Topical Issue Debate

Garda Compensation

Is the Minister, Deputy Varadkar, taking the first Topical Issue matter?

I am taking all Topical Issue matters. I should be getting some sort of allowance.

I thank the Ceann Comhairle for selecting this very important matter for discussion. I had hoped the Minister for Justice and Equality, Deputy Frances Fitzgerald, would be in attendance as I have been continually stonewalled by her and her Department on this issue. A retired garda attended one of my advice clinics in September and conveyed a concerning situation surrounding a compensation claim which has been sitting in the Department of Justice and Equality for two years awaiting further assessment. I will not go into personal details but this relatively young garda suffered malicious injury in the line of duty. According to a document which he produced, the Garda chief medical officer had passed it on to the Department of Justice and Equality in January 2014. This was confirmed by the Minister in a response to a parliamentary question.

The original application for compensation was made in 2010, which was five years ago. Garda authorities forwarded their report on the claim in January 2014 and it has remained in the Department awaiting further assessment. It was also confirmed by the Minister in her response to my parliamentary question that at the end of October 2015 there were 317 outstanding applications for Garda compensation under assessment by the Department of Justice and Equality. I asked the Minister for further details on the years in which these applications were received and their current stage of assessment. The Minister refused to provide the information, stating "such information could only be obtained by the expenditure of a disproportionate amount of staff time and resources".

I was wholly unsatisfied with the response received from the Minister, which raised more questions than it answered. It seems that the devil lies in the detail here. For this reason, I made further inquiries into the matter via parliamentary questions. I asked the Minister to spell out how many gardaí in Carlow, Kilkenny and the south east are waiting for their claims to be processed. Unfortunately, she refused to provide that information to me once again, citing the lack of computerised records as a reason she could not provide the figures.

This again highlights clearly how the Garda has been starved of vital resources. The lack of computerisation should not be an issue in this day and age. The retired garda who first approached me is a relatively young man.

I am gravely concerned about these gardaí, many of whom, I am told, are elderly, who are struggling financially while awaiting payment of their compensation claims in respect of which the Department of Justice and Equality is dragging its feet. The least we can do for gardaí injured while on duty is ensure their compensation claims are processed without delay, irrespective of the outcome of the claim. No person, particularly older retired members who have been significantly injured while on duty, should be forced to wait years to have his or her claims reviewed and decided on.

I am calling for a review of the manner in which compensation claims for serving and retired members of An Garda Síochána are processed. This is a serious matter. I understand more than 900 gardaí have lodged claims for compensation, 317 of which have been processed by An Garda Síochána and are now with the Department of Justice and Equality. I would like an explanation from the Minister on the reason this process is so lengthy. As I said many of those awaiting compensation, who have mortgages and are in dire straits financially, were injured while on duty. The Department needs to speed up the process in this regard and ensure these people are given their just rewards.

Will the Minister for Health, Deputy Varadkar, relay to the Minister for Justice and Equality the fact I would like these claims brought to a conclusion as quickly as possible?

I thank the Deputy for raising this matter which I am taking on behalf of my colleague, the Minister for Justice and Equality, Deputy Frances Fitzgerald, who is elsewhere on Government business.

Under the Compensation Acts 1941 and 1945, a member of An Garda Síochána maliciously injured on duty can make an application for compensation. It is the responsibility of the Minister for Justice and Equality to approve or refuse such applications, having regard to the circumstances of the case and the legislation. This assessment is discharged by designated officials of the Department and is informed by medical reports and previous court judgments in Garda compensation cases.

Before a decision to approve can be taken and the matter progressed to the High Court, certain conditions must be met. The injury being claimed for must not be minor in nature and confirmation must be received from the Garda Commissioner that the incident occurred on duty and that it was not caused as the result of wilful default or negligence on the Garda member's part. A full report from the Garda chief medical officer is also sought in addition to information from the applicant's legal representatives, often including independent medical assessments. Inevitably, this can be a long process, even in relatively simple cases. Unfortunately, in some cases, this has added to the amount of time spent processing applications before a decision to approve or refuse is made.

