I welcome the Minister and his officials to this meeting. I propose that we consider the Bill until 6 p.m. and that if we have not concluded our deliberations at that stage, we will arrange a further meeting. Is that agreed?
Health (Miscellaneous Provisions) (No. 2) Bill, 2000 [Seanad]: Committee Stage.
With the proviso that we can suspend the meeting if there is a vote in the Dáil.
Agreed.
NEW SECTIONS.
I move amendment No. 1:
In page 3, before section 1, to insert the following new section:
"1.-The Minister shall prepare and lay before both Houses of the Oireachtas a report on the implications of providing that products for the treatment of nicotine addiction be treated as budget-neutral for the purposes of the drugs budgeting scheme.".
This amendment arises out of an important issue raised by the Consumer Association of Ireland about which I spoke on Second Stage in regard to the provision of pharmacies. We all recognise that regulations must be made to ensure good standards in any profession. However, it seems the regulations in this area exclude the provision of pharmacies in certain parts of the country and may reward efficiency——
On a point of order, the Deputy appears to be discussing amendment No. 2.
I apologise; I was working from a different list. In relation to the amendment, there are various ways, of which some are more effective than others, of assisting people to kick the habit of cigarette smoking. I welcome the fact that there have been further advances in developing new medications, including Ziban. We need to ensure we facilitate the use of these drugs and measures to help people kick the habit. For a long time nicotine replacement therapy was not available on the GMS, but progress has now been made. This is another aspect of using drugs to enable people to give up smoking. If there is growth in the use of Ziban or a similar product, it could have an impact on the drug budgeting scheme operated by GPs. It would be a great pity if, for any reason, GPs found their drug budgeting being adversely affected because they were encouraging the use of addiction treatment. This is not a cheap product, but it appears to be effective. I know people using it and it seems to have worked wonders for them. As it is also an anti-depressant, perhaps many of the people concerned were depressed as well as being smokers. The product seems to have the potential to allow people to kick the smoking habit. The Minister should consider the cost implications of the scheme. If the cost is magnified by greater use of this product, it could have an impact on the budget of GPs.
I think the Deputy is referring to the indicative target savings scheme for general practitioners which is designed to promote safe, rational and cost-effective prescribing. Nicotine replacement therapy on the GMS will be budget neutral.
Does that include drugs? I am not talking about patches.
If the Deputy is talking about the treatment of nicotine addiction generally and the new drugs coming on the market, it is my intention that they will be included. My officials are working with the payments board on these issues in order that they can be introduced on 1 April. I agree with the Deputy that the drugs in question are a legitimate part of solving the problem in getting people off cigarettes, which is the bottom line, whether through the new drugs emerging or nicotine replacement therapy. As the indicative drugs savings scheme is not on a statutory basis, it would not be appropriate to include a regulation to deal with it. The key issue is that of the budget of doctors. I do not wish to introduce a disincentive for them in treating people in this regard.
Amendment, by leave, withdrawn.
I move amendment No. 2:
In page 3, before section 1, to insert the following new section:
"1.-The Health (Community Pharmacy Contractor Agreement) Regulations, 1996, are hereby amended in regulation 2 by the revocation of paragraphs (iii) and (iv) of the definition of 'definite public health need'.".
This amendment relates to the regulations which govern the establishment of pharmacies. While we all recognise the need for some regulation, the issues raised by the Consumers Association of Ireland are serious. There are complaints from Carlow and the well known cases of Knock and St. James's Hospital. There are at least two areas in my constituency where the regulations prevented the establishment of a pharmacy. One is the village of Roundwood, the highest town in Ireland. It is also quite inaccessible. It has a large elderly population and a transport service which is not great. It is important to have modern regulations to guarantee good quality and good standards in the provision of pharmacies, not regulations that prevent their growth on an even and equal basis. The population is growing and all the indicators are that more people are using medications, living longer and using alternative medicines.
The pharmacist is a very important part of primary care, which we are trying to encourage rather than have everyone go to hospital. If that is the case, it is time to review the regulations to determine whether it is possible to marry the two. There is deregulation of the taxi service - I am not sure if it is working - and, in effect, of pubs, which is fairly controversial. The provision of pharmacies is, however, being regulated in a way that is, to an extent, determined by those already in business. That sets off alarm bells. The Consumers Association of Ireland is looking for a review to ensure we develop regulations that are both sensible and not obstructive. We must accommodate this view in the legislation. If there is a better way of dealing with the issue, I will have no problem in being open-minded. It seems, however, that the problem lies in paragraphs (iii) and (iv) of the regulation and needs to be addressed.
I support the amendment. I have experience in Kildimo, County Limerick, where the request made by the community to have a pharmacy opened in the area was turned down, although a pharmacist was prepared to facilitate it. In the suburbs of the city a weird exercise was undertaken by way of counting heads in DEDs and parts of DEDs and it was eventually decided that a pharmacy should not be situated in the area. There should be a re-examination of this decision. I understand the Irish Pharmaceutical Union does not have a closed mind on the issue given that circumstances have changed. The communities in certain areas are growing and they expect services to be situated close to them. In one case a pharmacist is annoyed because permission has been granted for a pharmacy in a neighbouring town in a shopping centre for which planning permission has not yet been granted. Given the objections raised, it could be years before the centre is developed, if ever. While a licence for a pharmacy has been granted in a development which has not yet been constructed, a community a number of miles away has been denied this facility. There should be a full re-examination of how licences for pharmacies are allocated. I do not know if there are difficulties in relation to full deregulation. Some pharmacists are of the view that while there may be difficulties with it, there should be a considerable loosening of the current approach.
While I do not disagree with much of what has been said by both Deputies, I question the amendment. We need a new set of regulations. It is my intention, therefore, to initiate a review of the pharmacy regulations.
The two issues identified by Deputy McManus in the amendment are particularly problematic in terms of the definition of public health needs and the distance issue given that a new pharmacy must be a certain number of metres from an existing pharmacy, the viability of which must also be reviewed. There are other problems with the regulations. For example, I have tabled an amendment to ensure an appeal is heard by the Circuit Court, rather than by the Minister. I am unhappy that the Minister should hear appeals. Solicitors write in on behalf of the various parties and, invariably, when one comes to the end of the file, the only decision that can be made on appeal is to send it back to the health board for another look at, perhaps, one aspect of it, such as the demographics. There are many elements which are unsatisfactory.
