Vol. 148 No. 2
While there are no amendments down today, there are some points I wish to make regarding the two sections in the Bill. The Bill is totally dependent on the health boards being given finances — which is covered in section 2 — and on agreements reached between them and GPs.
Regarding the position of people who have applied to the tribunal but who have been offered——
The Senator is entitled to speak on sections 1 and 2 but the points he is making are more relevant to section 2.
I will refrain from mentioning the health board in discussing this section. The Bill sets certain procedures in place for the welfare of hepatitis C sufferers. The Minister indicated in a recent statement that he is allowing victims to postpone their hearings at the tribunal. I do not know where I can raise that matter other than section 1. It is of vital importance that the people involved know for how long they can postpone their hearings. Can they postpone them for a year or indefinitely? This is important because the House will be aware there is a test case in the courts and it would seem logical that we await the outcome of that test case, which may go to the Supreme Court. This information is of vital importance to the public and particularly to the victims of hepatitis C. The Minister should inform the House of the timescale regarding these postponements. Already some people have, to some extent, been railroaded into applying to the tribunal. The deadline set was totally unrealistic; it was a brow beating exercise as far as the victims were concerned. They have suffered greatly at the hands of the Minister because he has refused their request for a tribunal on a statutory basis and has forced them to apply to the tribunal. They want to know to what type of postponement they are entitled under the legislation.
We discussed this matter at length on Second Stage last week. Since then I understand 1,600 people who were infected with hepatitis C by contaminated blood products applied for compensation to the tribunal before the closing date on 17 June. I am pleased to note Positive Action has also decided to go to the tribunal. I understand it has stated that it reserves its right to legal action at a further date. I hope it will not be necessary. They have reservations about aspects of the procedure of the tribunal but I am delighted they have applied to keep their options open.
The Minister for Health indicated last week that the Department identified 1,356 cases of people suffering from hepatitis C and these are covered by the 1,600 applications to the tribunal.
As I stated last week — and I hope the Minister will confirm this — if people do not want to go before the tribunal, they have the option to pursue a case in the courts. If those who go before the tribunal are not satisfied with the award they receive, they also have the option of pursuing a court action. The tribunal is also empowered to make provisional awards. The Government and the Minister for Health have gone out of their way to try to assist people who have suffered because of hepatitis C. The House should pass the Bill as soon as possible to allow this procedure to be put in place.
I welcome the Minister to this debate on the Final Stages of the Bill. On Second Stage, Members welcomed the health provisions of this Bill which are designed to aid victims of hepatitis C. However, there are many reservations about the tribunal.
In fairness to Senator Doyle, it could not be claimed as a victory for the Government that 1,600 people applied to the tribunal. These people were given no choice because of the deadline of 17 June and were obliged to apply to the tribunal to protect their own interests. Many were very angry about having to do so. I am aware that the victims can reserve the right to pursue a case in the courts if they are unhappy with the awards made by the tribunal. However, many are anxious that their cases should not be heard by the tribunal until after a judgment is handed down in the case currently before the High Court. When Positive Action sought a judicial review into the matter of donor X, the cause of her infection, the point at which the Blood Transfusion Service Board became aware of it and whether this information was made available to the expert group, it was informed by the Minister that the High Court case would be, in effect, the judicial review. Positive Action should have been allowed to wait until a judgment was handed down in that case before deciding whether to go before the courts.
I am very anxious about recent press reports that a sum of money will be lodged in court by the Government and, if the awards they are given fall below this, the women involved will be obliged to meet the cost of legal fees. There is a lack of trust between many of the victims and the Government due to the history of this issue. Those victims were infected through the negligence of a State board and many are wary of placing their trust in the institutions of the State. It is not helpful that they are being railroaded into situations about which they are unhappy. Individuals affected by this matter have suffered much personal anger and are unsure of their future. In the cold light of day, it is difficult for those who are not affected to understand the problems involved. However, we must try to understand the feelings of those involved. They should not be railroaded into making decisions which they believe are not in their interests. Again, I must state that I am concerned about press reports that the Government, acting on our behalf, is pushing these people into a situation in which they do not wish to be.
