Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

We undertake individual negotiations, by and large, with the individual companies.

The third area in which we seek drug savings is, as Deputy Ó Caoláin mentioned, the issue of preferred drugs and the medicines management programme. GPs can prescribe alternatives to commonly used medicines. For example, in the case of medicines for the treatment of ulcers, there is already an identified preferred drug from among three or four drugs, and this will be the most cost-effective drug. Other countries have imposed formularies and decreed that doctors can only prescribe the most cost-effective drug in the class. We have not done this yet. In my view it would restrict clinical autonomy, and I would not decide to do that quickly, but it is an option. What we prefer to do, under the leadership of Dr. Michael Barry, is to encourage GPs, consultants and junior doctors to prescribe the most cost-effective medicine in the class and to do this by agreement rather than by compulsion. That is an option if we need it.

When it comes to savings on drugs, it is not all about saving money. The main reason we need to make savings in the drugs bill is so that we can fund new treatments and innovative therapies. We need to find the money from somewhere to fund the additional €30 million being spent on hepatitis C drugs to cure the virus, and this is the reason we are looking for savings on drugs.

The Deputy asked about Soliris. The HSE national drugs committee decided to approve the use of Soliris, following discussions with the manufacturer, Alexion. It is still considered not to be cost-effective. The view of the National Centre for Pharmacoeconomics is that a medicine costing nearly half a million euro a year per patient which does not cure the illness is not a cost-effective medicine. The reason it was approved is that it is an orphan drug, in that there is no other treatment for that condition. Where a medicine is an orphan medicine and there is no other treatment other than this medicine, the drug companies have us over a barrel. The HSE took the decision yesterday not to allow patients to suffer, notwithstanding the fact that the corporation has put its profits first and foremost. On that issue, I hope another company will develop a similar medicine for those conditions sometime soon, in which case I guarantee that both prices will decrease considerably.

With regard to medical cards, Deputies will appreciate that I cannot discuss individual cases. I do not have access to people's medical records nor to their financial information. It would be wrong and inappropriate to discuss individual cases. I will make the point that people with Down's syndrome are entitled to the long-term illness cards, which means they do not pay for their medicines. In that sense, it is actually better than a medical card because medical card patients have to pay a prescription fee. In some cases, very sick children or adults will have a doctor visit card, which means they do not have to pay the doctor. They will have a long-term illness card, which means they do not have to pay at all for medicines for their condition. Neither do they pay for aids and appliances. Patients with these three entitlements are actually better off than if they had a medical card, because medical card patients must pay a prescription fee. That often does not come across well in debates. People often do not realise that sometimes one can be better off having a suite of supports such as the doctor visit card, the long-term illness card and the aids and appliances card, in that these can be better than having a medical card. It is sometimes difficult to explain this to people.

Medical cards are means tested. Approximately 40% of the population - the least well-off 40% - have medical cards based on their means. Discretion is used where people are over the limit, but that discretion is based on their medical costs and their medical bills. For example, if a person is several thousand euro a month over the limit, it is very difficult to see how they would qualify for discretion because the most one can pay for medicines is €144 a month. For example, if a person attends a doctor twice or three times a month, that is €150. Therefore, the maximum one could pay is €300 a month. If a person is several thousand euro a month over the limit, then it is very difficult to find grounds for discretion. However, the number of people with discretionary medical cards has increased from 50,000 to 75,000 in the past year or so. With the addition of those with discretionary doctor visit cards, the number rises to 108,000. The HSE is now permitted to supply aids and appliances - such as crutches or wigs - where appropriate and regardless of income.

The next step in the reform process is the clinical advisory group which was appointed a week or two ago. Within three months the group will produce guidelines to widen discretion further. This will encompass more very sick children in particular, but I do not wish to prejudge the outcome of their determinations. It is important to bear in mind that sometimes the suite of supports given to a patient, such as a doctor visit card, a long-term illness card or aids and appliances, can be greater than the medical card he or she may be seeking. This point is often not understood.

It is important to regard free GP care for the under-six age group as just the first step in providing GP care without fees to everyone in the population. It has not been done yet, so it is certainly not being done at the expense of anyone else. I reject that suggestion because it is not true. It is additional, and it is not just for the children of better-off parents.

It is a new service for all children under six years. It will be an enhanced primary care service that will include areas such as the management of asthma in practice and health assessments for children at certain points as they grow up. All children will benefit. Currently, people go to GP surgeries with an illness for which they are treated and that is it. Under the new primary care service, there will be health checks for obesity, etc. This means that conditions not being diagnosed now are more likely to be diagnosed. That will have benefits down the line.

The real beneficiaries will not be very well-off parents but middle to low income parents, the kind of people who work hard and pay child care fees and a lot of tax without getting anything from the State other than education services. I really do not believe we should begrudge hard-working parents who often run out of money on Friday or Saturday of every week access to their GP without fees. Deputy Billy Kelleher mischaracterises what we are trying to do in that respect.

On mental health issues, my officials will revert to Deputy Dan Neville with more details. I have to hand information which states over 1,150 new posts have been approved since 2012. They facilitate the policy of moving away from traditional institution-based care to a patient-centred, flexible and community-based mental health service in which hospital admissions are greatly reduced, while still providing inpatient care, where appropriate. At the end of December, of the 416 approved posts, 95%, or 397, had been filled. I refer to the posts approved for 2012. Of the 477 posts approved for 2013, 78%, or 367, have been filled. The remainder of the vacant posts are at various stages of recruitment. There have been some difficulties in identifying outstanding candidates, primarily for geographic or qualifications reasons. Therefore, approximately 86% of combined posts in the period 2012 to 2013 have been filled.

On CAMHS, 233 whole-time equivalent posts were allocated for the years 2012 and 2013, of which 193, or 83%, had been filled by the end of the year. Of the 150.5 whole-time equivalent posts allocated as part of the 2012 investment, 94%, or 141, had been filled at the end of last year. Of the 82.5 posts allocated for 2013, 62%, or 52, had been filled at the end of the year. The remainder are at various stages of recruitment. Perhaps I might give a note to the Deputy later that will outline the statistics in more detail.