Damien English (Meath West, Fine Gael) | Oireachtas source

I welcome the opportunity to contribute to the debate on the Health (Pricing and Supply of Medical Goods) Bill 2012. It is unusual to be in the House on a Monday and it is good to get a chance to speak on this issue, among others. The Bill is another important part of a practical tranche of legislation which has come through the House lately. It will deliver greater reform and competition for the broader health sector. The Bill seeks to ensure value for money for the taxpayer and the consumer on a revenue-neutral basis. It is important to note, at a time of great public and media cynicism about politics and the work of this House, that the Bill answers the commitment given in the Fine Gael and Labour Party programme for Government to reduce the State's large drugs bill and to reduce the cost to individuals of medicine. The commitment was that this would be achieved through reference pricing and greater use of generics.

It is important to address not only the cost of medicines to the consumer but the cost to our health services of the purchase and supply of drugs. There has been a difficulty this year in getting reductions quickly and in securing the deals to prevent some of the necessary cuts or adjustments in the budget of the health service at the end of the year. It is a pity this has occurred but, ultimately, these things are delicate, they take time and they must be done right. We must ensure we are in a position for next year's health service budget - I believe we will be - to take advantage of the commitments and the deals that have been done this year. We would rather they had been done earlier. They should have been done years ago but they were not. At least the reforms are happening now and it is about time we benefitted from them.

I have no doubt that under the parties in government we will get great reform of the health service. However, that reform cannot happen overnight, in one week or in two years. It will take the full four or five year term of the Government and possibly one or two years into our second term in government. We must keep on with the fight to fix the health service. This Bill, along with other discussions held in recent months, is part of the reform.

In the short term, things will be difficult. In the past one or two months we have seen cuts to home help and home care packages and so on. In some cases there are areas where one can make changes without affecting others, but in other areas it is not possible and services are hit. This is because, in the short term, when one is trying to root out problem areas and the mismanagement and misspending that has taken place over the years, it takes time to find all the areas where money is going to waste. However, we must do this to reduce the negative effects on the front line and those who need it most. This is what we are trying to do. We are trying to find areas where we can save money in order that we can protect those on the front line. No one wants to see any reductions to home care packages or home help. I accept the Ministers involved are trying to bring in new ways of doing this to ensure those who need it most are getting the services.

I hope the reforms are introduced and bring about better management of resources on a 12 month basis rather than nine months and a crash course at the end to make savings. We should get a spread of change more easily because if one only makes budget savings in the last two months, inevitably one goes to the quick fix areas where one can save cash. It is as simple as that. I worked in the accounts area of the health service and I know what happens. To save money, sometimes it is easy to go to the areas where one can save cash quickly. These are easily identified but often they are the areas of greatest importance. There is no choice if we leave it until the last minute. We must manage the health budgets over a 12 month period and this involves every level of management and every worker in the health service doing their bit as well as the Ministers at the top. There must be a joint effort across the board. I speak to staff on a daily basis who can identify areas of waste. These staff should be allowed to speak up and must be listened to in order to bring about these changes. I have no doubt that we can save money in the health services without affecting services but we need everyone to come together to have that conversation and to find these areas. We need to be able to bring in the reductions without hurting the front line.

I have spoken about what happened in the health service budget. I have consistently said it was the greatest failure of previous Administrations. They were in power over ten or 15 years and involved several parties, but mainly Fianna Fáil with Bertie Ahern at the top for almost ten or 15 years. At that time budgets in every Department were left to go mad, as it were. There is no other way of putting it.

The health budget is as clear an example as one can get. In 1997, the health budget was about €3 billion. In 2007, it was €15 billion, which is crazy. The number of people working in the health service went from 70,000 to 140,000. I recall a debate in the House on the health service in 2006 or 2007. On the same day, the Taoiseach, the Tánaiste and a Minister were asked how many people worked in the health service. I forget which of them said what but one of them, who could have been the Taoiseach, said in the morning that 110,000 people worked in the health service. In the afternoon, the then Tánaiste, Mary Harney, said that 120,000 people worked in the health service. Later on, the then Minister for Finance, Brian Cowen, said the answer was 135,000. This shows that they did not have a clue about how many people were working in the health service. It is not that difficult to count 110,000 or 120,000 people. I know some of them are equivalent or work half or quarter time, but it is still no harm to count them. If one were the head of IBM or Intel, one would know how many worked for the company.

