I welcome the Minister for Health, Deputy Stephen Donnelly, to the House.
Nithe i dtosach suíonna - Commencement Matters
Covid-19 Pandemic
This is my first time addressing the Minister in the House so I warmly welcome him here. I commend him on the outstanding job he is doing in health which, in fairness, is something that has been acknowledged by all sides of the House.
I am sure the Minister is familiar with the very sad situation that obtains at Oaklands nursing home in Listowel, which is about two miles from my home. It has made the headlines recently for all the wrong reasons, in particular the fact that 23 out of 24 patients proved to be Covid-positive and, as of this morning, we had six Covid-related deaths. Just now, as I was walking into the Chamber, I was informed that the number has risen to eight. I sympathise with the afflicted and with the families of the bereaved. It is a terrible time for them. The reason I tabled this question is to try to help them to get information. They are very reasonable people but there has been a communications deficit both regarding what is happening in Oaklands and what is happening in some of the other community care facilities around the county, including in the town of Kenmare, as you know well yourself, a Chathaoirligh.
The situation in Oaklands is disturbing insofar as there is plenty of evidence to show that HIQA had concerns about the facility for a substantial period.
In its most recent unannounced visit during the summer, it found quite a number of deficiencies in the management, and a big list of improvements to be made was drawn up at that time. Unfortunately, we have no knowledge of what was taking place before the outbreak of the pandemic in Oaklands nursing home, but certain questions have to be raised. What was the follow through action on the issues flagged during the HIQA visits, and who supervised it? Either the facility was working appropriately and adequately or it was not.
I refer again to the issue of communications. The families involved, like all families, have suffered so much, and they have not been able to attend the funerals of their loved ones. The very least they need to know is what is happening there right now and what the immediate plans for the future of that facility are.
I will speak briefly on the other issue I wish to raise. As the Minister of State knows, patients from the nursing home have been dispersed to other community care facilities in the county. Latterly, and in the past few days in particular, this has given rise to widespread concern in all the other hubs involved in Kerry. I would like to know whether it is true that in places such as Kenmare there is an increased level of infection, either among the patients or the staff in the nursing homes there. Are there adequate staff rotation systems in place, for example, in Kenmare? What additional facilities does the Minister of State think should be provided to help homes like those in Kenmare to deal with the incursion that has been visited upon them as a result of the Oaklands situation? I am not trying to make any political capital out of this situation, and even though it is happening close to where I live, I have no real involvement in or knowledge of Oaklands nursing home. Like all the other facilities, it seemed to be working reasonably well, but this was all going on behind the scenes and we did not know about it. I look forward to hearing the Minister of State's response to the issues I have raised.
It is lovely to be back again in these beautiful surroundings. Every time I look up at those beautiful Waterford Crystal chandeliers, I think how very lucky we are to be in such an opulent room.
I want to thank the Senator for raising this very important issue. Every person who is supported in older person's services is entitled to expect and receive supports of the highest standard. Quality care and patient safety is a priority, and our continued focus is, and will always be, to deliver safe, high-quality services.
Nursing home providers are ultimately responsible for the safe care of their residents. Since 2009, HIQA has been the statutory independent regulator in place for the nursing home sector, whether homes are HSE-managed or private nursing homes. As the Senators will be aware, there are currently 585 nursing homes in Ireland, 80% of which are privately owned and 20% of which are run by the HSE. The authority, established under the Health Act 2007, has significant and wide-ranging powers, up to and including, withdrawing the registration of a nursing home facility, which means that it can no longer operate as a service provider. This responsibility is underpinned by a comprehensive quality framework comprising registration regulations, care and welfare regulations and national quality standards. In discharging its duties, HIQA determines, through the examination of all information available to it, including site inspections, whether a nursing home meets the regulations in order to achieve and maintain its registration status. Should a nursing home be deemed to be non-compliant with the regulations and the national quality standards, it may either fail to achieve, or lose, its registration status. In addition, the chief inspector has wide discretion in deciding whether to impose conditions of registration on nursing homes. As the Senator will appreciate, it is not appropriate to speak about individual cases, however, I can assure the House that the HSE is engaging directly with the nursing home in question, and has been since early November 2020.