As of the end October 2015, the number of applications being assessed in the Department of Justice and Equality, namely, those applications in respect of which the necessary information has been received from the Garda authorities to allow a decision to approve or refuse to be made, was 317. The current total now is 286. The Minister intends that this number will continue to reduce over the coming months and has instructed her officials to take steps to ensure this is the case.

I thank the Minister for the reply but it is not good enough. According to the Minister, the number of applications currently awaiting assessment in the Department has reduced from 317 to 286. The garda who contacted me lodged his claim five years ago. His claim has been with the Department of Justice and Equality since 2014, which is almost 18 months ago. The Garda authorities report and medical reports in respect of this claim have been made available to the Department, so there is no reason for it to be delayed.

I understand 900 claims have been made, 286 of which are now awaiting assessment in the Department. This means there are approximately 700 claims awaiting processing by the Garda authorities. I am calling on the Minister to speed up this process. As I said, the gardaí involved have mortgages and other loans and some of them are unable to work. They are dependent on their compensation and it is not good enough that they have to wait years for it. In regard to the Minister's statement that the number of cases currently awaiting assessment has reduced to 286, five years is too long to have to wait for payment of compensation. The Minister needs to ensure this process is speeded up so that these gardaí can be provided with their compensation quicker, in particular given all of their medical records have been made available to the Department.

As I said in my opening remarks, the assessment of each application for compensation is dependent on receipt of reports from the Garda authorities, including the Garda chief medical officer, and on receipt of information from the applicant's legal representatives. On average, both of these parts of the process take up more time than the decision-making process undertaken within the Department. Nonetheless, the Minister has assured me that she is very conscious of the current caseload under the Garda Compensation Acts and the pressing need to reduce the number of outstanding cases in her Department.

The Minister has asked her officials to take steps to address this situation as a matter of urgency. It is also the intention to bring transparency to this process through the collation of statistics relating to the compensation process, which will then be published on the Department's website. I cannot comment on any individual case as I do not have access to any individual's information. I acknowledge the Deputy's concern and interest in this matter and while the Dáil may be rising today, I will be seeing the Minister for Justice and Equality over the next few days and I will make her aware that the Deputy raised this issue in the House and ask that she contact the Deputy directly in relation to the matter.

Hospital Services

I thank the Ceann Comhairle for selecting this issue. I also thank the Minister, Deputy Varadkar, for coming to the House to deal with the need for a specialist heart failure unit in Cork, an issue I have raised a number of times in recent weeks.

Last Tuesday, 15 December, I attended the launch of the report entitled The Cost of Heart Failure in Ireland, which was produced under the auspices of the Irish Heart Foundation and presented by Mr. Brendan Kennelly of NUIG, who is a health economist. It makes for graphic reading. According to that report, the cost to Irish society of heart failure is €660 million per annum, which is a concern. The report also states that heart failure can be addressed at community level. The direct cost of heart failure to the HSE is €158 million. Some 90,000 people are affected and a further 160,000 have impending heart failure. Heart failure hospital admissions accounted for 8% of HSE inpatient bed days in 2012. The total annual bed days taken up for heart failure is more than 230,000 and the average length of stay is 11 days. The condition accounted for more than 40% of all cardiovascular disease bed days and 35% of inpatient stays during 2012. One in five people over the age of 40 will develop heart failure in their lifetime and it is set to become an epidemic due to an ageing population.

The report also estimates that nearly 4,500 patients are admitted to public hospitals with heart failure as their primary diagnosis each year, while heart failure accounts for 30% of all readmissions related to cardiovascular disease. Dr. Angie Brown of Irish Heart Foundation said at the launch that during 2012, 537 people had died as a result of heart failure. It is a huge health concern in Ireland and, worryingly, only 7% of people can identify the common signs of heart failure, with people often mistaking them for the signs of ageing.

