Select Committee on Social Affairs debate -
Wednesday, 8 May 1996

SECTION 1.

Minister for Health (Mr. Noonan,

Limerick East): I move amendment No. 1:

In page 3, between lines 14 and 15, to insert the following subsection:

"(3) This Act shall come into operation on such day as may be fixed therefor by the Minister by order.".

When introducing the Bill in the Dáil, I signalled that I would table a number of amendments on Committee Stage to take account of the views of various interest groups which were conveyed during the consultative process that followed the publication of the Bill in December last. I reiterate that I will provide the funds required by the health boards to meet the cost of the new primary healthcare services set out in the Bill. I am determined to ensure that a range of high quality and accessible services are put in place and maintained for as long as required. Apart from ongoing monitoring by my Department, I will arrange with each of the health boards to designate a specific officer to act as a contact for individuals and also to liaise with each of the various interest groups whose members will avail of the services set out in the Bill.

Miss Flaherty

The additional information provided by the Minister will be welcomed by those whom it affects. The appointment of a liaison officer in each health board is welcome and will assist in co-ordinating the variety of services. The commitment on funding is critical. During the briefing session earlier, there was a discussion about accessibility to various services. If there is insufficient funding the fact that one is entitled to a service is no guarantee that it will be available. This is a critical point when making extra demands on hard-pressed health boards. What is the Minister's view on the date of commencement?

Mr. Noonan (Limerick East)

It is not being done in this manner to delay implementation of the provisions in the Bill. If I were to state a definitive commencement date, I would be working against a deadline in the negotiations with the professional bodies involved in delivering the services. When the deadline arrived, no one would be obliged to continue with the negotiations. The cost of every new element of service provided free of charge by GPs under the GMS and the immunisation scheme must be negotiated in the normal way. If I were negotiating against a deadline I would not have much scope within which to work.

Amendment agreed to.

Section 1, as amended, agreed to.

NEW SECTION.

Mr. Noonan (Limerick East)

I move amendment No. 2:

In page 3, before section 2, to insert the following new section:

2—(1) A health board shall make available without charge to persons who, in the opinion of the chief executive officer of the board, have contracted hepatitis C directly or indirectly from the use of Human Immunoglobulin-Anti-D or the receipt within the State of another blood product or a blood transfusion and to persons of such other classes (if any) as may be prescribed—

(a) general practitioner medical and surgical services, in relation to all medical conditions, provided by registered medical practitioners (within the meaning of the Medical Practitioners Act, 1978) chosen by the persons,

(b) drugs, medicines and medical and surgical appliances,

(c) the nursing service specified in section 60 of the Act of 1970,

(d) the service specified in section 61 of the Act of 1970,

(e) dental, ophthalmic and aural treatment and dental, optical and aural appliances,

(f) counselling services in respect of hepatitis C, and

(g) such other services as may be prescribed.

(2) In this section ‘the Act of 1970' means the Health Act, 1970.".

This amendment is a new section and replaces section 2 in the Bill. It arose from submissions made to me during the course of consultation and I indicated on Second Stage that the Bill would be amended.

If Members consider the comparative texts, the major change involves the different categories who were infected with hepatitis C from blood or blood products. The Bill as originally published included those who were infected with hepatitis C from the anti-D product and I gave a commitment that those who were infected as a result of blood transfusions would be included by way of regulation. The group representing that category of people, Transfusion Positive — Positive Action represents those infected by the anti-D product — stated that they would rather be included in the Bill than covered under subsequent regulations. The first addition to the text is the phrase "or the receipt within the State of another blood product or a blood transfusion". This explicitly includes them in the section rather than by way of regulation.

The last line of subsection (1) of the amendment refers to "persons of such other classes (if any)". This will provide for any other group we may wish to cover under the Bill. It is a catchall phrase which will permit us to extend the benefits of the Bill to any unforeseen group.

Members argued with me about another issue relevant to the Bill during Question Time in the Dáil. To put it in context, Members will recall that when the tribunal was established in respect of those persons who contracted hepatitis C from a blood transfusion as distinct from the anti-D product, I was asked how this could be proven. This committee debated the issue of the criminal level of proof being beyond reasonable doubt and the civil level of proof being on the balance of probabilities. It was eventually decided that it would be on the balance of probabilities.