Last week, arising from concerns about the operation and management of the nursing home, HIQA's chief inspector initiated court proceedings under the Health Act 2007 to cancel the registration of the nursing home. In accordance with the legal process, the HSE has formally taken charge of the nursing home to carry on its operation until alternative arrangements for the residents can be put in place. The HSE is undertaking various assessments of the situation and is considering its options in order to ensure the safety and care of the residents in question. The situation is evolving rapidly, as the Senator has noted, and involves a complex set of circumstances.
I am aware of how distressing a time this is for residents and families of those who have passed away as a result of Covid-19. I express my condolences to the families of those who have lost their lives in this nursing home. The Senator said he had been informed of two more deaths today so that brings to eight the number of older people who have lost their lives in that home. I sincerely sympathise with all their families. My officials will continue to engage with the HSE on this matter and I will ask the HSE to ensure it communicates appropriately with residents and families. Communication is one of the key issues here.
Unfortunately, I am not in a position to answer questions about various individual nursing homes the Senator has raised or the transfer of patients. However, he may rest assured that I will raise these issues and concerns immediately with the Department of Health and the HSE to try to get some understanding of exactly what the situation is.
I welcome the Minister of State's answer. I acknowledge that she cannot talk about particular instances and I am reluctant to bring up an individual case. I normally would not do so but as the Minister of State said, this is a rapidly evolving situation. There is concern about it as Listowel has consistently had very high rates of Covid per capita and was one of the highest local electoral areas, LEAs, in the country for a period. It is worrying for us and now it is worrying for other sectors and parts of Kerry as well. What I take from the Minister of State's response is her commitment that the HSE will communicate with the families. I join with her in sympathising with the bereaved and I wish them well at this very difficult time.
I thank the Senator for raising this issue in such a sensitive manner because it is very difficult for the many families that may be listening in, who are very concerned about their loved ones receiving care in nursing homes throughout the country. I am sure the House will understand my reluctance to speak in any great detail about the specifics of one particular nursing home. Since the onset of this pandemic, HIQA has put in place a quality assessment process, whereby all designated residential centres are formally contacted on a regular basis by an inspector or social services to assess how they are coping, the welfare of the residents, any concerns they have and any deficits identified in their ability to sustain a safe, high quality service. As the regulator for the nursing home sector, HIQA has completed a risk assessment of all nursing homes. In addition, a HIQA Covid-19 assurance framework was published on 28 September to support social care services in order to ensure effective infection prevention and control practices are in place.
The central focus of the response to Covid-19 has been controlling the spread of the virus insofar as possible. Sustained communication and interagency co-operation also remains central to the response to Covid-19. A package of supports was put in place, which has been of critical importance. Those supports include guidance, PPE, staffing, serial testing of all staff on a fortnightly basis since June, infection prevention and control training, and financial supports for the nursing home sector, both public and private. In addition, public health outbreak control teams and multidisciplinary clinical supports are in place at CHO level, with 23 Covid-19 response teams.
Unfortunately, this information does not answer the Senator's specific questions and I cannot speak specifically about one particular nursing home. However, I assure him that the HSE has been onsite from a very early stage and is working constructively. I will make sure of the commitment I gave the Senator today that the families will be communicated with. As I have said, I will raise this matter immediately on my return to the Department.
I too express my sympathies to the families of the bereaved in Listowel who have lost their loved ones. They are in our thoughts and prayers at this time. I thank the Minister of State for coming into the House.
Presidential Elections
Gabhaim buíochas leis an Aire Stáit as a bheith linn agus tá mé i gcónaí sásta an t-ábhar seo a phlé. We know that the bulk of parties in the State, as their stated party policy, support the extension of the franchise in presidential elections to citizens who are resident outside the State. In September 2013 the Constitutional Convention voted overwhelmingly in favour of the proposal to extend that vote. In March 2017, the then Taoiseach, at an announcement in Philadelphia over the course of St. Patrick's Day celebrations, said that the Government would move forward with plans to hold this referendum. A number of dates announced by the Government in the last Oireachtas term, which were much welcomed by campaign groups in the North and overseas, had to be moved around. We were told this was because of Brexit. While there was much disappointment around that, in the heat of the climate we were in at the time, people understood and were prepared to give the Government that space and latitude. That cannot be an excuse, however, and I use that term carefully, in perpetuity.
