Hospital Services.

Questions (13)

Olivia Mitchell

Question:

135 Ms O. Mitchell asked the Minister for Health and Children the plans that are in place and the amount of money allocated in 2004 to ensure access by all who need it to a comprehensive neurology service. [1536/04]

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Oral answers (5 contributions) (Question to Minister for Health and Children)

Following a number of meetings with various interest groups, I requested Comhairle na nOspidéal to conduct a review of neurological services and related issues. Comhairle na nOspidéal established a committee to examine,inter alia, existing arrangements for the provision of consultant level neurology and neurophysiology services nationally and to make recommendations on the future organisation and development of those services. Comhairle na nOspidéal has now published its report and, having considered it, I am happy to endorse its recommendations.

The report recommends significant enhancement of neurology and neurophysiology services, including increases in consultant manpower. It also recognises that there are aspects of a number of other specialties and services, such as rehabilitation medicine, geriatric medicine and old age psychiatry, which are related to and overlap with neurology services. Comhairle na nOspidéal has recommended that a national multidisciplinary review of rehabilitation services be undertaken to further inform the policy framework on the development of neurology services.

Consistent with this recommendation and in line with commitments in the national health strategy, a national action plan for rehabilitation services is being prepared by my Department. The action plan will set out a programme to meet existing shortfalls in services and to integrate specialised facilities with locally based follow-up services. The rehabilitation action plan, together with the Comhairle na nOspidéal report and the work undertaken by the Neurological Alliance of Ireland through its publications, will offer a comprehensive policy framework for the future development of neurology and neurophysiology services in this country. My Department will continue to work closely with the alliance and the Irish Consultant Neurologists Association on the future development of services. The implementation of the recommendations will be progressed having regard to the evolving policy framework in this area and in the context of competing funding priorities.

Specialty costing data in respect of hospitals which provide neurology services indicate that in-patient costs for this specialty for 2002 were over €19 million. This figure excludes costs in respect of neurology services provided in out-patient and accident and emergency departments and specialist day case activity, which are not routinely collected by my Department.

It is incorrect to claim that the report has just been published — it was published last spring. I am concerned about what has happened since then. It appears the Minister has simply commissioned yet another report, the review of rehabilitation services. While that is welcome, it does not indicate that there has been any significant progress in appointing neurologists. The review showed that Ireland is yet again at the bottom of the league, as it were, with the smallest ratio of neurologists to population. We have less than one third of the required number of neurologists. What has been done to provide additional neurologists since the report was published? How many neurologists have been approved or appointed?

We have to consider how many additional consultants can be appointed in the context of the funding envelope that is available for this year and forthcoming years. There is a significant lead-in time from the date of sanctioning a consultant post to the post coming on stream. Generally, our consultant numbers across a range of specialties are below what pertains in other countries. That was the reason for the Hanly programme, the need for change in the consultants' contracts and the aim of doubling the number of consultants. There is caution, therefore, about making further dramatic increases in consultant numbers in certain specialties in advance of dealing with those critical issues.

There has been a dramatic increase in recent years in the number of consultants in the critical areas of cancer, cardiovascular and accident and emergency medicine. Unprecedented numbers of consultants were appointed. I will have to examine the financial envelope this year to see what can be done to advance the cause of neurology. I acknowledge the need for additional consultants in this area. The Comhairle na nOspidéal report was published too late for last year's financial envelope.

I am aware there is a long lead-in time from the time of sanction. That is the reason I asked if any appointments had been sanctioned. The Minister must be aware that neurological diseases can be treated and managed and the progress of the diseases can be postponed. The patient's quality of life can be immeasurably improved if the patient gets access to a neurologist and the neurologist's support team. The Minister said he opposes a dramatic increase in the numbers. I accept that this must be done in a planned and phased way, but has there been any increase? Is there any sense of urgency?

This is yet another specialty in which there is under-provision. The Minister spoke about the Hanly report and doubling the number of consultants, but this report has confirmed gross under-provision in neurology without an input from Hanly. However, there are no new consultants after more than eight months and there is no sign of any posts being sanctioned. Every day people are diagnosed with serious neurological illnesses and their outcomes are diminished by the fact that they cannot see a neurologist.

I do not dispute the need for additional consultants in neurology. However, I will have to examine how many additional posts can be sanctioned within the financial envelope available to me this year.

Health Funding.