Limerick East): Senators are aware that this is a health Bill. We have achieved full agreement with the four interest groups on the measures being put in place to guarantee a life-long health service to people unfortunate enough to be victims of hepatitis C or who contracted hepatitis C antibodies. We negotiated an extension of the closing date for the tribunal from three months to six months. The tribunal made it clear, through public advertisements, that it was operating to the date in question.
I remind Senators that the tribunal merely provides an alternative to claiming compensation through the courts. The health issue is separate and full agreement was achieved in that regard. The only area where there is some disagreement is the manner in which compensation claims may be pursued. The tribunal was established because of the numbers involved and, as I pointed out on a number of occasions, the advantages it has over the courts system. If people are not happy with an award made by the tribunal, they do not have to accept it and will not concede any rights as a result. People will be given one month to consider an award and if they accept it, they will have been compensated. I read newspaper reports which seemed to suggest that these people should be allowed to go before the courts to obtain further compensation. There are alternative systems in place and people can either go before the compensation tribunal or the courts.
Compensation is measured in accordance with the law of tort, which applies to the tribunal and the courts. If people are satisfied with awards given by the compensation tribunal, they will be advised to accept by their legal advisers. They will then decide whether to accept the award. If they accept, that ends the matter of compensation. However, the health issues continue. This Bill is designed to ensure that people, regardless of their means or the compensation they receive, will have free access to general practitioners and the services listed in section 2. If a person does not accept an award, they can pursue the matter in the courts.
An earlier speaker stated that a test case is currently before the courts, but this is not correct. I am concerned about the legal costs involved with processing large numbers of compensation claims. I want the tribunal to proceed, as it is at present, to give fair compensation awards to victims. The tribunal has been so satisfactory that, to date, no one has rejected an award. This is a fair measure of the satisfaction of applicants. However, a test case is not currently before the courts. If legal people describe something as a test case, they are entitled to charge more. There is no test case in the courts at present, but a first case, which is like any other compensation case, has been scheduled for hearing.
I am not arguing that there will be some kind of judicial inquiry when the first case comes before the High Court. I am merely stating that the normal powers of the High Court will apply when that first case comes before it. As a consequence of an applicant pursuing a compensation claim, the issues about which people are concerned will be investigated. The purpose of that case is not to have some kind of judicial inquiry; it is to enable a particular person to pursue a claim for damages. They must retain their civil rights in doing so, as they would in claiming compensation for a car accident or breaking their leg as a result of a fall in the street. If a such a situation comes before the courts, the first issue to be decided will be that of an individual's or institution's liability. The issue of liability is connected to that of negligence. Senators should not make categoric statements about these issues which will be at the centre of any court case, whether it is that listed for 8 October or a subsequent case.
One of the major advantages of the tribunal is that the issue of liability does not arise. An applicant need only prove to the tribunal that they contracted the hepatitis C virus or antibodies from infected blood or blood products. The only proof required by the tribunal is the connection between the infection and the infected blood or blood product. In the case of Positive Action, because the infection of its members was discovered as a result of a national screening programme, which screened 58,000 people, it is self-evident that the proof exists. These people were notified by the Blood Transfusion Service Board that they had tested positive.
There is no issue at stake in respect of these applicants, who need only submit the evidence that they were so notified. The tribunal will not discuss negligence or liability, it will simply measure the amount of damages to be paid in accordance with the law or tort. All the usual considerations then apply — the state of the person's health and the prognosis but also loss of earnings. Compensation is measured in the normal way, and our country is litigious enough for Senators to be familiar with that. The law of tort will operate the same way in the court as in the tribunal. We should not pre-empt the work of a court by stating on the record that an institution was liable or negligent — it may or may not have been, but those issues have not been tested in court yet. A person pursuing a claim through the tribunal does not have to pursue those issues, she can proceed quickly, privately and anonymously to compensation. As I said, people are happy with the level of compensation and the proof of the pudding is in the eating — over 70 awards have been made and none has been rejected. The women have legal advisers, they may consider the award for a month and may either accept or reject it.
