Adjournment Matters

Roadworthiness Testing

Senator Denis Landy

I thank the Minister for staying on to take this debate. This matter relates to the request by the Irish Vintage Veteran Trucks Association to reverse the decision to exclude vintage or veteran trucks from exemption from roadworthiness testing under the regulations the Minister made in 2013. These vehicles are vintage trucks and are all pre-1980. They are used by those who own them purely for display and pleasure. I understand that the basis for the exclusion was that the Minister was concerned that perhaps these could be used for commercial purposes. I live very close to someone who has some of these trucks, some of which are old army trucks. Nothing could be further from the truth that these trucks would be used for commercial purposes. They are used for display at vintage rallies and at St. Patrick's Day parades as floats. In many cases, the trucks are not even roadworthy and are transported from one event to another on the back of vehicle carriers. I am a little bit at a loss as to why the Minister included pre-1980 motor caravan vehicles, cars and motorbikes but excluded this group.

In discussions on this issue, I understand the Minister has agreed to review it in 2015, but some of these people will give up their hobby or will not use the vehicles until 2015, which is very unfair. If the Minister reviewed it now, he would see that this is a genuine group of people who are law-abiding citizens and who use this type of vehicle as a hobby. Many of them have been involved in transport and trucking all their lives, while many others are mechanics and this is their hobby. Will the Minister take a further look at this issue?

The matter was raised at the Joint Committee on Transport and Communications, which unanimously agreed to raise the matter with the Minister a number of weeks ago when the Irish Vintage Veteran Trucks Association addressed the meeting. Perhaps the Minister might have some good news for me in this regard.

Minister for Transport, Tourism and Sport (Deputy Leo Varadkar)

I thank the Senator for raising this matter.

As vehicles get older, their condition deteriorates, as evidenced by the increased failure rates for older vehicles undergoing the national car test and commercial vehicle roadworthiness tests. Components such as brakes, steering systems and tyres become more prone to developing faults. Consequently, older vehicles pose a greater risk to other road users and the general public than newer ones. It is, unfortunately, the case that not all vehicle owners adequately maintain their vehicles. Hence, significant numbers of defective vehicles are in use. Evidence from a number of international studies suggests that 4% to 5% of road traffic collisions are directly attributable to vehicle defects.

Introduced in 1991, the commercial vehicle test, formerly known as the DOE test, is a preventive road safety measure designed to ensure that commercial vehicles using Irish roads meet minimum acceptable standards. If used in a public place, commercial vehicles more than one year old, including vintage trucks and buses, must undergo mandatory roadworthiness testing annually and have a valid certificate of roadworthiness. The obligation to undergo mandatory roadworthiness testing annually has applied to vintage trucks since roadworthiness testing of commercial vehicles was first introduced in Ireland in 1991. Thus, the recent enactment of SI 347 of 2013 has not changed the obligation in this regard. Historically, it has been the case that older commercial vehicles have been used for commercial purposes, and that is why commercial vehicles first registered prior to 1 January 1980 have to be tested.

All cars used for commercial purposes have always been required to undergo roadworthiness testing. This includes pre-1980 registered vehicles being used in a commercial capacity such as wedding cars, limousines and other ceremonial vehicles. These vehicles are classed as small public service vehicles and are required by law to be tested annually up to the tenth anniversary of first registration and thereafter every six months.

I would like to clarify that while there is no exemption for older commercial vehicles, these vehicles are tested to the standards to which they were originally designed and not to the standards applicable to modern vehicles. Vintage vehicles are treated with exceptional care when undergoing an NCT and each vehicle is judged on its merits. For example, vintage vehicles will not be lifted on the wheels-free jacking system and many do not have their brakes tested using the rolling road; a road test is carried out instead.

In accordance with the Road Safety Strategy 2013-2020, the Road Safety Authority has undertaken to review the testing environment for vintage vehicles and to make recommendations to me on future roadworthiness testing arrangements for such vehicles. This review will be completed by the first quarter of 2015 and will include a public consultation with all stakeholders.

At the meeting of the Oireachtas Joint Committee on Transport and Communications on 12 March 2014, some members of the committee voiced road safety concerns and questioned why vintage trucks, irrespective of how well their owners believed they were maintained, should not undergo some form of roadworthiness inspection, even if only for the purpose of qualifying for eligibility for a reduced insurance premium. At that committee meeting, a suggestion was made that an engineer's report would address the safety issues. The Road Safety Authority will consider this as part of the review, but it should be noted that roadworthiness tests are carried out to prescribed standards by personnel trained, supervised and audited against those prescribed standards. Difficulties often arise in verifying the qualifications of the suitably qualified individuals responsible for preparing engineers' reports.