The regulations were introduced in 1996 because of the desire to harmonise with the rest of the European Union. To come to Deputy Neville's point, there is strong concern that, given the public health considerations, full deregulation would lead to an American type system with drug stores selling drugs over the counter. That argument is being made within the Department, so we must be careful about having too much deregulation because, in the final analysis, we are talking about drugs. We need a balance between regulation and a more liberal market that allows young people to come in as players. Young pharmacists cannot get in because of the regulations as they are structured. These are issues on which we will initiate a review.
I do not see much sense in giving the Circuit Court a role. What better judgment would a judge have to say——
His independence.
We are giving far too much of what should be in the political sphere of the Executive and parliamentary agencies to the courts. Some other body, such as the Competition Authority, might be more suitable, although that might not be the right body either. I would ask the Minister to think again about that. I do not think judges are particularly well qualified to make decisions of this kind. It is my experience that not many judges come from Dublin South Central or from inner city flats complexes. They often do not understand the issues. I doubt that giving this over to the Circuit Court is the right thing to do.
The Minister referred to clause 9 of the 1996 statutory instrument. Under this, pharmacies were to take a role in advising clients on the correct use of drugs. That cannot happen in any pharmacy in most of our constituencies where the shop is full and the client is expected to take advice across the cash register. A place in the pharmacy should be set aside where people can take advice. It has been suggested to me that up to 50% of prescribed drugs are not taken properly, either because they have an adverse effect and people stop taking them, or they take the wrong quantity or take them in conjunction with alcohol or something else. The people to advise on that, the doctor having properly prescribed, are pharmacists, but they are not meeting the requirements set out in the statutory regulation. The Minister should introduce measures to enable them to do so. If he did this, perhaps by way of a tax incentive to provide a separate section within their premises where they can consult in private with people about the uses of medicine, this might, together with proper investment in other areas of primary care, take some pressure off secondary care. I request, when the Minister is addressing these issues in totality, that he look at that issue.
Clause 9 was one of the major planks of the contract, the quid pro quo. We want pharmacies to be a central plank in the primary care infrastructure by advising the public on how to take medication. Some in the industry would argue that they have adhered to that and have pushed it forward, but I have an open mind on that. Nonetheless, it is important that we encourage pharmacies to become part of the primary care infrastructure, particularly in areas like alcohol dependency. We should use them more as an arm of the primary care area to promote positive health messages as well as advise on drugs, their effects and how to take them properly. I see the Deputy’s point.
If somebody in a person's family has epilepsy or some other condition, they do not want to talk about it where people are walking around buying toothbrushes and toiletries. There should be somewhere private. When somebody leaves hospital, doctors can take the advice of pharmacists on the right balance of medicine for that person before they leave. The same sort of facility should be available in the primary care area. It needs to be looked at in terms of clause 9 because it is not being implemented. I would not like to take advice across the counter in a shop with people all around the place. People who want to take advice on the medication they are taking want to be able to sit down in a quiet place and ask advice. They do not want everybody knowing their business. The Minister needs to look at the whole question of giving incentives to pursue clause 9, as well as the issue Deputy McManus quite rightly raised in her amendment.
Is the amendment being with-drawn?
I will withdraw it, subject to leave to introduce it on Report Stage.
Amendment, by leave, withdrawn.
SECTION 1.
I move amendment No. 3:
In page 8, line 13, to delete "proprietor" and substitute "proprietors".
Amendment agreed to.
I move amendment No. 4:
In page 8, to delete lines 36 and 37 and substitute the following:
"(d) for appeals by persons referred to in paragraph (a) to the Circuit Court against such determinations as aforesaid,”.
Section 1(1)(10) provides for the making of regulations in relation to community pharmacy contractual agreements, including that regulations may provide for the making of appeals to the Minister when an application for a community pharmacy contractor has been refused by a health board. This reflects the current situation where unsuccessful applicants may appeal to the Minister for Health and Children. We are satisfied that the operation of the regulations are fair to a certain extent, but I am concerned about Ministers hearing appeals which relate to particular communities because of the potential for Ministers to be vulnerable to lobbying. In other Bills there are new appeals mechanisms. For example, there is an appeals board in relation to social welfare and, in the area of education, there is an appeals committee to hear complaints from or pertaining to schools. I have been trying to come up with an appropriate appeals mechanism in this case and I have had legal advice on it. I want something that is independent of the system, independent of the health boards, and the best we have come up with so far is the Circuit Court, which is independent and which, we have been told, is the court that has an order to deal with issues such as this.
I have reservations about this. I will not press it to a vote here, but I would like the Minister to think about it between now and Report Stage. There is a whole plethora of State agencies.
I have gone through them.
Is there not one to which this could be referred instead of to the courts? I have doubts about giving things over to the courts. We have increased the number of judges exponentially. People talk about the numbers of Dáil Deputies and Senators, but the number of judges now compared to ten years ago has dramatically increased, and their salaries have dramatically increased also. Their holiday period has not been reduced, incidentally. We are just giving them more and more jobs. This is not a legal question. This is a question of competition, consumer needs, a certain amount of regulation. I see the Minister's objective. I also see his difficulty. However, I would like him to think about this matter again. Is there some body other than the Circuit Court that could deal with this?
I will look at that between now and Report Stage.
This is a truly lousy idea, and I support Deputy Mitchell. The basic thinking by the Minister has some justification at a practical level but, ultimately, the Minister for Health and Children is responsible for the country's health services, not the courts. Under the Constitution people can go to the court on issues or points of law. It is not appropriate for the courts to decide this. At the end of the day, if there are faults within the system there has to be some possibility of appeal. I would prefer an appeals system located within the Department of Health and Children because that Department, with the Minister at its head, is responsible for the health service. The Competition Authority is not the appropriate vehicle, although I can see there would be some sense in that. Ultimately what we are talking about is a health care service. People need to feel that, when the health board has blocked them because the regulations are too blunt, a senior authority will look at the matter. That does not mean the Minister has to plough through files. If one wants to protect the Minister from lobbying——
These are valuable.
