Dr. Mark Murphy:

I will touch upon the question asked by the Chair as to how we know that a drug is cost effective. In an evidence-based consultation, a doctor uses his or her own clinical experience. He or she also considers the evidence available about the drug, which will often have limited benefit but which is beneficial nonetheless. There may be side effects of the drug. The decision is shared with the patient and their preferences are considered. That takes time. For a patient who is on 14 different drugs, considering the fact that all of those drugs are dynamic and that at any one time they are not definite or absolute forever, a medication review every six months takes a significant amount of time. If one wants to take the prescription of medication seriously, apart from the capital infrastructure to make prescribing between interfaces safe, that time needs to be resourced. This is particularly true in the last five to ten years of a person's life. If a person is over 80 or 90 years of age the evidence base for those medications is limited, particularly for primary preventative purposes, and we need to fund that time to have those long conversations with patients. I believe we would reap dividends in terms of a reduction in health care spending.

On Sláintecare, the Irish College of General Practitioners really wants to commend the Chair and every Deputy and Senator here on their hard work in advocating for a long-term vision for a fairer and better health care system that is more community orientated. We absolutely support the initiative taken. We really are getting frustrated that the Department of the Taoiseach and other high offices have not taken this on to implement it.

On Social Justice Ireland and the working poor, it is those persons who are above the means threshold for a medical card, who have to pay to see the GP and who perhaps must pay €149 every month for their medications. It is extremely unfair, and it is a definite phenomenon that those patients are not compliant in returning to us or with taking their medications because of cost. Some of those patients end up with catastrophic out-of-pocket payments, which is simply wrong and immoral. It is a difficult issue, and I believe that Sláintecare is seeking to address it.

On the question of loneliness, I agree entirely with Senator Swanick. There are issues in the health care system about which we have to be honest. We cannot do anything about some of the issues. Much of the life expectancy improvement that has taken place over the last 50 years is not due to the medical profession but because of advances in other areas of the civic environment, such as education and social protection. A community health care system is very important and is useful for the prevention of loneliness. Having a day in a community hospital, accessing a GP, a public health nurse and a home care package are some of the benefits. However, we have to get real and not over-medicalise this. This is an issue of a fragmentation of our communities and a change in culture. It is a wider civic societal issue as well. GPs have a pivotal role in identifying loneliness but in terms of social prescribing and other phenomena to try to help loneliness, it is a major issue and I believe we should not over-medicalise it. It is a very important issue to raise.