Seanad Éireann díospóireacht -
Tuesday, 1 Jul 2014

Vol. 232 No. 10

Adjournment Matters

Tattooing and Body Piercing Regulation

Senator Pat O'Neill

This matter concerns the need for the Minister for Children and Youth Affairs to consider enacting legislation to regulate the piercing and tattooing industry in Ireland to safeguard children under 18 years, although I understand it is to be dealt with by the Minister of State at the Department of Health.

In Ireland we have no legislation on regulation of the tattooing and body piercing industry concerning the age of consent of our youth or their health, well-being and safety. Having a tattoo or a body piercing is a big decision and, in most cases, a permanent one. With the evolution from the metrosexual to the birth of the spornosexual, there is huge pressure, through the media and celebrities, placed on our youth to customise their bodies through tattooing and piercing to keep up with the latest fashion trends. We are all too aware of the medical consequences, such as eating disorders, that some children and teenagers develop to look like their celebrity icons. With this additional pressure now on our youth, and in an industry that is growing and unregulated, we need to ensure the health, well-being and safety of our youth. Trends and fashion change all the time and every teenager wants to be up to date with the latest fashion or trend and there is nothing wrong with that. However, when a trend or fashion becomes permanent for an individual, we need to ensure the decision was not one taken for the wrong reasons, such as through peer pressure or because of the media.

Adults do not always make the right decision either when it comes to tattoos. Many celebrities, such as Megan Fox, Kelly Osbourne, Johnny Depp and 50 Cent, have had their tattoos removed as they stated that they wanted to clean up their image. It is not that they immediately regretted getting tattoos in the first place, but some of the reasons they listed why they spent thousands of dollars having them removed were that they no longer identified with certain things that initially inspired them or felt that they had held them back from future prospects. The procedure of having tattoos removed is not only prohibitive for the majority but the pain experienced going through the procedure of having them removed is excruciating. Tattoos are forever, so "think before you ink".

This is a growing industry and according to the HSE there are no registration requirements, no minimum structural or operational standards to be attained before opening such a business, no basic training requirements for staff, no age of consent, and no medical history requirements for those availing of such services. Consequently, these premises are not included in any inspection programme by environmental health officers and receive no regular or routine visits from any statutory inspectorate. If not performed to the highest standards, tattooing and body piercing can potentially be an extremely hazardous practice. The risks associated with tattooing and body piercing range from acute infections to allergic reactions and can occur when the piercing or tattooing equipment becomes contaminated from contact with dirty surfaces or dirty hands, or from the infected body fluids or blood of the staff member or a previous client.

While most people associate tattooing with serious infectious risks such as hepatitis B, hepatitis C or HIV, even the most localised infection can be life threatening if it enters the blood stream and goes untreated. In addition, there is also a risk of an allergic reaction to the inks or metals used or the latex gloves worn by the service provider. Piercings are not permanent; they can close up but do leave a mark. Tattoos are permanent. I ask the Minister of State to consider regulating this growing industry as a matter of urgency to protect our youth. Parental guidance and consent should be required for those under 18 years of age.

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

I thank Senator O'Neill for raising this issue and for his insightful and well-informed survey of the issues. It provides me with an opportunity to update the House on this matter. At present, there is no legislation specifically regulating the activities of persons providing tattooing or body piercing services in Ireland. However, it should also be noted that there are many cases where young people acquire tattoos or piercings while on holidays abroad or travelling, so even the legal framework advocated by Senator O'Neill would not have extraterritorial effect. I understand the issues he is raising in respect of this jurisdiction.

Tattooing and body piercing businesses are required to comply with general public health and safety legislation in the same way as any other business. The responsibilities of all business operators include taking all reasonable precautions for the safety of persons using the premises. The infectious diseases regulations empower medical officers or health and environmental health officers to take any necessary steps to investigate the nature and source of any infections linked to tattooing or body piercing. Anyone who carries out tattooing or body piercing on a person without informed consent may face criminal prosecution.

