Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

I am glad of the opportunity to speak on this Bill. It has been a long time coming. It was a commitment made by the Government parties when in opposition and was part of the programme for Government. We hope that the Bill, like all of the other Bills on which we speak in this House, will achieve its purpose, which is an important aspect of any legislation.

We all are faced with a difficult time in spending in this country. Cost cuts must take place in respect of almost every service. It is a tragic position to be in but that is the way it is. The suggestion put forward in some quarters that some cuts are painless and that others can be diverted to other areas is not the luxury that people can readily live with. In all budgetary situations, cost savings and cost cuts are measures that hurt everybody. Whether in full health or ill, there is an impact. In some cases we can do nothing about it other than to try to make the best provision we can to deal with the situation even in the face of such a budgetary situation.

My colleague, Deputy English, referred to an issue I can never understand.

In a previous incarnation I spent a long number of years in a health board where we experienced a similar situation. There were always cuts coming from July onwards and more particularly from October to Christmas. That happened because there was not an ongoing evaluation of spending, which could have been done very simply. Every budget relates to 365 days a year. One can divide the budget by 52 weeks or 12 months, but either way it comes down to the same thing - it is possible to identify where the problems arise most and, consequently, what needs to be adjusted and changed within any departmental budget at any time. It is not something that works easily, however, because every departmental section, particularly in the health services, competes to avoid cutbacks. In the current situation, however, we do not have the luxury of avoiding cuts. I therefore ask the Minister and the Minister of State, Deputy Alex White, to ensure that henceforth the budget will be evaluated monthly at least. It is possible to input all the untouchables and unmentionables, in addition to - as a former American Secretary of State for Defence put it - the known unknowns and the unknown unknowns. I do not wish to go too far down that road, however. There are issues, within the health services in particular, that we know about and therefore it is possible to introduce economies that will benefit service delivery across the board.

I also wish to mention the prescription of generic drugs. I remember having an arduous and long drawn out debate as to the merits of reducing medical costs that could be derived from prescribing generic drugs. I also remember a long input from some Members on the opposite side of the House opposing that concept. A heated debate took place and eventually in one of the biggest health boards in the country it was possible, through block procurements and generic prescribing, to bring about substantial reductions in the cost of medicines across the board. It took a great deal of agitation to achieve that but it did happen. There was regard for the areas where brand name drugs were better known or deemed to be better for patients in certain conditions, and that was even allowed for.

We also found that the brand name drugs companies were able to compete effectively with the generics in many areas despite notions to the contrary. As regards the supply of goods and services, including drugs, and the delivery of health services in general, it is in the interests of all such patients to get the best possible value for money. We must use all the means that have proved effective in the past, without putting patient safety at risk. I believe that can be done.

One must also have regard to those suffering from cancer and other serious illnesses, as Deputy Catherine Murphy said earlier. This is not a new measure; it has been there previously, but in some cases it was not enforced. There is no good time for re-introducing legislation that was not enforced in the past. There is no reason either why it should be introduced selectively, but due regard must always be had for the severity of the illness faced by patients and their vulnerability. In that way, we can ensure that we do not become a careless society instead of a caring one. It is well within the remit of the health services to adjudicate between the various categories in terms of severity and need.

I am not a follower of the concept of centralisation when it comes to determining eligibility for medical cards. It is much easier to do so at a local level and was so in the past. There will be those who may say that it was more expensive, but it was a lot more personal. People at local level knew exactly the nature of the application and very often knew well who the patients were. In those circumstances, it was much more possible to be able to introduce relevant information that would clearly indicate whether or not the patient needed a more flexible and accommodating attitude. I am not saying for one moment that the current system is inflexible or uncaring. However, by virtue of the volume of correspondence and inquiries going into that department, it will naturally follow that the same degree of personal adjudication is not available.

Another area that warrants examination - I know it will come within the ambit of this Bill - is the supply of special clothing, footwear, wheelchairs and other appliances through the health services to individual patients. Like other Members of this House, I have received complaints from people who have appliances they no longer require. For whatever reason, such appliances are not collected or recycled for re-use in the system. Since such appliances are not available for other patients, the latter must await a further allocation of scarce resources. As a cost-saving measure, it should be possible to return appliances that are no longer required by certain patients. It happens in other jurisdictions all the time, so we should be able to do it here, particularly at the present time. I hope it will happen.

I am aware that a brokerage system exists concerning the supply of goods and services to the health service. The broker, for want of a better description, supplies a variety of goods and services, sourcing those products in various ways. Many of them emanate from outside this jurisdiction. Very often, however, a loss leader is used - in the same way that supermarkets use alcohol - in order to reduce the overall cost of the package and thus get more of the product from a particularly friendly source. That practice needs to be discontinued. I have tabled parliamentary questions about it in the past but the practice has gone on for many years. It is particularly difficult to challenge when costs are being reduced generally because the argument will always be made: we're reducing costs and this is how we have done it and it has been of benefit to the Exchequer. That is not necessarily the case because there can be hidden costs as well. I know the Minister is fully aware of this matter but I would like to see it being addressed. We must try to ensure that we source as much material and products as we can from indigenous sources, notwithstanding domestic and EU competition laws. We currently have our backs to the wall in terms of costs.