Let me finish my point. The Minister is likely to be lobbied on all sorts of things. The Minister's fellow Minister has made it clear that he is lobbying hard to keep two maternity units open in the North Eastern Health Board region with little justification and many risks attached. That lobbying is taking place. That one Cabinet Minister is lobbying another Cabinet Minster does not make it all right. If the Minister is, as he says, opposed to the liberalisation of pubs is he lobbying the Minister for Justice, Equality and Law Reform? Lobbying is taking place all the time in different forms. In this instance we are talking about an important part of overall health provision. It requires some body and I accept it may not be directly the Minister's responsibility although ultimately everything is his responsibility. The idea of hiving it off to the courts is a bad one.
The strong legal advice was in this direction.
I am sure it was.
The point is taken. Other avenues were put forward. There has been a laudable trend in terms of appeals against decisions that come within the aegis of, for example, social welfare. There was a time when appeals to the Minister for Social, Community and Family Affairs were unsatisfactory because the same people were hearing the same appeal. We set up a separate appeals board which was perceived to be independent, transparent and separate from the other process. Likewise, I had some experience with the Education Act where an appeals committee was headed by the Secretary General. Under that Act, appeals against a decision of a board of management of a school can be made to the appeals committee. For some reason the legal advice did not accept that proposition in relation to this issue. I will not take this matter to the wire. I propose to withdraw the amendment and to come back to the Deputy on Report Stage.
The Minister is aware of my view that there should be a separate health ombudsman and, if there were, this might be a task for that person. Perhaps appeal decisions in future could be based on the recommendation of the ombudsman so that an independent person would look at it and make a recommendation and the Minister would retain the right.
Given that I intend to review the regulations, that issue might be included in the review.
Amendment, by leave, withdrawn.
I move amendment No. 5:
In page 9, line 42, to delete "Payments" and substitute "(Payments)".
This is a drafting amendment.
Amendment agreed to.
I move amendment No. 6:
In page 9, line 43, to delete "the Health Act, 1970," and substitute "this Act".
This is a drafting amendment of a technical nature. The line in question refers to boards such as the GMS Payments Board established under section 11 of the Health Act, 1970. However section 1 of the Bill substitutes a revised section for section 59 of the Health Act. A more appropriate drafting reference would be to this Act.
Amendment agreed to.
I move amendment No. 7:
In page 11, between lines 3 and 4, to insert the following:
" 'supervising pharmacist' means a person who, pursuant to subsection (1) of section 2 of the Pharmacy Act, 1962, is responsible for carrying out the personal supervision specified in that subsection;".
Essentially it is a technical amendment. There is reference to a supervising pharmacist in the Bill in the context of regulations in relation to community pharmacy contractor agreements between the proprietors of community pharmacies and health boards. The term "supervising pharmacists" is not specifically defined in the Bill and I consider it appropriate from the point of view of clarity that a definition is included. The definition proposed reflects current practice and is directly in line with the provisions of the Pharmacy Act, 1962. Section 2(1) of the Pharmacy Act, 1962, deals with the keeping of open shop for the dispensing or compounding of medical prescriptions. For all practical purposes, this subsection provides that the shop and the dispensing and compounding of medical prescriptions therein must be under the personal supervision of a pharmaceutical chemist.
Amendment agreed to.
Section 1, as amended, agreed to.
SECTION 2.
Amendments Nos. 8 and 9 are related and may be discussed together by agreement.
I move amendment No. 8:
In page 11, line 24, after "£1,500" to insert "or to imprisonment for a term not exceeding 12 months or both and on conviction on indictment to a fine not exceeding £10,000 or to imprisonment for a term not exceeding 2 years or both, and the court on such conviction shall make an order prohibiting the person from selling, offering to sell, or making available, tobacco products to any person for such period as may be specified in the order".
The thinking behind these amendments is to send out the message that breaches of the law will not be tolerated, that we are taking the selling of cigarettes to underage persons extremely seriously and that every effort will be made in terms of getting that message across. Recently there has been a tremendous amount of publicity about the problem of alcohol consumption among young people. That is a serious matter but it is only equalled by the extent of cigarette smoking among young people. Until now measures put in place simply have not delivered. There is a high level of smoking among young girls. This is not happening without the collusion and connivance of those who want to make money of young people.
An interesting survey was carried out by either the Western Health Board or the North Western Health Board. It involved a person being sent to various tobacconists for cigarettes and being able to get them though under age. Respectable people were happy to sell these products even though they were breaking the law. That survey shows the seriousness of this problem and that there is a culture that has to be vigorously attacked. I am pleased to hear the Minister is concerned at the level of alcohol abuse but there is no legislation dealing with it - there is legislation dealing with another form of substance abuse. He has an opportunity to be clear about how he intends to tackle this growing problem.
I made a calculation based on the longevity of French citizens compared to Irish citizens and given the population of Ireland a similar population in France would live 13 million years longer collectively. It is an interesting figure because much of it comes down to the fact that women live longer in France. This is relevant to this section because it has recently been calculated that because of the increase in smoking among younger women in France they can now forecast with certainty that the death rate in France among women will fall to the average here. Conversely, if people here could give up smoking I have no doubt the longevity would extend to the level in France. There is no doubt that smoking contributes to death and poor health. Anecdotal evidence shows that young girls smoke more than young bogs. It has become fashionable. Perhaps it has something to do with weight watching. This is serious. I do not believe that retail outlets and pubs or garages with cigarette machines are as careful as they should be in upholding the law.
Tomorrow is Ash Wednesday, no smoking day, and the start of lent when many will try to give up smoking. If we, as members of the Oireachtas, were to send out a signal today that we are passing legislation banning retailers from selling cigarettes if caught selling same to persons under 16 years of age - which is why I support Deputy McManus's amendment - that would have the effect of making people check that they are selling them to persons over the age of minority as set out in the legislation. Unless that is done they will continue to take the chance because they make a profit on them. The Minister should include such powers in the legislation and give the courts the power to ban retail outlets from selling cigarettes if they are found selling them to minors. That is the only way to put an end to that. It would have an effect on the health of young people and the wider population in the long-term.
I endorse what the Deputy said about the centrality of cigarette smoking to our poor health status. If one was to select one issue that adversely affects the health status of our people, it is cigarette smoking. Research shows that about 7,000 deaths a year from heart disease and cancers are attributable directly to smoking cigarettes. The Slán survey of national lifestyles carried out by the health promotion unit in University College Galway confirms that young girls more than others smoke to a significantly greater degree, and we are conscious of that. Our most recent health promotion campaign was directed at young women, in particular the Nico advertisement, because of research done in that field.