It is also an offence if tattooing or body piercing is carried out on certain parts of the body of a child, even if consent has been obtained or purportedly obtained. High standards of hygiene are necessary when carrying out tattooing and body piercing to minimise the risks of infection for both the person carrying out the tattooing or piercing and the client. Standard infection control procedures developed for the health care setting can and should be applied to any setting where there is potential for persons to be exposed to blood or other body fluids and this includes tattooing and body piercing premises. It is also advisable that persons carrying out tattooing and body piercing be vaccinated against hepatitis B.

My Department and the Health Service Executive are reviewing policy on tattooing and body piercing. The focus is on the development of best practice guidance and aimed at practitioners in the area. The main objective of the guidance is to encourage best hygiene practice by tattooists and piercers, thereby minimising the risk of infection and thus protecting them and their clients. The issue of obtaining informed consent will also be examined in the course of the review. The draft guidance document has been developed and is the subject of consultation within the health sector. It is expected that the Department and the HSE will be in a position to bring it to completion later this year. It is not advisable for anyone under 18 years to seek to have permanent tattoos and it is important that people be cautious in body piercing and the Senator has reflected as much in his contribution.

Senator Pat O'Neill

I thank the Minister of State for his informed reply. It is welcome that the Department of Health is reviewing the policy and I look forward to seeing how the policy develops. It is important that we have best practice in this industry because, as I have said, young people can be subject to peer pressure and tatooing and body piercing result in a permanent marking on the body. I, therefore, call for the sector to be regulated.

Hospital Waiting Lists

Senator David Cullinane

I have raised this issue several times with the Minister for Health as it affects the orthopaedic unit at University Hospital Waterford, formerly Waterford Regional Hospital. I refer to two matters - the trauma aspect and elective surgery. Let us consider the trauma aspect first.

We have the busiest trauma unit in the State at University Hospital Waterford, but there is only one trauma theatre. Each of the next three busiest trauma units outside Waterford has two trauma theatres. Obviously, there is a problem with capacity which is leading to long waiting lists for those who need treatment. There is also a problem for people in accessing consultants, with referrals being made by general practitioners to consultants for treatment and elective surgery. One way of getting around this problem, as well as addressing the issue of long waiting lists, would be for the hospital to refer patients to private clinics and it has made arrangements with clinics such as Cappagh National Orthopaedic Hospital in Dublin for patients to be seen by a consultant and a report to be produced on what surgery is needed and then to have the surgery performed at that hospital. Many people - this applies to hundreds - have been referred to the hospital at Cappagh and some have been seen by consultants, while others have not. Many who were seen and did not receive treatment had their files sent back to Waterford. However, some files have not been sent back and people are trying to find out where they are on the waiting list. They have not seen a consultant; they were told they would, but that did not happen. Before I came into the House I spoke to an orthopaedic consultant who indicated that he was rather concerned about the situation. Let us consider elective surgery as an example. There are twice as many referrals than the hospital can cater for. Therefore, unless more consultants and more staff are provided, as well as more capacity, the position will get worse.

What are the waiting times? Do we see dishonest means being used to massage waiting list figures by sending people to places such as the hospital at Cappagh? Arrangements were to be made to enable patients to be seen by a consultant and treated, but that is not happening. In the meantime they are off the waiting list in Waterford, but the files will be sent back and eventually they will be back on the waiting list again. I have dealt with several cases of people who simply do not know where they stand. This is not good enough. If the orthopaedic consultants, the general practitioners who are making referrals and patients are concerned, we have a serious problem which can only be addressed by increasing capacity.

I appeal to the Minister of State to examine this issue and address it with the Minister for Health to ensure people are seen as quickly as possible. Furthermore, once they are seen by a consultant and if surgery is required, they should undergo that surgery as quickly as possible. There should be no massaging of the figures and no dishonest means used to reduce waiting lists. We need to be honest with people about the actual position and ensure the appropriate resources are put in place to ensure patients in Waterford and the south east are seen as quickly as possible.

Deputy Alex White

I thank the Senator for raising this issue and allowing me the opportunity to outline the progress made in reducing waiting times for treatment. I assure him and the House that there is no question of dishonest means being used in any respect with regard to the information I will give and reject any suggestion to the contrary.

