Dr. Rónán Collins:

In addition to my role as clinical lead in the national stroke programme, I am a geriatrician, and Senator Conway-Walsh is absolutely right that pain is an important part of chronic disease. Nobody disputes that. I think there is probably a feeling in the medical community that we need to invest more in our pain services in general. The model for what pain services should look like is probably a multidisciplinary service. The solution to all pain is neither a pill nor a patch but there are other aspects as well. The problem with having limited finance, and I am not speaking on behalf of Professor Michael Barry from the medicines management programme, who is very well able to speak on his own behalf, is that the resource is finite. Looking at the use of this patch as a medic, there is a significant gap in the evidence as to how this patch is working. It has a licence for one treatment but it has been used, and seemingly, I am not doubting the testimonials of patients, it is working in other areas as well. That always poses a problem in medicine in terms of prescribing something, when one does not have a clear licence to use it for that condition. Should it be withdrawn from patients who clearly benefit from it? Definitely not but to be fair, I do not think Professor Barry suggested that either. I think he is suggesting that he needs to have some sort of control over it in terms of how it is prescribed. My personal view is that the issue may have been possibly handled in a hard way but if there was not consultation with general practice, and I am not aware whether there was - that is not an ideal way to conduct business. In general terms, we are a small country with finite resources. I acknowledge the Minister has made an important move to get us involved with other smaller countries in Europe in order that we have better bargaining power for purchasing drugs. That is a very important issue but with resources that are finite, one must conduct some sort of analysis if there is a significant overspend in a particular area.