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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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  1 o’clock

(Speaker Continuing)

[Deputy Bernard J. Durkan: Information on Bernard Durkan Zoom on Bernard Durkan] In a previous incarnation I spent a long number of years in a health board where we experienced a similar situation. There were always cuts coming from July onwards and more particularly from October to Christmas. That happened because there was not an ongoing evaluation of spending, which could have been done very simply. Every budget relates to 365 days a year. One can divide the budget by 52 weeks or 12 months, but either way it comes down to the same thing - it is possible to identify where the problems arise most and, consequently, what needs to be adjusted and changed within any departmental budget at any time. It is not something that works easily, however, because every departmental section, particularly in the health services, competes to avoid cutbacks. In the current situation, however, we do not have the luxury of avoiding cuts. I therefore ask the Minister and the Minister of State, Deputy Alex White, to ensure that henceforth the budget will be evaluated monthly at least. It is possible to input all the untouchables and unmentionables, in addition to - as a former American Secretary of State for Defence put it - the known unknowns and the unknown unknowns. I do not wish to go too far down that road, however. There are issues, within the health services in particular, that we know about and therefore it is possible to introduce economies that will benefit service delivery across the board.

I also wish to mention the prescription of generic drugs. I remember having an arduous and long drawn out debate as to the merits of reducing medical costs that could be derived from prescribing generic drugs. I also remember a long input from some Members on the opposite side of the House opposing that concept. A heated debate took place and eventually in one of the biggest health boards in the country it was possible, through block procurements and generic prescribing, to bring about substantial reductions in the cost of medicines across the board. It took a great deal of agitation to achieve that but it did happen. There was regard for the areas where brand name drugs were better known or deemed to be better for patients in certain conditions, and that was even allowed for.

We also found that the brand name drugs companies were able to compete effectively with the generics in many areas despite notions to the contrary. As regards the supply of goods and services, including drugs, and the delivery of health services in general, it is in the interests of all such patients to get the best possible value for money. We must use all the means that have proved effective in the past, without putting patient safety at risk. I believe that can be done.

One must also have regard to those suffering from cancer and other serious illnesses, as Deputy Catherine Murphy said earlier. This is not a new measure; it has been there previously, but in some cases it was not enforced. There is no good time for re-introducing legislation that was not enforced in the past. There is no reason either why it should be introduced selectively, but due regard must always be had for the severity of the illness faced by patients and their vulnerability. In that way, we can ensure that we do not become a careless society instead of a caring one. It is well within the remit of the health services to adjudicate between the various categories in terms of severity and need.

I am not a follower of the concept of centralisation when it comes to determining eligibility for medical cards. It is much easier to do so at a local level and was so in the past. There will be those who may say that it was more expensive, but it was a lot more personal. People at local level knew exactly the nature of the application and very often knew well who the patients were. In those circumstances, it was much more possible to be able to introduce relevant information that would clearly indicate whether or not the patient needed a more flexible and accommodating attitude. I am not saying for one moment that the current system is inflexible or uncaring. However, by virtue of the volume of correspondence and inquiries going into that department, it will naturally follow that the same degree of personal adjudication is not available.

Another area that warrants examination - I know it will come within the ambit of this Bill - is the supply of special clothing, footwear, wheelchairs and other appliances through the health services to individual patients. Like other Members of this House, I have received complaints from people who have appliances they no longer require. For whatever reason, such appliances are not collected or recycled for re-use in the system. Since such appliances are not available for other patients, the latter must await a further allocation of scarce resources. As a cost-saving measure, it should be possible to return appliances that are no longer required by certain patients. It happens in other jurisdictions all the time, so we should be able to do it here, particularly at the present time. I hope it will happen.

I am aware that a brokerage system exists concerning the supply of goods and services to the health service. The broker, for want of a better description, supplies a variety of goods and services, sourcing those products in various ways. Many of them emanate from outside this jurisdiction. Very often, however, a loss leader is used - in the same way that supermarkets use alcohol - in order to reduce the overall cost of the package and thus get more of the product from a particularly friendly source. That practice needs to be discontinued. I have tabled parliamentary questions about it in the past but the practice has gone on for many years. It is particularly difficult to challenge when costs are being reduced generally because the argument will always be made: we're reducing costs and this is how we have done it and it has been of benefit to the Exchequer. That is not necessarily the case because there can be hidden costs as well. I know the Minister is fully aware of this matter but I would like to see it being addressed. We must try to ensure that we source as much material and products as we can from indigenous sources, notwithstanding domestic and EU competition laws. We currently have our backs to the wall in terms of costs.

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