On the options, if a person applies to the tribunal she may withdraw her application tomorrow if she wants. No one can force anyone to do what she does not want. What I said in the other House was that I had been informed by the tribunal that no one would be forced to have a hearing she did not want to have.
However, there are good reasons that people should be allowed into the tribunal, because vested interests are operating. I am not speaking about the women or men who have hepatitis C or about those who represent them. There is a public interest in this, because ultimately it is the Irish taxpayer who will provide the money. My best estimate of what will happen in the compensation tribunal is that awards may total over £200 million. Everyone knows what the legal fees were in the beef tribunal and I would not like to put unnecessary expense on the Irish people, because this is a taxpayers' issue. I cast no aspersions on any individual solicitor or barrister, that is not in question. We are blessed with a good legal profession. Our solicitors and barristers are good advocates and always serve their clients. In general terms, there is a cost issue, although I am not talking about the total cost of awards made. Whether the case is pursued in the tribunal or in the court, the manner in which the compensation awards are measured will be the same, in accordance with the law of tort. However, the legal costs will be lower if the case is processed through a tribunal. It stands to reason that if a tribunal is sitting four days a week and processing three cases a day, the legal costs will not be as high as for individual cases taking six to ten weeks in the High Court, with huge teams of barristers supported by solicitors. The cost issue is therefore not one of compensation but of legal fees.
Nonetheless, all options are open. A person can go to the court or the tribunal. If she has applied to the tribunal, she can withdraw the application or pursue it; if she pursues it and receives an award, she has a month to decide whether to accept it; if in the course of that month she decides to reject it, she can either recommence an action started in the High Court or begin again from the start. No rights are being taken away and the only addition to that information, which I provided as a point of clarification rather than a new point in the other House, is that the tribunal has advised me it will not force people into a hearing which they do not want.
The tribunal will last indefinitely. People have said that one cannot have such a tribunal because everything finishes; but this tribunal is unique and operates differently from the Stardust tribunal and the courts in that it can make provisional awards. The nature of a provisional award is that one can go back in years to come on a certain prognosis and claim additional compensation, so it must continue indefinitely. Clearly, when all the applications are processed in two to three years, the tribunal will not meet four days a week; but it must be in existence and available for a hearing if a person wishes to return to it.
We are all in the business of politics — the Opposition makes charges, we reject them, etc. — but there is another consideration. I believe that unnecessary stress and trauma are being caused to individual applicants and their families by people pretending that the best tribunal ever set up in this country is somehow faulty and that people are being treated unfairly, when no group was ever treated like this before and given such a sophisticated mechanism for compensation without taking away any rights they may have to proceed to court. As I said, it is only an alternative — in my view a desirable alternative —to the courts.
I am a defendant in the High Court cases, although not personally. The defendants are the BTSB, the health board involved, the Minister for Health, the Attorney General and Ireland, the normal formula when an agency of the State is being sued. If a Senator argues with me about the court case, I cannot reply to his questions; nor may I intrude into the confidential relationship between legal advisers and clients. So if he asks me how a particular defendant or legal adviser is proceeding, I cannot answer.
I did not hear the Minister answer my question about how long someone may postpone her hearing. I am amazed he compares the first High Court case on hepatitis C with a case on a broken leg suffered in a road accident. There is no comparison between those cases. While he may play with words to say it is not a test case, the first case on hepatitis C in this State is currently before the High Court, so how else can one describe it? It will be used as a precedent in all other such cases taken to court, so one must term it a test case. It does not compare in any way to a case following a road accident; they have nothing in common other than that both are being dealt with in court, and there the similarity ends.
