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Health (Pricing and Supply of Medical Goods) Bill 2012 [Seanad]: Second Stage (Resumed) (Continued)

Monday, 17 December 2012

Dáil Éireann Debate
Vol. 787 No. 2

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(Speaker Continuing)

[Deputy Damien English: Information on Damien English Zoom on Damien English] The health budget is as clear an example as one can get. In 1997, the health budget was about €3 billion. In 2007, it was €15 billion, which is crazy. The number of people working in the health service went from 70,000 to 140,000. I recall a debate in the House on the health service in 2006 or 2007. On the same day, the Taoiseach, the Tánaiste and a Minister were asked how many people worked in the health service. I forget which of them said what but one of them, who could have been the Taoiseach, said in the morning that 110,000 people worked in the health service. In the afternoon, the then Tánaiste, Mary Harney, said that 120,000 people worked in the health service. Later on, the then Minister for Finance, Brian Cowen, said the answer was 135,000. This shows that they did not have a clue about how many people were working in the health service. It is not that difficult to count 110,000 or 120,000 people. I know some of them are equivalent or work half or quarter time, but it is still no harm to count them. If one were the head of IBM or Intel, one would know how many worked for the company.

  Thankfully, we are now getting a handle on our health service and know how many are on waiting lists, including outpatient waiting lists. One must count the problem before one can fix it. It takes guts for Ministers to announce how many people are waiting for an operation but that they are going to tackle the matter. It takes guts to admit that there are 350,000 people on the outpatient waiting list but that we will tackle it. I spoke many times while in opposition about how one must first admit one has a problem and then one can put a plan in place to fix it. That is what we are trying to do here in many areas. Great progress has been made in respect of health service reform, but it will take time. Before they entered Government, both parties always said it would take over five years to fix the health service completely, and we will fix it.

  Two excellent reforms are the concept of money following the patient and increasing capacity in some of our units. The orthopaedic unit at Our Lady's Hospital in Navan is carrying out great work and is way ahead of targets set out for the year under the new concept of money following the patient. When we bring in these reforms that increase our capacity to deliver, the State must be able to benefit from the reforms. Sometimes, because of cash budgeting and a shortage of money, capacity has built up towards the end of the year in a certain unit, be it an orthopaedic or elective surgery unit, that could be used, but because of the additional cost of buying the equipment needed for the operations, things might not happen. When we introduce reforms, we need to ensure we can somehow find the extra cash to use the asset. If one has a theatre and staff who are ahead of capacity and ready to do more work, we must find the additional resources we need for that unit to do the extra work although I know this takes time. It might be a case of doing more private work through a deal with some of the private health insurance companies. I know this is on the Minister's mind. If capacity has built up in State-owned assets, we must be able to use it as best we can. All the reforms in the world will save us money in the long term and enable us to work much better, but we need imagination as we journey towards major reform.

  It is interesting to note that during the dreaded years between 2001 and 2008, spending went wild. There was an increase of 185% in HSE expenditure on medicines and non-drug items, with the figure reaching €2 billion in 2009 and falling back to €1.9 billion last year. At the same time, the number of items paid for by the HSE on the community scheme increased from 13 million in 2000 to 17 million in 2010. No one would dispute that it is important that people who are sick get the necessary treatment, but it is very debatable as to whether the level of sickness in Ireland rose 185% in ten years, even when one factors in a rising population and the stresses and strains of the Celtic tiger era. I know there were significant improvements in drugs and treatments but it is not right that the cost rose by 185%. There was clear price inflation, bad deals and a lack of regulation and oversight in this sector, which this Bill will provide a legal framework for dealing with.

  I stand behind the Minister and his team in any reform to put value for money for the patient and taxpayer ahead of bloated and outdated systems. As a public representative for Meath West, I am deeply aware of the price of medicines and the ability of hard-pressed families to deal with this necessary living cost, and I am sure the same can be said for all my colleagues in this House and local authority members. It is something that none of us as public representatives can escape. We know all about it through the people we represent, and it is an area we must tackle.