As the House will be aware, the special delivery unit was established almost three years ago. Significant progress has since been made in reducing the numbers of patients on hospital trolleys and waiting lists. The number waiting longer than the 52 week target reduced from 27% in April 2013 to 7% in April this year. In addition, the period from January to April 2014 saw a 6% increase in outpatient appointments provided by the HSE, that is, an extra 56,810 appointments compared with the number in the same period in 2013. Furthermore, in terms of scheduled care, inpatients and day cases, a comparison of the data in April 2014 as against April 2013 shows a 5% decrease in the number of patients waiting over eight months.

The Senator made particular reference to orthopaedic services in Waterford University Hospital. I understand the current waiting time for outpatient orthopaedic referrals is 20 months. I am acutely conscious that this waiting time is outside the so-called no longer than 12 month target set for outpatient appointments. I am advised, however, that the SDU and the HSE are working on a series of options to address waiting list issues and continuing to explore options to reduce waiting times for patients requiring treatment. The consultant staffing complement at the orthopaedic department at University Hospital Waterford is eight whole-time equivalent posts. Currently, seven posts are filled, two on a temporary basis. I am advised that the vacant eighth post will be filled on a permanent basis with effect from Monday next, 7 July. The filling of this consultant post should help to ease the pressure on the orthopaedic department in the hospital and have a positive impact on waiting times.

In 2012 University Hospital Waterford undertook an initiative with Cappagh National Orthopaedic Hospital and the National Treatment Purchase Fund. As a result, a total of 1,871 patients were sent from Waterford to Cappagh with an agreement that the hospital at Cappagh would complete the episode of care for this cohort of patients. The initiative progressed as planned and the hospital at Cappagh managed the patients as required, including validation, musculoskeletal review, investigations, procedure and follow-up discharge. In June 2013 this initiative came to an end and responsibility for the care of these patients was returned to University Hospital Waterford. All of the patients who were previously seen at Cappagh will be seen by University Hospital Waterford orthopaedic consultants to complete their episodes of care. Some of these patients have already been seen in Waterford and any patient with an appointment outstanding will be seen as soon as arrangements can be made. University Hospital Waterford has assured me and the Minister that it is committed to completing the episodes of care for the cohort of patients who had responsibility for their care transferred back from the hospital at Cappagh and the hospital will continue to work to ensure the care pathway is completed in each case.

I have referred to the current waiting time of 20 months for orthopaedic treatment in University Hospital Waterford. The SDU and the HSE are working on a series of options to address waiting list issues and continuing to explore options to reduce waiting times for patients requiring treatment. This initiative, with the appointment of a new consultant at University Hospital Waterford next week, will, I expect, lead to an improvement in waiting times for patients.

Senator David Cullinane

The response from the Minister of State on behalf of the Minister for Health only reaffirms my fear because the Minister of State accepts that 1,870 patients were sent from Waterford to Cappagh. Furthermore, he has accepted that there was an agreement that the hospital at Cappagh would complete the episodes of care.

That did not happen. The Minister of State then indicated that the initiative came to an end in June 2013. Why was that the case and why was the care not followed through on? He further indicated that people should return to Waterford for treatment. The logic behind sending them to Cappagh Hospital in the first instance relates to the fact that there are capacity issues in Waterford. In that context, the Minister of State accepted that there is a waiting time of 20 months.

This is a complete mess. No one is able to inform the patients why the arrangement with Cappagh Hospital was brought to an end in the way it was and neither can they tell them when they will be seen. With respect, all we get from the HSE in respect of this matter is spin and, in that context, the Minister of State was obliged to use the phrase "continuing to explore options to reduce waiting times". What options is it exploring? I have been raising this issue for almost 18 months and I have been continually informed that options are being examined. I do not see any options, nor do I see any solutions. All I see is waiting times increasing constantly. Arrangements that were put in place - such as that relating to Cappagh Hospital - which were designed to reduce waiting times have been brought to an end without an explanation being provided.

I am not sure whether the Minister of State is in a position to respond to me in respect of these matters. If not, perhaps he could revert to me on them. This is a crucial issue for people who are awaiting treatment. I genuinely believe the situation is unsustainable. It is also unfair on the excellent staff employed in Waterford University Hospital.