The Minister said he will oppose the court cases. This means that while one has the option to go to the tribunal or to court, the difference is that the State will defend the court case. Liability has been accepted to some extent, in so far as the tribunal has been set up and money is being provided to hepatitis C victims. It is the case that an arm of the State was involved in giving faulty blood products to people, which resulted in them getting hepatitis C — those are the facts.
The provisional award is not everything it is made out to be, because it is not guaranteed that everyone will get one on request. If the Minister was to say that everyone would receive a provisional award on request at the tribunal and that in five or ten years, in the event of their condition deteriorating, they could seek further damages, that would be a different matter. However, the Minister has not said that, nor has he given such a guarantee, so it is not as marvellous as he states.
It is unfair of him to say the Opposition is scaremongering. The people involved have made constant and persistent representation to the Opposition parties and if it was not for the associations representing women with hepatitis C and the Opposition, we would not have gone as far as we have. The Department and the Minister were dragged into this by the pressure applied by the associations representing the women and the Opposition as the record of the Houses will show. The Minister should indicate what he means by the postponement of hearings? For how long will people be able to postpone their hearings?
The Minister said that when the cases are taken to court he would be the defendant in the matter as Minister. Therein lies the difficulty; he would be the defendant and the women taking the cases would be plaintiffs. Who is representing the public interest as opposed to the State's interest in this matter? The Minister said the matter is of public interest because the taxpayer will have to pay for awards granted to the victims. There is great concern about how these people became infected.
The Minister referred to the issue of negligence. Liability has been accepted in the cases before the tribunal. The State has no choice; it has accepted that the blood products involved were from a donor who had clinical jaundice and this was known by the Blood Transfusion Service Board as far back as 1976, before any of the plasma from the donor was used to manufacture anti-D.
In the circumstances it would be difficult for the State to contest liability. The victims are innocent and the lives of many of them have been devastated. They have contracted hepatitis C for which there is no known cure and many of them face cirrhosis of the liver and liver transplants. It would be ridiculous for anybody to argue that the State has no liability in the matter.
I accept what the Minister said about the legal fees and the cost to the taxpayer but the main public concern should be about how the victims contracted hepatitis C at the hands of a State board. The only sanction for members of that board was retirement with a golden handshake. That hurt the women involved. The only court action taken by the State was against a victim who went to court to force her to disclose her name. I do not approve of that action being taken by the State on my behalf.
It is regrettable that we have not been able to convince many people of the benefits of the tribunal and that their interests would be looked after by it. Many of the issues of concern have been discussed in the Oireachtas. Assurances that no applicant would have their case heard before the tribunal without an agreement was reassuring to many people. It is also reassuring for them to know that all those who requested provisional awards to date have been granted them. However, as Senator Finneran said, that is not a guarantee for future applicants. They should have a written contract.
Many of the issues of concern to the applicants only became clear when they were discussed in the Oireachtas; they were not clear in the negotiations. However, there is no commitment that applicants will get a provisional award. The Minister may alter the terms of the tribunal and he could ensure that it was a condition that provisional awards would be made when requested by the applicants.
These issues have led to mistrust and a lack of confidence on the part of many people, which is regrettable given the circumstances in which they contracted hepatitis C.
The Minister has given a clear outline of how the compensation element works, whether it be through the tribunal or the courts. On Second Stage I said that I find it difficult to understand the criticisms that have been made against the tribunal, given that the Government has facilitated the victims. A number of those making the criticisms of the tribunal are those who did not wish to make compensation available to the haemophiliacs who contracted AIDS through an infected blood product in 1989. At that time the Houses of the Oireachtas refused to pass two motions calling for compensation for those people. Compensation was eventually given because it was the will of the people.
The Minister has generously put forward a tribunal with compensation available. As he said, 70 cases have been heard and the applicants have accepted their awards. If we allow this issue to continue, we will only increase the trauma of the victims. It should be our aim to see how best the victims' problems can be solved. To date the tribunal has proved the best approach because every award made has been accepted. In fairness to the victims we should bring this matter to a conclusion and allow compensation to be paid.
