Priority Questions

Health Services Reform

Billy Kelleher


57. Deputy Billy Kelleher asked the Minister for Health why the undertakings on universal health insurance and the introduction of free general practitioner care for the whole population, the two key health commitments in the 2011 programme for Government, were not honoured; and if he will make a statement on the matter. [4093/16]

If the Taoiseach comes to the Dáil, I will be happy to give way to him at any stage during my question. I want to ask the Minister for Health why the undertakings on universal health insurance and the introduction of the free GP scheme for the whole population, which were the two central planks of the Government's policy in 2011, have not been fulfilled. The Minister has abandoned universal health insurance and it now appears he has abandoned the roll-out of free GP care to the whole population. Will he explain why those two key policies were not implemented?

The Government has embarked on a multi-annual programme of health reform, the aim of which is to deliver universal health care, as defined by the World Health Organization, where everyone can access the health services they need, which are of sufficient quality to be effective, while ensuring that the use of these services does not expose them to financial hardship.

In April 2014, the White Paper on Universal Health Insurance, UHI, was published. Following its publication, the Department of Health initiated a major costing project, involving the Economic and Social Research Institute, ESRI, the Health Insurance Authority and others to examine the cost implications of a change to the particular UHI model proposed in the White Paper. The reports detailing the estimated cost of this UHI model were published on 18 November 2015. Having considered the findings, I concluded that the high costs associated with the White Paper model of UHI are not affordable and that further research and cost modelling on the best means to achieve universal health care was needed.

The next phase of research will include deeper analysis of the key issue of unmet need and a more detailed comparative analysis of the relative costs and benefits of alternative funding models. This work will be carried out under the auspices of the joint Department of Health-ESRI three-year research programme on health reform. Both the research undertaken to date and that planned in the next phase of the costing exercise will assist the next Government in its decisions on the best long-term approach to achieving the shared goal of universal health care.

I should add that when I assumed the office of Minister for Health, I concluded that while progress had been and was being made on health reform, the original timeline for implementation of universal health insurance, UHI, was too ambitious. I also emphasised my commitment to progressing health reform and my determination to push ahead with four key building blocks, namely, the Healthy Ireland strategy and the public health agenda; building sufficient capacity to satisfy unmet demand; the expansion and development of primary and social care; and reforming structures, information and communications technology and financial systems with key initiatives, such as the phased extension of GP care without fees, the establishment of hospital groups and community health organisations, the implementation of activity-based funding and the improved management of chronic diseases. These all are major milestones on the road to universal health care and have the potential to drive performance improvement and deliver significant benefits in terms of timely access to high-quality care.

Additional information not given on the floor of the House

Already GP care without fees has been successfully introduced for children under the age of six years and all people aged 70 years and over. This has resulted in approximately 800,000 people now being eligible for GP care without fees and without being obliged to undergo a means test. The under-sixes service includes age-based preventive checks focused on health and well-being and the prevention of disease including asthma and diabetes. In budget 2016, the Government made financial provision for the extension of GP care without fees to all children aged six to 11 years. It is envisaged this third phase will bring the total number of those eligible for universal GP care without the obligation to be assessed by a means test to approximately 1.2 million people. The progress made in recent years in introducing universal health care, together with the improvement in public finances, provides a very good basis upon which to plan the next phase of improvement in our health services.

A cursory glance at the programme for Government and an analysis of it with the benefit of five years of hindsight shows it is a catalogue of failure. The two central tenets of health care delivery in Ireland were to be universal health insurance and free GP care for everybody. There has been an abandonment of the universal health insurance model as was outlined. It appears to have been parked, even though there is a pretence it is not off the agenda. However, the bottom line is the Government has failed to implement any part of universal health insurance. If one moves on to universal GP access, the Minister announced last night he also was delaying or potentially abandoning it because of the lack of capacity in the GP services. In this Dáil Chamber, Fianna Fáil Members repeatedly and consistently raised the need to enhance the capacity of GP services before any roll-out of universality and were consistently ridiculed as being opposed to it. However, they were not opposing but were merely highlighting the inadequacies of preparation in bringing about universal access to GP services. Such services are not akin to buses in Calcutta, in that one cannot just keep putting things in and expect it to keep filling, as at some stage, something will give. The reason so many people are on hospital trolleys across Ireland, day in day out, is because GP services cannot cope.

