| Mrs.
Jackman: I understand what the Minister is saying
about the prescription aspect, but would he clarify the
other point? Mr. Martin: We said last
week on Second Stage that we have made the decision in
principle, in that we agree, in principle, with the
concept of making nicotine replacement therapies
available to those on the GMS or the medical card scheme.
The issue then is to decide the best way of doing that,
what logistics have to be sorted out, the feasibility of
doing it and the context in which it should be done - for
example, whether it should be done in the context of
cessation programmes. To that end, the advisory forum on
cardiovascular strategy was asked to make recommendations
to me on how best we could introduce nicotine replacement
therapy on the medical card scheme. That is one issue. I
have no difficulty with the article or the content of Dr.
Houston's conclusions.
The second
issue relates to this amendment which, I understand,
proposes making nicotine replacement therapies available
in shops and all retail outlets, irrespective of any
advice or whatever. It is in that context that the Irish
Medicines Board could potentially have some concerns, in
terms of general public health issues which would arise
from having nicotine replacement therapies available in a
widespread fashion. All I am saying is that the issue
needs far more careful consideration than simply deciding
overnight to do it. The medical card would be by
prescription, of course.
There is
evidence that better results are achieved if the nicotine
replacement therapy is provided in the context of
cessation programmes where, rather than just buying the
stuff, one is counselled and so on.
An
Leas-Chathaoirleach: Is the amendment being pressed?
Mrs.
Jackman: No, but I would like some research done on
whether other countries have adopted-----
Mr. Martin:
We will do that.
Mrs.
Jackman: More and more youngsters are becoming
addicted. It is an emergency at this stage.
Mr. Martin:
We will look at the policies of some other European
countries on this issue.
Amendment, by
leave, withdrawn.
An
Leas-Chathaoirleach: Amendments Nos. 4 and 5 are
related to amendment No. 3 and they may be discussed
together.
Government
amendment No. 3:
In page 5,
between lines 19 and 20, to insert the following new
paragraph:
"(b)
An approval may be such as to limit the use of a
drug to treatment of a particular condition or
conditions or to treatment of a particular class
or classes of person and in this section
'approved' and cognate words shall be construed
accordingly.".
Mr. Martin:
I am proposing this amendment because it is of the utmost
importance to be in a position to respond in a flexible
manner to the potential pharmaceutical needs of patients.
While the Bill already goes some way in facilitating this
approach, the amendment bolsters the Bill in this regard.
In some cases,
it may not be appropriate to make a product universally
reimbursable. For example, an over the counter product
with a very wide application may be used by the general
public in circumstances that do not warrant the use of
the product from a clinical point of view. If such a
product is universally reimbursable, a consequent waste
and lack of targeting can take place. The same product,
however, may be of therapeutic necessity for patients
with particular conditions. It is important to provide
the flexibility to reimburse such products in these
circumstances. In other words, a product may be necessary
for a person with a particular condition and there should
be flexibility in the legislation to allow the
authorities to make a reimbursement in such cases.
Amendment No. 4
is a technical amendment in regard to regulations, which
is standard. It will strengthen the subsection.
Amendment No. 5
refers to the definition of "supplier". The
Bill at present defines "supplier" as a person
who supplies drugs to community pharmacies. The amendment
is a technical amendment to the definition of
"supplier", so that it also encompasses a
person who supplies drugs to persons referred to in
subsections (4) and (5). Persons referred to in
subsection (4)(a) are doctors dispensing to
medical card patients where there is no local community
pharmacy, while persons referred to in subsection (4)(b)
are persons approved by the Minister for the supply of
non drug items. Subsection (5) refers to institutions
providing a specialist service under the direct
supervision of a medical consultant and approved for the
supply of drugs for the purposes of section 59 of the
Health Act, 1970. It is a tightening up of the
definition.
Mrs.
Jackman: I accept those amendments.
Dr. Henry:
This matter pertains only slightly to the amendment.
However, given that doctors are acting in a pharmacist
capacity here, I expressed my concern on the Order of
Business about the fact that someone who was struck off
the medical register in England has approval to be on a
pharmacy register here. I hope the Minister will bring
forward the new medical practitioners Bill and the
pharmacy Bill as soon as possible, so that we can rectify
this situation.
Mr. Martin:
We are working on that.
Amendment
agreed to.
Government
amendment No. 4:
In page 6,
line 36, after "section", to insert
"and such regulations may contain such
incidental supplementary and consequential provisions
as appear to the Minister to be necessary for the
purposes of the regulations".
