Mr. Tony O'Brien:

It is also worth stressing that we are conscious that while certain services related to children will migrate to the agency, the HSE will still be a very significant provider of children's services and will need to be fully in compliance with Children First and will need a lead in relation to children. It is a carefully sequenced extraction process. We would not want the view to develop that the HSE is no longer in the child care business because it is. The focus of child protection is appropriately moving to the new agency but the HSE will still provide a vast range of services to the benefit of children and needs to be appropriately organised for that. We have someone working on this process.

At this stage we are preparing for the full roll-out of money follows the patient. In that context we are not piloting any new areas. We will be seeking to move swiftly in line with the publication by the Department of Health two and a half weeks ago of a survey strategy and discussion paper in regard to money follows the patient. We will be seeking to move wholesale towards that in shadow form and then in full form as quickly as practical thereafter and there will be benefits that arise from it. Not every type of health service will be amenable to money follows the patient. That will emerge as we go through the process.

In terms of the cost of drugs, there are a number of key issues here, one of which is legislative in terms of reference pricing, sometimes referred to as reference pricing 1 and 2. The full benefit will flow in due course from reference pricing. At present we have a medicines management programme in place which will address also the issue of how best to interface the pharmacy sector in this issue. We know that our rate of generic prescribing by comparative standards is very low and we also know that there would be a significant economic benefit if that rate were to be increased and the medicines management programme is focused on that. Reference pricing would add to the value of that but there is significant to be obtained even in advance of that legislation.

On the issue of waste, I am sure there is no limit to the number of individual examples of less than ideally efficient practice. The clinical programmes and other measures are in place to draw attention to these. There is a constant focus on it but in an organisation of 100,000 people, unfortunately there will always be instances where there is room for improvement. We will continue to focus on that. I am sure the example used is a clear one.

In terms of clarity of funding flows, there is no doubt that the health sector is by its nature a complex funding flow environment by comparison with any of the other mainline Departments. We are moving towards a governance structure in accordance with the HSE governance Bill, which is currently under discussion, which will see us move to a focus on care groups rather than regions with the appointment of directors for acute, primary, mental health, social care and health and wellbeing. We will be organising our budgets in that way with a view to bringing greater clarity and money follows the patient will also add to that. I will ask Ms Laverne McGuinness to speak to the issue of medical cards.