Questions (14)

Liz McManus

Question:

136 Ms McManus asked the Minister for Health and Children if he has carried out or received any assessment of the casemix system that he is applying to hospitals, which is penalising patients awaiting treatment and causing further cuts in the budgets of certain hospitals, especially in the greater Dublin area where there are already severe problems; and if he will make a statement on the matter. [2104/04]

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Oral answers (9 contributions) (Question to Minister for Health and Children)

The casemix budget model is an internationally developed system, in use since the 1980s and at present used in most developed countries for health funding. As was stated in the health strategy "... the most developed system for assessing comparative efficiency and for creating incentives for good performance is Casemix." The casemix model is considered to be the only model capable of dealing with the complexities of resource allocation within the hospital services. Every year major improvements to the system are developed with the assistance of all the hospitals involved and in response to their needs and changing clinical practice. A comprehensive review of the national casemix programme has been carried out by the casemix unit of my Department. This review has taken place in an open and inclusive manner and included consultation with all the stakeholders in the process, including hospital managers and clinicians.

The intention of the review was to ensure that the system is fair, accurate and robust enough to incorporate all the strategic developments being proposed in the medium term. A report on the matter is being prepared at present which will make recommendations for the enhancement of the model. This will result in Ireland having one of the most advanced casemix systems in the world, while still being an "Irish" system for Irish patients.

On the matter of casemix penalising patients awaiting treatment, casemix has resulted in more rather than fewer patients being treated year on year. In the period 1999 to 2001, for example, where direct comparison is available, the numbers treated as in-patients and day cases in casemix hospitals rose by 72,829. With regard to some Dublin hospitals losing funding, many of the hospitals that lost some funding under the programme this year gained significant funding in other years. The Adelaide and Meath Hospitals incorporating the National Children's Hospital, Tallaght, for example, lost funding last year but gained this year. The Mater hospital gained funding this year yet lost funding last year.

The rationale for the use of casemix systems as part of the budgetary process is the wish to base funding on measured costs and activity, rather than on less objective systems of resource allocation, and to fund hospitals based on their "mix" of cases. In other words, a hospital should be funded for the patients they treat. The programme is operated in an open and transparent fashion and full details of the clinical and financial information on which casemix budget adjustments are based is provided to all participating hospitals.

Nobody argues with the aim of making hospitals efficient. However, does the Minister accept that the current casemix system does not provide an accurate gauge whereby it can be ensured that more problems are not created for hospitals under pressure, especially in the Dublin area? The result of the Minister's approach in the east coast area has been penal. More than €2 million has been taken away from two key hospitals, St. Vincent's Hospital and St. Columcille's Hospital in Loughlinstown. That must impact on patient care.

Does the Minister acknowledge that it is not a case of inefficiency in these hospitals but that a high number of elderly patients are blocking beds because there are insufficient rehabilitation units? That is a direct result of the Minister's failure to provide such beds. Does he also acknowledge that these hospitals have complied with the appropriate public private balance of 80% and 20%? Other hospitals have disregarded that balance and have catered more for private patients who do not stay in hospital as long as public patients. They are usually not as sick or as old as public patients. The Minister may be rewarding hospitals which care more for private patients than for public patients and which provide for acute cases in accident and emergency departments because they do not have reserve beds.

I know this is technical, but perhaps the Minister would recognise that the result of what he has done is to penalise hospitals which are already under pressure. Approximately 2,400 patients are waiting for care in St. Vincent's Hospital. It is a major hospital which deals with cancer patients and is subject to huge demand from patients in the locality and its catchment area. It is also a tertiary hospital, yet it is taking a hit of more than €1.2 million. That must be absorbed within the hospital and, inevitably, will impact on patient care.

I am glad the Minister is carrying out the review, which I welcome. He must also carry out an equally forensic survey of the impact of this approach. What evidence is there that benefits accrue to patients when hospitals are rewarded? The Minister is rewarding Letterkenny General Hospital, for example, which is great for it. However, that is not of comfort to the thousands of people trying to access services in St. Vincent's Hospital. A young woman I met through my clinic needs a colostomy reversal operation and cannot get into St. Vincent's Hospital because there are no beds. She was told she had to have the operation within a year. It is now the last month of that year and there is no sign that she will receive the necessary treatment. By fining St. Vincent's Hospital, the Minister is ensuring that there is less chance of such patients' needs being met quickly.

As regards the review, I urge the Minister to examine the context in which these hospitals operate and how they ensure that public patients are treated fairly, unlike many other hospitals which are being rewarded under the casemix system.

