Mary Harney (Dublin Mid West, Independent)

I said it is a specialist centre and everywhere should be a centre of excellence. Deputy Coonan implied there were only eight centres of excellence. He seems to be confusing the term "excellence" with "specialist".

There will be challenges in health service provision. Ireland spends 11% of national income on health services, going by GNP data as GDP data is somewhat unreliable due to the large multinational presence in the economy. By international standards, Ireland's spend on health is very high. While we may not be at the top of expenditure league tables, we are still high up. We must continue to seek value. This year €1 billion was taken out of the public health service which will put enormous pressures on services delivery. The priority must be to minimise any impact on front line services.

Today, I had a frank meeting with the Brothers of Charity. It must be remembered the organisation has seven chief executive officers, however. We must look at overheads in providing services without being critical of any organisation.

Funding for the organisation's Limerick respite service is €25 million and the challenge is to find €150,000 for the service to be kept open. I hope it can be restored but it will be a subject on the Adjournment tonight which the Minister of State at the Department of Health and Children, Deputy Moloney, will address. I support his efforts to drive better value in that sector among public and voluntary providers. I know the organisations involved are keen to make that happen too.

The Health (Amendment) (No. 2) Bill 2010 is being introduced to raise a modest but not inconsiderable amount. The €24 million it will raise is twice the increase we were able to provide for home care packages this year. It is not unreasonable for medical card patients to make a small co-payment on their prescription medicines. The reason it will only apply to medical card patients is because other patients pay €120 a month under the drugs payment scheme. An exception has been made for those on the long-term illness card scheme which would not include diabetics. No new illness has been added to the scheme since the mid-1970s. Eligibility legislation is being prepared which will bring greater coherence to the medical card and long-term illness regime as there are anomalies with those illnesses defined in the 1970s and the emergence of new long-term ones.

The Minister has the capacity in the legislation to make exceptions but it is more appropriate that it is done by regulation. One area, for example, I would like to cover but is difficult to define is palliative care. Another possible exemption would be for women who had suffered symphysiotomy. I will examine these matters with my officials and deal with them through ministerial orders.

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