On the issue of fines, which was debated on Second Stage and during the debate in the Seanad, my legal advice is strong that this is as far as I can go in relation to a summary offence. My legal advisers indicated this is the best way to proceed. We will make provision in the forthcoming tobacco Bill that retailers will lose their licences if convicted of selling cigarettes to those who are under age. I cannot move from the position on the fine on the basis of the strong advice I got from the Attorney General's office. Following the Second Stage debate in the Dáil and the debate in the Seanad on this point, I instructed our people to get further legal clarification or to establish whether we could increase the fine somewhat in line with the wishes of the Oireachtas, but the advice given is that this is as far as we can go because of the nature of this offence.
Is it not the case that the reason the Minister is limited by the fine relates to the District Court limitation of a £1,500 fine?
Yes.
Then presumably one could change court.
The legal advice is that one has a far better chance of prosecutions under a summary offence approach than under an indictable offence, as it is much more difficult to secure prosecutions under the latter as opposed to the former. From the point of view of enforcement, we are probably better to take the approach advised. The advice is that from experience we are better off sticking to the District Court level because the legal advisers consider that one conviction alone at that level would send a powerful signal in that no one wants to get caught selling cigarettes to persons under age. We provided an additional £1 million pound on the compliance side this year. We will appoint an additional 13 environmental health officers specifically for this purpose, to enforce the legislation on under-age cigarette smoking.
I would have thought it is important that the law reflects the people's political views on cigarette smoking. To limit such a fine to this figure simply because it is the District Court ceiling on a fine is not a sufficient argument. If it is a case that one cannot get a conviction at a higher court, surely one must make sure that the law is clear. We have assisted in that by proposing the introduction of an identity card system, which would make it much more difficult for retailers to sell cigarettes to those who are under age. Amendment No. 10 is rather vague and could be open to the arguing of a persuasive case in court. If an identity card system was in place, the position would be clear-cut in that it could be established whether a retailer checked it. Simply because there is a better chance of securing a prosecution in the District Court, it is difficult to accept that one should not consider a higher court. Presumably, the same argument could be used about illegal drugs, some of which - certainly soft drugs - it can be argued might not be as damaging to one's health as cigarette smoking - they are not as addictive. I cannot understand why those courts are appropriate for dealing with those who deal in illegal drugs, but not those who deal with legal drugs, which would not be legalised if they had only now suddenly appeared on the market. We know cigarettes would not be allowed to be sold if they were only now appearing on the market.
I do not know when the Minister intends to introduce the tobacco Bill. Not only should the court be empowered to ban retailers from selling cigarettes if caught selling them to under-aged persons, but perhaps they should be required to issue a notice stating they have been banned and why they have been banned. We must get serious about this issue.
A similar provision was introduced in the intoxicating liquor Bill.
That issue needs to addressed. If it is not appropriate for a 16 year old to buy cigarettes once this legislation is passed, is it appropriate that someone who is 16 years old can sell them? Often the only person behind the counter in a garage retail outlet is a young person doing holiday work or whatever. The Minister should consider this issue when introducing the tobacco Bill. The only way to stop the casual selling of cigarettes to persons under age is to hit the retailers where it hurts. They will be careful to whom they sell cigarettes if they know they will be barred from selling them, or that could be one of the possible outcomes in their selling them to persons under age.
I agree with that and that is what we will do.
Is the Deputy's amendment withdrawn?
I will withdraw it pending the discussion on Report Stage.
Amendment, by leave, withdrawn.
Amendment No. 9 not moved.
I move amendment No. 10:
In page 11, to delete lines 35 to 38, and substitute the following:
"been presented with an identity card in a form prescribed by the Minister for Justice, Equality and Law Reform purporting to show that the person was over the age of 18 years.".
I referred to this amendment. From the point of view of the proprietor of a tobacconist shop, who must make a judgment and could end up in court if it were erroneous, this provision would be helpful in clarifying the situation. There has been much talk about the introduction of identity cards in relation to alcohol consumption. The time has come for the introduction of an identity card system as a matter of course for people to prove they are over the age of 18. In this instance, there is a voluntary code in terms of identity cards. We need to move on from that. Section 2(3) is vague in its wording, ".. all reasonable steps to assure himself or herself that the person to whom the tobacco products were sold, offered for sale . . . had attained the age of 18 years." There is a slight touch of weasel words about the words "all reasonable steps" in that it is open to a variety of judgments to be made by judges. I am not happy with that description. When there is not an identity card system in place, what else can one say? The next logical step is to introduce identity cards to ensure there is no ambiguity.
I understand the thrust of Deputy McManus's amendment. I have no difficulty with persons under the age of 18 or who might appear to be under that age being asked to show proof of identity in a public house or when purchasing cigarettes. I have a difficulty with a measure in the direction of the presentation of identity cards being compulsory, as poorer children in our society would suffer most. A young person in Fatima Mansions whose name would be known would be asked, for example, "Murphy, have you got your identity card with you?" The lad would be known by name and age, while other young people would not be asked to present an identity card. I appreciate there is a case for introducing an identity card system, but I have reservations about moving in the direction of the introduction of a compulsory identity card system. On the Continent there is a compulsory identity card system in place, but the Schengen Agreement is also in place, which provides for the movement of people between countries without passports and such identity cards can be used for different purposes. A number of documents could be used as proof of one's age, such as a driving licence, a student identity card or some documentary evidence that one is over the age of 18. I have a difficulty with the introduction of compulsory identity cards. Living on an island where there are restrictions on travel with a passport, I have fears about an internal restriction such as a compulsory identity card and the way it would be used - others take a different view. I am not anxious to wander into that area.
I cannot accept the amendment for the reasons outlined by Deputy McManus. I accept the validity of the point, but in the absence of a compulsory national identity card system, it would be wrong in legislation to force people to adhere to what is, in essence, a voluntary scheme. I will, however, have talks with the Minister for Justice, Equality and Law Reform, Deputy O'Donoghue, with a view to establishing a compulsory scheme, notwithstanding the points made by Deputy Mitchell.