I reject the attempts to personalise the casemix process as "his approach", that is, the Minister's approach. It has been the approach of successive Governments and is an internationally accepted model. I cannot claim credit for inventing the casemix model.

The Minister should claim responsibility.

Order, please. The time is up and we must move on to the next question.

The Minister should not walk away from it.

I am not. We must be fair in our assessment and in terms of informing the public as to how this happened. I have often been lectured in the House and people have correctly commented about the need to be vigilant in maintaining value for money. This is probably the one model which attempts to achieve a value for money efficiency approach to the organisation of acute hospital activity.

As regards the Deputy's point about length of stay, the hospitals are not penalised for excessive length of stay and are not given credit for quick patient turnover. It is about the cost per case for the same case across hospitals. The costs are higher for the same type of case in some hospitals compared with others. Hospitals can make submissions. Accident and emergency departments place a significant degree of pressure on certain hospitals compared with others. These factors can be taken into account in the casemix model.

There is a need to modernise and enhance the model because there has been a comprehensive review of it. However, we have also examined other models, especially the Australian model, with a view to adapting them to the Irish situation. A report has almost been completed and submitted to the Secretary General of the Department. I have not seen the full report yet but, when I do, it will be sent to the Government for decision.

The argument that we are reducing patients' chances does not stand up. Additional patients are treated year on year in many hospitals under the casemix model. Using comparable figures, there was an increase of 72,000 patients for the years 1999 to 2001. There has been an ongoing increase in patient numbers year on year.

May I ask a further question?

We are well over the time. I must call Question No. 137.

Medical Cards.

Questions (15)

Caoimhghín Ó Caoláin

Question:

137 Caoimhghín Ó Caoláin asked the Minister for Health and Children the details of the new income guidelines for medical card qualification; and if it is intended to extend qualification as promised before the general election in 2002. [1789/04]

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Oral answers (20 contributions) (Question to Minister for Health and Children)

The medical card income guidelines issued by the chief executive officers of the health boards for 2004 are effective from 1 January 2004. They are as follows: a single person aged up to 65 years and living alone —€142.50; a single person aged between 66 and 69 years and living alone —€156; a single person aged up to 65 years and living with a family —€127; a single person aged between 66 and 69 years of age and living with a family —€134; a married couple aged up to 65 years —€206.50; and a married couple aged between 66 and 69 years —€231. The allowance for children under 16 years is €26 and is €27 for a dependant aged more than 16 years with no income maintained by the applicant. The allowance for outgoings on house, rent, etc. is €26, and for reasonable expenses necessarily incurred in travelling to work the allowance is €23.

The health strategy includes a commitment that significant improvements will be made in the medical card income guidelines to increase the number of persons on low income eligible for a medical card and to give priority to families with children, especially children with a disability. This should be viewed in the broader context of the strategy's emphasis on fairness and its stated objective of reducing health inequalities in our society. Due to the prevailing budgetary situation, I regret it is not possible to meet this commitment this year, but the Government remains committed to the introduction of the necessary changes within the lifetime of the Government.

Before the next election.

It should be remembered that health board chief executive officers have discretion in terms of issuing medical cards and also that a range of income sources are excluded by health boards when assessing medical card eligibility. Many allowances, such as carers' allowance, child benefit, domiciliary care allowance, family income supplement and foster care allowance are disregarded when determining a person's eligibility. Given these factors and the discretionary powers of CEOs, having an income that exceeds the guidelines does not mean that a person will not be eligible for a medical card, and a medical card may still be awarded if the chief executive officer considers that a person's medical needs or other circumstances would justify it. Non-medical card holders and people with conditions not covered under the long-term illness scheme can avail of the drugs payment scheme. Under this scheme, no individual or family unit pays more than €78 per calendar month towards the cost of approved prescribed medicines.

The health strategy emphasises fairness and the objective of reducing health inequalities in our society. Shorter waiting times for public patients are prioritised with the expansion of bed numbers and the introduction of the national treatment purchase fund. In addition, there are clear commitments to targeting vulnerable and disadvantaged groups, including continued investment in services for people with disabilities and older people, initiatives to improve the health of Travellers, homeless people, drug misusers, asylum seekers, refugees and prisoners and the implementation of the national anti-poverty strategy targets relating to health.

