I thank the Deputy for the amendments and the spirit in which they have been put forward. It is important to be able to have these discussions. I will deal with second one. The Deputy is quite right that ages of consent vary. Medical consent is 16, sexual activity is 17, consent under GDPR is 18, and that can lead to some complexity. It can lead to confusion on the part of young people seeking care and risk aversion on the part of the clinicians treating them. The HSE clinical experts recommend that healthcare professionals need a clear regulatory and legal framework to manage the complex needs of those aged under 17 who present independently away from parents or anything else. There is strong concern about the child protection elements of that. Though that framework should include training and education as well as child protection and legal protections, it should also provide access to contraception and sexual health services where clinically appropriate in line with international guidance on the rights of the child. However, they do not recommend lowering the age of consent, which I acknowledge is not necessarily what the Deputy is suggesting. They are suggesting that the linking of the two things is problematic and that it does not necessarily increase child protection. They are worried about different behaviours being adopted at earlier and earlier ages and having negative impacts for children. There was a very important piece of research done into sexual activity between children aged 15 to 17. It shows about 25% of 15- to 17-year-olds have had sex but the majority of those were 17 and therefore eligible for the free contraception scheme. I appreciate the point the Deputy is making. I will go with the clinical guidance on this because I do not want to rush something like that in legislation on this occasion with this amendment. I appreciate the importance of the point the Deputy is making but I also hear the case in relation to child protection more broadly and the protection of those more particularly vulnerable cases who may be presenting independent of parents. I am not in a position and I do not have research that enables me to take a position beyond the clinical expertise at this point in relation to it. I cannot put it any further than that at this time. On amendment No. 1, I understand exactly why the Deputy is raising it. I am not sure it is necessary in legislation. We can do so much of that through parliamentary questions, the health committee and other things, and we want to do that. It is very important that both the Deputy and the National Women's Council identify the particular barriers that exist for women in certain groups, whether it is, as the Deputy said, to do with PPS numbers, or Traveller, Roma or migrant groups. There are groups that have particular barriers to accessing health. That is one of the reasons we created the women's health task force, which has a funding stream specifically and additionally for that. When it came to funding the Health Research Board, HRB, this year, I asked it specifically to support women's research with a €2 million dedicated fund. This was in four areas: menstrual health, endometriosis, the mental health issues postpartum in traumatic birth cases, but in particular the issues around access to health generally for those much more marginalised groups. I say this as a measure of attempted reassurance about our concern for and awareness of those groups in trying to index as many different ways as possible to try to support those groups because I recognise the barriers they face in so many different ways whether it is language, culture, PPS numbers or customs and habits. There are so many different things and we want to provide healthcare for all. I am glad to have the opportunity to discuss it but I am not sure it is necessary for legislation. However, in any other context I will give the Deputy whatever information I can in relation to how we are doing with it.
Sentiment score: 0.13
If I had all of the money in the world, of course I would simply do these different things but I have to make choices between different things that the Oireachtas wants to spend money on. There are so many requests to spend money. There are never requests to find other things to do with them. Yes, if I had the money, of course, but that would also mean having to make choices around assisted human reproduction or putting more money into menopause clinics. There are so many different things for which we need more money and more positions. I do recognise the calls from the National Women's Council in relation to that. It really is a question of how much money we have for everything. I am struck by Deputy Sherlock's comments in relation to protection. I am trying to distinguish child protection from all other issues. I hope there would be no girl at this point in the Irish healthcare system who would experience any judgment for presenting to any healthcare professional. That is not the message we are trying to send in any sense whatsoever. I also recognise there are some girls who are in extremely vulnerable situations but those are exactly the girls who also need a child protection response to what is happening to them. Seventeen is the age of consent as legislated by the Oireachtas. It is the age of sexual consent. We have spent a long time with that and there is no proposal to revise that as such. It is not the case that a 15- or 16-year-old girl will be able to go into the pharmacy in the first instance. This Bill provides that the follow-up care and appointments would be in the pharmacy for the additional four and a half years but that she would still have to go to a GP in the first instance. If a 15-year-old presented to a GP for contraception that raises questions. Is it to manage a different condition, for example, for which there is evidence or concern? We have discussed endometriosis, for example. I do not know. I am not a clinician. I do not want to misrepresent that, but I can see scenarios as the Deputy describes in which that may be relevant. However, if there are broader child protection concerns that doctor also needs to be able to see and spend time with that girl. I am not happy to go against the clinical advice I have on this. The clinical advice I have is that earlier sexual debut is associated with adverse outcomes. It is not just about unplanned pregnancy; it is about other concerns and other protections. That is why we have chosen 17 and not 16. I was here for that debate some time ago. It is logical and aligned to have sexual activity consent age aligned with the age for accessing free contraception. Those things are logical. The Deputy might conversely say that it is logical around medical consent as well and I appreciate that point also. However, on the basis that I have the clinical advice, I do not have a reason to go against that at this point.