People do not want a situation to develop where their health needs would be contingent on their qualifying in court or under the tribunal for compensation. For example, a person who made an application to the tribunal because they were infected by a blood product and had contracted hepatitis C might not be awarded compensation. In such cases it is my intention to provide under the Bill that a more liberal view be taken in deciding who qualifies. Rather than stating that compensation will be available to those who contracted hepatitis C from the anti-D product or a blood transfusion, we are inserting the phrase "in the opinion of the chief executive officer". The chief executive officer will be able to take a more liberal view of the qualification requirements.

It is intended that anyone who became infected with hepatitis C from anti-D or a blood transfusion will automatically qualify for compensation. If there is a doubt and a person infected with the disease cannot produce the evidence necessary for a court of law or the tribunal, the chief executive will have discretion to allow them benefit under this Bill. All those who contracted hepatitis C from a blood product or a blood transfusion will be included and this gives discretion to the chief executive to widen that category further in circumstances where his opinion might be slightly at variance with that of the strict proofs which will be required in the different fora.

Those are the principal differences in the main body of the amendment. In listing the services to be provided, the Bill gave primary status to (a), (b) and (c) and then stated: "In particular, but without prejudice to the generality of subsection (1) (c) of this section, the following services or any one or more of them may be prescribed under that provision:". The Bill as initiated stated: "may be provided". This is now being explicitly provided for and there will be no differentiation between the elements of the list. It strengthens the package and gives a stronger primary statutory right to the benefits from (c) onwards. There are also some textual amendments of a technical nature.

Those are the differences between section 2 in the Bill as initiated and the new section which will replace it by way of amendment. They are designed to give a stronger statutory base to the service being provided. Some of them are in response to the normal screening work one would do in improving a Bill for Committee Stage and others are in direct response to points made by Deputies and groups representing people who want to avail of this Bill.

Mr. Foxe

Those services are available free of charge to people who contracted hepatitis C within the State but what would happen if somebody contracted the disease outside the State?

Mr. Noonan (Limerick East)

If a person contracted the disease outside the State, they would not have got it from anti-D or a blood product within the State. They would obviously have the same difficulty if they went to court looking for compensation as they would if they went to the tribunal.

As in the case of any other aliment, they would be entitled to free GP services if they qualified for a medical card. However, since hepatitis C is an infectious disease under the health Acts they would get all the normal free hospital benefits. The new element in this Bill is that these provisions will be provided without a means test and are additional to the range of public health and hospital services, which would be available under the health Acts without a means test.

If a person outside the State qualified for a medical card, they would be treated in the same way as anybody else. If they did not qualify, they would be covered under the health Acts for the whole range of public hospital services, but the specific medical card benefit of free GP services and drugs at the pharmacy would be missing. One may still qualify under the opinion of the chief executive officer because it would be a much looser level of proof than the kind we are talking about when it is debated elsewhere.

Dr. Moffatt

I welcome the inclusion of the other aspects relating to blood products and the leeway being given to the chief executive officer. The amendment specifically states "within the State". How far advanced are the Minister's negotiations with the general practitioners regarding the provision of these facilities? Will the Minister state what additional funding will be available to the health boards for these services? I do not want this to be an aspiration; the Minister should be specific about it. Counselling is not available in certain health board areas at present. Even if extra funding is provided, will it be available within a short time? The Minister was to set up a consultative council. How far has he gone down that road?

Mr. Noonan (Limerick East)

We are finalising the arrangements with the GPs. They are not reluctant to do this work and, in fact, they do it already. We are currently negotiating a price. We have good relationships with the different bodies representing GPs and had a successful phase of negotiation on the new immunisation programme for children recently. I do not foresee a difficulty there; it is only a matter of finalising it.

On the question of how much money will be provided and how we can be sure it will be provided, Deputy Geoghegan-Quinn proposed that, by 1 September each year, each health board should lay before the Oireachtas an annual report outlining the funding levels available for each category of service provided for in the Act. I said earlier that a designated officer in each health board will be responsible for ensuring that the range of services is provided in each health board and will also act as a liaison officer with the group.