Thankfully, we are now getting a handle on our health service and know how many are on waiting lists, including outpatient waiting lists. One must count the problem before one can fix it. It takes guts for Ministers to announce how many people are waiting for an operation but that they are going to tackle the matter. It takes guts to admit that there are 350,000 people on the outpatient waiting list but that we will tackle it. I spoke many times while in opposition about how one must first admit one has a problem and then one can put a plan in place to fix it. That is what we are trying to do here in many areas. Great progress has been made in respect of health service reform, but it will take time. Before they entered Government, both parties always said it would take over five years to fix the health service completely, and we will fix it.

Two excellent reforms are the concept of money following the patient and increasing capacity in some of our units. The orthopaedic unit at Our Lady's Hospital in Navan is carrying out great work and is way ahead of targets set out for the year under the new concept of money following the patient. When we bring in these reforms that increase our capacity to deliver, the State must be able to benefit from the reforms. Sometimes, because of cash budgeting and a shortage of money, capacity has built up towards the end of the year in a certain unit, be it an orthopaedic or elective surgery unit, that could be used, but because of the additional cost of buying the equipment needed for the operations, things might not happen. When we introduce reforms, we need to ensure we can somehow find the extra cash to use the asset. If one has a theatre and staff who are ahead of capacity and ready to do more work, we must find the additional resources we need for that unit to do the extra work although I know this takes time. It might be a case of doing more private work through a deal with some of the private health insurance companies. I know this is on the Minister's mind. If capacity has built up in State-owned assets, we must be able to use it as best we can. All the reforms in the world will save us money in the long term and enable us to work much better, but we need imagination as we journey towards major reform.

It is interesting to note that during the dreaded years between 2001 and 2008, spending went wild. There was an increase of 185% in HSE expenditure on medicines and non-drug items, with the figure reaching €2 billion in 2009 and falling back to €1.9 billion last year. At the same time, the number of items paid for by the HSE on the community scheme increased from 13 million in 2000 to 17 million in 2010. No one would dispute that it is important that people who are sick get the necessary treatment, but it is very debatable as to whether the level of sickness in Ireland rose 185% in ten years, even when one factors in a rising population and the stresses and strains of the Celtic tiger era. I know there were significant improvements in drugs and treatments but it is not right that the cost rose by 185%. There was clear price inflation, bad deals and a lack of regulation and oversight in this sector, which this Bill will provide a legal framework for dealing with.

I stand behind the Minister and his team in any reform to put value for money for the patient and taxpayer ahead of bloated and outdated systems. As a public representative for Meath West, I am deeply aware of the price of medicines and the ability of hard-pressed families to deal with this necessary living cost, and I am sure the same can be said for all my colleagues in this House and local authority members. It is something that none of us as public representatives can escape. We know all about it through the people we represent, and it is an area we must tackle.

Greater access to the Internet and more shopping outlets and chains north and south of the Border, as the desire to shop around for value for money has grown, have led to greater public awareness of the price of medicines. In some cases, this greater awareness turns to despair and frustration as there can be large disparities in the price of certain drugs between individual suppliers in this State and, more dramatically, between this State and Northern Ireland and other parts of the EU. This is before we factor in the use of generic drugs. While we all desire to shop as locally as possible, especially at this festive time, and to support our own neighbours and maintain local employment, facts such as those I have just mentioned present a serious challenge to this mantra. Some families do not have a choice. Their disposable income is so low that they have no choice but to travel to spend their money, even though they know it is probably not good for their community. If someone is travelling to Northern Ireland to purchase cheaper medicines, he or she may decide to make many other purchases there. These are the challenges presented by the existence of two jurisdictions on this island and our membership of the EU where price comparisons with the euro are much easier.