(Limerick East): As to the political charge that I have been dragged into action, if Senators look back at debates in the initial stages they will find that I said the areas of concern fell into two categories — health issues and compensation issues and I laid out the principles by which we would proceed.
There are four different interest groups involved — Positive Action, Transfusion Positive, the Irish Kidney Association and the Irish Haemophiliac Association. We have negotiated with all the groups. We have the full support of the four groups for all the health initiatives we are taking which were always stated to be the priority. I have heard many Deputies and Senators say they have been informed categorically by members of the interest groups that health and not money was the issue. This is a health Bill yet the debate seems to be about compensation which, although interesting, is outside the terms of the Bill.
The Bill gives free medical care and a range of services, including nursing, dental and ophthalmic care, counselling and any other services that may be necessary in the future.
They are available for life.
(Limerick East): Yes, they are available for life. Senators are familiar with the means test requirement to qualify for the medical card. However, in this case, regardless of compensation paid through the courts or the tribunal, there will be no means test. Access to this range of services for life will be without a means test. The health issue has been fully agreed and this the final phase. When this Bill is enacted its provisions will have a statutory basis.
Compensation is a different issue. Given that there would be so many people involved and many of them wished to remain anonymous — they did not want their identities made known to their neighbours or at their places of work — I felt a tribunal along the lines of the Stardust tribunal, although having learned lessons from the unsophisticated nature of that tribunal, would be a good alternative.
I became Minister for Justice in December 1982 and the Stardust fire had been about two years previously. In 1984 the cases arising from the fire were backed up in the High Court and no progress was being made. The then Leader of the Opposition, Mr. Haughey, in whose constituency the fire had taken place, was upset about the matter. He raised it publicly, but he also came to me privately asking if we could do something. John Rogers, S.C., was Attorney General at the time and he, together with myself as Minister for Justice and our officials, put the Stardust package together. That was the only other tribunal in the history of the State to deal with compensation to a large group of people.
The Stardust tribunal experienced many problems until it got underway. There were all sorts of criticisms and charges laid at it as well as claims that it was unfair. However, at the end of the day as soon as cases began to be processed, people accepted awards and they were happy with it. This tribunal is far more sophisticated. There were no provisional awards available at the Stardust tribunal.
I have been challenged as to why I did not include certain items in the terms of reference. What I put in the terms of reference were the general guidelines under which the tribunal would operate. If I got into too great a level of detail in the terms of reference I would tie the tribunal hand and foot and it would not be able to use its own discretion. I decided to give it general guidelines and appoint competent people.
People asked me whether I would appoint a District Court or a Circuit Court judge to head the tribunal. I appointed a former judge of the Supreme Court, who is a most eminent and generous man and whose record in compensation awards during his period in the High Court suggests that he was a generous, caring man who would look after people's individual needs. That is how it has worked out. I am not going to take a man like that and put him in charge of a tribunal simply to follow the instructions of a Minister and civil servants who have absolutely no experience, whatever our other virtues, in dealing in compensation issues.
There are also four women on the tribunal. They are barristers and solicitors who in my view are eminent enough to be worthy of being judges. The tribunal meets with Mr. Justice Egan chairing it and two of the women sitting with him. They do not all sit together; it is a tribunal of three. I have given them the discretion to run it within set guidelines, but I do not want them tied hand and foot so they cannot have discretion in dealing with individual cases.
I gave the tribunal the discretion to decide whether someone should get a provisional award in case a solicitor looked for a provisional award in circumstances where it was clear that it was not in the financial interest of the applicant to pursue a provisional award. I am normally accused of doing this to save money because the more provisional awards the compensation tribunal makes, the less immediate cost there is on the State. By definition a full and final settlement award will always be significantly larger than a provisional award.