The spirit of this amendment is good. I suggest that the appropriate place to raise this issue is in the debate on the Health (Amendment) Bill, 1996. Section 15 of the Health (Amendment) Bill, 1996 requires health boards, to lay an annual report before the House. That report may contain such elements as the board of the health boards may specify, but it would also have to contain such elements as the Minister may specify. I intend to specify that the arrangements which the individual health boards put in place each year in respect of this Bill, must be specified separately in their annual report. There is a section in the Health (Amendment) Bill, 1996 which will cover the Deputy's point and also takes Deputy Geoghegan-Quinn's idea on board. The issue of accountability should be more appropriately dealt with under that Bill.

The practical delivery of the service in health boards is a big problem in the Eastern and Southern Health Board areas. The number of people would be about 1,600. There are 755 people in the Eastern Health Board, 195 in the Southern Health Board, 190 in the South-Eastern Health Board, 95 in the Western Health Board, 125 in the North-Eastern Health Board, 120 in the Mid-Western Health Board and 70 in the Midland Health Board. In terms of cost and co-ordination, it is likely to be a big item in the eastern and southern health boards and to a lesser extent in the South-Eastern Health Board. However, the Midland Health Board would be dealing with only 70 people.

It does not have the same cost implications when you think of all the other free services that are provided. I understand what the Deputy is getting at from a political point of view; when public attention is diverted from this in years to come will it all fade away? It will not because I will ensure that every health board will have to specify each year in its annual report how exactly it is fulfilling the requirements of this Bill and what it did in the previous year to fulfil it, including the amount of money it dedicated to the various elements of it.

Miss Flaherty

I welcome the substantial improvements in this section. This Bill was broadly welcomed because it placed entitlement to specific medical services on a statutory basis and its amendment today by the Minister meets any remaining concerns. It strengthens and improves the range of services available and the groups who will have access to them. I welcome the amendment which meets the issues raised in the substantive Opposition amendment.

I welcome the clarification given on GP services. The question of personal choice is important as is the issue of maintaining continuity. That would not be available under the GMS service and so the amendments are a significant improvement.

Mr. Noonan (Limerick East)

There will be a choice and it will be free. The benefit is not confined to ailments arising from hepatitis C. A person who qualifies under the hepatitis C requirement will be entitled to any medical intervention necessary at GP level or any drug which is prescribed as a result of that.

The functions of the consultative council will include monitoring all health and counselling services for persons who contracted hepatitis C from a blood product or blood transfusion. This will include monitoring the funding provided in the Book of Estimates each year to ensure that the funding is sufficient to provide the range of health services, both primary and secondary. In the health care package which I circulated in December 1995, it was clearly indicated that the funding for the special health services would be monitored by the consultative council.

The consultative council will also make recommendations on the organisation and delivery of services for persons with hepatitis C. It will publish information on hepatitis C and liaise with the Health Research Board in relation to the special programme of hepatitis C research products.

Following consultation with interested groups, I circulated a draft establishment order to them and I am currently considering a number of amendments to that order to take into account the views expressed by the groups. I will put it in place when that is finalised.

Mr. Flood

The Minister gave us details on the numbers from each health board. Will he insist that each health board provides all the services within its own area or will health boards in some areas have the right to provide services through another area? I am thinking particularly of counselling. In previous discussions some contributors expressed concern about the availability of counselling. If memory serves me correctly, the Minister desired that those seeking counselling would be entitled to get it within 30 days. That does not seem to be covered here. Does the Minister intend to make regulations governing the provision of a counselling service within a specified time? Is it intended to extend counselling to family members?

With regard to the provision of services to people who may find it necessary, through no fault of their own, to go abroad either temporarily or permanently, is it left to them to tap into the health services in the country in which they will reside? Does the Minister intend to make arrangements to cover such cases?

Giving discretion to chief executive officers to deal with persons of such other classes is an interesting inclusion and could be all embracing. What type of case might come to the attention of a chief executive officer under that part of the amendment?

I asked in the private session about guaranteeing the provision, supply and availability of drugs, medicines and medical and surgical appliances. The availability of drugs and medicines is probably satisfactory. Does the Minister see a difficulty with regard to the immediate availability of medical and surgical appliances?

Under paragraph (e), will hepatitis C sufferers be on a waiting list for those services or does the Minister intend to allow health boards to purchase them from the private sector if the need arises so that sufferers could have ready access to them?

