Mr. Stephen Mulvany:

The total expenditure will be approximately €177 million. This relates to people who are receiving every type of aid, appliance or medical equipment at home, such as beds, hoists, aids, nebulisers, sleep apnea machines and continuous positive airway pressure, CPAP, machines. The range of medical appliances and equipment that people are receiving is only going in one direction; it is increasing. They are getting more complex. Much of that is a good thing because it means that people are getting out of and staying out of hospital and being maintained at home. The more we maintain them at home, the more kit that needs to go into the home. It is an ever-increasing piece.

Some €177 million is going to medical card holders under the local demand-led schemes that are administered in our six regions. In addition, another €88 million is going on primary care under a range of initiatives. We have provided significant policy guidance to the system on the need for proper clinical referral.

We have what we call local resource allocation groups which consider the more high-cost materials such as electric wheelchairs. Either through our direct provision in some areas and-or managed services from external providers, we have arrangements in place to distribute, collect, recycle, re-engineer and repair where it makes sense. Again, this is typically for the more high-end aids and appliances. In some cases it is more than aids and appliances and involves medical equipment. In other cases we do not recycle them in the sense of reissuing them for re-use because, as Deputy Cullinane said, they are low-cost, single-use items. Typically we seek to recycle the parts or the product itself at end of life. This is something under constant review given the green agenda. It is an area that needs focus and it is getting that focus, including between ourselves and the Department, in the community schemes. As the Deputy rightly said, it is a significant area for control. It is an expanding area and this is a good thing.