Ivor Callely (Independent)

The Bill allows for the imposition of charges on medical card holders for prescription items dispensed by community pharmacy contractors. The proposed charge will be 50 cent per item dispensed, to a maximum of €10 per month. The Bill allows for the possibility of higher charges in the future and lists two classes of people exempt from charges - children in care and methadone users. It also provides for further exemptions in the future. The Minister's intent is that this will be consistent with patient safety and continuity of supply of medication.

I have admiration for the Minister for Health and Children in her determination to address rising health costs. Most agree that the expenditure of nearly €20 billion on health services does not provide a reflective service. There are many areas where expenditure could be curtailed and this would not have an impact on the provision of services or take money from people on low incomes. Let us not lose sight of people who qualify for a medical card and are deemed to be on low incomes. Other speakers referred to these as the poorest and most vulnerable in society. Now, we want to impose a charge for required medication. Senator Prendergast expressed her view on crutches and if others have views on other areas, the Minister needs to clarify the safeguards for those who are not listed as exempt users in order to ensure consistency in respect of patient safety and continuity of supply of medication. What safeguards are in place if a person has a medical card, is on a low income and is fond of a pint or a pound on the horses and cannot afford regular medication even though this will have an impact on his or her medical and mental well-being?

The public is aware of the state of the national finances and looks at the performance and delivery of our health services when we speak of these issues. The public has a legitimate concern that, on one hand, people are being asked to contribute more and, on the other hand, the question of value for money in the delivery of health services arises. It is a legitimate question and the public are asking the question. I record the tremendous commitment of administrators, doctors, surgeons, consultants, dentists, nurses, social workers, physiotherapists, occupational therapists, speech and language therapists and all therapists. Most give an amazing commitment and are dedicated to the delivery of services. Most will also let one know of the shortcomings in the system and the need for improvement. They can indicate where money can be saved and where improvements in services for patients can be obtained.

For example, Senator Prendergast referred to the elderly. The Minister has been down the road that I am currently on with my mother. One asks why families are put under immense pressure where an elderly person is occupying a bed in a general hospital and has been assessed as requiring long-stay accommodation. Why do so many family members have difficulty understanding what is happening to their elderly parent or relative? People will jump to say that this is emotion but I do not believe it is. I suggest the Minister creates a one-page document to make available to family members detailing the procedures. The Minister referred to the holistic approach to the appropriate provision of care of the elderly. The message is getting lost at some stage. The families are put under pressure.

One questions productivity and value for money in so many other areas. Why are patients normally given the same time to attend a hospital consultant? Some 30 patients all arrive at 10 a.m. and they complain about queuing and the lack of other facilities. Where is the connectivity between the patient's doctor, the patient's regular pharmacist, the local hospital, the local HSE health centre, the regional HSE office, patient care, the occupational therapist, the social worker, the public health nurse, the home help organiser, the home helper and the family of the patient? The vast majority of people regard connectivity in these situations as unsatisfactory. This does not only involve patients and their families but also those working in the services, who are also frustrated.

There is a major demonstration of positivity on all sides and we should tap into it. It could have enormous beneficial consequences. One simple suggestion is to increase the use of modern technology between service providers. This could bring significant benefits. The Minister knows my view on the HSE as a single entity of service provision. I have covered that ground before. There is a lack of confidence and demoralisation arising principally from a feeling that there is no connectivity between service providers and that the HSE is at a loss and unable to cope. There are no insurmountable issues that should prevent us from realising our best effort in the delivery of health services. I support reform of medicine supply and price. The key is to achieve best value for money for patients and the taxpayer. We need to have a broader debate on the current structures and agreements. I am at a loss as to what these are but I know agreements and structures are in place between the Government, the Department of Health and Children, the HSE, manufacturers, wholesalers, the IPU, the IHCA and pharmacists. This is what sets the cost of medication in Ireland. Members will be aware that I had an interest in the pharmaceutical industry as an employee and I am delighted to record I brought one of the manufacturing companies which operates from Arklow to Ireland in the late 1980s. I note that only four of the top 20 manufacturing companies in Ireland with a turnover of approximately €100 million manufacture generic drugs. Pharmaceutical companies have made an immense investment in Ireland, in the process providing huge employment. I would love to know how all of this will be sorted out, in producing generic products, as well as continuing to attract the blue chip research and development activities of pharmaceutical companies to Ireland.

I do not suggest I have the answers, nor do I suggest there is a magic wand with which one may resolve all the issues. However, there is waste. Senator Feeney mentioned the quantities of medications to be found in people's homes, while Senator Prendergast made a simple point regarding crutches. The same point could be made about wheelchairs. Moreover, the Minister is aware of the provision of a tremendous service by the HSE, when a person who had been ill for some time with cancer was provided with an array of equipment and medications but who sadly died in January. Members must again ask about the issue of connectivity. They must ask about the best use of the resources available and where best value for money is being obtained.

I do not wish Ireland to lose the aforementioned 20 pharmaceutical manufacturing companies which are creating blue chip employment and investing hugely in research and development. They are the companies which have been identified as the ones we should be chasing to create employment. While I acknowledge there is research and development activity in the generic drugs sector, it is not being done to the same extent. All Members know how the system works; when a patent runs out, a company will jump on the bandwagon and create a generic product.

While I wish the Minister well, I am unsure whether taking what could be considered as the low hanging fruit route is the answer to the problem. Moreover, I do not believe the Minister believes this to be the case either, as she is aware of the bigger picture. While I would love to come up with the answer, unfortunately, I am not in a position to do so. The Minister is in such a position and this is the option she has chosen. Given all the mechanisms and ingredients she might put on the table for consideration, I hope she will answer a fundamental question. What safeguards will be in place for those who will be unable to afford the charge to ensure continuity of supply?