As regards accountability and the health boards making reports, does section 15 of the Health (Amendment) Act, 1996 stipulate that the health board must provide its annual report within a specified date? Annual reports tend to be out of date. I am not familiar with that section but would the delayed provision of annual reports be a matter of concern to the Minister?

Mr. Noonan (Limerick East)

It would be of concern to me. I hope the annual reports will issue in the early half of the year following the year to which the report applies. I presume this committee will discuss that Bill on Committee Stage so if it is of the view that something needs to be tightened in section 15, we will have an opportunity to do so. That Bill will give me a similar power to that which will be vested in the health boards to specify items which must be covered in the annual report and the manner in which these will be covered. I will use that power to specify that this information is included.

On the question of counselling for family members, the benefit would be to the individual but family members could well be included depending on family circumstances. We are dealing with a small cohort, approximately 1,600 people in all, some of whom have the antibodies but do not have the virus. In round terms, slightly more than half of the 1,600 people would have the virus. We can afford to be flexible in dealing with this group because it is such a small group in terms of the totality of the health services. We could extend counselling to family members as the uptake would be quite small.

In regard to services abroad, we cannot enforce our statutory views on other countries. However, a range of free services is available in the European Union under the reciprocal arrangements we have with other EU member states. In practice, if a particular difficulty arises, it will be dealt with by the liaison officer of the health board liaising with the groups on an individual basis. The Deputy will be aware there is provision within the health boards to finance medical or surgical care services abroad up to a cost of £10,000, on the authorisation of the chief executive officer of the health board, and beyond that on the recommendation of the health board with the permission of the Minister. This is an addition to the existing schemes and will not take away from any scheme already in place.

I envisage that all the services listed will be available within the health board areas. There would be no difficulty with someone living on the border of a health board area availing of the service in a neighbouring area if that were more convenient for them. Counselling should be available in all health board areas. Guidelines will be set down by the Department of Health following the enactment of this Bill to ensure that the counselling services provided are in line with the primary health care document we agreed with the representative groups. That was the base document which gave rise to this legislation and to the other commitments we made on health care. However, as Deputy Flaherty said, the interest groups are satisfied. I am sure Members received few representations from interest groups on this legislation or on the health care package because there is full agreement that we are meeting the need. The differences we may have with the interest groups are not in respect of the health care package but in respect of compensation in the High Court or the tribunal and so on.

Mr. Costello

I compliment the Minister on his very comprehensive amendment dealing with the range of services to be provided by the Department of Health. I was glad to hear his last remarks about there being full agreement among the various interest groups.

The amendment states that the service will be available "without charge to persons who, in the opinion of the chief executive officer of the board. . .". That is an addition to the Bill. All the health boards will deal with this legislation and each chief executive officer will have to give his opinion on how the person in question contracted hepatitis C. Will standards be laid down in regard to "the opinion of the chief executive officer"? I would have thought that how a person contracted hepatitis C is definable in medical terms and is not a matter of opinion. Why was that wording used?

There is also a reference to "other classes". Everything so far has been related to people who contracted hepatitis C from the use of anti-D or other blood products and blood transfusions. What is envisaged by "other classes"? Are there classes other than those who received infected blood?

A huge range of services is specified in the amendment and there is pressure on the State to deliver some of them now — dental, ophthalmic, aural treatment and so on. According to a recent statement from the Department of Health, 35,000 people between the ages of 16 and 35 years will receive dental treatment. That has been dealt with through the private sector rather than the general medical service. How will priority be determined for these services? Hepatitis C is life threatening in many cases and has to be dealt with rapidly. What is the timescale involved? Are our services capable of providing these facilities?

Mr. Noonan (Limerick East)

The genesis of the phrase "in the opinion of the chief executive officer" lies in the fact that approximately 58,000 women who received the anti-D product were screen tested for hepatitis C. The majority of them tested negative but some were positive. There is a record of the women who have hepatitis C and received the anti-D product and the causal link between the two. If I said "anybody who got hepatitis C from an anti-D product" as the section was originally worded, it would include all those women because there is absolute proof.