I am also advised that in certain cases insurance companies are happy to have the results of the vehicle test conducted by the authorised test centres rather than relying on an engineer's report. Cars used for commercial purposes are more easily identified as they must be registered as small public service vehicles. On the other hand, it is more difficult to differentiate between goods vehicles used for commercial purposes and those used for social and personal reasons only.

The Irish Veteran and Vintage Car Club and other enthusiasts say such vehicles generally do not travel more than 1,500 km per year on public roads and that using them in a commercial capacity is not viable due to the cost of maintenance and fuel. Nonetheless, consideration needs to be given on how to best to link the motor tax, insurance and vehicle testing requirements to ensure that if the analysis being carried out by the RSA indicates that an exemption should be provided, we can ensure it is afforded only to those vintage trucks genuinely used for social and domestic purposes.

The issues will be carefully considered in the review to be conducted by the RSA later this year which, following consultation with the key stakeholders, I am confident will come up with recommendations which reflect the competing needs of road safety, vintage vehicles which have limited road use and those which are used for commercial purposes.

Senator Denis Landy

I thank the Minister for his reply. Unfortunately, the review has been as slow as some of the trucks. This is not good news. In the review will the Minister take account of what is done in other EU member states in this regard where they are included? Perhaps we might take a lead from them. It is welcome that he is trying to find a solution which I hope we will have sooner rather than later.

Deputy Leo Varadkar

As part of the review, the RSA will examine best practice in other countries. I can certainly commit to this. I will also ask it if it can bring forward the review and perhaps start it now and have it done before the end of the year. I cannot promise that it will be able to do this, as it has a work programme. The first priority I have given it is to sort out all of the driving licence issues. I will see if it is possible to bring the review forward as part of its work programme.

Vaccination Programme

Senator Martin Conway

I welcome the Minister of State. I am pleased a Minister from the Department of Health is responding to this important debate.

The Government demonstrated a deep commitment to children by appointing a senior Minister with specific responsibility in this area. Through this and the children's rights referendum, it has displayed a commitment to children above and beyond what any previous Government did, which is appropriate. However, Ireland has the highest incidence of meningitis in the European Union which is not acceptable. An immunisation programme for meningitis C was introduced at one stage and dramatically reduced the number of children diagnosed with this awful condition to zero in 2012. It had a 100% success rate. Within two years one could count on one hand the number of children suffering from the disease. Thankfully, a vaccine became available for meningitis B at the beginning of 2013. It has been accepted in countries such as Australia, Germany, the Czech Republic, Poland and Italy and, in the past week, the United Kingdom. These countries are rolling out programmes to vaccinate all children against this dreadful disease.

Many people have lost loved ones to meningitis. We probably all know somebody who has. When my wife was aged four years, she was diagnosed with the disease and luckily survived it. We share a deep sense of responsibility to do what we can to ensure the lives of young people are saved when it is possible to do so. The national immunisation advisory committee, NIAC, met to discuss the new vaccine after the United Kingdom had decided to roll out a programme, but it postponed making a recommendation to the Minister, even though its members sit in on the deliberations in the United Kingdom on such programmes. They have all of the knowledge the UK Government has, but they decided to postpone making a recommendation to the Minister. This is serious. The families of people who suffer or who have suffered from meningitis and families who have lost loved ones to meningitis are appalled to think this vaccine is not being rolled out immediately. Children in Northern Ireland have access to a vaccine, but those in the South do not. What is worse is that if a family is wealthy, it can buy the vaccine because it is available to those who can afford it. Not alone is there inequality between people here and in Northern Ireland, there is also inequality between rich and poor. This does not equate to cherishing all the children of the nation equally.

I hope the Minister of State will outline a timeline for the introduction of the vaccine. If the NIAC is not prepared to make a recommendation quickly, I ask the Minister to direct the committee to do so and place a time limit on it. This is an important issue and a solution is available that will save children's lives immediately. There have been seven meningitis B cases in the past four or five weeks in counties Cavan, Limerick, Sligo, Dublin and Cork. Therefore, this issue needs urgent attention.

Minister of State at the Department of Health (Deputy Alex White)

I thank the Senator for raising this matter as it provides me with an opportunity to update the House on it.