I am almost speechless as a result of the Minister's response. I will do him one little courtesy by not referring to the Government's pre-2002 general election promise to extend the medical card to more than 200,000 additional people because he is already sufficiently discredited on that point.

The Government's health strategy, under what it calls, "National Goal No. 2 — Fair Access", promises to increase income guidelines for medical cards. Last year a married couple aged up to 65 years were entitled to a medical card if their income was under €200. However, the Minister has indicated in his reply that that figure has been increased by €6.50 for the current year, which is a 3.25% increase. Was that the best the Minister could do? If a married couple with two children under 16 years of age have an income of €260 per week, they will not qualify for a medical card.

Under the Minister's guidelines families with young children regularly face a terrible choice. To visit a GP costs between €30 and €50 depending on where in the country one is domiciled. Families must choose which of their daily needs to do without to visit a GP with a sick child. Up to one fifth and in some cases one quarter of a weekly income is spent on the GP visit alone, before the cost of medication. The figures the Minister has announced for 2004 continue a pattern that is removed from the reality of the daily living conditions of ordinary people and contributes to the basis of ill-health. Real needs, particularly those of children, which the Minister emphasised, are not being addressed because of the terrible and stark choices facing families.

How does the Minister morally justify the extension of the medical card to all over the age of 70, regardless of income or means, while children up to the age of 18 years, some living in real or relative poverty, do not have the benefit of a medical card? I do not believe that the Minister can morally justify that. This is a very serious matter affecting an increasing number of people because the curtailments and restrictions introduced on the medical card leave people in real poverty on a daily basis.

It is medically established that people over 70 have far greater need to visit their GPs than those under 70, perhaps with the exception of young children. The Deputy voted in this House for the measure that he now finds morally reprehensible.

I am asking the Minister to justify it morally.

The Deputy voted for it and the record speaks for itself.

I asked the Minister to justify it morally. There is a major difference.

The Government gave this commitment and I regret it is not in a position to deal with it this year, but there has been fiscal confinement or restraint for the past two years. I have concentrated on other areas of our commitments, particularly to have public patients treated faster. Soon we will reach the point where 12,000 who had been waiting longer than 12 months will have been treated by the national treatment purchase fund, to which we allocated €30 million. The cost of the GMS has risen dramatically in the past two years, from €890 million in 2002 to €1.2 billion. These are all factors at which we have been looking and we have been drilling deeply into the GMS scheme to see if we can effect savings that can be returned to the people whom the Deputy mentioned. The significant escalation of the GMS, however, cannot go unnoticed or uncommented on, or be tossed aside as if it has no application to the decisions we take.

There are fewer people in the GMS scheme today.

That is a fairly significant factor which requires reflection.

The Minister is causing that problem.

The consumption levels of medicine are increasing each year——

So is the number of people over 70.

——as is the rate of prescribing.

Why penalise patients?

They are the key factors. One only has to look at drugs such as statins, peptic ulcer drugs and so on for an illustration of that.

The Minister is encouraging that. It is a good thing.

Yes, it is a good thing, but it is a factor.

Others are affected as a result of that.

Mental Health Services.

Questions (16)

Dan Neville

Question:

138 Mr. Neville asked the Minister for Health and Children if he will set up a public independent investigation into the midlands psychiatric hospital in which a mildly autistic person was allegedly repeatedly raped; his views on the opinion of the rape crisis network that sexual violence against persons with disabilities in residential institutions is prevalent; and if he will investigate the extent of this and appoint an independent inspectorate which has the expertise and authority to identify whether residential settings can protect the human rights of residents. [1696/04]

View answer

Oral answers (7 contributions) (Question to Minister for Health and Children)

An independent inspectorate of psychiatric hospitals has existed for many years, under the provisions of the Mental Treatment Act 1945. The Inspector of Mental Hospitals, Dr. Dermot Walsh, who is retiring this year, has for many years inspected our psychiatric hospitals and issued detailed reports on matters arising from his inspections, including those pertaining to patients' human rights.

This year, a new inspector of mental health services, Dr. Teresa Carey, has taken office. Dr. Carey, who is employed by the Mental Health Commission, has a broad remit under the Mental Health Act 2001 to inspect all facilities where mental health services are provided. Under section 55 of the Mental Health Act 2001 the Minister may request the Mental Health Commission to cause the inspector to inquire into any matter in respect of which an inquiry is appropriate. Yesterday, I invoked my powers under the Act and formally requested the commission to inquire into the case referred to by the Deputy.