There is a second cohort who got hepatitis C from a blood transfusion. They are represented by Transfusion Positive who wrote to every Deputy. They made the point that if they went to the tribunal and the proof was on the balance of probabilities, and hospital records were missing how would they prove it? We argued about that and explained the tribunal would not require absolute documentary evidence — if it was the most probable source of the infection that would be the level of proof required. For example, if somebody was pursuing a case in the High Court which did not come up for three years and they wanted to avail of the health package in the meantime, they would not have proof of actually having got compensation either in the High Court or in the tribunal and therefore, the chief executive officer, to use the vulgar term, could not piggyback on the decision of the court or the tribunal. He would have to use his discretion and say that, in his opinion, the person has hepatitis C and, according to the doctor's records, contracted it from anti-D products.

Another example is that people with hepatitis C, for reasons best known to themselves, might not apply for compensation. They may want to avail of the health package but might not pursue compensation in the court or in the tribunal for private reasons. They might not want their case to become public knowledge.

The intention was to cover any person who got hepatitis C from anti-D products and the Minister had the power to include other people who got it from blood transfusions. The wording "in the opinion of the chief executive officer" allows the chief executive officer, when he has dealt with cases where there is proof positive or proof on the balance of probabilities, extra discretion to deal with cases we did not envisage and which, if they were not covered, would create an anomaly in the legislation. We are aware of such cases from our dealings with health boards. This provision will give the chief executive officer that discretion and enable us to make representations on those grounds.

As regards other categories, one group I envisage is children of infected mothers. It may be appropriate to extend some or all of these services to the children of infected mothers. I would like to have the provision in the Bill now because in politics certain issues are fashionable from time to time when they are of immense concern. However, as time passes legislative and public attention is diverted elsewhere and it may be difficult to amend primary legislation. I thought it prudent to insert it here.

The proposed enabling legislation will provide that the Minister for Health may provide in regulations other categories of persons who shall be entitled, free of charge, to general practitioner services. Children born to hepatitis C positive women for 13 months after their birth will be prescribed, by regulation, to be a category of persons entitled to GP services free of charge. They would have their mothers' antibodies for up to ten months so there is no point in testing them until they are over ten months old.

I know of women with hepatitis C who are pregnant. It is a catch all phrase and it is prudent to have such an element in the section.

Dr. Moffatt

Does the Minister envisage that the services provided by general practitioners will be on a fee per item basis?

Mr. Noonan (Limerick East)

That is close to where we are negotiating at present.

Dr. Moffatt

The Minister was asked if he could extend the closing date for the tribunal in view of what is happening in the courts.

Mr. Noonan (Limerick East)

I have already extended it from three to six months. When I receive the committee's letter I will consider the matter. I do not see any great need to extend it at present because it has been signalled since last September when the tribunal's terms of reference were first put on the table. In the negotiations prior to Christmas we extended it from three to six months and 17 June is the final date.

Dr. Moffatt

In view of the findings in the High Court, does the Minister not think it would be wise to extend it now that files or other documentation, which were not supposed to have existed previously, have become available?

Mr. Noonan (Limerick East)

We are contesting that in court. The only new element is that the court date has been set for 8 October, but I do not see how that disadvantages anyone. People can pursue their claim in court or in the tribunal. If they pursue it in the tribunal and are dissatisfied with the award, they can pursue it in court. When we last checked there were 371 applications before the tribunal. It has been indicated to us that there are close on 200 applications imminent, according to solicitors who are sending in quite a number of them. Within the next two weeks we will be talking in terms of between 500 and 600 claims before the tribunal. The tribunal deals with 12 cases per week over four sitting days. There are enough cases in the pipeline to carry into next year. Those who apply before the closing date will not get a tribunal hearing until well after the result of the High Court case, if that is the issue which is being put.

Dr. Moffatt

I know the tribunal may be ongoing, but the problem is that the Minister has specified a closing date for applications.

Mr. Noonan (Limerick East)

Yes, 17 June.

Dr. Moffatt

It is in view of what might happen in the High Court — there might be new evidence and people may change their minds on how to proceed — I am asking if the Minister should extend the date.

Mr. Noonan (Limerick East)

When you apply to the tribunal you are not committed to having your hearing before it; you can withdraw at any time and go to the court. Even if you have your hearing before the tribunal and an award is made you have a month in which to make up your mind. If, on your solicitor's advice or in your own opinion, the award is insufficient, you withdraw from the tribunal and go to the court.