It would be good to have a national compulsory ID system as it would help young people many of whom cannot gain entry to dance halls, even if they are 19 or 20 years of age because they look younger. The other side of the coin is equally true in that some 15 or 16 year olds can gain entry to dance halls because they look older. The prosecution issue in that context is difficult because there is no definitive evidence available. It is a debate to which we will return as it will re-emerge in the context of alcohol and cigarette smoking. There are both civil liberties and public health issues. There are also the benefits young people would derive from having ID cards. There is conflict at dances and discos where self-esteem is ruined, for example, when young people are told that they are not over 18 years of age when, as often happens, they are. I cannot accept the amendment.
Amendment, by leave, withdrawn.
Section 2 agreed to.
NEW SECTIONS.
Amendments Nos. 11, 19 and 20 form a composite proposal while amendment No. 17 is related. Is it agreed that amendments Nos. 11, 17, 19 and 20 be discussed together? Agreed.
I move amendment No. 11:
In page 11, before section 3, to insert the following new section:
"3.-The Minister for Health and Children may by regulations make provision for the regulation of the advertising and sponsorship of alcohol products and the Tobacco Products (Control of Advertising, Sponsorship and Sales Promotion) Act, 1978, shall apply with any necessary modifications to alcohol products as it applies to tobacco products.".
We are aware of the progress made in the curtailment of cigarette advertising. When in Greece last summer I was astonished at the extent of such advertising. It is obvious that there is a commercial interest because many of its farmers still grow tobacco. The difference a ban on advertising can make is clear, however, in creating a new culture which is not as dependent on this type of promotion.
Given the information available on binge drinking and the crisis of alcohol misuse among young people, the amendment suggests that the Minister for Health and Children should have the same powers to curtail alcohol promotion. As the Minister may have many powers of which I am not aware, perhaps he will describe them. The fact that cigarette advertising is regulated to a far more strenuous level is the result of legislation and EU-wide determination. Anybody who watches television or attends a sports or cultural event, however, will be bombarded with promotion by commercial interests which are making huge profits, particularly out of young people. This is no longer acceptable.
While I accept that there is a voluntary code which has limited impact here as well as international considerations, in terms of the culture, promotion and propaganda endemic in society and directed at young people in order to make money out of them, regardless of the consequences, it is a serious matter which must be addressed by way of legislation.
Amendment No. 17 seeks to give the Minister the power to ban the association of alcohol products with sporting events and require the Minister to lay regulations before both Houses of the Oireachtas within 90 days of the passing of this legislation. We are dealing with addictive substances in the case of alcohol and tobacco and should deal more strenuously with alcohol.
I said on Second Stage that the Guinness advertising slogan, "Live life to the power of Guinness", accompanied recently by a series of one page advertisements suggesting that alcohol, specifically Guinness, should be taken on every occasion from a celebration to the hair of the dog, crossed the line between glamourising or pushing the product and advertising it. It goes too far. Consider the fact that Guinness is allowed to sponsor the national game of hurling, including the All-Ireland final in Croke Park. If we are glamourising alcohol in this way and allowing it to be glamourised by being associated with the national game, which has a national authority or sanction about it, we are not serving the best interests of young people.
In a survey conducted by the Eastern Regional Health Authority last year almost 80% of boys between the ages of 15 and 18 years said that they had an alcoholic drink at least every month. The figure for girls of the same age was 65%. When the figures for those between the ages of ten and 14 years are included, the percentage is a frighteningly high 51% for schoolboys and 38% for schoolgirls, an average of 45%. We have a chronic rate of suicide, particularly among young men. What contribution does alcohol make to this?
Alcohol does more damage to families than all the illegal drugs together. I spoke recently to a young man from France who asked what one could do in Ireland if one did not drink. I also spoke recently to a taxi driver from the inner city part of my constituency who had emigrated to Austrialia where his family grew up. He had returned with his family, but his son had returned to Australia. His son was very much involved in sport and, although people drink in Australia, he had found that everything here started and ended with a drink. We have allowed that culture to develop. An important signal would be given if the Minister was given power by the Oireachtas to ban the sponsorship of sporting events by companies involved with alcohol.
Baileys sponsors the television programme "Friends", with which we are familiar. It is shown on Network 2 on Mondays at 8.30 p.m. It is specifically aimed at young people, so much so that there is no alcohol in the programme. It is centred on apartments and a coffee shop. Baileys, which manufactures a spirit based product, is allowed to advertise it in contravention of both the Minister's regulations and the advertising regulations. We need to take a stronger look at this issue. The Irish Examiner reporter Karl Brophy researched and reported on it recently. I understand the Baileys sponsorship is worth approximately £500,000 per year to RTE. What is it worth to Baileys? Do we think that Baileys has not conducted its own research and does not know that young people watch this programme? This spirit based product is not being advertised for the good of RTE, but for the good of Baileys and its profits.
There is a need to tighten up. The Minister will have seen the recent report on alcohol. If one looks at the damage being caused to young people by alcohol, one will see that stronger powers are necessary. I urge the Minister to accept amendment No. 17 which would give him the power to ban the sponsorship of sporting events by producers of alcohol products.
I thank Deputies for their comments. Undoubtedly, alcohol is a major issue. It causes much harm not only in terms of its significant damage to the health of the population, but also the trauma suffered by families because of break ups and abuse. Another aspect is the associated economic cost. An economist from the Dublin Institute of Technology carried out an assessment of the economic impact of alcohol. He estimated that, at 1999 prices, it cost the economy approximately £1.7 billion a year. This is an enormous sum.
In terms of the advertising issue, the significance of the ESPAD study is that it shows 15 year olds and 16 year olds, particularly 16 year old girls, are binge drinking more than their European counterparts. The level is approximately 5% higher than that of their peers in Europe. The levels of consumption are a cause of major concern in terms of the yardstick for measuring binge drinking of five drinks in a row three times a week. The voluntary advertising code has been breached in so far as spirits are not meant to be advertised at all. One can argue whether Baileys is a liqueur or a spirit.
It is spirit based, it is whiskey based.
I was not aware of the make up of Baileys. I will take the Deputy's advice on it. However, it is more damaging that the new Bacardi Breezer and Smirnoff Ice products are increasing the level of spirit consumption. They have been a success in terms of marketing. They are now being advertised and that is a breach of the code.