The Midland Health Board informs me that, to date, it has received no formal allegation of rape in this case. The board has indicated in writing to the Garda Síochána that it will co-operate fully with any Garda investigation and will respect the primary role of the gardaí in investigating allegations of a criminal nature. The board has also taken steps to investigate the matters which fall within its control and to establish an independent review group to review the care this former patient received while in its care. In particular, this group will review all pertinent matters concerning this former patient while in the care of mental health services in the Midland Health Board, investigate allegations made on behalf of the former patient by her father and review the response of the board's mental health services to previous complaints made by this patient's father on her behalf while she was in the care of those services. The group will make any recommendations deemed appropriate on the board's care management systems, processes and services and submit a report to the board's chief executive officer.

In line with Government policy, the transfer of patients with an intellectual disability from psychiatric hospitals is ongoing. The transfer programme aims to provide more appropriate care settings and enhanced levels of services for persons with an intellectual disability and those with autism accommodated in psychiatric hospitals. In his report for the year ended December 2002, the Inspector of Mental Hospitals acknowledges and details the considerable progress made in recent years in transferring such patients to appropriate facilities.

I remain committed to ensuring that all persons with intellectual disability receive appropriate care and treatment in suitable facilities. I have no evidence to support the assertion that sexual violence against persons with disabilities in residential institutions is prevalent and urge any agency with evidence to this effect to make such evidence available to the appropriate authorities.

I thank the Minister of State for his reply and welcome the announcement that the commission to investigate this case has been set up. We look forward to a speedy conclusion of that investigation and a report on it. Is the Minister of State concerned at the statement of the rape crisis network and, although he says he has no knowledge of the fact, that such an organisation should state that sexual violence against people with disabilities in residential institutions is prevalent? Research highlighted the difficulty women with learning difficulties had in gaining access to medical, psychological and legal help when sexually abused as there was a culture of disbelief. Will the Minister examine that issue because the rape crisis network and CARI have expressed concern about it? Is he concerned at the statement that the greater the level of disability the greater the risk of sexual violence — in most cases this refers to rape?

Anybody would be concerned and the Government would be especially so if there were substantiated allegations of sexual violence against residents in any institution. If the Deputy or those organisations which have made statements have evidence to substantiate these allegations I will investigate them.

The Minister of State should be concerned that such bodies as the rape crisis network and CARI would publicly make such statements about these places, rather than looking for information on specific events which these organisations may not have permission to reveal. In such circumstances many families would not reveal that information because of the difficulties it might create for the victims. There is an onus on the Minister to investigate the statements of eminent bodies which suggest that sexual violence is prevalent in such institutions.

As I said in my reply, Dr. Dermot Walsh was an inspector for many years, and we now have a new inspector, Dr. Teresa Carey. She regularly inspects all aspects of care in our institutions, as did Dr. Walsh for many years. I will bring to her attention the statements made by these bodies, and if there is any substance to the allegations, I will do my best to ensure they are examined.

It is clear that if this is happening, it is without the knowledge of the institutions. If there is a problem, the institutions may not be fully aware of it. The inspector may call annually to examine books and so on, but the concern is that if something is happening without the institutions knowing of it, it may not come to the attention of the inspector.

I do not want to delay the House, but as the Deputy knows, allegations such as those to which he refers are extremely difficult to prove. Allegations have been made in the past which have not been substantiated. I have responsibilities to the employees in the institutions as well as to patients, and I am aware of unsubstantiated allegations made against specific people in institutions. I am also aware, as is the Deputy, of certain cases where unsubstantiated allegations were made against some employees. That causes major problems, not only for the employees but for their families and the health boards. One has to be extremely careful in examining any of these allegations.

Smoking Ban.

Questions (17)

Liz McManus

Question:

139 Ms McManus asked the Minister for Health and Children when he expects the draft regulations regarding smoking in the workplace to come into operation; if any comments have been submitted or objections raised by other EU member states; the procedures that will be put in place to monitor and ensure compliance with the regulations; the planned start-up date for implementation of the prohibition on smoking; and if he will make a statement on the matter. [2105/04]

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Oral answers (12 contributions) (Question to Minister for Health and Children)

A report commissioned by the Office of Tobacco Control and the Health and Safety Authority on the health effects of environmental tobacco smoke in the workplace was published in January 2003. This report was prepared by an independent scientific working group. The conclusions of the expert group are quite blunt on the risks to health from environmental tobacco smoke. Environmental tobacco smoke is a cause of cancer, heart disease and respiratory problems. Employees need to be protected from exposure at work. Current ventilation technology is ineffective at removing the risk to health. Legislative measures are required to protect workers from the adverse effects of exposure.

