Mary Harney (Dublin Mid West, Independent)

The things that receive attention in the health service are the things that go wrong, but I am happy to say many things are going right. Among them is the decision to allow nurses to prescribe. Although we do not yet have definitive research, the findings from other countries and the anecdotal evidence here suggest nurses are much more conservative in prescribing. They put much more thought into it than, say, doctors who are busy in general practice.

We must do much more to educate patients. I recently opened a new primary care centre in Leopardstown. That team undertakes some fantastic pioneering projects, as do many other primary care teams, one of which is on the management of diabetes another on smoking cessation. They have told me that those who stick to the smoking cessation programme - I accept many drop out after the first or second week of what I believe is a ten week programme - have a 70% success rate if they come to the centre every week to participate in what is effectively counselling. That is a fantastic result. It is amazing how one to one contact and group therapy has a huge impact on the way we behave.

Equally, many diabetics - I know this from experience in my wider family - sometimes feel they are fine and do not need to take their medication. It is estimated that 45% of medication is not used appropriately and that 20% of people do not use it. It is clear that this does not make sense from a cost and health outcome perspective.

A medicines usage review is under way, involving pharmacists and 16 primary care teams, for which the training was done in May. The pilot scheme is being run in the months of June, July and August and we will know the outcome in the autumn. Some pioneering work done last year in Cork with 500 chronic illness patients and the results showed that medications some patients were on conflicted with others and that there was over-prescribing and overuse of certain medications. Data are important, but we must find a way, whether it is through using the public health nurse, the general practitioner, the pharmacist or a combination of all three working together as part of a primary care team, to talk to and educate patients on the use of medicines because the rate of prescribing of medications is high here in comparison with in other countries. As I said, nearly twice as many medications per prescription are transcribed here than in the North. There appears to be no reason for this. We have a long way to go, therefore, in dealing with the issue.

On the fail-safe mechanism referred to by Senator O'Toole, that is the reason the Minister will the power to make regulations to exclude categories of patients. If a case is made to me - a case is often made to me about mental health patients - and there is evidence to support it that patients are not taking their medication, I will not stand over this. That is the reason I have introduced the modest sum of 50 cent.

When this measure was placed before the Government and the wider political system around the time of the budget when it received more attention, the one comment most people made to me was: why is the charge so low? It is low because we are starting something new; we are moving into unknown territory; it is pioneering work, and we want to keep the matter under constant review. I will report back to the Seanad, the Dáil and the Joint Committee on Health and Children on the regulations made.

Regarding the person who lost medication and looked for a taxi to bring a repeat prescription, I know Senator O'Toole said that was the exception, but when something is free, people sometimes adopt an attitude that is not appropriate. I am told by some doctors that patients often ask them to prescribe a particular medication in case they need it. We do not need to prescribe medication in case people need it. We want to make sure everybody obtains the appropriate medication, that he or she takes it and is educated on how to use it. We do not want to spend money unnecessarily at a time when many services are under pressure. There has been a rise in the cost of drugs in Ireland, notwithstanding the changes made last year. We have reduced the cost base by approximately €250 million, but because the level of prescribing is increasing we are not seeing the reductions we should be seeing, nor will we. This is about halting the rise in rather than reducing the overall cost.

The amendments were ruled out of order on cost grounds. Senator Fitzgerald is opposing the section which effectively gives the Minister the power to implement this modest charge which, as I said, will be kept under constant review. I repeat what I said, the international evidence is mixed, although I accept arguments can be made both ways. Our experience in Ireland seems to be very different, particularly in terms of the numbers of items prescribed, from that in other jurisdictions. We have a relatively young population, yet the rate of prescribing seems to be increasing at a level that is unjustifiable in terms of cost, the number of items prescribed and the number of new prescriptions. There has been an increase of 4 additional million items in a short period and 15 million items in a five-year period.