There are currently 12 heart failure units operating across the country, six of which are located in Dublin at St. Vincent's hospital, Tallaght hospital, St. James's Hospital, the Mater hospital, Beaumont Hospital and Connolly hospital. There is also one heart failure unit in Drogheda, Wexford, Galway, Cavan, Sligo and Limerick. There is no heart failure unit in the south, which is the reason I have raised this issue today. Cork University Hospital provides a tertiary referral service for cardiology and cardiothoracic surgery to the southern region. I am told that there were to be two heart failure units in Cork, one in CUH and the other in the Mercy hospital but that this was put on hold in 2010-2011 to focus on the development of a unit in CUH. A limited heart failure clinic was established in Cork University Hospital in April 2008 from within existing resources. However, this service is very limited in scope because of a lack of dedicated resources. It operates from the rapid access chest pain clinic, RACPC, located at level 3C, cardiac renal centre, CUH. Between ten and 15 follow up heart failure patients are reviewed per week. There is no dedicated inpatient heart failure service and no new heart failure patient referrals have been accepted to the clinic since August 2011.

Due to nursing and wider resource challenges and the negative impact the heart failure clinic was having on chest pain clinic activity and patient wait times, a dedicated heart failure service was a key priority of the HSE national acute medicine programme and the CUH service plan in 2011. I was advised by the HSE that the recruitment embargo prevented its implementation in CUH. How is it that opening of the units in other parts of the country were not affected by the recruitment embargo? As I said, there is no heart failure unit across the southern region. Will funding for various positions be made available or has such funding already been made available but was not spent? It would be a serious matter if that was the case. I would like an answer to that question. I understand that submissions on a heart failure unit have been made in respect of the 2016 service plan and that resources for a unit in CUH is the number one priority in this submission.

I was advised by the Minister recently that he is not in a position to commit funding. I reiterate that this is a very serious matter. The service could save money because many of these issues can be dealt with in the community. I look forward to the Minister's response and hope it is positive.

I thank Deputy Stanton for raising this subject and for giving me the opportunity to speak on it in the House. The tertiary referral service for cardiology and cardiothoracic surgery in the south is provided at Cork University Hospital, CUH. This includes extensive interventional cardiology services and a 24-7 cardiac catheterisation laboratory. In 2010, following an €85 million investment, the cardiac renal centre opened at CUH. This facility spans some 13,000 sq. m over six floors and was a very significant service development for the region. In 2008, CUH established a heart failure clinic. I am aware of the limitations of the current service. However, funding and service development priorities for the region must be considered in the context of the strategic plan for the south-south west hospital group. It will be up to the group to decide on its priorities for developments in the years to come.

Speaking more broadly, I welcome the publication of the report, The Cost of Heart Failure in Ireland. This report advises on future policy and direction for heart failure services. As the report acknowledges, more than half our hospitals have dedicated inpatient and outpatient heart failure services. However, it also notes that these services are not distributed evenly across the country. The report's findings will inform the HSE's national clinical programme for heart failure in its work on service development. This work will build on its previous service developments. Integrated management programmes covering primary care and hospital services are very important for the successful treatment of heart failure. They can produce significant reductions in hospitalisation for patients and achieve better quality of life and outcomes.

The Department of Health's Changing Cardiovascular Health: Cardiovascular Health Policy 2010-2019 was launched in 2010. Following this, the HSE established three key clinical cardiac programmes, namely, the acute coronary syndrome programme, the stroke programme and the heart failure programme. Through these, significant improvements have been made on access to acute treatment for coronary disease.

The HSE's national clinical programme for heart failure aims to reorganise the way heart failure patients are managed by: identifying heart failure early, in the primary care setting or in general practice ideally; intervening early by supporting GPs in primary care; developing specialist care teams, so expertise is available at primary and secondary care level, to manage and prevent deterioration, including acute exacerbations and emergency presentations; and developing the heart failure cardiac rehabilitation service nationally, for self-management support to patients and secondary prevention of deterioration and complications.

It is intended that in 2016 there will be a national needs assessment of heart failure cardiac rehabilitation services. A significant amount of important work for patients living with heart failure has been done under the programme and I am confident, with the momentum that will be generated by this report, that this will continue.

The Minister might let me know, now or another time, if funding was available in the past for this particular unit and, if so, why it was not spent. If it was not spent, that is another story.

