John Crown (Independent)

I second the proposal. I welcome the Minister of State, Deputy Kathleen Lynch, to the House on this occasion and thank her for her contributions to the discourse in Seanad Éireann over the past year or so. I commend the Bill across the House as one which was wholly thought of by Senator MacSharry. I acknowledge it as very innovative potential legislation and I acknowledge the fact he has been the inspiration and driver for it.

I am not a starry eyed idealist. I know we live in a real world. I know that every penny I prescribe is a penny that is not available for some other part of the health service or, indeed, some other part of essential social and educational services. I am well aware there is an opportunity cost to every penny that is spent by every person, in particular those spent by Government. I am aware we have children on waiting lists for spinal surgery and cardiac surgery, and we have older citizens waiting to have their sight restored from simple cataract surgery or their mobility restored from simple hip operations. There are children who cannot hear their teacher in school who are waiting to get their hearing tested and to get hearing aids fitted, if they need them. There are people in some parts of the country waiting one and two years to see specialists in the areas of rheumatology, diabetes and so on.

I know there is not an endless pot of money and I know it is not as simple as pulling a financial rabbit out of the hat and making every drug available. I know somebody has to make hard decisions and I am very respectful of that fact. However, I believe there is a sort of deal implicit in this legislation being accepted, which is that we have to grit our teeth and also be part of the hard decisions which are made by the Minister, even if they are ones which we wish had gone a different way.

The reality is we have lost our sovereignty, we are broke, our tax take is down, our spend on social welfare is up and we cannot pay for every treatment for every patient all of the time. In general, in our public but not in our socialised private health system - I have said this on many occasions over 20 years and it is becoming truer than ever - the way we deal with financial constraint is to put people onto waiting lists. We close the ward, close the operating theatre, do not make the extra appointment, do not replace the people and we let the waiting list lengthen, because the person on the waiting list is a patient who costs the health service nothing whereas the patient who is in the hospital is not a revenue source but a cost source.

This is why I have and continue to be extremely supportive of the plan of the current Government to introduce a fundamental revolution in the way the health system is run, organised, managed and financed. What do we do in the meantime, however? Cancer patients cannot readily go on a waiting list because they have a life expectancy that has to be dealt with. This is why issues, such as that which arose with Ipilimumab, become so emotional in that they become fired up by the urgency of individual patients. Hard cases make bad policy but it is difficult to ignore them at the same time.

We need to look at some of the precedents. Historically, in this country, we had good access to cancer drugs and we were one of the more liberal environments for cancer drugs, certainly when compared with Her Majesty's United Kingdom National Health Service, which by every measure is the worst of the developed countries and also has the worst cancer survivals of any major country.