Neisseria meningitidis is a major cause of invasive meningococcal disease, commonly known as meningitis. In 2013, 81 cases of invasive meningococcal disease were notified in Ireland, with serogroup B, commonly referred to as meningitis B, accounting for 68 of these cases. This represents a decline of 77% from the peak in 1999 when 292 cases of meningitis B were notified. Despite this significant improvement, Ireland has the highest incidence of meningococcal disease, particularly meningitis B, among EU countries. Since 1999, 51% of cases have occurred in children aged under two years. The highest age specific incidence rate for meningitis B cases is seen in young children under four years of age, particularly those in the first year of life. In 2013 the age specific incidence rate was 35.9 per 100,000 for children less than a year old, with another smaller peak seen among older teenagers. Low rates are normally seen in those older than 25 years.

The immunisation programme in Ireland is based on the advice of the national immunisation advisory committee, NIAC. This is a committee of the Royal College of Physicians of Ireland comprising experts in a number of specialties, including infectious diseases, paediatrics and public health. The committee's recommendations are informed by evidence based public health advice, international best practice and cost benefit analyses carried out by the National Centre for Pharmacoeconomics.

In January 2013 a new vaccine against invasive meningococcal disease serogroup B received marketing authorisation from the European Commission. The NIAC is monitoring international data for the use of this vaccine as part of immunisation programmes. It has recently issued guidance relating to its use in the control of clusters or outbreaks of meningitis B. However, to date, as the Senator pointed out, it has made no recommendation on the introduction of meningococcal B vaccination in the primary childhood immunisation schedule. Meningococcal B vaccine was discussed at the NIAC meeting on 24 March. The decision on whether to recommend the inclusion of the vaccine in the primary immunisation programme raises complex issues that require thoughtful consideration. New information on this issue, including revised parameters for assessment used recently by the joint committee for vaccination and immunisation in the United Kngdom, is being taken into account.

I am sure the House will appreciate that it would be inappropriate to comment on anticipated outcomes of the deliberations of the NIAC. However, should the committee advise the inclusion of a new meningococcal B vaccine in the primary childhood vaccination programme in Ireland, the Department, in association with the Health Service Executive's national immunisation office, will then examine and address the matter.

Senator Martin Conway

I thank the Minister of State for his reply. In the past five weeks, there have been seven meningitis B cases. I raise this in case I got the figure wrong earlier. I fully accept that the Minister cannot intervene in the recommendation process but he certainly can give a timeframe. The Minister can say he wants a recommendation by a particular date. We need a timeline. I cannot see any reason the Minister cannot express to NIAC that he would like a recommendation, one way or another, as a matter of urgency.

Deputy Alex White

With respect, I do not believe it is open to the Minister to give a direction to NIAC in that regard although I understand what the Senator is driving at. NIAC, as I pointed out, is a committee of the Royal College of Physicians of Ireland. It is a committee that advises the Minister. I do not believe there would or could be any inordinate delay on the part of the committee with regard to its analysis of this problem or, as the Senator pointed out, this pressing issue. If I can establish further information on how matters stand, I will certainly do so for the Senator. As far as I am aware, I do not believe it is open to the Minister to make a direction because it seems to me, without my having checked the detail on the specific relationship between NIAC, the HSE and the Minister, that the advisory function of the committee is such that it must be left to do the work it conducts for the Minister and HSE. I take the Senator's point on the importance of this matter, however, and I will certainly obtain for him any further information I can glean on expediting this matter.

Senator Martin Conway

I will get my office to contact the Minister of State's office.

General Practitioner Services

Senator Fidelma Healy Eames

The Minister of State, Deputy Alex White, is very welcome. I thank him for attending in person to address this matter because it is directly related to his brief. I wish to raise the need for the Minister for Health to outline the reason he will not enter negotiations with general practitioners on the delivery of free general practitioner care for those under six if he wants reliable universal delivery of care across the country.

I am sure the Minister of State is well aware that I stood for election on a platform of reorienting care from hospitals to the community. I refer to complete reliance on primary care. From my having built a case in the past for a primary care centre in Oranmore, which case was dumped down the list by the Minister for Health, Deputy James Reilly, over 12 months ago, I learned there is no hope unless there is a general practitioner on board.

Just over a week ago I listened to approximately 200 general practitioners in Galway. I am not here to advocate for general practitioners but for families, including children under six years. From what I have heard, the contract the Minister for Health is now presenting to general practitioners will fail. I do not want that to happen and I am sure he does not either. The main reason the initiative will fail is that the contract has not been drawn up in collaborative negotiation with general practitioners.