Dr. Moffatt

I am aware of that but I wanted to give an extra possibility to those people who might want to avail of it.

Mr. Noonan (Limerick East)

We must try to reach finality. There are many people who have different interests in this and we must be as fair as possible. I understand from newspaper reports that this committee's letter to my office will raise those specific points, and I will consider them then.

Mr. Costello

My query relates to our ability to deliver services urgently and rapidly to those who have contracted hepatitis C. What number of people is in that category?

Mr. Noonan (Limerick East)

About 1,600.

Mr. Costello

Has the Department of Health a rough estimate of the services and timescale involved?

Mr. Noonan (Limerick East)

The total number is about 1,600 but many of them would already have medical cards and free GP services. A person can avail of the free service with any GP, it does not have to be tied into a GMS list. They will not compete with existing medical card holders. They have their own family doctors and, by definition, do not qualify for a medical card at present.

I do not see any difficulty about the service from a general practitioner because their family doctors are treating them at present. The new element is that they will now be treated free of charge, but they will not get a new service in respect of their family doctor. The same applies to drugs and medicines. There would be no difficulty providing normal medical and surgical appliances. If somebody has cirrhosis of the liver and suffers a complication which makes it prudent for the person to be in a wheelchair he or she would not be placed on awaiting list. Nursing services are in place. We are extending dental services to those aged 35 years. A group of dentists is available to provide that treatment. The cohort is quite small and I do not envisage a problem in that area. By and large counselling services are already in place. We can monitor and add to them if necessary.

A designated officer in each health board will be responsible for ensuring that this package of services is delivered. He will also act as a liaison officer with representative groups. We will combine that with the requirement under the Health (Amendment) Bill, 1996 that health boards specify in their annual reports how they delivered on this package.

Mr. Flood

Is there a timescale within which people will get an appliance, such as a wheelchair, if they need it? As regards sub-paragraph (e), if the services are not available immediately from the public sector will service providers be entitled to purchase them in the private sector to meet the immediate need? Is the Minister leaving it to the health boards to make a decision on that basis?

Mr. Noonan (Limerick East)

We will prioritise the needs of the cohort and the liaison officer in each health board will ensure that everything necessary is done to deliver the services. As I understand it, the delay in the provision of a wheelchair or similar item at present is because the model required, which must be in line with certain specifications, is not available on demand. That also applies to a number of surgical appliances.

On the private sector element, GPs are in the private sector and need not necessarily be on a GMS list. Dental services are being provided by the private sector so there will be an element of that. In the future, if an individual who wants a particular service cannot get it readily, a liaison officer in the health board will deal directly with him or his representative group and we will overcome the difficulty. I do not see difficulties arising but as time goes by there may be problems in individual cases. The liaison system is designed to ensure that what is being provided under the Bill will be readily available in practice.

Amendment agreed to.

Chairman

Acceptance of this amendment involves the deletion of section 2 of the Bill. Is that agreed? Amendment No. 3 to the original section 2 is out of order.

Dr. Moffatt

Is there a reason?

Chairman

There is a potential charge on the Exchequer within the meaning of Standing Order 124 (2). Amendment No. 3 seeks specifically to include in the Bill another category of persons, that is, those who contracted hepatitis C from the use of other blood products or blood transfusions. It would, therefore, involve a charge on the Revenue by giving them the entitlement to benefit as of right and removing the discretion of the Minister under section 2 (1) to prescribe the category of persons.

Dr. Moffatt

The Minister was able to incorporate it in his section.

Mr. Noonan (Limerick East)

Amendments Nos. 3 and 4, tabled by Deputy Geoghegan-Quinn, were ruled out of order. However, I have incorporated what she sought in the new section 2 and have now explicitly designated persons who get hepatitis C from blood as well as from a blood product.

Amendment No. 3 not moved.

Chairman

Amendment No. 4 is out of order as it involves a potential charge on the Revenue.

Amendment No. 4 not moved.

Section 2 deleted.

NEW SECTION.

Dr. Moffatt

I move amendment No. 5:

In page 3, after line 30, to insert the following new section:

"3. — Each health board shall lay before the Oireachtas, by the first day of September each year, an annual report outlining the funding levels available for each category of service provided for in the Act.".