I do not accept the analysis that people are on hospital trolleys because GP services cannot cope.

That may be true for a small number of patients on trolleys but generally speaking, it is the case that if somebody is on a trolley waiting for a hospital bed, that person is there because he or she has been seen by a doctor, or perhaps by two or three doctors, and those doctors have determined the person requires admission to a hospital. Consequently, the idea there is somehow a direct correlation between GP services and patients on trolleys is incorrect.

I appreciate the Government's term of office is almost at an end and the Dáil will be dissolved this week. The Deputy's question has two parts and the programme of Government will cease to exist as a live document this week. As for proposals being put forward by different parties for the general election, different parties of course will put forward different proposals. The proposal of my party is to extend GP care without fees to everyone under 18, as well as to provide for chronic disease management care for adults with common chronic diseases such as diabetes, asthma, chronic obstructive pulmonary disease, COPD, heart failure and other things like that.

I thank the Minister.

I believe that is all achievable and affordable in the lifetime of the next Government.

Everybody accepts that primary care is the way to address the challenges being faced in the delivery of health care. The Minister himself has consistently stated that if it is possible to increase the capacity of the primary care system or to enhance the ability to deal with chronic disease and chronic illness, it will have an impact on overcrowding in the emergency departments. The point I make is that while there is overcrowding at present in GP practices nationwide, they are incapable of dealing with complex issues. They are under huge time pressure and if one contemplates ensuring that people are dealt with in the area of least complexity, that is, in the GP services or at home, one must increase primary care capacity. However, the Government has singularly failed to do this. All the Government has consistently stated was it intended to roll out universal GP access to everybody. This has not happened and in the meantime, there has been an undermining of the capacity of GP services nationwide to deliver health care in the primary care setting.

All in all, as this Dáil comes to an end, the Minister must accept the Government's health policy has been a disaster from start to finish. Every benchmark or index on which the Government wishes to adjudicate its success or failure shows it has singularly failed in every area.

Better primary care and better social care are part of the solution to the problems in our hospitals. It is not the entire solution. The Deputy must bear in mind that if more people are seen in a primary care setting, that may result in more referrals to hospitals. On one level, more people will be managed in the community but, on another, more illness will be picked up. If we have much better primary care in Ireland, for example, doctors will start diagnosing the 50,000 to 100,000 undiagnosed diabetics in the community and even if only 10% of them have to be referred to hospital clinics, that will mean an additional 10,000 attendances. There are interplay factors and people often over-simplify this too much. There is evidence, although it is less than convincing, that GP care without fees for those under six years of age has resulted in an increase in referrals to paediatric emergency departments. I would like to see a full season's data before being convinced of that because other factors could be at play, not least the respiratory syncytial virus.

We have learned a great deal from those under six years of age and those over 70 years of age. It has been a great success but we are learning from it. There has been an increase in attendances by those under six years of age at GP services and there has been a significant increase in attendances at out-of-hours services. We have to factor all that into future planning. It will be necessary to increase the number of GPs over time and, therefore, we need to ensure there is not a mismatch between the increase in the number of GPs and trainees and what we ask them to do. That is why my party is putting forward proposals that we believe are ambitious but achievable in a five-year period. I am disappointed that the Deputy's party proposes to stop at six years of age and not extend the scheme further. That is a real shame.

Ambulance Service Provision

Caoimhghín Ó Caoláin


58. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the steps he is taking to address the seriously inadequate ambulance provision, on standby and in service, in County Monaghan and in counties Cavan, Louth and Meath generally; if he accepts that, despite this Deputy highlighting to him in advance the serious lack of ambulance cover across these counties over the Christmas-new year period, there was a total failure on his part and on the part of the ambulance service to act; and if he will make a statement on the matter. [4081/16]

I seek to establish the steps the Minister has taken and intends taking to address the inadequate ambulance provision covering my home county of Monaghan and the neighbouring counties of Cavan, Louth and Meath and to highlight to him once again the questionable practice of extending significant leave to important emergency care providers over the Christmas-new year period with inadequate cover to cater to the population of these counties.

Over the past few years, the national ambulance service, NAS, has undertaken significant reconfiguration and modernisation of its services. It now operates on a national and regional rather than a local basis. Ambulance resources, including rapid response vehicles with advanced paramedics, are dynamically deployed over an area from individual stations within, and surrounding, that area. This helps to ensure optimum cover is provided and that the NAS is best placed to respond to calls as they arise. I understand that the capacity review has been completed and will inform how NAS deploys resources across specific areas.