Deputy Alex White

The objective of all concerned is to ensure that patients receive treatment. I do not know why the arrangement with Cappagh Hospital came to an end. If the Senator is unable to discover why that occurred, I will certainly assist him in trying to establish the facts. I reiterate that patients who were previously seen at Cappagh Hospital will now be seen at Waterford University Hospital in order to complete their episodes of care. Some of them have been already seen and any with appointments outstanding will be seen as soon as arrangements can be made. That is the commitment which has been made.

On the additional questions posed by the Senator, I am, as always, available to try to assist in any way. If he contacts me separately, I will try to obtain for him the information he is seeking.

Medical Card Reviews

Senator Marie Moloney

I thank the Minister of State for coming before the House to take this matter, which relates to the need for the Minister for Health to set out the reason a person in County Kerry who is under review for a discretionary medical card has not had an application for a review halted in accordance with an instruction from the Minister and is not being treated in the same way as other people whose discretionary medical cards are under review. My client was selected for a review and this was under way when the decision relating to discretionary medical cards was announced. Anyone would have formed the opinion that as soon as the decision to which I refer was announced, the review of discretional medical cards would have been brought to a halt. However, the review is ongoing. The man in question telephoned approximately one hour ago to inform me that he was with his doctor earlier and discovered that his card has been cancelled. The man is paralysed from the shoulders down and confined to a wheelchair for life. As the Minister of State will appreciate, he has particular needs.

I am of the view that the person to whom this matter relates is being treated unfairly by the primary care reimbursement service, PCRS. Why is this man being treated differently from everyone else? His discretionary medical card was under review when the Government made its announcement and everyone expected the review to be brought to a halt. I contacted the offices of the PCRS and I was informed that he was up for a natural review and that this time was up. When I brought this to the attention of my client, I discovered that his card was not due to expire until May 2015. This means that his case was certainly not up for natural review. I do not know why he is being treated differently and I wait to hear from the Minister of State whether there is a reason for it. The man to whom I refer needs his medical card now.

Deputy Alex White

I should clarify that, under the relevant legislation, determination of an individual's eligibility for a medical card is the statutory responsibility of the HSE. It is very clear, under that legislation, that there is no role for the Minister for Health in assessing medical card eligibility. Furthermore, under the Health Act 2004, as amended, the Minister for Health may not give a direction to the HSE relating to a decision concerning the eligibility of an individual. As a result of her assiduous work in this area, I know Senator Moloney is aware of the PCRS contact service for Members of the Oireachtas so I will not read the part of the script relating to it.

In the context of the person in County Kerry to whom this matter relates, I do not believe it would be appropriate to discuss an individual's financial or medical circumstances in public in the Seanad. However, I can advise the Senator and the House of recent developments with regard to medical card eligibility, including with respect to discretionary cards. The Government has decided to formulate a new policy whereby eligibility for health services can take account of medical conditions, in addition to the existing basis of financial means. The HSE has established an expert panel to examine the range of conditions that should be considered as part of this process and has been asked to submit a report by September. The expert panel, which is chaired by Professor Frank Keane, past president of the Royal College of Surgeons in Ireland and clinical lead of the national clinical programme for surgery, includes a range of 23 clinical experts from primary care, specialist services and therapies. In addition, the HSE has put in place a public consultation process to facilitate the public, patients, representative groups and professional bodies to feed into this process. I understand that more than 2,800 individual submissions have been received at this point. The HSE will also arrange a consultative forum of representative patient groups to support and enable them to feed into the process in a structured fashion. In the context of this policy development, the HSE suspended reviews - including appeals - of medical cards where discretion had been exercised to take account of medical circumstances, pending the outcome of this process. The HSE has extended the eligibility of the individuals concerned.

Whereas I am not in a position to discuss the specifics of the case to which the Senator refers, I can inform her that if the medical card of the individual concerned was under review in circumstances where discretion had been exercised, it is difficult to understand why his card was not covered by the decision to suspend reviews. That is, of course, if the person concerned falls into the relevant category.