Sentiment score: 0.03
I move amendment No. 3: In page 4, lines 26 and 27, to delete “or medical device”. We have a number of Government amendments to the Bill which collectively remove a reference to a medical device or devices from the Bill. Our pharmacy regulators, the Pharmaceutical Society of Ireland and the Health Products Regulatory Authority, HPRA, have been able to confirm to me that none of the contraceptives to be included in the pharmacy scheme are classified as medical devices. Amendments Nos. 3 to 5, inclusive, essentially look to remove the reference to medical devices. Amendment No. 4 removes references to medical devices from the proposed amendments to the Pharmacy Act 2007. To recap, sections 2 and 3 amend the Irish Medicines Board Act 1995 and the Pharmacy Act 2007 in order to support the clinical service and associated training requirements that must be fulfilled to provide the contraception-prescribing service. Those sections ensure that the scheme is clearly enabled and cross-referenced through a refreshed legislative framework supporting pharmacy prescription of contraception. Amendments Nos. 6 and 7 are to delete the references to medical devices within the Long Title. As I said, both of our regulators have asked that references to medical devices be removed. As stated last week, the current forms of contraception that will be included in the pharmacy prescription services are the contraceptive pill, the patch and the ring. Those are medicinal products and not medical devices. I hope the House is happy with those changes, which are largely technical in nature.
Sentiment score: 0.11
I move amendment No. 4: In page 4, line 27, to delete “or medical devices”.
Sentiment score: -0.15
I move amendment No. 5: In page 4, line 32, to delete “or device or devices”.
Sentiment score: -0.15
I move amendment No. 6: In page 5, lines 8 to 10, to delete all words from and including “subsection (3A)—” in line 8 down to and including in line 10, and substitute “subsection (3A),”.
Sentiment score: -0.15
I move amendment No. 7: In page 5, lines 15 to 17, to delete all words from and including “subsection (3B)(a)—” in line 15 down to and including line 17, and substitute “subsection (3B)(a),”.
Sentiment score: -0.15
I thank the Deputy. I confess that we were not exactly clear on the nature of the contraceptives overall. Can I just clarify whether the Deputy is referring to progesterone only or combined, or simply the initial access in the pharmacy?
Sentiment score: 0.02
I have better clarity on that now. This Bill is the culmination of a couple of years of work begun by my predecessor on the provision of contraception through pharmacies. That work commenced with consideration of the matter by the expert clinical committee on contraception, which was convened by the HSE. The crucial thing about the recommendations is that we are so pleased to be able to extend the follow-up service to pharmacies but we are not in a position to remove it from the clinical judgment of the GP in the first instance. That initial prescription has to come from a GP because there are so many contraindications for contraception for so many different types of women. I am aware that in some other countries, some contraceptives are given out over the counter, such as a progesterone-only pill. Combined hormonal contraception is recognised as being much more effective than that but it carries additional risk, for example for women with a personal or strong family history of certain conditions like blood clotting, cardiovascular disease and cancer, those who have significantly high blood pressure, those who smoke, or those who are aged over 35. There is a link with a higher risk of adverse effects. There are other contraindications too. The clinical advice in the draft protocols, which was constructed with advice from our expert clinicians and pharmacy regulators, is looking to see that measurements such as blood pressure and other risk factors are evaluated in person and in the privacy of a consulting room. That is obviously initially with the GP but the follow-up is with the pharmacist. The more structured approach that we are trying to give is about making sure that those protections are in place, that there is the clinical judgment of the GP in the first instance, followed up by the pharmacist, and also that it is not a simple over-the-counter service and there is a consultation or appointment for it. I do not think this is the case, but the Deputy can imagine a situation where a person is asking for something over the counter and there is a stigma. I am not sure that is the case at all because people have the ability to ask for things in private in pharmacies generally. Having the consultation room set-up, which I know the Deputy is not suggesting we do not have, is important. It is important that we have constructed a scheme which is more dedicated to that privacy and confidentiality structure. We are not in a position to accept the amendment, again based on the substantial clinical advice which has gone into this from the HSE and the pharmacy regulator. I am and we are trying to expand so much of what our pharmacies can do. The Deputy has great belief in pharmacists and their technical expertise. Obviously, we have established the common condition service. We are now giving them this power too and we would very much like to extend that. When it comes to contraception, that first prescription-based structure followed by a structure that monitors how women are over time, recognising that their health may change in a five-year period, is a clinical structure that is important to maintain.
Sentiment score: 0.15
Like everything, it is better to start something and develop it rather than wait for something else. We are trying to start so much with pharmacists. It is important to remind everyone about the national condom distribution scheme too, which we are expanding to pharmacies on a phased basis. Obviously condoms are not prescription items and do not have to be covered by this legislation. Pharmacists do not have to prescribe them as such. Free condoms are being made available in pharmacy consulting rooms. Access is being phased into pharmacies in different regions. By the time we launch that scheme, participating pharmacies will be able to access a free condom supply for their consulting room so they can offer them to people who might need them, which is a good thing. For reasons of patient safety, it is better to begin a scheme like this in a structured way. The scheme expands access more broadly and it achieves the goal of trying to get pharmacies to do more while making life easier for women generally, which I am a big fan of. Let us start this and see how and where it goes. If the clinical advice changes on the operation of this scheme, we can come back to it. Let us start this well and move forward with it.
Sentiment score: 0.30
I move amendment No. 10: In page 3, lines 8 and 9, to delete “medicines, products and devices” and substitute “medicines and products”.
Sentiment score: -0.15