Leo Varadkar (Dublin West, Fine Gael)
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On the specific issue of periodic payment orders, the Minister for Justice and Equality is due to publish legislation early next year. I expect it to go through the House next year.

There is the bigger issue. I think tort reform is required in this country. In terms of payments for medical negligence, in many cases these are not cases of medical negligence at all and can be biological events in some cases. Health care, by its very nature, is risky and there will always be a certain level of claims even against good physicians and good surgeons. A lot needs to be done when it comes to tort reform. Our legal costs and awards are very high. I intend to engage directly with the Minister for Justice and Equality on the matter in 2015. However, law reform is slow and I doubt it will produce savings in 2015.

Separately, the HSE is moving very firmly towards a change in culture - in hospitals and health care settings - to one of open disclosure. The evidence is very strong that people are less likely to sue, and are less likely to be awarded big damages, if health care professionals are upfront and honest about what happens when things go wrong. Unfortunately, that has not been the culture across our health service in recent years. We have seen a number of very distressing examples where staff have not been willing to tell patients and their families the truth about what happened. I think if they had done so not only would the outcomes have been better for the families and patients concerned, the cost to the taxpayer would have been lower. That is a big change that can happen without legislative reform.

On the issue of service level agreements for section 38 and section 39 organisations, they are nearing finalisation. The target is to have them ready for the early new year. Thereafter, the target is to have them signed in January or February with the vast bulk of them being signed before the end of quarter 1 of 2015. That means the end of March 2015 is the target.

In terms of financial control, there is a stronger incentive than ever for the HSE and hospitals to stay within budget. In recent years savings had to be delivered in order to reduce the central Government deficit. Now, more and more, savings above a certain level can go back into the health service and into services.

I hope that is an incentive to drive savings more in the future.

If the economy is growing by 3% or 4% a year, we should seek an increase of that amount in the health budget. There is little point in having economic recovery if it does not mean more money in people's pockets and more money to provide better services. The problem we have had so often in the health service is that increases in health spending do not result in better services. We saw this particularly during the boom years when increases in spending went largely towards having more staff and increased pay for staff but not better services. There were improvements in some specialties, but the intractables such as overcrowding in emergency units and waiting lists were the same or even worse at a time when the budget was much higher. There is a major challenge to ensure additional spending benefits patients and service users.

There was a debate on fampridine, which is marketed as Fampyra, in the Seanad a week or two ago. Decisions on what medicines are reimbursed are not made by me. They are not political or ministerial decisions and there are no patient charts on my desk. That is not how it works in my job. A decision is made on objective grounds by the HSE's national drugs committee on the advice of the National Centre for Pharmacoeconomics. Fampyra is not being reimbursed in many countries and it is not reimbursed by the NHS because the evidence produced by the National Institute for Health and Care Excellence, NICE, in the United Knigdom, Dutch researchers and the National Centre for Pharmacoeconomics shows that it is not particularly effective as a medicine. It is costly and the evidence suggests it does not work for most patients. In the case of those for whom it does work, it works less well than physical therapy and only marginally better, by a few seconds, than a placebo. That is not a very good evidence base on which to reimburse any medicine.

Having said that, the door is never closed and no medicine is refused absolutely by the HSE which is always open to a manufacturer coming back with a more acceptable cost and new evidence showing that it is effective. This happens from time to time. Alternatively, the manufacturer can come back with risk sharing proposals such as allowing the medicine to be reimbursed in the case of those who do respond to it. Sometimes, a medicine may not be generally effective, but a small cohort of patients may find it to be so. Rather than reimbursing it for many, for whom it does not work, we can make risk sharing arrangements to allow the HSE to reimburse the medicine for the small group for whom it does work. These options are open to the company concerned, but, more and more, the message that should come from this Parliament is that we need to put more pressure on the drug companies and the pharmaceutical industry to come up with fair prices. It is often the case that Ireland is asked to pay more than other jurisdictions for the same medicine. We would do better for patients and taxpayers if we were all united in putting pressure on the industry, not the HSE or the Government to overpay for certain medicines.