The Government was concerned that a number of people with serious medical conditions had been refused the renewal of their discretionary medical cards since the centralisation of assessment was completed in mid-2011. Therefore, it has decided that medical cards or GP visit cards are to be issued to persons with serious medical conditions or disabilities who had the renewal of their discretionary card refused by the HSE, having completed an eligibility review during the period from 1 July 2011 to 31 May 2014. That does not seem to cover the individual to whom Senator Moloney refers. The HSE has been working assiduously to issue cards to the estimated 15,000 persons whose reviews were completed between 1 July 2011 and 31 May 2014. It had already issued 4,151 discretionary cards by the end of last week. This priority should see all those qualifying issued with cards by mid-July. Those who wish to obtain further information can contact the HSE via the relevant LoCall number.

It is also recognised that a small number of individuals may not have been able to have been reviewed during the defined period, whether due to circumstances relating to their medical condition, hospitalisation during treatment, change of residence during treatment, etc. As a result, the director general of the HSE may act, on his own initiative, to take account of an ad misericordiam appeal on a case by case basis to issue a discretionary card to such a person who has a serious medical condition. I take this opportunity to point out that regular probity reviews in relation to those who qualify for medical and GP cards on financial grounds. The provisions of the Act have not changed in that regard.

If the individual to whom Senator Moloney refers falls into the category of people whose reviews were in train when the Government's decision was announced, then he should be able to benefit from the suspension of the review process. That is all I can say in respect of this case. I will, however, undertake to ensure that the Senator obtains a response to the query she raised with the PCRS.

Senator Marie Moloney

I thank the Minister of State for his reply. Unfortunately, he only told me that which I already know. He agreed with me that in the context of this policy development, the HSE suspended reviews - including appeals - of medical cards. Why was the review relating to the man in question not suspended? I accept the Minister of State's point to the effect that the Minister for Health has no input regarding an individual's eligibility for a medical card. However, he had a huge input when he announced that he was going to suspend that review and that discretionary medical cards would be reissued to people with medical conditions or disabilities. If we cannot obtain an answer from the PCRS, to whom should we turn if not the Minister for Health? Where should I go from here? Should I go to the Ombudsman if the Minister will not or cannot respond to my query? Surely someone in the PCRS could answer a question submitted by the Minister. I do not understand what is happening. In the meantime, the man in question who, as already stated, is paralysed from the shoulders down and who is confined to a motorised wheelchair, does not have a medical card. Where does he go from here?

Deputy Alex White

I accept what the Senator says, and if she is unable to obtain an answer to her question, we will have to assist her. We will do so. I understand this can sometimes be frustrating for Senators, but it was not the Minister who halted the reviews; it was the HSE. The Government made a decision on developing the policy framework to cover medical conditions in the future, not just financial means. Therefore, the Government made a decision on policy grounds, which was the basis for the HSE, not the Minister, suspending the reviews. People will ask what the difference is. The difference is very clear in the legislation governing the HSE.

Planning Issues

Senator Mark Daly

I have a very simple question on planning legislation passed by the previous Government whereby those whose planning permission was about to expire were able to apply to a local authority by way of a very simple mechanism to have it extended for a period of up to five years. Obviously, it was hoped that banks would begin lending and that people would be able to build on those sites in that five-year period, but many have found that they are unable to commence building. If planning permission lapses, the cost of reinstating it is quite large. There is always the issue of whether it will be granted for the same site again. Is there any proposal by the Government to amend the legislation by ministerial order or Act of the Oireachtas to allow for multiple extensions of a five-year planning permission?

Deputy Alex White

I thank the Senator for raising this important matter, which I take with the permission of the House on behalf of my colleague, Deputy Jan O'Sullivan, the Minister of State at the Department of the Environment, Community and Local Government.

The Minister of State considers it appropriate that planning permissions be subject to a time restriction to ensure that only bona fide developments likely to proceed to construction in the short to medium term are submitted for planning approval. Accordingly, the Planning and Development Act 2000, as amended, provides that, unless otherwise specified, the duration of a permission is restricted to a period of five years beginning on the date of the granting of permission. This five-year limitation, which is aimed at ensuring regulated development control, is considered reasonable in the circumstances.

