Mary Harney (Dublin Mid West, Independent)

It is impossible to define in legislation what palliative care means and to identify it with the medical card. That is why there is a need for specific regulations because these are complex and difficult issues.

With regard to the IMO proposals, essentially, we need doctors to prescribe differently. The clinical care pathways being rolled out by Dr. Barry White will include prescribing protocols. In addition, the reference pricing and generic drug substitution I will introduce later this year will mean we will be closer to the position in the United Kingdom than we are. In the United Kingdom 63% of the medicines prescribed are generic; in Ireland the equivalent figures are 18% under the medical card scheme and 12% under the drugs payment scheme. Reference pricing and generic drug substitution will greatly increase the volume of generic drugs dispensed. That is an effective way to do it. The IMO suggestions would have involved the investment of money to make this happen. In the current climate we do not have additional resources to apply. It is best done, therefore, by way of protocols laid down by the lead clinicians, including those involved in primary care, and through reference pricing and generic drug substitution.

To achieve savings, we have to examine every aspect of the pharmacy chain, including producers, distributors, whom we addressed last year, and the community pharmacy sector, as well as examining this modest prescription charge. In his report Mr. Colm McCarthy said it should be €5 per prescription, which would have been substantially more severe. Instead of raising €24 million per year, we would have raised more than €90 million on the basis of 16 million prescriptions. The proposed levy is modest in comparison with what was recommended in the review of public expenditure.