Amendment
agreed to.
Government
amendment No. 5:
In page 10,
subsection (1), line 51, after "community
pharmacies", to insert "or a person
referred to in subsection (4) or (5)".
Amendment
agreed to.
Question
proposed: "That section 1, as amended, stand part of
the Bill."
Mr.
Costello: Will the Minister clarify the application
of the regulations in relation to agreements between
proprietors of pharmacies and boards, pursuant to which
community pharmacies may supply drugs under subsection
(10)? What does that mean in practice, in terms of
creating cartels and monopolies in the pharmacy area?
Mr. Martin:
Where there is contractual agreement?
Mr.
Costello: Yes.
Mr. Martin:
It was introduced in 1996 and places obligations on
community pharmacies which were not placed on them
before. The idea was to provide for a review by the
pharmacist of the medicine therapy of the patient,
including screening and so on. The intention was to get
pharmacists into the primary care area in a more
proactive way.
As the Senator
knows, there is a set of criteria by which health boards
consider an application to set up a pharmacy. They make
the initial decision, in accordance with criteria that
are published, on whether a pharmacy should be located in
a particular area, given the size of the catchment area
and so on. My understanding is that the decision can be
appealed by the applicant if it is refused or by somebody
else if it is granted. At the moment the appeals are
heard by the Minister of the day. I was going to say
later in the debate that I intend to put down an
amendment on this issue when the Bill goes back to the
other House. I do not think the Minister should be
involved in the appeals process. In line with modern
practice we should have an independent court of appeal,
whether it is the District Court or another court. We are
working on this with the draftsman's office at the moment
so that, in essence, there will be an independent appeals
forum to look at these issues.
At present my
officials make representations to me as Minister as to
whether a pharmacy should be given sanction and I am not
sure that a Minister should be involved with the minutiae
of deciding where a pharmacy should go. In the first
instance it is the health board which makes a decision
based on criteria that have been established regarding
catchment area, the public health needs of an area and so
on.
Mr.
Costello: I am glad the Minister intends to introduce
an amendment relating to the appeals, as obviously the
Minister is not the proper person to deal with such
appeals. I have received some documentation on this
matter which I will pass on to the Minister if he is
going to deal with it in the other House.
Mr. Martin:
Yes.
Question put
and agreed to.
NEW SECTION.
Mrs.
Jackman: I move amendment No. 6:
In page 11,
before section 2, to insert the following new
section:
"2.---The
Tobacco (Health Promotion and Protection) Act, 1988,
is hereby amended by the substitution of the
following sections for section 3:
'3A.---(1)
Any person who sells, offers to sell, or makes
available in relation to the sale of any other
product, cigarettes or any other tobacco product to a
person under the age of 18 years, whether for his or
her own use or otherwise, or who sells to any person,
acting on behalf of a person under the age of 18
years, any tobacco products, shall be guilty of an
offence and shall be liable, on summary conviction,
to a fine not exceeding £2,500.
(2) The
owner, or any person in charge, of any machine for
the sale of tobacco products who permits the machine
to be used for the sale of such products to a person
under the age of 18 years shall be guilty of an
offence and shall be liable on summary conviction to
a fine not exceeding £2,500.
(3) The
owner, or any person in charge, of any machine for
the sale of tobacco products who keeps the machine in
place in any premises frequented by a person or
persons under the age of 18 years shall be guilty of
an offence and shall be liable on summary conviction
to a fine not exceeding £2,500.
(4) It
shall be a defence for a person prosecuted under this
section to establish that the person to whom the
tobacco products were sold, offered for sale or made
available, had upon request furnished to him or her a
document, as specified in regulations made by the
Minister for such purpose, verifying he or she to be
18 years of age or older, where it was reasonable to
regard the documentation concerned as authentic and
as applicable to the person to whom the tobacco
products were sold, offered for sale or made
available.
(5) Where,
in a prosecution for an offence under this section,
it is alleged that the person in respect of whom the
offence was committed is under the age of 18 years,
and such person appears to the court to have been, at
the date of the commission of the alleged offence,
under the age of 18 years, such person shall for the
purposes of this section be presumed, until the
contrary is proved, to have been at that date under
that age.
(6) The
Minister may, by regulations, specify the document or
documents that may be relied upon pursuant to subsection
(4) by a person against whom a prosecution is
brought for an offence allegedly committed as
specified in this section.
3B.---(1)
Any person who sells or offers to sell cigarettes or
other tobacco products in a retail outlet, shall at
the point of sale exhibit in a prominent position
notices warning of--
(a)
the addictive and health dangers posed by
cigarettes, and
(b)
the age restriction on sale and the vendor's
obligation to ask for age verification.