The Minister has admitted that this service in CUH is very limited. The whole of the south of Ireland does not have the kind of service that is available in Dublin and that is quite worrying. In the long term, this service would save money and, more important, lives. As I said earlier on, 90,000 people currently suffer from heart failure. Some 160,000 are at risk of impending heart failure. It is estimated that we will have more than 10,000 new cases of heart failure each year. Only 7% of people can identify the common symptoms of heart failure and one in four people with symptoms will wait a week or more to seek medical advice or will not seek medical advice at all. Some 84% of people have incorrectly thought people with heart failure live longer than those with cancer or who have suffered a heart attack or stroke. Heart failure causes more deaths than breast cancer and bowel cancer.

This centre is needed urgently in CUH to serve the southern region. Will the Minister use his influence and resources to set it up? It will, in the long run, save money and, more important, lives. I was amazed to learn that the whole south of the country does not have this service while other parts of the country do have it. There are six such units in Dublin. Why was it not done in Cork? More important, however, is that we should now get it done. I urge the Minister to make contact with the hospital group and to support it and give it what it needs to get the service established as soon as possible.

At the launch of the report, a heart failure patient spoke about the difference that the availability of a heart failure unit made to his life. This unit is in Dublin and is led by Professor Ken McDonald, who also spoke at the launch. This is something which should be done urgently. It is very important and it would save money and lives.

I thank the Minister for being here and wish him and the Leas-Cheann Comhairle a happy Christmas.

Go raibh míle maith agat, a Theachta.

I do not know if funding was made available in the past or whether it was spent. If it was made available, I have not been so informed but it may have been some time ago.

The recruitment embargo no longer exists and some 4,000 staff were hired in the health service in the past year. We are not back to where we were but we are not far off it. At the rate we are going, we will be there in the next year or two. It is acknowledged that the heart failure clinic in CUH established in 2008 is very limited. It was established using existing resources and operates from the rapid access chest pain clinic in the cardiac renal centre. I am told that between ten and 15 follow-up heart failure patients are reviewed each week.

As is always the case, health care always faces competing demands. The next Topical Issue concerns funding for stroke rehabilitation and the one after it concerns approving a medicine for a particular type of cystic fibrosis. It is never a case of whether to do something or not but rather opportunity cost and prioritisation. In the context of the budget for that particular region, it will be up to the hospital group to assess all of its different needs and priorities across the region, prioritise them and work out which ones will be done first. I have no doubt that all these things will be done in time but everything cannot be done now. I only wish it was so.

I acknowledge Deputy Stanton's particular interest in this issue. He has spoken to me about it privately on other occasions. I am sure it will be done but I cannot say exactly when. I return the compliment and wish him the best for the Christmas and new year break.

Health Services

Guím Nollaig shona ar an Leas-Cheann Comhairle agus ar an Aire, chomh maith le gach duine eile anseo sa Teach. I thank the Ceann Comhairle for choosing this matter for discussion and the Minister for being present.

The Minister got in first by saying there are so many demands in different areas of health, which clearly is true but I wish to make two initial comments. I acknowledge that there have been improvements in the services available for stroke victims in the past number of years, in particular in the past three years. I also acknowledge that it is difficult to deal with everything. However, good interventions for stroke victims, especially younger victims, pay off. These interventions bring a benefit to the State and I think the Minister would accept that point.

Stroke is the third most common cause of death in Ireland but audits have shown huge shortcomings in the nation's stroke services. Approximately 2,000 people die from stroke each year and it accounts for more deaths than breast cancer, lung cancer and bowel cancer combined. Proper rehabilitation in the community could make a major difference to these patients and, ultimately, save the State many millions of euro. Research carried out by the Economic and Social Research Institute and the Royal College of Surgeons in Ireland found that 54% of stroke survivors, approximately 3,000 people per year, could benefit from early supported discharge programmes. This would reduce hospital bed days by 24,000 and lead to a saving annually of between €2 million and €7 million.

Early supported discharge is used in many countries worldwide. It involves an intensive approach to rehabilitation. Unfortunately, it is not usually available in Ireland. The report notes that if it were to be properly introduced here, there would need to be a major investment in community staff such as physiotherapists, speech and language therapists, occupational therapists and community nurses.

