Winning hearts and minds

Health is the area of public policy that experiences the highest levels of lobbying, according to the most recent statistics from the www.lobbying.ie website.

The figures, which are continuously updated, show health as the policy area with easily the highest number of registered returns of lobbying, with 2,433 at the time of going to press. The next-largest area is ‘economic development and industry’, which does not even have half of health’s total, with 1,128 registered returns. In third place is agriculture, with 1,099 lobbying returns.

The figures include all registered returns since the website was established in late 2015 following the commencement of the Regulation of Lobbying Act 2015 in September 2015, and is run by the Standards in Public Office Commission (SIPO) Commission.

“The Regulation of Lobbying legislation is designed to provide information to the public about who is lobbying whom about what,” according to the website. “If you are lobbying, then you must register on this website and make a return every four months.”

Further evidence of the significant volume of health lobbying in Ireland is available when examining which public bodies have been lobbied most frequently. The Department of Health remains the Government department that is lobbied the most, with 1,611 incidences since 2015. By way of comparison, the next on the list is the Department of Agriculture, Food and the Marine, which comes in at 1,247 instances.

Overall, the Department of Health is the third-most lobbied public body in Ireland; it only lies behind the Dáil and the Seanad.

It must be noted that not all instances of registered lobbying are high-level meetings with Ministers or Departmental officials; often, they can just be emails, tweets or even a chance meeting at a TV studio (see panel). Those who conduct lobbying can range from charities and NGOs, to private insurance companies and major pharmaceutical companies.

Over the final three months of last year, the heath policy area saw 382 incidences of lobbying registered. A quick perusal of this list shows some issues that reoccur regularly, including the cancer strategy, the interests of private insurance companies, tobacco and vaping legislation and telemedicine development. Unsurprisingly, the Eighth Amendment is an issue that crops up frequently, with lobbying returns made on the topic by such diverse groups as the Coalition to Repeal the Eighth Amendment and the Sisters of Mercy.

However, one issue in health has been the central focus of lobbying in recent months more than any other. The very slow passage of the Public Health (Alcohol) Bill has been accompanied by claims of intense lobbying by industry around aspects of the legislation.

<h3><strong>Alcohol</strong></h3>

The Department of Health told this newspaper last week that the much-anticipated and delayed Bill is expected to be introduced into the Dáil “shortly”. However, a spokesperson said they could not be more specific in terms of how long it is expected to be debated in the Dáil before it is passed.

“It looks like it will [pass],” said Prof Joe Barry, Chair of Population Health Medicine at the Trinity College Centre for Health Sciences, when contemplating the slow passage of Bill.

But this leading supporter of the legislation warned that the ‘battle’ is not over yet for public health advocates and he urged caution.

“They [alcohol industry] will try and water-down this one, so I wouldn’t think this is done yet,” Prof Barry told the <strong><em>Medical Independent</em></strong> (<strong><em>MI</em></strong>).

“They [industry] will fight very hard; they are using a lot of money. Lobbying influences politicians — we all are influenced by it.

“You can see the strength of the lobby, so we suggest that we keep the pressure on. [Minister for Health] Simon Harris, to be fair to him, has said ‘yes, it will go through’. We all appreciate things get put down the list, and abortion comes up, and there are all sorts of reasons for it [not remaining a legislative priority]. That is why we are keeping the pressure up.”

<strong>Prof Joe Barry</strong>

So does Prof Barry expect the alcohol industry to maintain its lobbying in the coming weeks and months? “Yes, because they obviously know well that advertising works,” he said.

“They would not be spending up to a €100 million a year if they didn’t. But they are very worried about this Bill because they believe it will reduce alcohol consumption, which is the whole point of it. They say they are ‘in favour of the Bill, except’, and then they list every part of it that they are not for.

“Obviously, they have PR people. You know, it’s very extensive but hopefully the Government will resist it. I am hopeful. I think the thing is going in the right direction. The antecedent of this Bill was a report done by the Department of Health in 2012, which you know is now six years ago.

“They are just delaying, delaying, delaying. It’s all about money. It’s all about profits. Even if you look at the current problems with the emergency departments, reduced alcohol consumption would help a lot with that.

“There are a lot of benefits to the health service and hospitals in general, apart from just people’s health.”

<h3><strong>Future </strong></h3>

But will lobbying by other industry continue with future public health legislation around sugar taxes and other measures?

“Probably, it will,” Prof Barry tells <strong><em>MI</em></strong>.

“We do live in a democracy and people are entitled to lobby. That is not the issue. We think it’s not good for the health of the people [but] it’s [lobbying] not illegal, obviously.”

Having closely watched the lobbying around other public health initiatives such as the smoking ban, Prof Barry sees a difference with lobbying undertaken under the new legislation framework.

“I suppose you can definitely say that the lobbying register (www.lobbying.ie) is helpful in that way. It has made it [lobbying] more explicit and you can document it,” he commented.

“So yes, for sure [it’s an improvement]. It documents it, then names it.”

Looking into the future at other possible public health initiatives, like the sugar tax, Prof Barry expects that industry will again be in the corridors of power lobbying.