I included this provision because solicitors, while a very good profession and so on, sometimes make mistakes. If they were to advise an applicant to opt for a provisional award where it was clear to the tribunal that the situation would not deteriorate in any way, they would be short-changed by a tribunal because they made the wrong application. That is why the discretion was given. What has happened in practice is that the tribunal has not refused anybody a provisional award. However, I happen to know as a result of a conversation I had that the tribunal advised legal advisers on a number of occasions that instead of looking for full and final settlement, it might be in the interest of their client to opt for the provisional award.
I am not rooted in not changing. One of the major reasons we decided to go the informal rather than statutory route was so we would have the flexibility to respond to problems as they arose. If it was all nailed into statute we might not get back here for another 18 months. I have the power to change the terms of reference of the tribunal if something arises. I am leaving that option open all the time because I want the tribunal to operate in the interests of the applicants. However, it is in the interests of the applicants to allow the people running the tribunal under Mr. Justice Egan discretion to handle individual cases.
The charge is that we are doing something wrong because the provisional award is at the discretion of the tribunal. It is suggested that we provide that anyone who applies for a provisional award should get it. That is grand if a person is sure that it is in their interest to pursue the provisional award. However, if I write that into the legislation and somebody applies for a provisional award when it is as clear as crystal that they would be much better off with a lump sum by way of full and final settlement, will you all come back and ask me why I wrote it in and say that the judge could do nothing because I handcuffed him? That is the problem I am facing on this issue. We all know informally from the way the tribunal is operating that they have no intention of turning down any application for a provisional award if it is in the interests of the applicant. They are proceeding on that basis and will continue to do so.
We have not admitted liability at the tribunal. We have simply said that liability is a matter for the courts but we are setting that aside when giving awards at the tribunal. All a person must prove at the tribunal is that they unfortunately have hepatitis C antibodies or hepatitis C itself. Once that link has been proved by the testing, a person is entitled to compensation. All the tribunal decides is the amount and the manner of payment. The amount is in accordance with each application's individual position and the manner is either full and final settlement or provisional payment with the right to go back. That is what the tribunal decides and it is working extremely well.
If modifications are required in the future, we will look at what has happened in the autumn when a good cohort of cases have gone through. We will see if fine tuning is required in the terms of reference and I will take the advice of Members. Senator Honan has been very involved in this from the start and has given me very good advice privately on this issue. Senator Finneran is carrying the case for his party today and I know he has a strong interest in it as well. I will listen to people, but we must proceed on the basis that we accept each other's bona fides and goodwill. We are trying to be helpful and put a package together. This is very difficult in all circumstances.
I was asked about postponement. It is not a question of postponement. Applications are lodged but a date of hearing is not fixed. I have been informed by the tribunal that they will not fix a date for hearing unless there is an agreement. It is not the case that people have a date which is being postponed. They are doing that all the time because people are not available on the day. The issue is that the tribunal will not arrange a date for hearing without consultation with applicants and agreement. People who do not want an early hearing do not have to go through a process which will give them an early date. That is the advice we have been given. The tribunal has worked very well in all respects thus far and I do not see any problem with it.
This discussion is very interesting and I am glad of the opportunity to clarify these matters, but the Bill before us has absolutely nothing to do with compensation. It sets out in very simple terms how people will be in a position to get a range of services, including free service from their family doctor, regardless of means.
As the Minister said, this is just a short Bill to provide general medical services to the people who have been unfortunate enough to contract hepatitis C. It has absolutely nothing to do with the court or tribunal procedures. There are people who are suffering at present because they have contracted hepatitis C. They have major emotional and stress problems and money worries. This Bill will help them rather than hinder the situation. We must concern ourselves with these unfortunate people and move this Bill on as quickly as we can and give these people some hope. The tribunal and the courts is a discussion for another day. We should move on and not make this any more political than it is.