Across the north Leinster area, dynamic cover is currently provided from stations in Monaghan, Castleblayney, Cavan, Virginia, Dundalk, Ardee, Drogheda, Navan, Trim and Dunshaughlin. In the event of a high volume of emergency ambulance calls in the north east area, the NAS may seek assistance, if necessary, from colleagues in the Northern Ireland ambulance service. There has been considerable investment in new technology which ensures the nearest available and appropriate resource is dispatched to an incident.

I am aware that concerns were raised prior to the Christmas and new year period regarding the level of cover which would be available in the area, given the number of staff who had announced annual leave around the holiday period. However, the NAS has advised that leave arrangements for the period were finalised in the normal fashion and that an appropriate level of cover was provided during that period.

I will rely on the facts relating to a case to demonstrate the problem. A constituent has outlined his experience having become ill at home with severe chest pains during Christmas week. Having suffered a previous attack, he called the ambulance service at approximately 8.45 p.m. and was answered promptly by a call attender. The call attender took details and advised that an ambulance was en route from the Castleblayney area. However, the ambulance was subsequently diverted to another urgent call in the Castleblayney area. The call attender attempted to contact doctor-on-call but to no avail and there was no ambulance available in the Monaghan town, Cavan, Louth or Meath areas. Despite the call attender's best efforts, including requesting an ambulance from Northern Ireland, his efforts had no success. He continued to stay on the phone for almost two hours with the gentleman who had had the cardiac experience giving advice, keeping him calm and providing updates on ambulance availability.

Eventually, an ambulance arrived from Manorhamilton, County Leitrim, at 11.15 p.m. and brought the patient to Cavan for treatment.

I thank the Deputy.

He wishes to record, in the strongest possible terms, his complaint about the non-availability of an ambulance for two-and-a-half hours on that night. He also wishes to record that there were two ambulances parked at the Monaghan ambulance station base - which is located less than three miles from his home - during the period in question. Those are the consequences of the situation that I highlighted prior to Christmas. That is a factual case on which I can share the details with the Minister. I ask the Minister, in these closing hours of the current Dáil, to highlight this situation to the National Ambulance Office. What happened is absolutely unacceptable. I ask that the Minister do as I have requested and that he and his colleague, in whatever elected roles they hold after the upcoming general election, use their voices to lobby the next Government - regardless of its configuration - for change. Communities depend on the ambulance service and there is an inadequate level of cover at present.

The Deputy will know that I cannot comment on individual cases. I was not given prior notification that the Deputy would raise this individual case but, certainly, if he wants to give me the details, I will have the position checked by the National Ambulance Service. It is important to point out that there has been a significant increase in investment in the ambulance service in recent years. The budget will increase by €7 million this year and it increased by €5 million last year. We now have the emergency air ambulance service, which did not exist until this Government came to office. We have the rapid response vehicles which take paramedics to people's homes. We are moving away from an ambulance service that is just about transporting people to hospital to one which ensures that they are given emergency treatment by paramedics both in their homes and at the roadside. That is a major improvement. We have also opened the new national emergency operation centre, NEOC, in Tallaght and we are increasing investment in community first response teams. Therefore, there is a big programme of reform, investment, change and improvement under way in our ambulance service. That will continue. No matter what role, if any, I hold in the next Dáil, the Deputy may rest assured that I will continue to take an interest in ambulance services. If I ever get time off, one thing I would love to do is retrain in advanced cardiac life support, ACLS, and advanced trauma life support, ATLS, and perhaps I can actually become a community first responder myself.

I thank the Minister.

It is the case that a great deal more must be done. I accept that we need to improve our ambulance response times. As individuals who could potentially be the next Minister for Health, I say to Deputies Ó Caoláin and Kelleher that they should be careful about what they promise. It will never be possible to have an ambulance, a squad car and a fire engine at every crossroads in every village in every small town. There will always be instances when these emergency vehicles do not arrive as soon as we would wish.

I thank the Minister.

We need to be honest with people about that.