We have undertaken research into the impact of advertising in Ireland and we expect the results of that research in approximately four weeks. I have spoken to my colleague, the Minister for Arts, Heritage, Gaeltacht and the Islands, about broadcasting issues and the advertising of alcohol products on television stations. I received a note from her Department about the no frontiers directive which poses certain logistical problems in terms of how it can be banned. The French Government has been taken to court in relation to its ban on advertising. We are trying to ascertain the position in terms of the French case. The Swedes took certain decisions in relation to this matter, but it was caught out by the no frontiers directive.
Cigarettes can be banned because primary legislation was in place. Ireland did not have to depend on the EU directive, which was successfully challenged by other countries on the grounds that it was implemented under an internal market measure. It has collapsed and the Commissioner must produce a new EU directive on banning cigarette advertising and sponsorship. However, Ireland was able to retain its ban because of the Tobacco Act, 1978, under which new regulations were introduced. There is a need for a new Act in relation to alcohol advertising and sponsorship. This would be the legal framework for regulations banning advertising and sponsorship in this area. This is the route that must be taken.
Does the Minister intend to break the link between sporting events and sponsorship by drink companies?
That is what I want to do. If we want to ban advertising, there must be a debate and, in fairness, all concerned, including the committee, must be consulted. Cigarettes and alcohol are not the same. Nevertheless, there is an overwhelming case to be made in this area. I echo Deputy Mitchell's comment that the GAA and the all-Ireland championship should not be sponsored by an alcohol company because it sends the wrong message to young people and creates a culture that drink is fine. We must face up to that and I hope the ESPAD study has given us all a wake up call.
Corrective action must be taken to deal with this problem. Many people, particularly parents, are crying out for some corrective action. This must be taken on the educational front and in terms of the implementation and enforcement of the Intoxicating Liquor Act. Action must also be taken in terms of advertising and sponsorship. The research conducted by our European colleagues highlights the impact of advertising. The research is not as strong in its conclusions as it is on the issue of availability, outlets and deregulation. The European research suggests that availability creates more problems down the line.
It is not as clear-cut with regard to advertising. Cork was involved in an all-Ireland series two years ago and it shook me that, two years later, children were able to remember some of the more dramatic advertisements during that campaign, for example, a player soloing with a pint of Guinness on the base of the hurley. That dramatic advertisement has had an enduring impact in terms of how children play with hurleys. A new Act must be introduced to regulate the advertising and sponsorship of alcohol.
I accept new legislation might be necessary. The Budweiser "Whassup?" campaign is specifically aimed at getting children to remember the name of the product. Children are shouting the slogan. Further legislation may be necessary to deal with this area, but this is a miscellaneous provisions Bill. I ask the Minister to accept amendment No. 17 which would empower him to lay before both Houses of the Oireachtas within 90 days regulations to ban the sponsorship of sport by alcohol related companies.
The Minister recently involved the Department in sponsoring a particular sport to displace the involvement of cigarette advertising in it. There is plenty of money in the kitty and it would be possible for the State to tell Guinness that it could no longer sponsor the hurling championship. The Government could sponsor it for three years and give the GAA an opportunity to find a replacement sponsor. The Minister must get tough and show his teeth on this issue. I accept primary legislation might be needed for the other aspect, but the committee is dealing with legislation which could address the advertising of sponsorship of sporting events by alcohol related companies which sends completely the wrong message. It runs counter to everything the Minister, his Department and the Oireachtas wants to do. There is no reason to allow it.
The company is based in my constituency and I have a pint of Guinness occasionally. Four generations of my family worked in Guinness and it is a good product. However, the company has been allowed to take over the national game and, although it does not like me saying so, it has crossed the line between advertising and pushing its product. It is time we acted and pushed it back over the line. Banning the sponsorship of sporting events would be one way to do it.
I would prefer to take a comprehensive approach. There would have to be a lead-in period before it could be banned because the implications are significant in terms of funding and ascertaining the level of dependency. The GAA is the headline organisation in this regard, but we need to ascertain the degree to which clubs all over the country in a range of codes are dependent on alcohol sponsorship. This analysis must be done and I take the Deputy's point that a timeframe can be built in regarding the discontinuance of the sponsorship of sport. I sought legal advice on the amendments, but it is not complete. I undertake to get further legal advice between now and Report Stage. Perhaps the Deputy will withdraw his amendment on that basis.
Amendment, by leave, withdrawn.
I move amendment No. 12:
In page 11, before section 3, to insert the following new section:
"3.-The Minister shall prepare and lay before both Houses of the Oireachtas a report on a system of inspection for public welfare homes for the elderly.".
The amendment relates to the inspection of public welfare homes which has not been available up to now. Private nursing homes were subject to inspection but public welfare homes were not. I understand that the Minister made a statement about extending the inspectorate for child care facilities. I could not put down a more specific amendment than this one because otherwise it would have been ruled out of order. Perhaps the Minister could outline what he intends to do about this matter. It is worrying that, at present, nobody is responsible for inspecting these publicly owned welfare homes where many elderly people stay for long periods of their lives.
My amendment No. 16 is similar and we have to dispose of it at the same time as amendment No. 12, as we agreed. I do not have the perfect answer and, like Deputy McManus, I want to see something being done. The Minister should be authorised to appoint health boards as inspectors of public hospitals. They could fulfil that role in relation to welfare homes, although perhaps they should not be the people to do so. Perhaps it should be somebody else.
They own them.
Yes, where they own them it would be difficult. The thrust of both amendments is that there needs to be an independent inspectorate both for welfare homes and hospitals. There is to be such an inspectorate for mental hospitals, although I do not think the legislation has been introduced yet.
There is an inspector of mental hospitals.
Yes but there is to be a new inspectorate, is there not?
There is a new commission.
Yes, but there is no such body for public hospitals and welfare homes for the elderly. The Minister should consider both these amendments to see if there is a way of creating an inspectorate, or two different inspectorates, that could deal with these issues.
Is it agreed that we should take amendments Nos. 12 and 16 together?