The draft referendum Bill was published towards the end of the last Oireachtas term and a significant amount of work and research has been done by Department officials, and indeed by the Government, in preparing for this referendum. Given that it is included as a commitment in the programme for Government, at this point the onus is on the Government to actually firm up a date and to settle on a date that we can work to. We understand that we have a load of work to do to build a positive and inclusive representative campaign that celebrates our citizenship, that includes those of us who are citizens in the North, and that seeks to affirm Article 2 of the Constitution in order that we connect with, celebrate and appreciate the international community of Irish citizens around the world, many of whom are now more connected in the modern age with home and with what happens here than ever. I look forward to hopefully a positive update from the Minister of State, and more importantly again I look forward to working with all colleagues across these Houses and outside to ensure that when we get this referendum it is won and won decisively.
It is my great pleasure to welcome my very good friend, Minister of State at the Department of Foreign Affairs, Deputy Colm Brophy. I congratulate you on your appointment and on the success you have been having.
I thank the Senator for raising this matter. It gives me the opportunity to outline to the House the position in relation to the commitment in the programme for Government to hold a referendum on extending presidential voting rights to Irish citizens resident outside the State. I appreciate that in his contribution, the Senator mentioned some of the main timeline points, to which I also will allude.
The fifth report of the Convention on the Constitution, of November 2013, supported an extension of the right to vote in presidential elections to citizens resident outside the State, including those resident in Northern Ireland, and recommended that a referendum be held to amend the Constitution. The recent programme for Government reaffirmed the commitment of the Government to submit this proposal to referendum. The office of the President is representative of all Irish people, and the extension of the vote to Irish citizens outside the State would provide the President with a truly inclusive mandate as the democratic choice of all our citizens.
My Department and the Department of Housing, Local Government and Heritage have been working closely to analyse the various policy, legal and practical issues that would arise in a proposed extension of voting rights.
As the Senator noted, the Thirty-ninth Amendment of the Constitution (Presidential Elections) Bill 2019 was initiated on 16 September 2019 by the then Tánaiste and Minister for Foreign Affairs and Trade.
While the Bill itself is relatively short, it is a significant piece of legislation that aims to extend voting rights at presidential elections to Irish citizens resident outside the State, in line with the next scheduled presidential election in 2025.
A referendum commission was also established by order of the then Minister for Housing, Planning and Local Government on 26 September 2019 to inform the electorate about the subject matter of the Bill, subject to it passing both Houses of the Oireachtas. In broad terms, the Bill provides for the replacement of the existing Articles 12.2.2° and 12.3.3° of the Constitution as well as for the insertion of a new Article 12A in the Constitution. These amendments would extend the right to vote for the office of President to all citizens, not solely to those who are ordinarily resident in the State as is currently the case, for elections held on or after 1 January 2025, which would be the beginning of the year in which the next scheduled election for the Office of President would fall due.
Implementing legislation, by way of amendments to the Electoral Acts, will be required to give practical effect to an extension of the franchise if the proposal to amend the Constitution is approved at a referendum. While the Bill lapsed with the dissolution of the Thirty-second Dáil, the Government has recently restored the Thirty-ninth Amendment of the Constitution (Presidential Elections) Bill 2019 to the Dáil Order Paper. The date for the holding of the referendum will be decided once the legislation has been approved by the Oireachtas.
While I thank the Minister of State for the review of where this issue has come from and its journey to date, I am disappointed. I appreciate that he is relatively new in his post. This is something that he may wish to take some time to navigate through. I appreciate that we are in a serious period with the double threat to society of Brexit and Covid-19 looming large. This issue may not be at the very top of the political agenda now but, as the Minister of State has acknowledged, it is one of deep political and societal significance, not least for those who live in the North but also for those living overseas who want to affirm their connection with home, many of whom have been forced to emigrate as a result of political and economic decisions taken in this State over a long time. While I welcome the reintroduction of the Bill, when can we expect the Government to table it? As it is a Government Bill, the Minister of State, who is responsible for the diaspora, should encourage the Government to ensure it goes before the Oireachtas. I am sure people will be keen to debate it and strengthen it, where required. This campaign has been going on for decades. If we are serious about the programme for Government commitment and about telling citizens outside the State that they are valued and we want them to be enfranchised, we need to get this referendum done.