A great many sacrifices have been made by a great number of people and Members should try to ensure that those providing the services, whether directly or through agencies, are also subject to the same cost-cutting and saving exercises applied to patients and everyone else.

In response to the points made by various people in comparing carers with pharmaceutical companies, drugs companies and so on, while I acknowledge it is natural to do this, one must separate the two. Everyone in this country is a caring and compassionate person. Traditionally, as a race, we have shown this over many years. No one, either in government or outside it, goes out to make life more difficult for anyone. The suggestion coming from some Members on the Opposition side in recent weeks that the Government comprises a careless and heartless group of people who are imposing punitive measures on top of a luckless and hapless public is not true. Moreover, for those who keep repeating there are always options and alternatives, the alternatives put forward by the Opposition invariably are easy options that apparently do not have an impact on any of their constituents. While they give the impression to the public that such alternatives are painless and somehow will be washed away with the next shower of rain or whatever the case may be, nothing could be further from the truth. There are no cost-cutting exercises without pain and there are no budgetary constraints that do not cause concern to a great number of people or that do not affect many people in a negative way. Any Government cannot but be fully aware of this. Moreover, no one can give Government members lectures on caring and compassion and no one should try to so do. The suggestion in some quarters that all the care and compassion is on the opposite side of the House is rubbish and they know this.

A number of speakers have mentioned the issue of promoting health awareness as being of particular direct benefit to the Exchequer. I had an experience in this respect a couple of years ago in which a friend was accidentally diagnosed - that is the only way to describe it - by a passing physician. I refer to an encounter at a crowded reception, when the person concerned was quizzed by the medic as to when the person's blood pressure has been checked. This is the difference between a highly observant person and someone who may not be so observant. The would-be patient replied it would be checked at the weekend, only to be told that would not be sufficient. The person concerned then stated it would be done at the end of the day, only to be told that would not be sufficient either. Eventually, my friend's blood pressure was checked within the hour and the results were alarming. I use this analogy to illustrate one's lack of awareness of, for instance, the tell-tale signs of blood pressure that requires monitoring or kidney failure, which are of huge importance, as well as a range of cardiovascular illnesses that must be monitored on a regular basis. There are ways and means to do so effectively at an early stage if one is alert to them. In the same way, the health issues and concerns of young people must also be addressed on a more regularised basis than has been the case in the past. In particular, efforts should be made to try to ensure that young people do not get overly concerned about, for instance, the need for weight loss or the lack of need for weight loss or whatever the case may be. However, this should be done in a balanced way and knowledge should be imparted in such a way that is supportive of whatever is required and where those concerned will feel they have support as opposed to criticism and thereby will be in a position to deal with the issues.

Other points have been made with regard to patients who suffer from cancer, for example, although the same is true of any serious illness. There used to be a tradition whereby a medical card automatically was made available for all patients who suffered from cancer. Some time ago, I heard a debate among some medical people, ironically, in which it was suggested perhaps one should wait to ascertain whether a serious form of cancer was involved. However, I do not believe this to be the issue. The impact on a patient who is greeted, for want of a better description, with the prospect of an illness of that nature is so great that one should try to give whatever support is possible and necessary in the shortest possible space of time. Moreover, the question of the cost to the patient should not arise at that stage in particular. The danger of creating further stress and concern for the patient at that time is counter-productive to all concerned and can do no good to anyone. Consequently, I ask that the discretion the health services have with regard to such matters should be used carefully to try to ensure it is acknowledged to patients who are sufferers of serious illnesses that there is a problem. It should be made known to them that it is realised they require immediate support for their particular problems, and not next week or next year and not awaiting the outcome of a debate in some other location at some time in the future. Clear time and energy must be devoted to this issue.

Earlier, I mentioned the issue of generic drugs versus drugs with brand names. In particular, I again emphasise that no one seeks to create a risk for patients. In the use of generics, it must be both possible and shown clearly that the patient being encouraged to use generics will have at least as good a product as the one that is brand-named. Unless this is the case, the entire concept will be completely undermined because patient concern will become obvious. Moreover, on the points raised with regard to epileptic sufferers, where it has been presented that a particular brand has been found to be useful and has been consistent in terms of reaction and response, it should be used. However, it should not be allowed that the company should influence such a drug's use or otherwise. The company obviously has its own reasons for making the case and it must be possible to be able to set out, purely on the basis of the ingredients, to ensure the same purpose can be served by the use of the generic products.

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