Yes. I take the point. There is a huge anomaly here in that under the Health (Nursing Homes) Act, we have inspections for private nursing homes but not for health board community nursing units and welfare homes. We intend to rectify this by expanding the role of the social services inspectorate which is already up and running. We intend to provide additional resources to cover services for older people. Clearly, additional resources will be required because the initial phase was to deal with children's homes and care units. We will be bringing forward proposals this year toprovide additional resources to the socialservices inspectorate to inspect community nursing homes under the aegis of the health boards.
Does that mean legislation will be required, and will private and public facilities be included? There is a concern that health boards are inspecting private nursing homes. There are contract beds in many nursing homes, however, and the Minister's initiative added another 500.
Yes.
There is a huge number of public beds in private nursing homes, which creates a conflict of interest. Will this inspectorate take over the entire workload of inspecting both the public and private sectors?
It will deal with the public sector in the initial phase and, logically, that would extend to contract beds in private nursinghomes.
There will be two sets of inspectors. That will be a problem.
That poses a wider question concerning rationalisation, but in the initial stage we want to have public homes inspected, or at least have a system in place to inspect them.
To be fair to nursing homes, it is not a great idea to have two separate inspectorates going into private nursing homes.
Yes.
I heard of a case today where, as a result of an anonymous phone call, a person has been subjected to 11 visits by the health board. At no time did they find problems, other than light bulbs not working. To be fair to nursing homes, one inspectorate should be involved if at all possible. Presumably the social services inspectorate is the body that should deal with the whole package.
I will take those points on board.
Thank you.
As regards Deputy Mitchell's point concerning hospitals, two elements are involved. We are developing a hospital accreditation scheme which will be a significant development over time in terms of improving standards in public hospitals. Much work has gone into that and it will most likely lead to the establishment of a hospital accreditation agency. Hospitals will have to obtain accreditation from this agency, somewhat like the ISO 9002 industrial standard. The yard-stick will be an objective set of standards to which hospitals will have to adhere. That, in turn, will be about better risk management performance and a better consumer-oriented process.
In our work on developing a health strategy, we are looking more keenly at patient advocacy and the complaints process which is very patchy at the moment. People are not necessarily aware of their right to make complaints to hospitals and very often when they do they do not receive satisfactory responses in time or of a comprehensive nature. The Ombudsman has put forward views about the complaints process within the health sector. As things currently stand, the Ombudsman has a role in dealing with complaints concerning health board hospitals but not voluntary hospitals, which is an anomaly.
The inspector usually has a role if one complains.
If one complains, yes. I take the Deputy's point. There is room for developing a better system to deal with people's complaints.
Amendment, by leave, withdrawn.
SECTION 3.
Amendments Nos. 13 and 21 are related and may be taken together by agreement.
I move amendment No. 13:
In page 13, line 19, to delete "1999).'." and substitute the following:
"1999).',
and
(c) by the substitution of the following section for section 14:
'Laying of regulations in draft before Houses of Oireachtas.14.-"Whenever a regulation is proposed to be made under this Act a draft of the regulation shall be laid before each House of the Oireachtas and the regulation shall not be made until a resolution approving of the draft has been passed by each such House.'.".
This is a technical amendment in line with the Ombudsman's report on the nursing home subvention scheme which was recently laid before the Dáil and Seanad. This is probably the first legislation to give effect to the kind of motion which seeks an affirmative resolution from the Houses of the Oireachtas before it can come into play.
May I speak on amendmentNo. 21 since the amendments are being taken together?
You may.
While this represents progress, unfortunately, it took the Ombudsman to bring about this change. His report's description of the lack of accountability of secondary legislation was devastating. I have raised this proposal before with the Minister's predecessor concerning earlier legislation and with other Ministers, yet I have not been successful in getting them to budge. I would like to compliment the Minister but, to be fair, I should really compliment the Ombudsman for having obtained this sea change. It is progress and at least it is positive rather than simply an annulment of regulations.
The Minister should also accept amendment No. 21. This committee is an important part of the way in which the Oireachtas can review legislation and ensure it is operating properly. We saw in the regulations that were subject to the Ombudsman's scrutiny just how things can go wrong. If amendment No. 21 is accepted, it will enhance the process of scrutiny by the Members of this House in that although primary legislation is already under scrutiny, secondary legislation would also be. I ask the Minister to accept this. He does not have to do this as an absolute minimum. He can actually develop this idea of accountability a little further. They are not exclusive by any means.
My amendment deals with nursing homes while the Deputy's amendment deals with every aspect of this Bill. The Deputy said these draft regulations should be brought before the joint committee. If every regulation had to come before the joint committee, one could clog up the system unnecessarily. If we look at that on Report Stage with a view to tabling an amendment which is similar to amendment No. 13 in that it would be an affirmative resolution of the House——
I am not reading this as relating to nursing homes only. The Minister's amendment reads: "Whenever a regulation is proposed to be made under this Act a draft of the regulation shall be laid before each House of the Oireachtas". It refers to all regulations attached to this Bill.
My amendment states under any section of the Health (Nursing Homes) Act, 1990.
Which Act are we talking about?
The Health (Nursing Homes) Act, 1990.
That is not clear. I took it that——
It is clear if one reads it. My amendment refers to any draft regulations which it is proposed to make under any section of the Health (Nursing Homes) Act, 1990.
That is not what it states. It reads "this Act".
Has the Deputy got the wrong amendment?
No. Is it specified under section 14 already?
It is a replacement of section 14 of the 1990 Act.
I take back my congratulations. It is mean-minded and mean-spirited that the Minister has restricted it to the nursing homes Act——
I am offering something now——
——instead of adopting a new approach having taken on board the lesson of the Ombudsman. He was not talking about the nursing homes Act only.
I know that and it is something the Oireachtas has to discuss.
Why not do it now?
Will the Deputy agree if we table a composite amendment on Report Stage which would have the effect that any regulation under this Act would have to be passed by affirmative resolution of both Houses? We have a safeguard there in that the House could decide that regulations were of such importance that they should go to the committee. Some regulations may not be of that importance. We do not want to totally clog up the system but, on the other hand, I would prefer if this referred to the entire Act. I will come back on Report Stage with a composite amendment embracing all of this.
Amendment, by leave, withdrawn.
Section 3 agreed to.
NEW SECTIONS.
I move amendment No. 14:
In page 13, before section 4, to insert the following new section:
"4.-The Minister for Health and Children shall report annually to the Oireachtas on the numbers of suicides in Ireland and details of contributing factors thereto.".
