19th April, 2002
Dr. Henry: I am delighted the Minister is back here with this Bill. I am glad she accepted the principle of the amendments tabled by Deputy Jim O'Higgins and Deputy O'Shea. They relate to an area that is very costly on which I also spoke during the debate in this House. I did not mention it at that time, although I am sure it is something the Minister will encourage, that it is important that the new commission co-operates with the regulator in Northern Ireland, as has the current regulator which has been important. There are areas in the Border regions which will not get broadband unless there is good co-operation on both sides of the Border because there is not the population there to attract people to bring broadband to those areas. I am conscious that the Leader of the House takes a great interest in the BMW regions, although I think that is an unfortunate name for those regions which are said to be deprived. It is important to continue such good co-operation. I have contact with Mr. Courtenay Thompson who is the head of the regulatory commission in Northern Ireland. I know that the people there are most anxious that the co-operation they have had with the regulator here should continue now that we will have a new commission.
Dr. Henry: I welcome the Minister of State to the House and her clear speech which explained everything that we need to know about the Bill which is important legislation. It was useful also that Senator Doyle explained the episode in 1989, when he attempted unsuccessfully to achieve the establishment of a compensation scheme. It is welcome that we have now come to this juncture. I know that a great deal of hard work has gone into the Bill and compliment the Irish Haemophilia Society on its efforts on behalf of its members and the families of deceased members.
Speaking on behalf of my own profession, while this has been a dreadful episode for the patients, it has been shocking for the doctors and members of the nursing and paramedical professions involved. Nothing is worse than being involved in the production of iatrogenic disease. The first principle of our profession is to do no harm. Therefore, to find that the treatment one provided caused such dreadful harm and death is terrible. A great toll was taken on members of the medical profession involved. They echo what the Minister for Health and Children said at the Lindsay tribunal, which I am glad was read into the record of the House, about the regret at the pain and suffering caused to so many by the administration of infected blood and blood products.
When I was doing medicine, I do not remember seeing a person with haemophilia who survived beyond 15 years of age as it is a very serious disease. The advances made in the 1970s were tremendous. We were proud that so many people with haemophilia were surviving longer. Therefore, it was devastating to have this happen in the 1980s and 1990s. At that time blood banks internationally were being encouraged to try to be self-sufficient. This put a great strain on our blood bank as it was inadequately staffed and funded. Most of the infections, as Senator Doyle pointed out, resulted from imported products, on which there is still a reliance.
It is important to learn from this episode and look to the future. At that time HIV and hepatitis C were presenting problems, not just in this country, but worldwide. Unfortunately, one cannot find out about something until it has occurred. This must never be allowed to happen again, but it will take the greatest vigilance and co-operation on an international scale to ensure this is the case. People have come to expect the best international standards to be implemented consistently here. We must be sure, therefore, that the framework is in place for this to happen. One of the most important lessons we must learn from this episode is there is a need for good co-operation between clinicians and those who work behind the scenes in the preparation of blood products or in any laboratory setting on the evaluation of tests, without which we will run into serious problems.
Senator Doyle referred to anti-D. Two general practitioners, Dr. Garret May and Dr. Peter Connolly, contacted the Rotunda Hospital to inquire if anything could be the matter because they had patients contracting jaundice. At the time the hospital requested the Blood Transfusion Service Board to look into the matter, but obviously the connection was not properly made.
It is hugely important to ensure there is sufficient co-operation between those involved in clinical practice and those working within laboratories. Those working in laboratories can only test for what they know about. This requires them to have all the information possible about the patients in their care. It is essential that this point be stressed. An accreditation system should be put in place for laboratories to ensure they meet required standards. Those working within them must get the necessary support to ensure this happens.
Every crisis leads to promises of financial support. Huge sums have been invested in upgrading the Blood Transfusion Service Board and increasing the number of staff. Previously it was totally inadequate. This sometimes led to a person being in control where he or she was rarely, if ever, questioned about his or her judgments. It is important that there is a proper level of staffing in order that they can query each other about the decisions they make, that they have the necessary clinical competence and that there is regular upgrading of their skills. Progress is being made in these areas, not by the day, but by the hour. It is essential that we ensure we are at the forefront of developments.
While we have a very good body of medical scientists, there are too few of them. Not only does this impinge on places like the Blood Transfusion Service Board, it also creates a problem in regard to cervical screening as we do not have the necessary cytologists to look at slides. BreastCheck has been unable to expand around the country, not due to meanness on the part of the Department of Health and Children, but because we do not have sufficient radiographers. We have to look ahead constantly in regard to training to ensure we have an adequate number of personnel to do what is expected in the health service.
