Mary Harney (Dublin Mid West, Independent)

If we compare this jurisdiction with Northern Ireland, we have similar demographics, a similar cultural experience and a shared history. In Northern Ireland the number of items per prescription is 1.7 whereas it is 3.7 here. If we compare two populations on the same island with similar demographics, doctors here prescribe much more than their counterparts in Northern Ireland. Any Minister for Health and Children would have to be concerned about this.

I seriously examined the evidence and the literature and it is mixed. One can make as many strong arguments against doing this as one can in favour of it, but it will be an experience for us to see what the measure will do for prescribing practice. International evidence suggests essential medicines are still prescribed and consumed. According to one statistic, half of those who need blood pressure tablets are not on them and half of those on them should not be on them. That is a poor use of a limited resource. We need to do much more with patients, which is why the clinical pathways being rolled out by the lead clinicians in dealing with diabetes, coronary care and neurology will be of benefit. They will put in place appropriate protocols for prescribing and appropriate reviews of medications, all of which have a part to play.

In the United States insurance companies entered into agreements with Merck, Sharp & Dhome which meant it was in the interests of the pharmaceutical company to make sure medicines were prescribed and that it was in the interests of the insurer to make sure they were prescribed to the right people and both were able to achieve savings in working together. These measures are being implemented by health financiers all over the world because the cost of medications is increasing. The increase in Ireland has been greater than in any other OECD country, at 12.5% annually for the past six years. We must, therefore, consider every measure to contain the cost, while recognising that this measure must be kept under review because it is new.

If there were no financial pressures, we would probably not do this. It was by no means the first item on my agenda, which was why I addressed the distribution and wholesale margin last year, the retail payments and the payments to manufacturers. We are doing this as a contribution to saving money and I hope it will make all us think about the medication we are using and, in particular, encourage doctors to discuss with their patients whether they need a prescription just because they have visited their doctor. The evidence suggests that many patients feel let down if they do not get a prescription. We have become a little obsessed with drugs always being necessary to help the recovery process and in many instances they are unnecessary, certainly as far as prescribed medication is concerned.

We must keep this legislation under review and watch its impact on a constant basis. We must hear about its impact from the professionals and analyse its impact in terms of prescribing practice. That will be done by me and my officials and, no doubt, by the HSE. We will be able to get data quite early because it is one area where we have fantastic data, due to the manner in which we pay for medication. The HSE can literally tell what each person with a medical card is on per month. As Senator Feeney said, the average payment will be approximately €2.50 per month. Even in the current constrained environment in which many families operate, it is not an undue burden. Senator Callely asked about people who have their pints and back horses. I do not know if he suggested that we should not take a prescription charge because of that.

We must consider all the options to achieve good prescribing practice and to reduce the unsustainable and growing cost of medication in the health system.