(2) The
Minister shall, by regulations, specify the size of
the notices specified in subsection (1) and
the detail and print size of the information to be
contained in them.
(3) Any
person who sells or offers to sell cigarettes or
other tobacco products in a retail outlet and who
fails to comply with subsection (1) or (2)
shall be guilty of an offence and shall be liable on
summary conviction of a fine not exceeding £2,500.
3C.---Any
person who having been found guilty of an offence
pursuant to section 2 or 3 of this Act
is subsequently found guilty of a further offence
under either of the aforesaid sections shall be
liable on summary conviction to a fine not exceeding
£5,000 and/or to a term of imprisonment not
exceeding 6 months, or as an alternative to the
aforesaid term of imprisonment may be directed by the
court to undertake community service pursuant to the
provisions of the Criminal Justice (Community
Service) Act, 1983.' ".
On Second Stage
we all made it clear how concerned we are with the high
level of tobacco smoking, not just among young people but
generally. The statistics on smoking among over half of
the children sitting their Junior Certificate examination
attributed to Dr. Des Carney, an oncologist at the Mater
Hospital, are quite alarming. The fact that 90% of those
who smoke start smoking before the age of 20 is also
unbelievable.
The reason for
this amendment is that fines are not always implemented,
such as in the case of litter offences. The figure of
£1,500 is too low and the amendment states:
Any person
who sells, offers to sell, or makes available in
relation to the sale of any other product, cigarettes
or any other tobacco product to a person under the
age of 18 years, whether for his or her own use or
otherwise, or who sells to any person, acting on
behalf of a person under the age of 18 years, any
tobacco products, shall be guilty of an offence and
shall be liable, on summary conviction, to a fine not
exceeding £2,500.
The Minister
said on Second Stage that it would not be possible to
raise the level of the fine, but I have been told by a
legal source that it is. Perhaps we can agree to differ
on this, although the Minister should justify his
argument that the amount cannot be raised. The offence is
so grievous that £2,500 is low, considering the amount
of money being made by racketeers and by those abusing
young people in this manner - they know the contents of
cigarettes and we know that cigarettes are being sold
singly. It is easy for young people to have access to
cigarettes and the fine I have suggested is the least
amount that could be imposed.
The same
applies to someone in charge of a machine selling tobacco
products. We stated last week that we hoped such machines
would be out of reach of young people and that they would
not be in areas where young people congregate. All these
offences should carry a fine of £2,500. Subsection (4)
of the amendment is important. It states:
It shall be
a defence for a person prosecuted under this section
to establish that the person to whom the tobacco
products were sold, offered for sale or made
available, had upon request furnished to him or her a
document, as specified in regulations made by the
Minister for such purpose, verifying he or she to be
18 years of age or older, where it was reasonable to
regard the documentation concerned as authentic and
as applicable to the person to whom the tobacco
products were sold, offered for sale or made
available.
This is an
important provision in the context of those who may say,
"The person said she was 18 and she offered me a
forged ID card." Many people are taken in by how
sophisticated young people can look - those of 14 or 15
can pass for 21 and they are adept at getting into
nightclubs and at gaining access to liquor and
cigarettes.
The identity
card issue must be dealt with for once and for all. It is
virtually impossible to police the matter. I know that in
Limerick pupils in one school had quite a business going
on forging identity cards for young people. They are full
of imagination and creativity and we need a national
identity card whereby the person selling tobacco can be
protected. Young people are playing Molly bawn with
proprietors, picking their times to buy cigarettes and
drink, and there must be some protection for the person
who is prosecuted.
Another
important subsection of the amendment states:
Where, in a
prosecution for an offence under this section, it is
alleged that the person in respect of whom the
offence was committed is under the age of 18 years,
and such person appears to the court to have been, at
the date of the commission of the alleged offence,
under the age of 18 years, such person shall for the
purposes of this section be presumed, until the
contrary is proved, to have been at that date under
that age.
This is a very
important point. The amendment goes on to state:
The
Minister may, by regulations, specify the document or
documents that may be relied upon pursuant to subsection
(4) by a person against whom a prosecution is
brought for an offence allegedly committed as
specified in this section.
This means that
we will need to know what documents will be needed.
The proposed
new section also provides:
Any person who
sells or offers to sell cigarettes or other tobacco
products in a retail outlet, shall at the point of sale
exhibit in a prominent position notices warning of--
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