The role of Government is to rise to and meet this challenge for the good of the consumer. Pricing and affordability, especially in these more stretched times, should not be allowed to put people's health in jeopardy. As a Deputy meeting constituents, I have plenty of evidence that this is a stark and sad choice facing many. Problems and delays in processing medical cards and GP-only cards add to a sense of stress and worry which also impacts negatively on people's physical and mental health. Today's article in the Irish Independenttouches on this area. It is only when one reads the article that one sees what the problem is. When one reads the headline, one thinks that everyone will be hit for the extra daily charge of €75, but that is not the case. It again identifies the problem we are trying to fix in Government. It is those who do not get a medical card, cannot afford health insurance or have had to let their health insurance lapse who are affected. It is the people left in the middle who must fork out for this daily charge of €75. It is not just for chemotherapy or other cancer treatment, rather it is for any treatment for which one has to go into hospital.

The charge was not always pursued. This is a sign of more mismanagement because, in times gone by, people could have afforded to pay that charge and there are probably many who can still afford to pay it but, instead, put their heads down and hide and let those who cannot afford to pay get hit the same way. The article states that hospitals are engaging debt collectors, a development I do not like and with which I must regularly deal on behalf of people. That should not be necessary because there are quite a few people who could pay their bills but will duck and dive and hide. One then ends up with people who do not have much money being pursued because everybody gets pursued, which is unfair and wrong. The same can be said for all our services. We as Deputies work to help people who fall between the red lines to access services, and we come across many people who get those services but do not necessarily need them. That is the way it is in this country, because so often people who need things cannot get them because of procedures we put in place to protect them from abuse.

The article in the Irish independentdealt with cancer sufferers undergoing the most traumatic time of their lives. Dealing with medical card procedures can lead to the build-up of considerable stress and we must solve the problems associated with them. I accept the system was centralised and that there are many staff trying to work through this under immensely tough conditions. However, there are systematic failures in how we deal with this. I know the volumes of medical and GP-only cards have increased by hundreds of thousands but we must look at this system to ensure those facing severe physical and mental threats, for example, those dealing with cancer, get priority and a decision. I know staff probably do their best and sometimes one sees priority being given, but we need a system-wide approach in order that it becomes the norm that those most in need get it. People are under enough pressure as it is. Due to the increased numbers of medical cards, the ability to apply common sense has probably been taken away and members of staff must follow rules and regulations to the letter of the law, but some people then fall between the cracks. We need to apply common sense in the same way the system worked years ago with the community welfare officer where short-term medical cards lasting three or six months could be given out. We must address this problem because people are under so much pressure.

The newspaper article also mentions volunteer drivers and how cancer sufferers require more heating in their homes. I am very familiar with the work volunteer drivers do with people suffering from various medical conditions, chiefly cancer. They bring people to their treatments every day or three or four days per week. These people, who do great work in all counties, must be thanked. Sometimes they do this work at great expense to themselves. In some cases, they do this work along with the Flexibus and community transport schemes in our towns. In my constituency, Meath Flexibus does great work along with the volunteers in co-ordinating and matching that and bringing people to some of those services. They must be thanked.

They were going to address the problems of the health service, which needs everybody to put their shoulders to the wheel with ideas, imagination, cost solutions, support and help. While medical cards are very important they are costly items from the perspective of the State and we must target them as quickly, efficiently and fairly as possible at those most in need. It happens in some Departments that material goes missing or information does not arrive in time or gets stuck in the post. We can no longer allow this to happen. We must be able to deal efficiently with matters. It is not good enough to have to ask for information a second time, particularly if the people involved are dealing with difficult circumstances.

In recent years there has been much talk of generic drugs. Consumers are becoming more aware they are a low-cost option. This will not always suit drugs companies which are naturally profit driven but, it must be said, they also re-invest some of this profit into research and development, most of which benefits the domestic Irish economy. The Bill must strike a fair balance. I listened to recent debate and comment about who the Taoiseach does and does not meet. From what I can see he is open to meeting all groups. The pharmaceutical sector employs more than 29,000 people in the country and we must recognise this. Companies spend a fortune to bring a drug to the market and we must understand this in our debates. However, in some cases we pay a disproportionate amount compared to other countries and we must correct this. Let us not forget what the companies spend to bring a drug to market. Many other drugs may not get to market and this involves great losses.