The Academy of Medical Laboratory Sciences was founded 23 years ago and has been instrumental in pushing for the upskilling of those involved in medical laboratories. Since 1992 all graduates in biomedical sciences hold a qualification at honours degree level. More recently, masters programmes in molecular pathology have been introduced. Many of these graduates are working to doctorate level. These developments are to be very much welcomed because, to avoid another episode such as the one we are discussing today, we have to have people in the background who can do the work.
It is very important that we try to bring forward the legislation dealing with the statutory regulation of these professions. The Minister of State came to the House and promised it for the autumn. Senator Hayes and I said we were more enthusiastic about the promised Bills than the one before us that day. It is very important that statutory regulation is provided for in order that we will be assured that those working in the health service are of the highest professional competence. The academy has had a voluntary professional enhancement programme in place for several years. What is now required is a commitment from the Government to provide adequate funding for the further development and maintenance of such programmes. It is most important that participation in such activities is funded under adequate training programmes.
A further point in regard to adequate staffing brings to mind an incident which occurred during the Finlay tribunal where a lady who gave evidence was described as the chief biochemist. Her title fascinated me as there was no other biochemist employed. One simply cannot run proper institutes unless there is adequate staffing. It is worthwhile remembering that we are competing on the international stage because the training provided here is reckoned to be good. If we do not have good career structures in place, graduates will be snatched by other health services and we will find ourselves in short supply despite having trained them.
Although HIV and hepatitis C are a universal problem, in this part of the world they have become serious, but manageable chronic conditions. I would not like to be a patient who has haemophilia with one or both of these conditions. It is a very sad situation because the side effects of the treatment are hard to bear. I am glad that the Minister of State spoke so much about the need to compensate those to whom the disease was transmitted sexually. No counselling was provided at the time, even though we did know that the disease was transmitted sexually. It is most unfortunate that there appears to have been a reticence in regard to telling people about this or in giving them the results of their tests fast enough in order that they would know it was essential for them to take precautions if involved in a sexual relationship.
I read a horrific newspaper story about one member of the Irish Haemophilia Society bringing condoms to the car park of St. James's Hospital to distribute them to those who came to clinics from parts of the country where it was impossible to get them. In view of the increased incidence of sexually transmitted diseases it might be worthwhile to try and bring forward a national sexual health strategy. Those working in the sexually transmitted diseases department of St. James's Hospital have suggested that this would be a good idea. The Southern Health Board is the only one I know of which has tried to do something in this area. We are very reticent about discussing the fact that we have a problem in regard to sexually transmitted diseases. This might be an opportune time to do something about it.
While the matter we are discussing is regrettable, the Government has done everything it possibly can to try to ameliorate the situation for those infected who are still alive. I am very glad the legislation has been extended to cover those infected by either anti-D or other blood products. While welcoming the Bill, the most important point is that we learn from this terrible episode and try to ensure nothing like it ever happens again. There must be greater encouragement of co-operation and communication between clinicians and those working within laboratories and more training, particularly in the medical laboratory sciences. One cannot do testing if there is insufficient personnel to carry out tests. That is simply de facto. We should ensure that there is proper funding and a proper career structure for those working in this area. I welcome the Bill.
SECTION 4.
Question proposed: "That section 4 stand part of the Bill."
Dr. Henry: I wish to say something cheerful about this section, having reminded people of how easy it would be for a similar situation to occur if we did not invest time, people and money in this area.
This section provides that children diagnosed HIV positive because their mother was infected by someone or some blood product are to be compensated. We were probably the first country in Europe to have universal testing of pregnant women and as a result we have not had one single case of vertical transmission of HIV infection in the last three years. That is quite astonishing, given that some women who enter this country pregnant have not received any antenatal care.
Testing in this area is so good that I can almost swear we have not had one case of vertical transmission in the last three years. I thank the former Minister for Health and Children, Deputy Cowen, for its introduction. Colleagues of mine working in this area raised with the Minister the issue of introducing universal testing. Within about two weeks he decided it was to be introduced and it was. It has been of huge benefit and it means that at least one group of people are being very well dealt with in the medical system.
Dr. Henry: I congratulate the Minister of State on bringing this important and compassionate Bill through the House so efficiently. I am sure she will convey our remarks to the Minister, Deputy Martin, and his officials who put much work into bringing the Bill forward.
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