David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I commend Deputy Pádraig O'Sullivan on bringing forward this excellent Bill, which relates to an area in which I have an interest. The previous health committee looked at this issue and made recommendations, many of which are included in the Bill. I thank an Teachta O'Sullivan for his interest in this matter and for continually raising all these important points, as well as his predecessor, John Brassil, and others, from all parties, who have championed this issue for so long.

The first point I want to make is to acknowledge the amazing work that is being done in the area of innovation in medicines and healthcare. We are seeing a lot of groundbreaking treatments, all of which are to be welcomed. Many new medicines have come on stream, including a large number of high-tech drugs, especially in the area of cancer, as well as huge advances in technology in regard to precision treatment and gene therapies. Many of these treatments require high-tech drugs, including orphan drugs, which are very costly but also very necessary if we are to save lives. This ties in closely with drug trials and the need for more funding in that area. When we look at all this innovation, it is noteworthy that many of the high-tech drugs that are coming forward, several of which an Teachta O'Sullivan named, are produced in Ireland by pharmaceutical companies and their workers. Much of the research, development and innovation that is leading to the development of these drugs, which are saving lives across the world, is happening here on our island and in this State.

I am somebody who believes we should be leaders in research and development, encourage innovation and support and reward it when it happens. I have met many people in the industry and they are at a loss when they look at the league tables of countries that can avail of many of the drugs produced on this island through reimbursement processes similar to our own. We languish somewhere near the bottom when it comes to how quickly public patients can access those drugs in this State. Even though we produce the drugs and support the research and development, because of our complicated, convoluted, bureaucratic system to enable drugs to get on the reimbursement list, patients on this island are not able to avail of them as quickly as patients in other countries. That needs to change.

We all appreciate and understand why the Minister, Deputy Donnelly, is not here to take this debate. The Minister of State, Deputy Butler, said in her opening statement, "We cannot overlook that, in the context of finite resources, paying more for orphan medicines would have a very real impact on the health service's capacity". There are many areas of the health service where capacity is needed but has not been delivered by the Government. We have all asked for more capacity in healthcare. In the case of new medicines and drugs, which we are talking about in this debate, the action needed is costly, yes, but it saves lives. People simply cannot afford the huge cost that would be associated with any of these drugs being administered. No individual would be able to fund it. There are times when the State has to step up and give funding because it simply cannot be done by individuals.

The Minister of State is saying we have finite resources and cannot put in place the type of funding that is necessary in this area because we must look at all the other areas of healthcare, which we do. That statement is juxtaposed with what was done in regard to Covid. Let us take a step back and look at how much money was spent on dealing with the pandemic over the past two years. It comes not to tens of millions of euro but billions. The reason we spent billions on Covid was, above all, that we had to protect people and save lives, which involved spending money on testing, tracing and vaccines. It was the pharmaceutical industry that stepped forward in rapid time to create a vaccine from which we are all benefiting. The booster jab is now being rolled out, which is giving us a very high level of protection from Covid. That would not have been possible were it not for the innovation, research and development that is happening in the sector and politicians trusting the science which by and large most of them in this State did.

When Covid-19 came, we responded quickly and we put in the funding. We spent billions of euro to save people's lives by putting and infrastructures for testing, tracing and vaccine roll-out and so on. Yet, for whatever reason, we do not seem to want to fund orphan drugs to the same extent, or even at a fraction of it. In budget 2020 - and I welcomed this - the Minister made €50 million available for new drugs. In our alternative budget 2021, we provided for an additional €50 million, but truth be known this still is not enough. I agree that you cannot throw endless amounts of money at it and that there cannot a blank cheque for any area of healthcare. Demand will always outstrip supply in healthcare because of the decades of neglect we have seen in investment into our public service.

However, we need to put a much stronger emphasis on the areas of drug pricing and the supply of new drugs. I have made my points about funding, about the need for the State to do more and my rationale as to why the State can be the only driver for this. My understanding is some of these drugs cost hundreds of thousands of euro to administer, in some cases maybe more than a million euro. Very few citizens who could afford that, and certainly not many I know. If we want patients and people to avail of the groundbreaking drugs that can keep people alive, then the State simply has to do more. That is on the funding side of it.

There are also problems, to which the mover of the motion has already referred, about the reimbursement process. Again, I have spoken to industry. I accept fully, and I put my cards on the table here, that we have to strike a balance between what the pharmaceutical sector wants and protecting the taxpayer. Nobody is saying and I am not saying there should be a blank cheque. There has to be a process. I assume the proposer of the motion supports this. Of course we have to have a process. However, the process is too convoluted and it takes too long. As an Teachta Pádraig O’Sullivan said, it can take years for many of these drugs to find themselves on the reimbursement list. I looked at the layers and layers involved in the process and all of the hoops that have to be gone through. When you compare that, as the mover of the motion did, to the situation in other countries, they have much quicker processes, yet they can still find that balance that protects the taxpayer and they have a process that enables transparency and accountability. Although we have that process, other countries can get much quicker decision-making so that drugs can appear on the reimbursement list more quickly.

Those are the two issues here, if we are to cut to the chase. We have to streamline the reimbursement process. We have to make sure the drugs can be approved as quickly as possible and find themselves on the reimbursement list. Critically, we also have to provide the additional funding. This is because we can approve what we like, but if the funding is then not there then the drugs cannot be made available to patients.

I talk to many people in healthcare. On the course of my travels over recent months, I met many people in the area of cancer care, who provide excellent work. It is mind-blowing what these specialists do in our hospitals throughout the State. We sometimes talk about the inefficiency of our healthcare system. However, we cannot overlook the work that is being done by so many people. When we see the precision technology, robotic technology, the advancements in cancer care, the gene therapy treatments, the trials and the research being done in our hospitals with linkages to universities, it is mind-blowing. We also see the treatments that come with that work, and all of these new drugs that are coming on board. People working in healthcare are telling me they can only do so much. They can only do their jobs as consultants. Their job is to save people's lives.

Imagine being a consultant who is treating a very sick patient and knowing that a particular drug can save that person's life, but it is not on the reimbursement list so he or she cannot get it. Imagine knowing, as a consultant, that this drug would make a difference but you are not in a position to prescribe that drug because it has not found itself on the reimbursement list. That is what consultants and specialists are dealing with day-in-day-out. I am sure they understand everything the Minister of State said about finite resources. However, when we talk to them about balance, funding and other capacity issues, they say they have to make decisions every day that save people’s lives. They are not in a position, at times, to be able to administer, provide or prescribe drugs, which they would like to be able to do, because the funding is not available. I have heard one of our former colleagues who was a Member of the Upper House, Professor John Crown, talk about this issue several times. As we know, he is a specialist in this area and has been critical of the slow pace of getting many of these oncology high-end drugs onto the reimbursement process.

I appeal to the Government to do more to listen to the experts and the consultants, to make sure we put patients first and to work with Deputies, such as an Teachta Pádraig O’Sullivan and others, who have taken a keen interest in this issue.

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