The safety of generic drugs has often been questioned but I suggest that at times this has been for negative public relations reasons. The debate has moved on from this but the suggestion still lingers among some members of the public. This is why the Bill requires that all generic medicines on the Irish market be fully licensed and compliant with the standards set out by the Irish Medicines Board. There will be cases where allowing a generic drug to be interchangeable on a prescription will not be appropriate and the Bill allows for this. I trust it will be used sparingly and for the right reasons.

The recent Trinity College Dublin Irish LongituDinal Study on Ageing, TILDA, of adults over 50 is timely and worth mentioning in this debate. It highlights how many older people take combinations of often very costly drugs to help with the fact that as we age we accumulate more health problems and even severe chronic pain. According to the TILDA report, on average those over 50 take two medications per day, those over 65 take three per day and those over 75 take four medications per day. The report also states there is much risk of duplication, inappropriate prescribing or overprescribing and we must watch this and deal with it. I have dealt with clients in my office of a much younger age who arrive in with various health problems, sometimes physical and other times mental, with a bag of prescription drugs which they have been given over the years.

More than half the annual cost of prescribing drugs is accounted for by those aged over 50 years. The TILDA report highlights that greater use of generic medicines by this sector of the population could save upwards of €150 million a year. However, it also highlights price surges in the Irish market even for generic drugs when compared to the UK. Seven of the top ten generic drugs are more expensive here than in the UK with two being almost six times more expensive. While generic drugs are a much-needed help, this situation requires careful monitoring and tough questions should be put to the industry, particularly in light of price reductions agreed in 2010 and 2011.

If we are to adopt a medium to long-term view of the health sector in Ireland, and the Government has done so, as well as dealing with the day-to-day issues, we must return again to the concept of health screening and promoting better health rather than just treating and managing illness and pain. The Minister of State, Deputy Alex White, and the Minister for Health want to tackle this through the primary care strategy and dealing with preventative medicine. People's health should be managed as close to their homes as possible. This goes back to everybody in the community getting involved and not only leaving it to the State to help out. Everyone has a duty to help out their families where they can and the State steps in where people cannot do so.

The HSE and health insurance companies could tackle long-term costs with a greater focus on health screening and early diagnosis. It costs relatively little to identify and warn somebody of their risk of type 2 diabetes or the consequences of not managing their blood pressure and to urge cheap lifestyle changes through diet and exercise patterns compared to the cost of dealing with impaired vision, amputation, heart attack or stroke for the same person in 20 or 30 years time. We see a great demonstration of this in the television programme "Operation Transformation". It is a great programme and would be of help to us all with our health. It shows how easy it is to get a hold of the issue and tackle it at an early stage. It is about advice and education. The Minister and Ministers of State at the Department have been involved in these programmes and other similar programmes.

This is clearly in the public good in terms of quality-of-life and making better use of taxpayers money, but it requires a shift in our thinking as individuals and as a society. This may sound like political aspiration but with political will it can become political reality and would change the goalposts for the health debate in the Dáil for many of our children or grandchildren who will aspire to serve here.

Earlier I referred to the greater awareness the Internet brings to the cost of medication and the choices available. However it also brings with it many dangers. A huge increase has taken place in the number of people buying medicines and medical products over the Internet and this is a serious health issue. The Oireachtas Joint Committee on Jobs, Enterprise and Innovation has begun to look into the black market and the illicit trading of goods. Part of this has involved examining the illicit trading of medicines and the purchasing medicine on the Internet. A regional meeting with the Irish Pharmacy Union raised many issues of concern. It is a major problem and we must realise counterfeit medicines are too easily available. We have much to do to protect people and warn them of the health risks involved. Many of these products are fake and no good to anybody. We have many issues to tackle and the committee hopes to bring forward solutions to a range of Ministers to address them. They include cost and small changes that could be made to the taxation code or with regard to information. However, education is the key. People must realise illicit trade is not victimless. It can have health implications but can also cost jobs. We must tackle the issue.

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