“Of course if there is other stuff, they will be lobbying, for sure. That is a healthy thing at one level, I suppose. There are parts of the world where you can’t lobby.”

Last year, a spokesperson for the Alcohol Beverage Federation of Ireland (ABFI) insisted to this newspaper that the “drinks industry is in favour of the policy objectives” behind the Alcohol Bill.

“We fully agree that legislation is needed to tackle the problem of excessive drinking, an issue which is in nobody’s best interests. Our concerns are that certain proposals are not supported by evidence with regard to decreasing misuse,” the spokesperson said.

<h3><strong>Pharma</strong></h3>

As any mining of the returns on www.lobbying.ie will show, the nature of lobbying is varied, although a simple meeting between leading business people and politicians can be part of it.

During the last quarter of 2017, the CEO of Shire plc, Danish businessman Mr Flemming Ørnskov, contacted the Minister for Finance Paschal Donohoe to propose a meeting. The meeting, according to the details provided by Shire Pharmaceuticals Ireland Ltd to www.lobbying.ie, would focus on the relevant matter of “zoning or development” and the intended result of the meeting was “to provide an update on Shire corporate investment”.

The hoped-for location of the meeting was to be at that great gathering of global political and economic elites — the recent World Economic Forum in Davos, Switzerland. However, because of timetable constraints, the meeting did not take place.

“I can confirm that a letter was received from the Chief Executive Officer of Shire, Flemming Ørnskov, requesting a meeting with Minister Donohoe while they were both at Davos,” a spokesperson for the Minister told <strong><em>MI</em></strong>.

“In this letter, Mr Ørnskov looked for an opportunity to introduce Shire and their plans in Ireland and they did not raise the issue of zoning or development.

“Due to time constraints, it was not possible to facilitate a specific bilateral with Flemming Ørnskov on this occasion.”

This is just one example of the varied type of returns lodged on www.lobbying.ie.

There are restrictions placed on former Departmental staff and Ministers and others working in the lobbying area.

“The Act provides that certain Designated Public Officials (DPO) are restricted from being engaged in lobbying in certain circumstances for one year after they leave their employment or office,” a SIPO spokesperson explained to <strong><em>MI</em></strong>.

“In effect, they are subject to a ‘cooling-off’ period in respect of involvement in particular lobbying activities. The DPOs concerned are Ministers and Ministers of State, special advisers to Ministers and Ministers of State and prescribed public servants.

“Others who are DPOs for the purposes of the lobbying registration requirements are not covered by this provision, namely TDs and Senators (who are not Ministers or Ministers of State), MEPs and local authority members.

“A DPO who is subject to the cooling-off period may apply to the Standards Commission for consent to waive these restrictions for all or part of the relevant period. The Commission may consent, may impose certain conditions, or may refuse consent. A public official who is unhappy with the decision may appeal the decision of the Standards Commission to an independent appeal officer.”

<strong><em>MI</em></strong> contacted a number of public affairs companies who lobby for different health interests and some pharmaceutical companies. Of those that had replied by our deadline, most said they were generally happy with the current lobbying legislation.

MSD Ireland is increasingly active in the health lobbying area, with 22 returns registered on www.lobbying.ie. Ms Liz O’Donnell, former Minister of State at the Department of Foreign Affairs and Trade, works on behalf of MSD Ireland, according to its returns, and she has recently lobbied politicians on the issues of “access to innovation” in oncology, Alzheimer’s disease and immunisation programmes.

<strong>Ms Liz O’Donnell </strong>

A spokesperson for MSD Ireland said that having a former established politician like Ms O’Donnell adds to the company’s knowledge and experience in engaging with politicians.

“Companies engage with Government and designated public officials for a host of reasons,” said an MSD Ireland spokesperson.

“For a company like MSD, which employs 1,600 highly-skilled people across four locations in Ireland, and which makes medicines to treat some of the world’s most challenging health conditions, it’s necessary for us to engage with Government and various State agencies to ensure we can inform discussions on key areas of public health policy or indeed strategies to promote the STEM sector.

“It is therefore imperative that any lobbying is conducted by people who have knowledge and experience of the workings of the Oireachtas and Government and how best to engage with these bodies in a transparent manner.

“Some companies use public affairs companies to engage on their behalf. In the case of MSD, we have an in-house Director of Policy Government Affairs and Communications, Liz O’Donnell, who retired from politics in 2007, and who has overall responsibility for liaison and engagement with Government and the Oireachtas.”

<h3><strong>Industry</strong></h3>

Novartis Ireland Ltd currently has 10 returns on the website.

“Novartis welcomes the current lobbying legislation, as it increases transparency and allows better visibility of issues across all industries,” a spokesperson for Novartis told <strong><em>MI</em></strong>.

“In our experience, the database is very user-friendly and practical; for example, there is a simple three-step test to decide whether an activity is lobbying or not.”

Asked whether the company employs any people who once worked in the health sector, whether in the Department or in the industry, etc, to help with lobbying, the spokesperson for Novartis replied: “Novartis engages in lobbying activities to provide policy-makers with data and insights to enable widely-informed decision-making conducive to improving patient health outcomes and a sustainable business.

