Colm Burke (Fine Gael) | Oireachtas source

I thank all those who made presentations this morning. I apologise if I go over some of the ground again. I had to deal with a Commencement Matter in the Seanad.

I am grateful for the comprehensive reply to my question on the availability of drugs. There is a question mark over short supply of some medication, some pharmaceuticals. I have got a comprehensive reply and I appreciate that. There are two issues. The reply confirms that there is a short supply in some areas and the HSE is dealing with it. The Sunday Business Postrecently had a report on overprescribing. The usage of one particular drug has gone up by more than 1,000%. That huge increase in the use of medication is a major cost to the health service. In one case it went from slightly over 100,000 people taking an item to more than 600,000 using it. There is also a big budgetary problem with orphan drugs. Is it time to look carefully at the availability and use of drugs? On the one hand we seem to have overuse and on the other hand we do not seem to have funding to provide for particular drugs. Do we now need to have a full review of how we are managing the cost of pharmaceuticals and drugs?

As part of my question I also raised the issue of the effect of Brexit on the availability of drugs because we are very much tied to the UK market in many ways. We need to plan for that adequately. In fairness, the reply deals with that. That is another issue we need to plan for.

I know people may be tired of me raising the issue of the increase in administration and administrative staff. I was given figures this morning indicating an additional 2,605 administrative and managerial staff in the HSE since 2014, which I calculate to be a 17% increase. I know the argument will be put to me that there were cutbacks in difficult times and this needs to be made up. However, the HSE now has 17,715 people in administrative and managerial roles. That is an increase of 17%. The number of staff nurses has increased by 3.65%. The number of public health nurses, who are to the forefront of helping us keep people out of hospitals, has increased by 3.69%. People on the front line in section 39 organisations are having difficulty because we have not restored the cuts they suffered.

While I know there is more paperwork related to health care, there has been a disproportionate increase in administrative and managerial staff. A 17.2% increase does not sit right with me. I raised this question 12 months ago and I raised it two years ago. Where is the cut-off point? The HSE now has 17,715 people. Is the cut-off point 17,800? Is it 18,000? Is it 19,000? Surely the HSE has a plan. If we go down this road, we will not have the funding to sort out the people in the section 39 organisations. We will have a difficulty in recruiting public health nurses. The whole job in health care is to keep people out of hospitals. The only people who can do that are the people who work on the front line - out in the community. I ask for a detailed reply on that issue.

I also raised the issue of elderly care. I am grateful for the reply on that. I suggested we need to have a forum involving all the focus groups, nursing homes and the care providers. We have a huge change in the demographics with a greater number of people living longer and therefore greater demand. Many nursing homes are experiencing difficulty in getting GP cover at weekends. How will we deal with that? I am talking about dealing with that immediately because that cannot be parked.

Many people need to go from nursing homes into hospitals because our health service does not provide the care for them in the nursing home. A simple example is with dieticians. Dieticians employed by the HSE will not attend nursing homes because they are not covered for travel expenses. If a patient needs to see a dietician, someone has to go into the hospital with them. It takes up time in the hospitals and there is an issue with value for money. The private sector is coming into many nursing homes and prescribing supplements giving rise to a huge cost to the health service. Those are simple examples. That is why we should have a forum. There are 23,000 or 24,000 people in nursing homes. We need to see how we can create efficiencies in dealing with people in nursing homes rather than putting them through accident and emergency departments, but it needs to be co-ordinated.

Those are the issues I want to raise. I again thank the people who dealt with the questions I submitted. I raise those issues on foot of those replies.