I would like to see annual reporting to the Oireachtas on this issue which would cause the Oireachtas and, in particular, this committee to debate incidents of suicide in Ireland. It might have relevance not only to this committee. For example, it might have relevance to the justice, equality and law reform area and to the sport and recreation area, particularly given the national drugs enforcement role of the Minister of State with responsibility for local development at the Department of Tourism, Sport and Recreation. It could have application across Departments.
It is time there was some form of reporting directly to the Oireachtas which would cause us annually at least to look at the problem of suicide in Ireland and to get as much detail as we can on the contributing factors thereto so that we, as legislators, and the Minister and his colleagues could look at what we need to do to roll back this situation which is now acute among young males in particular.
I am glad Deputy Neville is here because he is one of the leading authorities on this issue. Had I not been going away last week when I drafted this amendment, it would have been in Deputy Neville's name, or in both our names. This is an issue on which we need some annual reporting which would give not only this committee but also Departments a chance to debate it.
I welcome the opportunity to speak on this amendment. I fully agree that there must be some annual review. What we have at the moment are statistics and the report of the review group. How much teeth does that review group have? I know the people on that review group and some of them, including the chairman, are excellent people. However, the review group does not seem to have enough teeth to go beyond a statistical review and a review of what is happening in the health boards.
I appreciate resource officers have been established in most of the health boards and some of them are very good. I cannot judge it other than to say that I know some very good resource officers and I know of others who are temporary. I know that in one health board area two people are doing the job, each on a part-time basis. That is mixed as well.
Until we start to investigate why these things are happening rather than reflect on what is happening, we will not get to the bottom of it. I know how complex that is. Research has been done internationally but we cannot determine what is happening in Ireland based on what is happening internationally. For the past two years there seems to have been a trend in terms of a reduction in the level of suicide, but we are talking about moving from roughly 63 per annum in the 1960s to as high as 503 in 1999 and 439 in 2000. The figure of 439 is only at the level of the previous year. While there is cause for encouragement, there is no significant drop other than from a very high of 503. For a number of years, the figure had been increasing by 16%.
As Deputy Mitchell said, there is no doubt there is a problem, especially with young males. While some of us feel we have some idea of what is happening, no real research has been done. Young people have not been spoken to or researched extensively in this area. I do not think much research is done in regard to anything about young people. I saw very interesting research done by Foróige in October 1999. I do not know how many politicians read it, but young people want to be involved in what is happening in their surrounding areas and in their communities. We assume, however, they do not want to be involved and that they are only interested in doing drugs and whatever. That is the impression among a certain generation but research done shows that is not the case. If we, as a society, have a perception about young people, they will become negative.
This whole area needs to be examined as well as the changes in the role of young people and the area of education, of which the Minister will be well aware and about which the national task force made strong recommendations. There have been some moves in that area. The Irish Association of Suicidology held a conference in December attended by more than 300 teachers. Levels of despair were expressed in that what does teacher do when he or she feels somebody is suicidal? They said that there is nowhere for them to go, there is no agency to which they can turn. Most general practitioners do not understand the stresses faced by young people or suicide ideation. A general practitioner will only have to deal with a case of suicide once in every five years because it is still a reasonably rare occurrence. Schools in other countries have resources and personnel available to help those in crisis.
There is no reason a group of schools could not have a central office to which they could turn if a pupil was in crisis or suicidal. I heard teachers say recently that when they took a pupil who had become seriously ill in their class to the general practitioner they were informed to take him home, but there was no one there because both parents were working. What is a teacher supposed to do in that instance? We must investigate the reason many young people, particularly young men, are in such despair that some of them take their own lives.
There has been a big increase in the number of men between the ages of 65 and 75 years committing suicide in rural areas. Loneliness could be a factor. We are seeking to have a day centre provided for elderly persons in Newcastlewest in west Limerick, but have not succeeded.
Whose fault is that?
The health board or the Department of Health and Children or both.
It is, probably, a local issue.
I take issue with the Minister because there is a good local committee in place.
That is not what I mean. It is the responsibility of the health board to respond to local needs. I apologise for asking the question. I propose to accept the amendment subject to redrafting. I would not have a problem with an annual report on suicide being laid before the Oireachtas. We need to pull together the statistics in the Central Statistics Office report laid before the Oireachtas annually. The national suicide review group published its 1999 report in August 2000. It includes details of the number of suicides and a comprehensive overview of activities in suicide prevention in the year in question. We must be clear about what the Minister will be doing. He or she should report annually to the Oireachtas and may use the CSO figures and those in the national suicide review group's report as a basis for his or her report. The Deputy is anxious to have an annual debate in the House.
Or consideration by various committees.
Is it agreed to withdraw the amendment and reintroduce it on Report Stage?
Will I resubmit the amendment on Report Stage?
We will draft it to ensure the wording is right.
The Department will come back to me on it.
Amendment, by leave, withdrawn.
I move amendment No. 15:
In page 13, before section 4, to insert the following new section:
"4.-All boards, agencies and bodies under the aegis of the Department of Health and Children shall be constituted only after the Ministers' nominees to serve on such boards, agencies and bodies have been ratified for appointment by an Oireachtas Committee appointed by Dáil Éireann for such purpose.".
As an Oireachtas committee cannot be appointed by Dáil Éireann, the amendment should read "Oireachtas Éireann". As I raised this matter on Second Stage, the Minister is aware of my views. It is a matter about which I am concerned. The Oireachtas should have a greater role in ratifying ministerial nominations to boards and courts.
Amendment, by leave, withdrawn.
Amendments Nos. 16 and 17 not moved.
I move amendment No. 18:
In page 13, subsection (2), line 22, after "Act" to insert ", except in so far as it relates to the Tobacco (Health Promotion and Protection) Act, 1988,".
This is a technical amendment which excludes the Tobacco (Health Promotion and Protection) Act, 1988, from the collective citation for the Health Acts, 1947 to 2000. The Tobacco (Health Promotion and Protection) Act, 1988, is included in the collective citation in subsection (3).
Amendment agreed to.
Amendments Nos. 19 to 21, inclusive, not moved.
Section 4, as amended, agreed to.
Title agreed to.
Bill reported with amendments.