Section 2 is the meat of this Bill; it is about the health care programme which the Minister has decided to put in place to help people suffering from hepatitis C. The Bill sets out a laudable list of measures which will be made law to cater for the health problems of those people. However, it will only be as good as the resources made available to implement it. Herein lies the difficulty as far as this legislation and this health programme are concerned.
The Minister has allocated £2 million in 1996 to the health boards towards this programme. I have been reliably informed that to provide a health programme for a hepatitis C victim can cost up to £5,000 per annum, so £2 million will not go very far. When we debated this Bill on Second Stage, I asked the Minister if he had reached an agreement with the health boards as regards the measures he proposed in this legislation. He informed me that negotiations were ongoing but that an agreement had not been reached. I also asked if he had reached agreement with the general practitioners on the implementation of their part of the legislation. Again, I was informed negotiations were ongoing but that agreement had not been reached.
I appreciate negotiations can often be difficult, but surely in such a situation would it not be in everybody's interest that agreements and contracts, which would be made known to the public, would be available at this stage? I ask the Minister if he has reached agreement with the health boards and the general practitioners on the implementation of the health programme. How much money does the Department need to allocate to the eight health boards annually? Will the Minister assure the House that there will be transparency as regards the implementation of this health programme? Will this programme be intermingled with other health board programmes? If so, we will not be able to establish what was spent by a health board on hepatitis C victims.
The Minister should insist that health boards report on the services they provide annually and the amount of money they spend on services for hepatitis C victims so we will know exactly what the situation is. I have been a member of a health board for many years and unless the Minister allocates specific funds to this programme, the chief executive officers of the health boards at the time of the estimates will indicate to board members a shortfall in finances and the fact that they are not in a position to implement the full programme set out in law because the Minister has failed to provide adequate finances to do so. The Minister should refer to those points when replying and I hope he will be able to make a statement as regards contracts and agreements.
Whether the Minister likes it or not, women are still scared and those upon whom this major health problem has been foisted do not trust him or the Department. I appreciate the Minister's earlier statement, which was to some extent reassuring, but he will have to go further. In the future health boards could decide to do their own thing because they have a safety valve; they can say the Minister failed to respond to demands for money so they cannot implement the full programme, which would include that for hepatitis C victims. That is a worry which these people have and to which the Minister should respond. I hope he will be able to give assurances in that regard.
I welcome the services being provided for those who have contracted hepatitis C and the fact the health board "shall make available these service without charge to persons who, in the opinion of the chief executive officer of the board, have contracted hepatitis C". Transfusion Positive was concerned that its members might have difficulty acquiring their medical records and, therefore, determining proof of the contraction of hepatitis C from a blood transfusion. It is welcome that the chief executive officer of each health board will have discretion in this regard.
I support what Senator Finneran said in relation to the negotiations that have taken place with the GP bodies which will implement the provisions of this Bill. The fact that no detailed negotiations have taken place is a cause of concern to those who would qualify for the services in terms of when they will be delivered. What timescale does the Minister envisage? When does he expect these services to be available? Many people who have contacted hepatitis C still must pay for GP services and they are concerned about these issues.
I have been informed there is no consultant haematologists in Beamount Hospital, one of the six special units designated for the treatment of those who contracted hepatitis C. If we want to reassure people, promises which have been made will have to be fulfilled. I ask the Minister to ensure that no other department within a hospital will get their hands on sums earmarked for these units.
Counselling and other services are being provided for under section 2, which is a vitally important element of this. Will the Minister give an assurance that each health board will provide an independent quality counselling service which will be accessible to everyone who needs it? For instance, I have been told there is currently no independent counselling service available in the Minister's constituency of Limerick. This is of great concern to the people who have contracted hepatitis C and we need to assure them that all the provisions outlined in this Bill will be implemented.
This is a good Bill and as long as what is intended is provided, these health services will be satisfactory. However, we need assurances that the finances will be there and the health boards will not have a get out clause. Will funds be specifically allocated for the implementation of these services? Can the Minister ensure that they are not touched by any other section of the health board? The people need to be reassured on this issue.