The Minister of State will know there has already been quite a strike at the incomes of general practitioners by way of the FEMPI cuts and the over-70s deal. This has led to a cut of approximately 35% to 40%. From all the evidence I have heard, I note this is the one area of the health service that is working well. Expenditure on general practitioner and primary care amounts to between 3% and 4% of the national health budget.

At the meeting I attended, a doctor said that, of the 100 patients he treats, 1.3, on average, go to hospital, and 98% are taken care of by him. That is a fantastic record. Therefore, let us be really careful not to break something that is not yet broken and move carefully. I will support universal health care for those under six if we can make it happen. However, I will not support it if it is only for show. From what I have heard so far, show is what will be evident because few, if any, general practitioners are prepared to sign up to the contract. The issue is really the general practitioners' right to negotiate terms and conditions of their contracts.

The Government, represented by the Minister, Deputy James Reilly, is saying general practitioners are all independent contractors under competition law. The Government suggests general practitioners are working in a pure market and it asserts its right to design and price a contract with minimum or no consultation. It denies the right to negotiate, and this is the fundamental problem.

I am so serious about health care, as is the Minister of State. Let us not let it fall owing to our not having the humility and courage to negotiate with general practitioners. Let them design the flaws if there are to be any. At least in that case the general practitioners will feel they are involved. If it means amending competition law, let us do so. It is clear that the under-sixes contract designed by the Department is flawed beyond recovery and that very few general practitioners will sign up to it. This was also the case regarding the cervical screening programme. It eventually required line-by-line negotiation to deliver a proper contract. The Minister of State will recall that himself.

There is a shortage of general practitioners. In rural areas, it is now almost impossible to get one, which is incredible. There is no market as there are fewer and fewer general practitioners available to take up posts. I will give the Minister of State a few examples. In Ballaghaderreen in County Roscommon, a list of 1,200 patients in the Westdoc co-operative could not attract one candidate. A list of 800 patients became available at the same time in Ballyhaunis and there were only two candidates. Eventually, the unsuccessful candidate in Ballyhaunis took the post in Ballaghaderreen. In Galway, the HSE dissolved a list in Dunmore after its having made it so unattractive as to attract no candidates, thus reducing the number of general practitioners in the area providing services. There was a similar case in the Mervue area of Galway city.

The HSE has been attaching many onerous additional requirements to contracts, such as the requirement to make a future commitment to move one's practice, despite the fact that general practitioners are expected to invest in their practices. This is ludicrous. The general practitioners borrow and invest heavily. Some young general practitioners, from whom I heard at the meeting in Galway, now regret their decision. This has happened in Frenchpark, Dunmore and Williamston, for example.

There are 264 general practitioners over the age of 64 years in Galway. Some 1,100 Irish general practitioners have become principals in the NHS in the past four years, which amounts to 50% of the whole-time general practitioners in the country. The HSE recruitment policy is failing abysmally and the under-sixes contract has hardened the view of many young general practitioners that this is not a doctor-friendly country. They are leaving in their droves. Let us stop and think about this. It is deplorable for the general practitioners' families and themselves. It is particularly deplorable for the country. The Minister of State and I know the State has invested heavily in the young general practitioners' training. This must be watched and reversed. We need the doctors here; we need our own people.

The under-sixes contract represents everything that, to me, appears to be worst in the HSE. It is centralised and rigid and amounts to intrusive control of everything from data to the right to professional advocacy for patients. Does the Minister of State believe it is correct that there is gagging of general practitioners? I do not. We are trying to bring whistleblower legislation into effect, but the gagging of general practitioners looks like the quelling of whistleblowers to me.

The ultimate effect will be that patients will find it increasingly difficult to gain access to quality general practitioners in the very near future. This is no way to start our journey to universal health insurance. I want from the Minister of State a commitment to enter negotiations on a new general practitioner contract. If that means amending the Competition Act, let us do so. I do not want to see us lose fine young general practitioners, nor do I want to see general practitioners put on the breadline. One general practitioner, Dr. Casey, spoke about trading recklessly. He said he has now an insolvent practice.

If the Government does not take this action, it will be saying to me that this was nothing but an empty political promise and if it fails, the excuse will be to blame the doctors. I cannot stand over this. I am looking forward to the Minister of State's reply but we must find a way to work with our doctors and bring them on board if we are serious about delivering free GP care to those under six years of age.