Absolutely. Honesty is critically important. The very fact that the Minister is indicating a commitment to ensure that the current provision is significantly enhanced is a statement of recognition that there has been inadequate cover during this considerable period of years. Communities such as mine have lost all of their acute hospital services with the transfer of same from Monaghan Hospital to Cavan General Hospital. Other hospital facilities across the region are totally dependent on the ambulance service in terms of emergency situations relating to road traffic accidents, RTAs, cardiac arrests, stroke victims or whatever is the case. We were promised that there would be significant ambulance cover - that is, appropriate ambulance cover - but that has not been the case. For whatever short period after the advent of the construction of the new station, there was a presence. However, this has been watered down significantly over the period and shared, I understand, with the north Louth area in the context of Castleblayney. It is hugely important to ensure that - not only in the area I know best but throughout the length and breadth of this State - the requisite number of ambulances and staff are provided in order to guarantee full cover at all times. That matter must be a priority and it is one I will be happy to pursue, regardless of whether I am in government or in opposition, after the election.

I reiterate that an additional €7.2 million - this is an increase on outturn - is being provided in the budget for the ambulance services in 2016.

That includes €2 million to recruit and train extra staff and also to expand the community first responder scheme. The National Ambulance Service has recently completed a national recruitment campaign and is commencing an international recruitment campaign for qualified paramedics. The number of paramedics in training more than trebled in 2015 and the additional funding provided in 2016 should provide for further increases. It is important to note the latter on the Dáil record. Last year, 63 ambulances were replaced or refurbished and one new rapid response vehicle was provided at a cost of over €9 million. The investment in this regard will be doubled to €18 million in the current year.

Hospital Equipment

John Halligan


59. Deputy John Halligan asked the Minister for Health why it took 11 months to redeploy staff from an old computed tomography, CT, scanner in University Hospital Waterford to a new scanner which opened in April 2015; if he is aware that the older machine was in perfect working order when it was taken out of use; if the hospital ever made an application for additional staff in order that both machines could be operated simultaneously; if it is best practice to have a perfectly functional CT machine not in use at the hospital while waiting lists for scans are at an unacceptable level; and if he will make a statement on the matter. [4100/16]

The new CT unit at University Hospital Waterford was officially launched by the Minister's predecessor, Deputy Reilly, in 2014 at a cost of €1.75 million. The new scanner was explicitly described at the time as a second CT unit for the hospital. It has come to my attention that the original CT scanner, which the Department has confirmed is in perfect working order, was closed once the new model began operation. Will the Minister explain why a perfectly operational scanner is left idle?

University Hospital Waterford opened a new CT scanner in April 2015. I understand the staff who operated the older scanner were redeployed to the new machine but no additional staff resources were available to allow for the continued operation of the old machine. Operation of the new scanner required additional nursing and health care assistant staff. Delays in staff recruitment at that time contributed to a corresponding delay in the operational opening of the new scanner. There was no interruption to the CT service available to patients as a full service continued to be provided with the older scanner until the new machine was fully operational.

The new CT scanner is of a much higher specification than the older model and allows the radiology department to significantly improve the quality of imaging provided to a standard more appropriate to a modern health service. In saying that, the older scanner is still in working order and is used, on occasion, such as during scheduled preventative maintenance and unscheduled downtime on the new scanner, in order to ensure continuity of service.

It is planned to use the older machine to manage waiting lists for routine, non-urgent diagnostic work. This should reduce wait times overall for patients in the south east who require diagnostic imaging and will free up access to the new scanner for more critical cases. I am advised that a business case is being developed for the additional staff required for this purpose.

I thank the Minister. I was present on the day the then Minister, Deputy Reilly, described it as a second CT scanner for Waterford. He told us it would provide improved access to patients for CT diagnostic services and that Waterford would finally have two CT scanners based on the fact that over 16,500 examinations were carried out in 2014. The new scanner was ready for use in 2014 but the machine did not come into operation until April 2015. We have been repeatedly informed that the delay was down to the hospital not being able to provide additional nursing staff. Since then, no additional resources have been made available for the new machine and, instead, staff who worked with the old machine have been redeployed. If this was the intention in the first instance, can the Minister explain the 15-month delay in getting the new machine into operation? Does he think it is value for taxpayers' money to have a perfectly working machine gathering dust in the basement of University Hospital Waterford?