We are very serious about our programme for Government commitment. As the Minister of State with responsibility for the diaspora, I am very much committed to this. In recent days I launched our new diaspora strategy, a centrepiece of which is this extension of the franchise to Irish citizens. Since I became Minister of State, I have worked extensively on this area to ensure it remains a political priority, as it is for me. I believe the proposed extension would be an incredibly strong and strengthening part of how we recognise the role of the President and its inclusivity. It matters greatly. I have had an opportunity to engage with many organisations that represent the Irish diaspora and Irish citizens outside our State who really feel a very strong desire and attachment to seeing this happen. The will is there on the part of the Government. I will put down the marker that we must be cognisant that we are progressing legislation with a view to a referendum, and we must do so in the context of the safety of people during a pandemic. We must conduct that referendum when we can best do so to allow for the fullest possible participation. My commitment as Minister of State with responsibility for the diaspora is to the Government's commitment, as set out in the programme for Government.
Veterinary Medicines
I welcome the Minister for Agriculture, Food and the Marine, Deputy McConalogue, to the House.
I welcome the Minister to the House. I know he is a very busy Minister and there is pressure on his time so I appreciate him coming here to deal with this matter.
The matter relates to EU Regulation 2019/6 in regard to veterinary medical products, which is to come into effect in January 2022. The antiparasitic resistance stakeholder group has sought a regulatory impact assessment in advance of the implementation of EU Regulation 2019/6 on veterinary medical products. There was a very detailed discussion on the matter at the Oireachtas Joint Committee on Agriculture, Food and the Marine, of which I am a member, but a lot more discussion is required. The meeting was lengthy but there were many items we did not manage to complete. This is an ongoing issue, which I am sure has exercised the Minister's officials, who were at that meeting.
This EU regulation will restrict the sale of antiparasitic drugs for livestock to farmers by making it illegal for anyone other than a vet to prescribe to them. These drugs are routine medicines given to animals to kill parasites such as gut worm, liver fluke and many others. Currently, these medicines are available from licensed merchants across this country, pharmacies and vets. As such, there is a wide chain of distribution of these medicines. A restriction has been proposed to deal with what is known as "antiparasitic resistance". I understand and acknowledge the concerns of vets and officials of the Department of Agriculture, Food and the Marine in regard to this matter, which are valid concerns. However, in removing the pharmacies and licensed merchants from the chain, we run the risk of creating a monopoly around these products. Rural pharmacies and licensed merchants will be impacted, farmers will have to pay prescription charges, possibly adding to the cost in regard to these matters, and we run the risk of increased prices and the creation of a monopoly in regard to veterinary and agricultural medicines.
There is much talk of a shared island. I am in favour of a shared island. Northern Ireland has a derogation from this regulation. If we do not do that, we enter into uncertainty with separate jurisdictions and separate approaches to dealing with this, with all of the negative issues arising in that regard. This is a concern. It is important that we have consistency of approach in how we deal with this across the island of Ireland. We cannot, will not and should not compromise on human or animal health and safety and an important knock-on effect on the food chain. I understand the chain of events and I understand the concern of the Minister's officials, but I also understand the concerns in regard to the need for a unified approach across the island of Ireland.
I urge the Minister to seek definitive legal advice from the Attorney General on this matter. It is important that an economic assessment of the impact of this regulation is undertaken. The antiparasitic resistance stakeholder group is seeking an economic assessment of the impacts of the regulation. These are critical issues in regard to agriculture, animal welfare, animal health, the food chain and responsible persons, all of which are within the Minister's brief. We may need to improve issues around responsible persons in terms of the impact of this regulation, ultimately, this regulation will impact on rural communities in terms of cost.
Has the Minister received legal advice on this? If not, is it his attention to seek such advice from the Attorney General? Is it his intention to seek a derogation from this regulation?
The Minister is welcome. I hope the temper and mood of his response will not be coloured by the events of recent days, specifically of Sunday last.
My congratulations to the Leas-Chathaoirleach's county. Despite the tremendous disappointment we felt in Donegal, there was also great joy to see Cavan progress-----
I must say that Donegal is my favourite holiday place.
We can certainly agree on that. I thank the Leas-Chathoirleach and wish Cavan the best of luck in the semi-final.