If the additional staff were to be provided, the tools they use would have to be greatly advanced and modernised. In the Baggot Street centre where survivors are trained to get back to work, the IT equipment is totally out of date. Patients need constant physiotherapy and while this is driven on a personal level, it is greatly assisted if facilities are also provided in rehabilitation centres. These centres should not be using exercise equipment that is faulty or out of date, which is sometimes the case. Recovery methods are only effective when instruments are in good working order and up to date.

Stroke survivors say that the best thing after a stroke is getting out of hospital but they can only do this with proper assistance and community care. Centres like the one on Baggot Street do great work but are not accessible to everyone. There is a real need for community centres across the country to have proper and adequate staffing in order to continue the rehabilitation process. Without proper assistance, too many people are losing the chance to regain as much of their strength, speech and mobility as possible.

Less than half those of working age return to work after a stroke and most of these either leave soon after or take on a reduced role. In order for these statistics to improve, the Government needs to invest more in stroke rehabilitation services and infrastructure. This investment will allow stroke survivors get back to a normal life, both professional and personal.

I thank Deputy Dowds for providing me with the opportunity to speak on the subject of rehabilitation services for stroke survivors. The aims of the HSE's national clinical programme for stroke are to improve the quality, access and cost-effectiveness of stroke services in Ireland and I am pleased to report that significant improvements in stroke services have been made, as Deputy Dowds has acknowledged.

Emergency thrombolysis is provided now to patients in all regions of the country by improved hospital and ambulance protocols, health professional training and the appointment of new physicians. There is national 24/7 access to safe stroke thrombolysis, the rate of which has increased from 1% in 2006 to a current rate of 11.6%. This exceeds the national target of 9% and is among the best in national rates worldwide.

Access to stroke unit care has been shown to improve stroke patient outcomes through reduced rates of death, dependency and shorter lengths of stay. Since the commencement of the national clinical programme for stroke, nine new stroke units have been opened, bringing the total number of stroke units in acute hospitals to 22. New care pathways have also been developed to standardise stroke management. Early rehabilitation, including speech and language therapy, physiotherapy and occupational therapy are key parts of the care provided in these units. This is a major improvement from the first national stroke care audit report in 2006, which reported that there was only one stroke unit in the entire country.

As it stands, fewer stroke patients are dying in hospital, with the rate having dropped from 16.1% in 2009 to 15.1% in 2013. This represents an average of 36 fewer deaths a year. There are fewer stroke patients being discharged to nursing homes, which is an indication of reduced disability outcomes after a stroke and more stroke patients are being discharged home directly from acute hospitals. The average length of stay in hospital for stroke has fallen from ten days in 2009 to nine days in 2013. This is estimated to have saved 19,000 bed days in the 2011 to 2014 period.

The Deputy mentioned early supported discharge services for stroke patients which aim to accelerate discharge home from hospital and provide rehabilitation in the home setting. Three early supported discharge services for stroke patients have been established at the Mater Misericordiae University Hospital and HSE north Dublin, Galway University Hospital and Tallaght hospital. Excellent clinical outcomes and very high patient and care satisfaction rates are reported across all three sites. The average bed days saved per patient range between 6 and 12.6 days across sites.

My Department is conscious of the business case for early supported discharge submitted to my Department by the HSE's national clinical care programme for stroke and the Irish Heart Foundation. This advocates a phased roll-out of early supported discharge services. It was considered as part of the development of the HSE's national service plan for 2016 but unfortunately, there was no scope to develop this initiative due to other funding demands. My Department will take account of the additional resources needed to expand this initiative gradually in the context of next year's Estimates process. These additional resources will then be considered as part of the HSE's service planning process next year. Funding for stroke rehabilitation is provided in the overall allocation to the HSE for acute hospitals and community services.

I am glad that the Minister is committed to improving the services for stroke victims. Given our improved economic situation, the faster that can be rolled out the better, particularly for younger people who have a better chance of making a fuller recovery. I would also suggest that more targeting is required in this area because some people will need more support at home than others. For example, people who live on their own would need more support than those who live in family situations.