I can only go on what I am told by the hospital because I am not involved in the day-to-day running of the facility or the recruitment of staff there. I am advised by the hospital that there was a difficulty in recruiting staff and that this is the reason the new machine did not open until April 2015 and that it is now putting together a business case to open the second machine. With two machines, there is an argument for doing this either way. It may actually make more sense for the hospital to use the new, more modern scanner for longer hours, and to run it at night and at weekends, rather than running a new machine and an old machine from 9 a.m. to 5 p.m., and only using one machine on an on-call basis. As I said, the hospital is putting together the business case for additional staff which, no doubt, it will submit to the hospital group and up the line from there.

Given its proximity to the accident and emergency unit, I have no doubt the new scanner provides improved access. There is no question about that. However, the issue is that the current waiting time for a CT scan in University Hospital Waterford is still six months. I already made the point that 16,500 examinations were carried out in 2014 and patients suspected of having heart disease or other anomalies were told there was at least a six month waiting list for scans. I understand the annual service contract for the older machinery remains in place and that it is used during scheduled preventative maintenance and unscheduled down time of the new unit. We have two scanners in perfect working order and we have more than 16,500 examinations being carried out in the hospital but there is still an average waiting time of six months for access to a scan. I imagine that a small cost would provide a small staff that would be able to reduce the waiting time significantly to two or three months for patients waiting for a CT scan.

That is the plan. I am advised that emergency and very urgent CT scans are completed on the same day or within a week, that there are 208 patients waiting for urgent scans, that the average wait time is three to four months and that there are 313 patients waiting for routine or semi-urgent scans and that the current average waiting time for them is from four to six months.

Given this may be the last time we are together in the current format, I took the opportunity to look at the Independent Alliance's ten point charter. Many times in this Chamber, Deputy Halligan has raised issues relating to University Hospital Waterford and hospitals in general and while there is lots of motherhood and apple pie talk in the charter about protecting the vulnerable and so on, I was struck by the fact that it makes no mention of hospitals at all.

This is not the time to be scoring political points.

Even though the alliance has a ten point charter, it is going to the people-----

Fine Gael has the five-point plan.

This is not the time to be scoring points against those who are ill. The Minister knows damn well that on many occasions there have been opportunities to discuss the issue of the hospital and, without being abusive, to score points against the Minister for Health.

The Deputy had the floor already.

I think the Minister is out of order.

The fact the Deputy is so sensitive that he must-----

I am sensitive because the Waterford hospital is in chaos.

We must move on to the next question.

We do not have a 24-hour cardiac care service as the Minister and the previous Minister promised. Trying to score smart political points off me does not do him any justice in view of the thousands of people on waiting lists in Waterford.

We must move on to the next question. I call Deputy Keaveney.

Sorry, Leas-Cheann Comhairle, Deputy Halligan kept interrupting me and took my time. I would like my time back.

Please conclude so.

The Minister should have concentrated on answering the question about the CT scanner instead of trying to score political points.

This is not fair to other Deputies with questions.

Deputy Halligan will now contest a general election based on a ten-point charter, with no commitments at all on waiting lists or for Waterford hospital.

Waterford hospital is in chaos and the Minister knows that. He should go down and pay a visit to some of the nurses and staff and they will tell him what it is like.

Congregated Settings Report

Colm Keaveney


60. Deputy Colm Keaveney asked the Minister for Health the funding the Health Service Executive will provide in 2016 for moving persons out of congregated settings; the number of persons this will benefit; the proportion of persons currently in congregated settings that will benefit; how long it will take to move all those in congregated settings out of them at this rate of support; and if he will make a statement on the matter. [4094/16]

The purpose of the question is to afford the Minister an opportunity to explain the rationale for the funding provided to the HSE to move vulnerable people from congregated settings. The question also affords the Minister an opportunity to explain the benefits of that strategy, the number of persons in congregated settings who would be positively affected, how long it will take for those in congregated settings to see the type of supports in the community required for the scaling down of congregated settings and the plans to resource that kind of care and love in the community to ensure the human rights of citizens in the community are provided for.

The HSE’s 2011 report, Time to Move on from Congregated Settings – A Strategy for Community Inclusion, proposes a new model of support in the community by moving people from institutional settings to the community over a seven year timeframe. The plan will be rolled out at a regional and a local level and will involve full consultation.

The HSE has established a subgroup under Transforming Lives, the programme to implement the recommendations of the value for money and policy review of disability services, which is developing an implementation plan for moving people from institutions. I welcome the fact that the needs of people moving from congregated settings will be fully taken into account during this process as the model of care for individuals will be based on a person centred plan.

