Mr. John Hennessy:

Yes. There are controls in place for high-tech medicines - the subject of the Comptroller and Auditor General's report. There is room for improvement and the report contains five recommendations which are implementing and which will strengthen them.

The issue in high-tech areas, as in most others, is finding the balance between supplying a service on which patients who need drugs and medicines can rely and control. Approximately 30,000 patients rely on the delivery of high-tech medicines every week and month across the 1,800 pharmacies around the country. Typically, they include patients with cystic fibrosis or multiple sclerosis, MS; transplant patients who need anti-rejection medications and some very serious metabolic disorder cases. They tend to be the sickest patients in our system and are very reliant on a reliable supply of medicines. As the report also pointed out, it is a growth area. Expenditure is increasing, contrary to what is happening in most other areas where we are securing substantial cost reductions. Therefore, controls are important, although supply is also very important and the first priority.

We implement stock controls and the just-in-time delivery principles and provide stock management guidance for pharmacies. The aim is to minimise the level of out-of-date stock. It often occurs for very understandable reasons.

Patients' circumstances change. They go into hospital, often at short notice, and pharmacies are left with stock on hand that, perhaps, they are unable to use. Our efforts with the pharmacies are to try to minimise that to the greatest extent possible. The recommendations from the Comptroller and Auditor General's report will help us to do that and to strengthen those controls in the form of sample validation and electronic stock control systems. Incidentally, we have already commenced the implementation of those.

While the level of out-of-date stock sounds high at €2.7 million, it represents approximately 0.5% of our expenditure on high-tech medicines. That is not to underestimate it. Our efforts will always be towards bringing that down further, but obviously there is a balance between the two issues of control on the one hand and ensuring that patients are able to get their medicine.