Mary Harney (Dublin Mid West, Independent)

I am not in a position to accept the amendment. The powers in the legislation will allow the Minister to set the charge at zero if he or she wishes to do so. The powers do not necessarily mean the charge will go up; it can come down, go up or be set at zero. The legislation indicates the issues to be taken into account, in particular the consumer price index, information on expenditure, the number of items prescribed, the medical needs and financial burden on persons who avail of the service and the necessity to control health expenditure. We will keep this matter under review.

I accept this measure is new and has not happened before. Deputy Reilly made some valid points about the patient populations in Northern Ireland and here. However, why is it 83% of items are prescribed in their generic form in the UK as against 18% under our GMS scheme? What is the reason for this? This is not to do with people who are sicker. The fact is our prescribing of branded products is extraordinarily high by any standards and, unfortunately, we must legislate to deal with that through reference pricing and generic substitution.

I refer to the wider issues. If someone moves and buys another prescription elsewhere, I am advised the computer system will be able to deal with this. With regard to medical card applications, among the reasons for the difficulties which arose this year were the industrial relations difficulties which operated throughout the public service. As Deputies are aware, many staff in the HSE, elsewhere in the public service and Civil Service, in Departments and other public sector organisations were engaged in industrial relations activities for a considerable time. Thankfully, that has now been suspended. This led to delays in the administration of medical cards and the centralisation of medical card applications, which is now proceeding to free up staff to carry out other duties. We cannot have it every way. We wish to reduce the burden of administration and bureaucracy but at the same time maintain all the various offices dealing with medical card applications. This is not the case with other social benefits and the approach operates successfully on a centralised basis in the case of welfare payments.

I believe the charge is modest. I accept a DPS patient pays €120 per month. Many patients in nursing homes are DPS patients who pay €120 per month, which does not pose a difficulty or challenge for the operators of nursing homes or pharmacies. Pharmacists are used to charging such people. I accept they have never before had to charge medical card patients but medical card patients may also receive items not covered under the medical card and would be accustomed to paying for these in a pharmacy environment.

Earlier, I stated that in an ideal world this would not be necessary. However, we must examine every possible option to control costs, which are rising here rapidly, in respect of the number of items being prescribed and the volume and cost of medication. Everything we are doing, including measures to address the off-patent price, the retail margin and the wholesale margin is to reduce the rate at which the costs are increasing. This year we will spend more money than last year because of the higher volume of items prescribed and dispensed, the ageing of the population and all the other factors of which we are aware and which affect the demand-led schemes, including medical cards.

I am unsure whether we have ever had as many medical cards in the population as at present. Some 1.55 million people are covered. In addition, we have the doctor only card, which has been allocated to more than 100,000. This amounts to 1.65 million people who have free access to their general practitioner either through the doctor only card or through the medical card. I refer to those who have a medical card and an LTI, long-term illness, card. For the purposes of certain listed drugs, such people would use the LTI card. Some 16 conditions are covered under the LTI card. I realise Deputy Reilly has tabled an amendment with regard to extending this which we will have a chance to discuss later.

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