Mr. John Hennessy:

I take the point that there is a broad strategic issue across multiple Departments in relation to palliative care. In the context of the Department of Health, it is a critical service that has a huge bearing on the operation of the overall health service. It is acknowledged that the palliative service countrywide is uneven. However, as evident from the responses we are attempting to address that in a systematic and strategic way and to bring consistency and standards into place. This takes the form of addressing gaps where inpatient specialist units are concerned. There are some examples about which I can speak in detail to the Deputy, including in relation to additional consultant posts and clinical nursing posts. There is a very strong focus in our service plan 2015 on addressing this issue and on working closely with voluntary providers and the hospice foundation. I accept the point that there is a wider dimension to this that involves multiple interests, including other Departments.

On Deputy Dowds' question regarding the cost of drugs, I will forward a precise response to that question to the Deputy. In approximate terms, current reimbursement costs are €1.8 billion per annum. That encompasses drugs provided under the medical card scheme, drugs payment scheme, long-term illness scheme and hi-tech medicines. On reductions, the approximate reductions over 2013, 2014 and 2015 will be €400 million. This is part of a concentrated and ongoing programme of cost reduction on drugs and medicines designed to bring us more into line with our European neighbours. Drug components, in terms of reference pricing, and preferred prescribing initiatives, are significant issues. The process of seeking to achieve the outcome required while ensuring continuity of supply continues.