Section 28 of the Planning and Development (Amendment) Act 2010 amended section 42 of the 2000 Act to provide that the duration of a permission may be extended for a further five-year period where substantial works have not been carried out or where the development has not even commenced in cases where the planning authority is satisfied that there were factors of a commercial, economic or technical nature beyond the control of the applicant which substantially militated against either the commencement of development or the carrying out of substantial works on the development in the original five-year timeframe. This provision is, however, subject to the submission of an application for extension of the duration of permission prior to the expiry of the original permission. Where an application is submitted, the planning authority must be satisfied that there have been no significant changes in the development objectives in the local development plan or in regional development objectives in the relevant regional planning guidelines since the date of the original permission such that development would no longer be consistent with the proper planning and sustainable development of the area. It is also subject to the requirement that the development is not inconsistent with proper planning and sustainable development of the area, having regard to any planning guidelines issued by the Minister under section 28 of the Act after the date of the granting of the original permission. Where the development has not commenced, the planning authority must also be satisfied that an environmental impact assessment or an appropriate assessment, or both of those assessments if required, were carried out prior to the granting of the original permission.

While the possibility of obtaining a second extension of permission was previously available to all holders of planning permission under the provisions of the 2000 Act, this was considered too open-ended. Consequently, the provision was removed via the 2010 Act on the basis that it was considered reasonable that a development should be completed within ten years of the original permission being granted. Where a development proposal is not completed within this timeframe, it is considered appropriate that it be required to go through the planning process again in order to ensure that it remains a viable and sustainable development and to give the public the opportunity to make submissions and observations on the proposed development, having regard to the time that has elapsed since the original granting of permission. Accordingly, the Minister of State, Deputy Jan O'Sullivan, has no plans to review the current practice of only allowing one five-year extension to planning permissions at this time.

Senator Mark Daly

I thank the Minister of State for his reply and wish him the best of luck in the election. The issue here is not only one for private developers who have zoned lands and planning permissions, but also for those who hold single permissions for one-off developments in the countryside. It is also an issue for the Government, because NAMA has a large number of properties which are subject to live planning permissions, as do the banks. Hopefully, they will have been diligent and extended the full five-year period. If a permission in respect of lands held by NAMA was granted in 2005 and extended in 2010, there is now the prospect that a huge amount of value will be lost, incurring for the taxpayer massive fees to reinstate planning permissions.

In Kerry County Council, it costs €89 to extend a planning permission. That could apply to NAMA. In the event that the Minister does not consider it prudent to allow for an extension, the burden of the loss will be borne by the taxpayer. If someone applied for planning permission in 2004, it would have lapsed in 2009 but for the extension period of five years. It may not have got the entire period, but in any event that five years will start to run out. Whether it is for a developer who has retained his portfolio and is hoping to build - we have a housing crisis - or a one-off development in rural Ireland, an entire planning process will have to be undergone. If the planning permission were allowed to remain live, the holder could start to build much more quickly. NAMA and the banks will sustain the largest losses, and huge fees will be incurred on behalf of the taxpayer simply to reinstate planning on land that is currently covered.

Deputy Alex White

I listened carefully to what the Senator said. I thank him for his good wishes. There are competing imperatives here in terms of public policy. The planning system must have its own integrity. There is a general proposition that a five-year limit makes sense. Of course, things can change objectively in an area. That something is a sustainable proposal in a particular year may not make it a valid assumption in another year. It may not be acceptable from a planning perspective five years later. New issues may have arisen. There is a general proposition there that it is a good idea to have a restriction. There is also a case for allowing extensions for five years. One must balance the planning imperative with the issues the Senator rightly raises in terms of costs and commercial matters.

Overall, the Minister of State considers from a planning point of view that the correct balance has been struck by establishing a five-year limit and a single extension of five years. These are issues that the House and the community can keep under general review, but for the time being there is no proposal to make a change.

The Seanad adjourned at 8.40 p.m. until 10.30 a.m. on Wednesday, 2 July 2014.