In terms of housing, the Department of Health and the Department of the Environment, Community and Local Government are working in collaboration to support the transition of people with a disability from institutions to social housing in the community under the Government's National Housing Strategy for People with Disability 2011-2016.

The HSE's 2016 national service plan has set a target of 165 people to move from institutions in 2016 into suitable accommodation. This is being supported by €20 million in capital funding from the Department of Health in respect of acquiring and renovating properties in priority institutions identified by the HSE. In addition, I am pleased to note that the Department of the Environment, Community and Local Government will provide €10 million under the capital assistance scheme to provide suitable accommodation for people transitioning from institutions in 2016. The HSE estimates that a further 100 people could benefit from this initiative. Additionally, €1 million in ring-fenced leasing funding is also being made available by the Department of the Environment, Community and Local Government in 2016 to support people moving from institutions into suitable social housing in the community. This demonstrates the joined-up commitment of both Departments to support decongregation.

I am sure the Minister of State will agree that progress on moving people from congregated settings has been abysmally poor, and there are over 3,000 people living in congregated settings. The 2015 HSE outturn with respect to the congregated settings indicate that only 150 citizens were moved from the setting. At the time of the publication of the HSE annual service plan, the projected outturn was only 112.

The 2016 service plan promises to enable the transition to the community of at least an additional 160 service users. Will the Minister of State confirm in her response the financial resources being provided by the HSE to maximise on the decanting of the setting? What is her vision with respect to the care supports that will be required in the community to ensure that citizens who have traditionally lived in the setting would have an active citizenship in society?

I will try to give the Deputy as much information as possible. We have managed to secure €20 million from the Department of Health and €10 million from the Department of the Environment, Community and Local Government. As I have already stated, there is an additional €1 million for transitioning. That €10 million will be for each of the next four years. That is an agreement we came to with the Department of the Environment, Community and Local Government, and we are insisting that when it comes to housing strategy, one cannot possibly allow people with disabilities to be outside that loop.

There has been a difficulty in certain areas and the Deputy knows about the shortage of housing and blockage in the capital assistance funding. It was always going to affect us because of the downturn in the economy. The Deputy knows there was also a difficulty relating to people who were presumed to lack capacity in signing leases. The capacity legislation deals with that now, which is very important. There were delays in securing HIQA registration and we are talking about small community homes, as opposed to what we were used to with big institutions. There has also been insufficient funding from service providers to allow the transition to occur. I will try to answer the other points in my next contribution.

Some parents have expressed concern with respect to residents moving from the congregated environment to an unfamiliar new experience when compared with their traditional home or setting. Is the Minister of State satisfied the Department has the resources to provide for that adjustment in the community? Unsupported relocation causes great distress. Is the Minister of State satisfied the recruitment strategy is in place to have the resources available in the community, such as those provided in A Vision for Change, with synchronised closure of long-term institutions? There would be a care facility, the virtual ward in the community. Is the Minister of State satisfied she has the resources to provide for that?

When one comes into government at first there is always an insatiable urge to do things as quickly as possible. When it comes to people with significantly greater needs in terms of disability, however, one must be absolutely certain that one is doing it, first, with their consent. Second, we must ensure that the type of wrap-around service or supports they will need - be it moving back to their own communities and families, or to another area - are there. That is why we have to be extraordinarily careful. As regards the available funding, which is within the existing service provision, and additional capital funding, I am convinced that we do have the necessary resources. It will be a different type of resource, but sometimes that is about attitudes and culture. We have had some experience of that with A Vision for Change, but I think it will translate over into this area also.

Medicinal Products Availability

Caoimhghín Ó Caoláin


61. Deputy Caoimhghín Ó Caoláin asked the Minister for Health why the drug Sativex is not available to persons who suffer from multiple sclerosis despite the then Minister of State for Primary Care, Deputy Alex White, signing a statutory instrument legalising its use in July 2014; when it will be available; and if he will make a statement on the matter. [4082/16]

I seek to establish the reasons why a cannabis-based medication, the drug Sativex, is not yet available to persons in this State who suffer from multiple sclerosis. This is despite the fact that a former Minister of State with responsibility for primary care, Deputy Alex White, signed a statutory instrument legalising its use as far back as July 2014. What are the obstacles to its introduction? Can we expect to see progress concerning its availability for those for whom it may make a significant difference?