Deputy Alex White

I thank the Senator for raising this issue. The Government's vision for primary care is the development of a single-tier system where access is based on medical need and not on ability to pay. The Government, therefore, committed to introducing a universal GP service without fees, on a phased basis, within its term of office. The orientation of health systems towards primary health care and general practice has advantages in terms of better population outcomes, improved equity, access, continuity of care and lower cost.

As announced in the budget, the Government has decided to commence the roll-out of universal GP services by providing all children under 6 years of age with access to a GP service without fees. The decision to commence the roll-out with this age cohort is in accordance with the recommendation in Right from the Start, the report of the expert advisory group on the early years strategy. Universal screening and surveillance services are already made available for children in this age cohort. Evidence suggests that a high quality primary care system with universal access will achieve better outcomes for young children. The Government is providing new, additional funding of €37 million to meet the cost of this measure. The implementation of this measure will require primary legislation which is expected to be published within days. The necessary administrative arrangements will be made when the specifics of the legislation are published.

The introduction of this service also requires a new contractual framework to be put in place between the HSE and individual general practitioners. In this regard, I emphasise that a draft contract is currently the subject of a consultation process. In excess of 280 responses were received by the HSE during the consultation process. These responses are currently being examined and a report will be published in due course. While there has been some negative reaction to the draft contract, I am pleased that the Irish Medical Organisation, the primary representative body for general practitioners, has confirmed that it is supportive of Government policy to introduce GP care free at the point of access, albeit conditional on the provision of adequate resources and full and meaningful negotiations with the IMO. I welcome this response and I have assured the IMO most recently in my letter dated 26 March, that the Department and the HSE are fully prepared to engage meaningfully with it and are prepared to negotiate with it on all aspects of the scope and content of the proposed contract. I have also explained to the IMO that there will be an opportunity for its input on the fee structure which will be addressed by means of a complementary consultation process. However, the ultimate setting of fees must remain a matter for the Minister for Health.

I trust that the IMO will accept my invitation to commence negotiations with the Department and the HSE. This will afford the IMO the fullest opportunity to obtain clarification from the Department and the HSE on any aspect of the draft contract and to raise any other issues which it may have regarding it. I am confident that a process of open discussion as advocated by the Senator has the potential to significantly enhance the draft contract for patients, general practitioners, the HSE, the Department and the people of Ireland, thus helping to progress our common goal of free GP care at the point of access.

Senator Fidelma Healy Eames

I thank the Minister of State. I am delighted he has stated he is open to full and meaningful negotiations with the IMO because that is what the doctors are looking for. I stress that they are not looking for consultation. I accept there is no doubt that we will improve population health if we have universal health care but only if we have the doctors to serve the patients. I take from the Minister of State's reply that he wants the doctors to co-operate. In the UK NHS system it could take seven days to get an appointment for free GP care for a child. That is not what we want to happen here because it would make a nonsense of the plan. I will take the Minister of State's reply in good faith. That information certainly had not trickled down to the doctors in Galway a week ago. I look forward to hearing that meaningful negotiations took place.

Deputy Alex White

For the information of the House it is important for me to emphasise again that on three occasions in recent weeks I have extended an invitation to the IMO and to the doctors' representatives to meet me in this regard. On 27 February 2014, I wrote to the IMO as follows:

The Department and the HSE are fully prepared to engage meaningfully with the IMO. We are ready to meet with you, and we are prepared to negotiate with you on all aspects of the scope and content of the proposed contract. I should state, however, that the ultimate setting of fees must remain a matter for the Minister for Health, though there will be an opportunity for your input on this aspect, and on the fee structure, which it is proposed to address by means of a separate consultation process....

Accordingly, I am now formally inviting the IMO to meet with the Department and the HSE to commence the process, and to afford you an opportunity to elaborate on your submission of 21st February. My preference is that this meeting should take place during the week beginning 3rd March 2014 but a mutually agreeable date can be arranged if this week does not suit....

It seems to me that we can work together to seek a consensus on the many important matters of mutual concern, and it is my genuine wish that we should proceed in that spirit.

I repeated these sentiments on 26 March and made it very clear that we wished to proceed by way of negotiation:

I am confident that we can make good progress in achieving our common goal of GP care free at the point of access and therefore again invite the IMO to commence negotiations with the Department and the HSE.

Seanad Éireann díospóireacht - Wednesday, 2 Apr 2014