A draft of regulations to prohibit smoking in the workplace was notified to the Commission in April 2003, and during the three-month standstill period, which allows member states to voice opinions on the measure, no objections or reservations were put forward. The Commission was notified of two amendments to the draft regulations in November 2003 to allow for exemptions for prisons and outdoor work areas and for psychiatric hospitals, nursing homes, certain charitable institutions and sleeping accommodation in hotels, guest houses and bed and breakfast accommodation. As a result of these amendments, it was necessary to change the commencement date for the introduction of the ban. The standstill period for the amendments notified will end on 4 February and 16 February 2004.

Surveys carried out by the Office of Tobacco Control show widespread support for smoke-free workplaces, and the trade union movement is strongly in favour of the measure.

The owner, manager or person in charge of a workplace is legally responsible for ensuring compliance with health and safety requirements, including the prohibition on smoking in the workplace. As part of the process of monitoring compliance with the smoke-free workplace requirement, authorised officers from the health boards and the Office of Tobacco Control will visit premises. I expect that the vast majority of employers, employees and the public will respect the new measures which are primarily to protect people from exposure to toxic environmental tobacco smoke. I will make a decision on the new date for commencement of the smoke-free workplace regulations in the near future.

Is the Minister aware that he is being criticised for creating a political and administrative muddle that has now become a farce, that this is not my criticism but that of the media, and that he has shown himself to be remarkably inept in trying to achieve a goal supported by the Opposition and approximately 60% of the population? Despite such considerable support — I cannot say the same for the support he receives from his backbenchers — he has failed abysmally to deliver the ban he promised. Why can he not tell us when the ban will become law? He has had to revoke the date he set. I understand the ban was to be introduced on 4 January. He has twice amended the statutory instrument, a sign of the muddling and bungling in an area for which he is responsible.

Regarding the implementation of the regulations, there remains an issue which he has again failed to deal with. Who will monitor workplaces other than those where food and drink are sold? This is not within the Minister's competence, as it is the responsibility of the Department of Enterprise, Trade and Employment, but I would like him to answer the question. It is clear these workplaces will not be monitored by environmental health officers, nor by staff of the Health and Safety Authority, without new legislation, as I understand it. Does the Minister propose to introduce — at some stage — a ban on smoking in the workplace without the means and staff to implement it in a large sector of working environments which do not include pubs and bars in restaurants and hotels?

Is he going to wait for the Tánaiste to bring it in for him?

I reject the charges made by the Deputy regarding the introduction of the ban. We have had a very significant debate over the past year which has resulted in a significant public consensus being built up. I and others engaged in that debate in order to convince people of the merits of this approach. The ban will be a major milestone in public health legislation in this country.

The Minister will have to convinceThe Irish Times of that.

I will take criticism on the chin. It does not worry me. I keep my eye on the big picture.

That is part of the problem. The Minister should listen a little more.

He said he would have the legislation on the ban ready.

The Minister without interruption.

I gave the Deputy latitude to make her points without interruption. I am keeping my eye on the big picture, which is the introduction of this measure. It is a very significant milestone in terms of protection of public health and one which people want to see implemented.

When we debated these regulations, all the Members on the other side of the House implored me to grant exemptions for the areas I have mentioned, such as psychiatric nursing homes. We took a cautious approach in deciding to create legal exemptions as per the regulations. Under the European transparency directive, they must be notified to Brussels. Even though the main regulations have been notified without any objections or observations, and one might argue that there was no need to notify the exemptions, we did so in order to be safe. The standstill period will end shortly. No objections, opinions or reservations have been articulated. Once the standstill period ends, we will be able to give a definitive date. It is wise to wait until the standstill period concludes, particularly relating to 4 February, and that is one of the issues which is a factor in terms of the definitive date being announced.

We sought legal advice on cross-authorisation, and the Office of Tobacco Control has powers under the Public Health (Tobacco) Act to cross-authorise. We are in discussions with the Department of Enterprise, Trade and Employment and the Health and Safety Authority regarding the issues raised by the Deputy.

Is legislation needed?

No. There is a very explicit provision in the Public Health (Tobacco) Act which facilitates cross-authorisation.