“Novartis employs a broad range of people from multiple disciplines and industries.”

Hume Brophy Ireland represents a number of different clients, not just restricted to the health area (it currently has 68 returns registered). But it has often lobbied on behalf of clients in the health area, including around the Public Health (Alcohol) Bill.

Ms Maria Cryan, Managing Director of Hume Brophy Ireland, said that her company was happy with how the lobbying legislation is working at the moment.

“Hume Brophy fully supported the introduction of the Lobbying Act in Ireland and we do not believe that it has impacted in any way the willingness or ability to influence policy here,” Ms Cryan told <strong><em>MI</em></strong>.

In terms of employing former public officials from Government Departments to help with lobbying, Ms Cryan said: “Hume Brophy staff come from a variety of backgrounds.

“Our staff are very experienced communications and public affairs practitioners across a variety of sectors. We do not currently have any staff who previously worked in the health sector or in the Department of Health,” she added.

A spokesperson of Roche said it was disappointed at the results of some of its recent lobbying.

“Irish patients now have the worst access to new medicines of any country in Western Europe. It can take four-and-a-half years for patients to get access to new drugs,” said the Roche spokesperson. Roche has seven lobbying returns registered on lobbying.ie.

“We lobby policy-makers to change the system so that Irish patients can get the same access to new medicines as patients elsewhere in Europe. We have lobbied Minister Harris to pilot a new reimbursement system for a drug that would give patients immediate access to the drug and provide the State with what we believe to be a fair price,” continued the spokesperson.

“We are disappointed that we have not received a response. The onus is on both the State and pharmaceutical companies to create a system that delivers fast access to new medicines at a fair price.”

Interestingly, the HSE is not currently registered as a public body with DPOs on the www.lobbying.ie site, so instances of lobbying by officials in the Executive are not covered under the current legislative framework.

A spokesperson for the Department of Public Expenditure and Reform (DPER) told <strong><em>MI</em></strong> that whether the HSE will be covered under the lobbying legislation in future will be reviewed again in 2019.

“The decision as to what bodies were to be included in the Act was a decision made at the time of bringing the legislation forward,” a DPER spokesperson said.

“A review of the Regulation of Lobbying Act 2015 was carried out in 2016/2017 and the review report was published in April 2017.

“No changes were made to designated public officials as a result of the review. The next review of the Lobbying Act is scheduled to take place in 2019 and the matter will be further considered then.”

<div style=”background: #e8edf0; padding: 10px 15px; margin-bottom: 15px;”> <h3><strong>When is lobbying… lobbying? </strong></h3>

So under the present framework, when is an interaction counted as an instance of lobbying?

A perusal of the returns in the health section of the www.lobby ing.ie website from the last year throws up some unusual entries.

Last year, the ICGP registered an appearance by some of its leadership on RTÉ’s <em>Claire Byrne Live</em> TV show.

“The ICGP was invited by the Claire Byrne show on RTÉ to speak about the challenges facing the healthcare service,” reads the ICGP entry. “The Minister for Health Simon Harris and Dr Ciara Kelly were panel speakers on the show. Three ICGP spokespersons were in the audience and spoke briefly: Dr Laura Noonan, Dr Mark Murphy and Dr John O’Brien.”

Also, the Coalition to Repeal the Eighth Amendment recently registered some of its tweets online, noting they were “tagging Oireachtas members in tweets re: stats/info/news items”.

But is a tweet directed towards a Minister or a Department official always lobbying?

“It is the content, not the method of communication, that determines whether a communication should be recorded as a lobbying activity,” a spokesperson for SIPO told <strong><em>MI</em></strong>.

“In certain cases, use of social media will be considered as ‘relevant communications’, as defined in section 5(4) of the Regulation of Lobbying Act 2015.

“For example, generally, a tweet directed at a broad audience and not targeted at someone would not be considered lobbying. However, if a tweet is sent to an individual recipient, or a Designated Public Official (DPO) is tagged in the tweet, it may be lobbying, depending on whether the subject of the tweet concerns a relevant matter and whether the person sending it falls within the scope of the Act.”

But what about an instance very particular to the medical world — what if a Government Minister’s own GP or consultant is a leading member of one of the medical representative bodies, and before or after a medical check-up with the political patient, they raise some health policy concerns or some campaign issues his/her organisation are involved in?

Would this count as lobbying, and therefore should it be registered by the GP or consultant in question?

“Whether a communication counts as lobbying depends on whether it meets all three steps of the three-step test — the communication must be made by a person who falls within the scope of the Act, to a designated public official, about a relevant matter,” said the SIPO spokesperson when reacting to this hypothetical situation.

According to the legislation, those within the scope of the Act include “an advocacy body with at least one employee where the primary purpose of the body is to advocate on an issue” or a “representative body with at least one employee where the primary purpose of the body is to communicate on behalf of its members”.

“If the person falls within [this] scope and they communicate to a DPO about a relevant matter, it is lobbying — regardless of the venue or level of formality of the communication,” the SIPO spokesperson told <strong><em>MI</em></strong>.

“In the situation you describe, it would depend on whether the person communicating is within scope and whether they were discussing a relevant matter.”

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