The Minister has listened to the groups representing the victims. He went all the way on the health provisions and I compliment him for that. I would not like to be seen as always criticising the Minister; he has done a good job in this regard and he should now ensure that these provisions come into being.
(Limerick East): This Bill is dealing with primary health care. Secondary health care is already provided free of charge and that is where the £2 million to which Senator Finneran referred comes in. It is principally provided at the Mater, Beaumont, St. James's, St. Vincent's, University College Hospital Galway and Cork University Hospital. The total cost in 1994 was £1.8 million, £1.98 million in 1995 and £2 million this year, and this is adequate to provide secondary health care. What we are providing in this Bill is additional to that.
The provisions in this section range from general practitioner services to drugs, nursing, dental and counselling services. As an experienced member of a health board, Senator Finneran will know this ranges across many budgets. Therefore, making a specific allocation would be a peculiar way to fund it. Of course, additional money will be required in each health board to provide this service.
The amount required is not evenly distributed. The estimated distribution by health boards to persons with hepatitis C is as follows: in the Eastern Health Board it is 661, in the Midland Health Board it is 61, in the Mid-Western Health Board it is 105, in the NorthEastern Health Board it is 109, in the North-Western Health Board it is 44, in the Southern Health Board it is 171, in the South-Eastern Health Board it is 166 and in the Western Health Board it is 83. If one thinks in terms of the scope of free primary health care in the Western Health Board area an additional 83 people, even with these additional range of services being applied, is not a major financial issue. However, we must ensure that the Bill and its terms are implemented in full.
A liaison officer will be appointed in each health board area. That officer will liaise not only with the interest groups but with individuals to ensure that they can go to a designated person and say, for example, that they are happy with the doctor, drugs and nursing but not with the counselling. There is a specified person who can then move to correct that situation. To ensure that happens, we are instructing the chief executive officers to do that.
In the Health (Amendment) Bill, 1996, which we recently put before both Houses——
It has not come here yet.
(Limerick East):——there is a new obligation in section 15 to prepare an annual report not later than 30 June of each year. In reply to an amendment put down by Deputy Geoghegan-Quinn, I said I would invoke my powers under that section to instruct health boards to deal with specific items in the annual report which must be published by June of the subsequent year. I intend instructing them that they must specify in the annual report how they comply with the provisions of this legislation.
Having a designated liaison officer and requiring a reporting system in the annual report is the way we will ensure that, when our attention is no longer as focused on this issue as it is today, the service being provided will still be delivered and that there is a system in place to deliver it to the satisfaction of the individuals and the interest groups concerned.
With regard to the doctors, it will eventually come down to the fee, but we have precedents for negotiating it. I was not able to negotiate in case there would be changes either here or in the Dáil. If I had agreed a fee with the doctors and we had to accept an amendment which would change, even slightly, the obligation on them to deliver a service, they would reopen the issue with me, as would any professional body. We need to conclude this Bill before I am able to negotiate.
However, I do not foresee any difficulty. The numbers involved are small; the Western Health Board only has 83 people affected. We can imagine that spread across the different counties in the region. It will not be a huge imposition on any GMS doctor. We are not talking about a doctor taking on new patients but one who already has them. They are currently paying for the service but they will not have to do so in future. The doctor will be paid by the health board through the usual mechanism.
We have a precedent — we negotiated a successful immunisation scheme for a certain fee and had constant negotiations with the medical profession on appropriate fees for the extra service they provided. I do not envisage any great difficulty in this instance but we cannot negotiate until the Bill has passed through the Seanad. However, we indicated that we want this issue dealt with quickly and it will be; there will be no delay in the provision of these services.
The GP service is available at the moment. It is free to people who qualify under the means test but others have to pay. However, it will be available free to everybody once we sort the position out.
When is it proposed to sit again?
At 2.30 p.m. next Tuesday.