The Minister said this will be incorporated in the new Bill. However, that relates to performance by the health board and it is not specific in that it does not detail hepatitis C per se. We ask the Minister to accede to this amendment on the grounds of specificity.

Mr. Noonan (Limerick East)

The amendment would require health boards to lay an annual report before the Oireachtas by 1 September each year. Section 15 (1) of the Health (Amendment) Bill, 1996 provides that:

A health board shall, not later than the 30th day of June in each year, prepare and adopt a report (which shall be known as and in this section is referred to as an "annual report") in relation to the performance of its functions during the preceding year.

The section also states what the annual report will include. The date in that Bill is 30 June whereas in this amendment it is the end of September, so the provision in the other Bill is better in terms of accountability. Section 15 lays down certain items which will be in the report and goes on to provide that the board or the Minister may specify others. The commitment I make to this committee is that I will specify that what is requested in this amendment will be required in the annual reports stipulated under the other Bill. Since we have a Bill which makes health boards accountable for a range of matters, a provision relating to accountability is more appropriate to that Bill than to this. What is being sought is being granted in the primary legislation rather than in this Bill. I ask the Deputy to withdraw the amendment.

Dr. Moffatt

I withdraw the amendment on that understanding that the Minister will request that this be included in the performance section of the Health (Amendment) Bill, 1996.

Mr. Flood

Will the provision be enshrined in legislation?

Mr. Noonan (Limerick East)

The Second Stage of the Health (Amendment) Bill, 1996 will be taken by the Minister of State, Deputy O'Shea. Section 15 of that Bill states that a health board shall, not later than 30 June in each year, prepare and adopt an annual report in relation to the performance of its functions during the preceding year. Section 15 (2) states:

An annual report shall include—

(a) a statement of the services provided by the board in the preceding year, and

(b) such other particulars (including financial statements) as the board considers appropriate or as the Minister may specify.

The commitment I will give to the committee is that under the power in sub-paragraph (b) I will specify that each health board will state in its annual report how it has dealt with the provision of the services required under section 2 of this Bill. It will be a matter arising from section 15 of the Health (Amendment) Bill, 1996.

Mr. Flood

Will the Minister specify that by way of regulation?

Mr. Noonan (Limerick East)

No, it will be by directive which will require me to write to the chief executive officer of the health board specifying that, in the annual report, it must include a report on what it has done to comply with section 2 of the Health (Amendment) Bill, 1995 in respect of hepatitis C, and it will have to comply with this under section 15 of the Health (Amendment) Bill, 1996.

Mr. Flood

Will that directive remain in force when this Minister leaves office?

Mr. Noonan (Limerick East)

Yes. If I am on the backbenches next year, and given the fortunes of war one could end up anywhere at present, in theory, a subsequent Minister could tell health board chief executive officers that my directive no longer applies but people will act prudently. Whoever succeeds me as Minister could change a section or regulations.

Mr. Flood

A Minister would be less likely to change a section than a directive.

Mr. Noonan (Limerick East)

Why would a Minister change this directive? I expect our successors will act reasonably.

Mr. Flood

We hope so.

Mr. Costello

The amendment states that the annual report should outline the funding levels available for each category. That is one aspect of the matter but, as the Minister says, a much broader range of activities will be covered in the annual report. That seems a more desirable approach.

Mr. Noonan (Limerick East)

We will also include funding.

Amendment, by leave, withdrawn.

Title agreed to.

Report of Select Committee.

Chairman

I propose the following draft report:

The Select Committee has considered the Bill and has made amendments thereto. The Bill, as amended, is reported to the Dáil.

Is that agreed?

Ordered to report to the Dáil accordingly.

Chairman

I thank the Minister, and his officials and Members for their contributions.

Mr. Flood

I, too, thank the Minister and his officials for providing us with detailed information and for debating what is for those who suffer from hepatitis C reassuring legislation. It was good that all sides of the House were able to co-operate to ensure its smooth passage through Committee Stage.

Dr. Moffatt

I echo that. We were supposed to meet the Blood Transfusion Service Board. I presume it was not on the Minister's instructions that it did not meet us. Could he reassure us in that regard? Will it meet us on a future date?

Mr. Noonan (Limerick East)

The board decides on these issues, but I understand it acted on legal advice.

The Select Committee adjourned at 6.35 p.m.