On 11 July 2014, the Misuse of Drugs Regulations 1988 were amended to allow for certain cannabis-based medicinal products to be used in Ireland. The Health Products Regulatory Authority subsequently granted a marketing authorisation for the cannabis-based medicinal product Sativex to be marketed in this State. This product is indicated for the relief of symptoms of spasticity for people with multiple sclerosis where other conservative treatments have failed to provide adequate benefits.

The HSE has statutory responsibility for decisions on pricing and reimbursement of medicinal products under the GMS and community drug schemes in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013. Decisions on which medicines 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. They are not political or ministerial decisions.

Following the granting of a marketing authorisation, it was open to the holder of that authorisation to make the product available for prescribing in Ireland. In September 2014, the HSE received an application for inclusion of Sativex under the community drugs scheme's high-tech arrangements. A health technology assessment report on Sativex has been completed by the NCPE, which did not recommend reimbursement of Sativex at the submitted price. The report by the NCPE is an important input to assist the HSE in its decision-making process, and informed further engagement between the HSE and the supplier in relation to potential pricing arrangements for this product.

As the matter remains under consideration by the HSE, unfortunately, I am not in a position to make any further comment.

As the Minister of State knows, there are approximately 8,000 multiple sclerosis sufferers in Ireland. Two of them are very dear to me, as members of my family. Sativex is already in use in a number of EU countries for the relief of spasm symptoms in multiple sclerosis patients. The availability of this and other cannabis-based treatments has long been sought by MS Ireland, which is the representative non-governmental organisation, NGO, for people with multiple sclerosis.

Ongoing research into the benefits of medicinal cannabis, and cannabis-based medication extract for the symptoms of MS, has shown the efficacy of such treatments to alleviate spasticity, sleep disorders, pain and other symptoms associated with multiple sclerosis. As the Minister of State has acknowledged, in July 2014, her predecessor, Deputy Alex White, signed regulations that would allow for approved medicines containing the active ingredients of cannabis to be prescribed in Ireland. It is extremely frustrating for that cohort.

It may not make the difference to all those challenged by MS but there is unquestionably a significant cohort to whom this would bring great relief. The Minister of State concluded by saying that she could make no further comment. Even in these closing days, I ask her to reflect with the HSE on the importance of continuing engagement. I take the view that there is no substantive reason for not proceeding. We are talking about treatment of the order of €500 per month per patient over whatever number might be involved. We have approved far more expensive treatments across many other conditions through the National Centre for Pharmacoeconomics.

There is not an elected Member of this House or the other one who does not know someone who suffers from MS. We are all aware of the degrees, some mild and some far more advanced. Sativex is licensed for use throughout the UK but it is not reimbursed by the NHS. The National Institute for Health and Care Excellence has recommended that health care practitioners should not offer Sativex to treat spasticity in people with MS because it is not a cost-effective treatment. I very much take on board the Deputy's point about other treatments we have approved that cost multiples of what we are talking about here. The Deputy and I know that in the first instance, one's instinct is always to try to help people who find themselves in difficulty but on the other hand, we must always ensure that we are getting value for money in respect of the taxpayer. This is not to take from our empathy or sympathy for people who find themselves in this position. We must take the advice of those who are charged with looking at the complexities of issues, whether in terms of treatment or economics, and take that advice when it is offered.

The critical advice is the clinical assessment of the efficacy of the drugs in question. This is a proven science at this point in time. There is ample evidence across a number of EU countries as to the effectiveness of this drug.

There is a serious fault line in our insistence as a single entity - a State - on trying to engage with the drug distributor or manufacturer in this and many other cases when it is already being provided in a number of EU countries. In terms of the EU, we should be using the opportunities for collective engagement, purchase and distribution. This is not beyond the gift of this State and its representatives and would be welcomed in other EU member states. We should collectivise to our strength and in the interests of those for whom the effort will mean so much.

As the State is a small outlier in the EU, I could not agree more with the Deputy and I think it needs to be a priority for whatever Government comes in after the election. The strength of the EU should be that we would collectively bargain. This would benefit us as much as anyone else. We cannot always be at a point where we simply say that we cannot afford this and where we are isolated and picked off one by one in terms of the types of negotiations that need to occur. It will not be about this but will be about something that could be far more unique which will treat something far rarer than that which we are experiencing here. I fully agree with the Deputy that this type of negotiation under whatever Presidency within the EU needs to be a priority for the next Government. We must insist on this happening because we would benefit more than others.