There is also a requirement for additional funding to provide psychiatric help for stroke victims because the impact of stroke is not just physical; it can have a major impact on people's state of mind too. At the moment, one third of stroke survivors have no access to physiotherapy, half cannot get any speech and language or occupational therapy and only one in ten get psychological help. More than one in three stroke survivors have to pay for their own rehabilitation and 60% of them are financially worse off after their stroke. Less than half of those of working age return to work after suffering a stroke and most of these people either leave soon after or take on a reduced role. In that context, any improvements in the services provided to stroke victims would have a positive impact. Given that around 40% of stroke sufferers have reported that their close relationships were damaged in the aftermath of stroke, improvements in services will not only have hugely beneficial effects for the individuals themselves but also for those with whom they associate.

Again, I thank the Deputy for raising this important issue. I worked for a period of time in care and medicine for the elderly and have a limited knowledge and a particular interest in stroke. The Deputy was in the Chamber for the previous discussion on heart failure which is another area in which we should do a lot more. We know that there are very cost effective interventions in the area of heart failure that we are not making at the moment but we simply cannot do everything. The same applies to stroke. There have been enormous improvements in stroke services in the last ten or 15 years and further development of those services would certainly be cost effective and not terribly expensive. However, the first priority must always be to maintain existing services and then with any additional funding available - which in any year and in any country, no matter how rich, is limited - one must prioritise those areas which will cost the least and be the most effective. We are very disappointed that we cannot proceed with a national roll-out of early supported discharge for stroke in 2016, which we would have loved to do. Unfortunately, it is not possible. However, it will be possible to ensure that stroke telemedicine is available and provided to all hospitals in the country, thus ensuring that we can maintain and improve on our thrombolysis and thrombectomy rates.

Medicinal Products Availability

I dare say there is not a citizen in this State who is not conscious of cystic fibrosis, given its prevalence in this country. I understand that we have the highest rate of cystic fibrosis in the world but I cannot explain why that is the case. We are all aware of how this condition affects the individual and by extension, their families.

In terms of science and research, we all welcome the new Orkambi drug which has been developed to treat the condition. Evidence from the United States indicates that it can significantly improve the quality of life of cystic fibrosis sufferers.

Anything which alters this horrific condition for sufferers has to be welcomed.

The big issue for all of us, particularly the Minister and the HSE, is the cost of this drug, given that it is so expensive. The drug is currently being assessed. When will that assessment be presented to the Minister?

"Can someone please tell me why my life and the lives of CF patients in Ireland have a price tag on them?" That question was asked by Jillian McNulty, who has written to the pharmaceutical authorities in Ireland describing how her life was transformed while partaking in a trial of Orkambi over two years and how her condition has gone backwards and deteriorated since the trial ended. As we have the highest rate of cystic fibrosis in the world, with one in 19 people carrying one copy of the gene that causes cystic fibrosis, this is a major issue in Ireland. The Orkambi combination of drugs is beneficial for 60% of CF people, resulting in a 40% reduction in worsening symptoms and hospital admissions for those partaking in the trial. It results in an increase in lung function, an increase in weight and an increase in people's quality of life, delaying the need for lung transplants and lengthening life expectancy.

What exactly is the stance of the Government? Dismay was caused by the initial reaction of the HSE to the potential cost of Orkambi. How much value is the Government placing on the lives of cystic fibrosis patients? Orkambi was reportedly going to cost €92 million, which was compared to the cost of running Temple Street Hospital for a year. With only a few hundred people benefitting, it could not be afforded. I find that quite incredible. Irish Water, a company that nobody wants and nobody needs and a complete waste of money, spent €83 million on consultants last year, yet €90 million cannot be found for these patients.

We have to tackle the issues of the cost of drugs, who owns the drug companies, who conducts the research and the way people's lives are being placed in jeopardy by the profiteering of these companies. As my speaking time is running out, I will try to deal with this issue in my supplementary question. We have to deal with these companies that are profiteering from people's misery.