I thank Senator Boyhan for raising this matter which he has also raised with me privately and at the recent meeting of the Oireachtas Joint Committee on Agriculture and the Marine. EU Regulation 2019/6 on veterinary medicinal products comes into effect in January 2022, and as part of the transposition project, my Department has committed to undertaking a regulatory impact assessment, RIA. This process essentially addresses the same issues that an economic impact assessment would address. The RIA will focus on areas where Ireland has national discretion with regard to transposing the regulation and specifically where intended policy decisions may impact stakeholders.
The antiparasitic resistance stakeholder group was established by my Department primarily to address the concerns stakeholders have with the changing route of sale of antiparasitics and its impacts. At this juncture, the RIA, which evaluates all the impacts, costs and benefits of the proposed policies, cannot be finalised until the relevant policy options have been agreed. These include the length of validity of a prescription for antiparasitics, the definition of a proper assessment and the development of a secure electronic prescribing system. It is my intention that policies will be developed in a pragmatic manner that will deliver a substantive role for all stakeholders who currently operate in the supply chain for veterinary medicines while protecting the efficacy of the products to the ultimate benefit of Irish farmers. Irish farmers would be the big losers if we allow resistance to antiparasitics to deteriorate further.
On the question of seeking a derogation to Regulation 2019/6, when it was signed into law in January 2019, the regulation provided for the exact same regulatory regime as currently exists in Ireland, that is, antiparasitics can be supplied without prescription. The regulation did not change that. However, in line with its statutory remit, the Health Products Regulatory Authority, HPRA, established an expert task force in February 2019 which reported in December 2019. The task force identified risks in terms of the environmental safety of antiparasitics and conclusive evidence of widespread anthelmintic resistance. These findings meant Ireland could no longer avail of Article 34(3) of Regulation 2019/6 which exempts certain products from requiring a prescription. It is this report that has had the effect of requiring Ireland to make antiparasitics subject to a prescription and not the new regulation. Ireland has no national discretion on this issue.
A derogation under Article 105(4) was never a legal avenue open to Ireland as it refers to allowing someone other than a vet to prescribe certain medicines, but only if our national law allowed this prior to January 2019. Ireland clearly does not fall into this category as no one other than a vet has ever been legally allowed to prescribe, and the legal advice received to date by my Department reaffirms this view. As recently as last week, a response to a written EU parliamentary question made it clear that the derogation can only apply if national law allowed someone other than a vet to prescribe. My Department is engaging further on the matter with the Attorney General's Office for a definitive legal view as I am aware that other stakeholders have presented an alternative legal interpretation. While we continue to explore all avenues, at this point, the Department's view remains clear that Article 105(4) is not an option open to Ireland.
My Department remains committed to working with all stakeholders over the coming year in delivering a regulatory framework that provides a role for all actors currently in the supply chain while ensuring farmers have access to important antiparasitics that help them manage their farms and animal health.
I thank the Minister for his response. I share all of his concerns as set out in his response. What gives me hope is the fact that he has not ruled out ongoing engagement with all of the stakeholders, which is critical.
As I have said, the Minister will be aware of the issue of responsible persons and of the distribution networks of antiparasitics in rural communities. He will be conscious that any increased costs arising from veterinary prescription charges would be of concern. He will be, and should be, concerned about the potential for a monopoly to develop and about the inconsistency arising from having different regimes North and South. It is one island with regard to agriculture, or at least it should be. That is our objective and aim. I thank the Minister for his response. It is important that we have ongoing discussion in that regard. I will bring his response back to Oireachtas Joint Committee on Agriculture and the Marine. I thank him again for his time.
I thank Senator Boyhan. I am very much aware of the issues and of the concerns among wholesalers and merchants with regard to the potential impact this regulation may have on their businesses. I am also aware of concerns among the farming community as to whether any change could lead to an increase in costs or additional challenges for farmers. I see the role of the stakeholders' group as important. While we have to comply with our obligations under EU regulations, I want to ensure that we meet those obligations in a practical manner which takes into account the situation facing farmers to ensure that costs do not increase. It is also important to recognise the role played by licensed merchants in this process and the significant business they have in this regard. We are obliged to work to ensure that resistance to antiparasitics does not build up. We must do everything required of us in that regard but I will work with the stakeholders' group over the coming period to develop a way to implement the derogation which takes into account all of those various factors.
Sitting suspended at 2.12 p.m. and resumed at 2.45 p.m.