Kate O'Connell (Dublin Bay South, Fine Gael) | Oireachtas source

I worked in the NHS in the south of England when I was qualifying as a pharmacist when Agenda for Change was being introduced. It had its problems and did not completely work out but there are lessons from Agenda for Change that can be applied to the system here. One of the benefits of coming late to the table is being able to do things correctly and learning from other jurisdictions' experiences.

Improving patient outcomes is the whole point of the health service. One must focus on the people and culture, human resources, industrial relations or whatever one wants to call it. It is very difficult in the health service where there are things such as recruitment embargoes or moratoriums being introduced. They are blunt instruments. If one stops recruiting consultants and there are support staff wandering around with no direction, it might save money on the budget this week but it can have a negative effect in the long term. The approach we have had of cutting spending on pay by imposing recruitment embargoes is an ignorant tool.

Finance is a constant issue in health. The graph is going up. It is important to note that demand and demographics will always push the graph up, at least in the short term until the improvements to health over a lifetime bear fruit. We have a huge issue with the cost of drugs, including orphan drugs, and with pressure where, as Senator Dolan noted, those who shout the loudest get the most. I am greatly concerned that where we have a very robust system of authorising drugs, sometimes there is political pressure or those who have the loudest voice lead to exemptions being made, over others who require other medication or treatment who have no voice. The key to success is ring-fencing or some control on drugs spending annually, so that when the money is gone, it is gone. That has to be balanced with the pharmaceutical companies knowing how much money is in the basket to start with.