James Reilly (Dublin North, Fine Gael)
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Question 208: To ask the Minister for Health and Children if she and the chief executive of the Health Service Executive received a letter from a group (details supplied) criticising the proposal to withdraw or limit access to oral nutritional medicines that protect against malnutrition; if she and the chief executive accept that this will have a detrimental effect on patient outcomes; and if she will make a statement on the matter. [44745/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I have recently received correspondence from the organisation mentioned by the Deputy. I understand that this correspondence was also to be forwarded to the Health Service Executive. As the Deputy is aware, my Department and the Health Service Executive (HSE) have been reviewing the pharmaceutical supply chain, with a view to seeking value for money in the State's drugs bill in order to better fund existing and innovative therapies without compromising continuity of supply or patient safety.

The Government remains of the view that the costs of pharmacy services under the GMS and community drugs schemes are not sustainable, a view that is reinforced by the current budgetary challenges. It is clear that there are significant savings capable of being made for taxpayers, presently and in the future.

Expenditure on the medical card, drug payment and other demand-led schemes is approximately €2.6 billion and represents 18% of HSE current expenditure. The average annual increase in expenditure in recent years has been 13%. This rate of increase cannot be sustained.

It has been decided to introduce a range of further measures in 2009 to slow the rate of increase in these schemes and generate savings of €175m. These measures include an increase in the threshold for the Drug Payment Scheme from €90 to €100 a month; new guidelines for GPs on the prescribing of nutritional supplements; and other measures to reduce drug costs. It is therefore not a question of withdrawing nutritional supplements but rather an issue of appropriate prescribing and reducing wastage.

The HSE is developing an information pack for GPs which will include assessment tools and prescribing protocols for a defined group of oral nutritional products (sip feeds) restricted to defined categories of patient, time bound prescriptions (maximum two weeks) and needs monitored every three to six months. By reducing wastage and inappropriate prescribing this measure is expected to result in savings of approximately €7 million per annum.

The HSE is also undertaking competitive tendering arrangements to determine cost effective reimbursement prices for agreed non-drug items where appropriate. The estimated annual savings are approximately €3 million.

A review of demand led schemes is currently being carried out by the HSE with a view to commencing the implementation of targeted improvements at the earliest possible time while taking account of budgetary challenges in the short, medium and long term.

In addition, I established a process under the Chairmanship of Dr. Michael Barry, to develop recommendations for good practice which will secure safe and effective prescribing for patients while maximising the potential for economy in the use of public funds. The initial report from Dr. Barry has been received in my Department and is being considered.