  Greater access to the Internet and more shopping outlets and chains north and south of the Border, as the desire to shop around for value for money has grown, have led to greater public awareness of the price of medicines. In some cases, this greater awareness turns to despair and frustration as there can be large disparities in the price of certain drugs between individual suppliers in this State and, more dramatically, between this State and Northern Ireland and other parts of the EU. This is before we factor in the use of generic drugs. While we all desire to shop as locally as possible, especially at this festive time, and to support our own neighbours and maintain local employment, facts such as those I have just mentioned present a serious challenge to this mantra. Some families do not have a choice. Their disposable income is so low that they have no choice but to travel to spend their money, even though they know it is probably not good for their community. If someone is travelling to Northern Ireland to purchase cheaper medicines, he or she may decide to make many other purchases there. These are the challenges presented by the existence of two jurisdictions on this island and our membership of the EU where price comparisons with the euro are much easier.

  The role of Government is to rise to and meet this challenge for the good of the consumer. Pricing and affordability, especially in these more stretched times, should not be allowed to put people's health in jeopardy. As a Deputy meeting constituents, I have plenty of evidence that this is a stark and sad choice facing many. Problems and delays in processing medical cards and GP-only cards add to a sense of stress and worry which also impacts negatively on people's physical and mental health. Today's article in the Irish Independent touches on this area. It is only when one reads the article that one sees what the problem is. When one reads the headline, one thinks that everyone will be hit for the extra daily charge of €75, but that is not the case. It again identifies the problem we are trying to fix in Government. It is those who do not get a medical card, cannot afford health insurance or have had to let their health insurance lapse who are affected. It is the people left in the middle who must fork out for this daily charge of €75. It is not just for chemotherapy or other cancer treatment, rather it is for any treatment for which one has to go into hospital.

  The charge was not always pursued. This is a sign of more mismanagement because, in times gone by, people could have afforded to pay that charge and there are probably many who can still afford to pay it but, instead, put their heads down and hide and let those who cannot afford to pay get hit the same way. The article states that hospitals are engaging debt collectors, a development I do not like and with which I must regularly deal on behalf of people. That should not be necessary because there are quite a few people who could pay their bills but will duck and dive and hide. One then ends up with people who do not have much money being pursued because everybody gets pursued, which is unfair and wrong. The same can be said for all our services. We as Deputies work to help people who fall between the red lines to access services, and we come across many people who get those services but do not necessarily need them. That is the way it is in this country, because so often people who need things cannot get them because of procedures we put in place to protect them from abuse.

  The article in the Irish independent dealt with cancer sufferers undergoing the most traumatic time of their lives. Dealing with medical card procedures can lead to the build-up of considerable stress and we must solve the problems associated with them. I accept the system was centralised and that there are many staff trying to work through this under immensely tough conditions. However, there are systematic failures in how we deal with this. I know the volumes of medical and GP-only cards have increased by hundreds of thousands but we must look at this system to ensure those facing severe physical and mental threats, for example, those dealing with cancer, get priority and a decision. I know staff probably do their best and sometimes one sees priority being given, but we need a system-wide approach in order that it becomes the norm that those most in need get it. People are under enough pressure as it is. Due to the increased numbers of medical cards, the ability to apply common sense has probably been taken away and members of staff must follow rules and regulations to the letter of the law, but some people then fall between the cracks. We need to apply common sense in the same way the system worked years ago with the community welfare officer where short-term medical cards lasting three or six months could be given out. We must address this problem because people are under so much pressure.

  The newspaper article also mentions volunteer drivers and how cancer sufferers require more heating in their homes. I am very familiar with the work volunteer drivers do with people suffering from various medical conditions, chiefly cancer. They bring people to their treatments every day or three or four days per week. These people, who do great work in all counties, must be thanked. Sometimes they do this work at great expense to themselves. In some cases, they do this work along with the Flexibus and community transport schemes in our towns. In my constituency, Meath Flexibus does great work along with the volunteers in co-ordinating and matching that and bringing people to some of those services. They must be thanked.


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