I thank the Deputies for raising this important issue. Decisions on which medicines are licensed for use in Ireland and which are reimbursed by the taxpayer are made on objective, scientific and economic grounds by the HSE on the advice of the National Centre for Pharmacoeconomics, NCPE. The NCPE conducts health technology assessment of pharmaceutical products for the HSE and can make recommendations on reimbursement to assist the HSE in its decision-making and negotiation process. The HSE has statutory responsibility for decisions on pricing and reimbursement of medicinal products under the community drug schemes in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013. It is appropriate that these decisions be scientific and that an evidence-based approach be taken to determining the extent to which patients would benefit from treatment with expensive new drugs, whether the drug is effective and what a fair price would be.

As the Deputies will be aware, ivacaftor and lumacaftor, marketed as Orkambi, is a combination drug for the treatment of CF in patients with two copies of a specific CF gene mutation. The drug was approved by the US Food and Drug Administration in July 2015 and by the European Medicines Agency less than a month ago on 19 November 2015. I am not aware of any public health service that currently reimburses it.

Orkambi's manufacturer, Vertex Pharmaceuticals, submitted a rapid review application to the NCPE on 26 November. This rapid review represents the first step in a pricing and reimbursement application. The company is expected to submit a full pricing and reimbursement application to the HSE's primary care reimbursement service in the very near future, although it has not yet done so. Based on pricing details in the rapid review file, the HSE estimates that reimbursement could cost approximately €90 million per year. Given the considerable budget impact, the NCPE is likely to require that a full health technology assessment of the drug be carried out before a recommendation is made. This is the normal process for approving expensive new technologies or medicines, and Orkambi will be assessed fairly and in the same way as other such drugs or technologies. As part of this work, the scientific evidence will be assessed independently and objectively to see if the suggested benefits in terms of life expectancy, quality of life, improved lung function and reduced hospital admissions stack up and, if so, to what extent.

Since early 2013, the HSE has reimbursed more than €60 million for CF patients receiving ivacaftor, marketed as Kalydeco, and there are now approximately 140 patients being treated with this drug. Over the next decade, the HSE expects to spend well over €200 million on this patient group alone. The HSE has also invested in other CF services. The Lieben building at Limerick University Hospital has been developed and commenced operations in November, providing a dedicated outpatient facility and nine isolation rooms. The HSE has made a total of €9 million available in 2015-16 for this facility, of which almost €2 million relates to the CF facility itself. A new CF facility also opened in the last couple of weeks at Cork University Hospital, funded through the voluntary Build for Life programme to the tune of €2 million and a further almost €1 million from HSE.

While I appreciate that some may take the view that the taxpayer should reimburse every licensed medicine for whatever price the drug company demands, the interests of the public, the health service and all patients require that we only reimburse the most effective medicines, and do so at a fair price. In the past, the carrying out of health technology assessments and subsequent informed discussions with manufacturers have ensured that the best value was achieved and health funding was used in the most effective way. In the last 18 months, this system has resulted in savings against the initial price submissions by companies of €19 million a year, and that saving is ongoing and recurs every year. The interests of neither patients nor the taxpayer are best served by just agreeing to whatever price a manufacturer deems appropriate on whatever evidence it happens to put forward. The opportunity cost is enormous, and overpaying for any new drug costs lives in itself, as the money thus used could have gone into other services such as ambulances, which would save lives, maternity services, which would save lives and prevent disabilities, and cancer screening, which would save lives, to give just three examples. I could equally give examples from the two Topical Issue debates prior to this. Deputy Dowds made a very strong case for greater investment in early supported discharge in cases of stroke, which would save lives and prevent disability. Before that, Deputy Stanton made the case for more investment in heart failure treatment, which would benefit many people at a very modest cost.

I appreciate and fully understand that people suffering from cystic fibrosis will be anxious for an early and positive decision in regard to reimbursement for this drug. However, it would not be appropriate for me to appear to prejudge decisions that are matters for the HSE in the first instance, under legislation passed by the Oireachtas in 2013. I trust the Deputies will understand my position on the matter.

I am in agreement with the Minister. I am on the record, as a member of the Oireachtas Joint Committee on Health and Children, as stating that the taxpayer should not be held to ransom by the pharmaceutical companies, as we have been in the past. I hope this is a view all Members hold. These companies exist and operate to make as much money as possible, and that is their primary concern.

