process will be completed in the next week or so. As I said, the Minister never used the word "tomorrow" and I am not saying "tomorrow". It will happen next week.

We want this done as it is a priority for the Government. We want to give people the option to be able to rent a home. For many that is not an option, meaning it is important we increase supply.

The Senator is correct that in certain cases it is not suitable that people have bought houses under certain conditions and discover there is an issue with adjoining properties or their apartment block. The Minister, Deputy Eoghan Murphy, will be dealing with this in the next week.

Sitting suspended at 11.02 a.m. and resumed at 11.30 a.m.