I remember a discussion in the health committee with the Minister's predecessor in regard to attempts that were to be made on a European-wide basis to try to control the cost of drugs, which I believe would be an effective way of doing this.

In reference to the Minister's final paragraph, I do not expect him to prejudice what the HSE may decide, but can he provide any information that may give comfort to those living with this condition as to when the assessment may be done?

The Minister does not need to tell me about the pharmaceutical industry and how it is profiteering from people. In the United States currently, one company has raised the price of an AIDS drug by 5,000%. It costs $1 dollar to produce the drug, but the cost has been increased from $13.50 to $750. That is the kind of profiteering these companies engage in.

The company that makes Orkambi made the point that if it reduced the price of Orkambi and related drugs for minority illnesses, it could be swallowed up by bigger drug companies. We see from this that ordinary people are being held hostage by the profiteering of these companies under our capitalist system. That is why I am a socialist and why I believe health should be a priority. I believe research should be conducted in a unified manner, with results shared by different companies. It would be best if it was funded by the Government and it and our health service should also be funded by progressive taxation.

If a member of the Minister's family was ill, he would be moving heaven and earth to ensure this drug became available. The Minister must negotiate to reduce the price. The HSE seemed to come out with a prejudged decision that frightened and upset a lot of families with a cystic fibrosis sufferer. This is not good enough. The cost should not be €90 million, but we could compare that with the €7 billion in interest we are paying on a debt that was not the debt of the ordinary people of this country. We need a completely different type of health service. The pharmaceutical companies that are provided with big tax incentives should be taken over and run in the interest of ordinary people.

On Deputy Maloney's question, I am advised by the NTP that it plans on doing the health technology assessment in the first quarter of 2016, with a view to making a recommendation report in the second quarter. I will ask for that to be expedited, although there are other technologies and drugs in the pipeline also. However, it is important that everyone is treated equally and that no one group is given priority over another disease group. That would be unfair, but I know that is not what the Deputy is asking for. When the report is presented, the evidence will be assessed to see if it stacks up and a fair price will be calculated. This will then go to the HSE national drugs committee which will then try to negotiate a fair price for the medicine.

Deputy Coppinger referred to the possibility that the HSE may have prejudged the decision. I have spoken to the director general about that matter and we both agree this should not be prejudged and that the new technology and medicine should get a fair hearing and assessment, as has been the case in the past for any other new technology. Therefore, it is not being ruled out without being assessed properly. I am happy to clarify that is not the case. The Deputy asked what value the Government puts on the lives of people. The only fair thing for the Government to do is to put an equal value on the life of everyone. That is the only way resources can possibly be apportioned. Even the richest and most socialist countries in the world have limited resources. The important thing is to treat everybody equally and to value every life equally.

I totally agree with her on the conduct of the drug companies. We know what they do. They overcharge and use patients as pawns. In some countries - not here to the best of my knowledge - they even hire PR companies to coach and encourage patients to advocate on their behalf. I do not believe that has happened here, but it has allegedly happened in other countries. These people also pay themselves massive salaries, draw down massive profits and pay massive dividends. They are people whose bonus every year is based on how much they can overcharge a small country. They target small countries and get the small country to set the high price and then offer bigger countries slight discounts. This is a case of greed incorporated. While I am not a socialist, dealing with some of these companies would bring out whatever socialist instincts may be buried in me.

I believe that in the future these matters should be dealt with at European level and that we should task the European Medicines Agency with the role of deciding which drugs should be reimbursed and then use the buying power of a Union of 500 million people to ensure we get a fair price so that we can treat more people. Perhaps we could then set aside some funds to do some of the other things raised here today.

Finally, as the last man standing today on this the last day of the session and the last sitting of the year, I believe it is customary to say a few words of thanks to Deputies, the ushers and the other staff of the House. It has been a busy and interesting year and much good work has been done. On behalf of the Government and the whole House, I want to extend sincere thanks to all the staff in this building for the hard work they have done in the past year. I wish them all a very happy Christmas and a good new year.