Speech by Minister Simon Harris Irish Pharmaceutical Healthcare Association (IPHA) Annual Dinner
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I am delighted to join you this evening and to have the opportunity to address you. I would like to begin by thanking your president, Mary Dickens for the inviting me to be here this evening and I would like to congratulate Mary on her new role as President and to wish you every success in the years ahead.
I would like to take a moment to thank Leisha Daly for her contribution during her time as President. Leisha and her team worked extensively with my officials in negotiating the new Industry Agreement on the Supply and Pricing of Medicines and I would like to recognise the professionalism and dedication she showed to getting the deal done.
I would also like to take this opportunity to acknowledge the very important contribution that the pharmaceutical industry makes to Ireland’s economic growth, in terms of investment in research and development, jobs growth and exports. When you consider that Ireland is the largest net exporter of medicines in the European Union, your investment is significant and it is valued by me and my colleagues in Government.
A little over six months ago I became the Minister for Health. The clear message from the election was still ringing in my ears – a better health service is a priority for our citizens. This demand for a better service is real, it is genuine and it is a challenge not just to me as Minister, but to all my colleagues in the Dáil. All of our citizens at some stage in their life will rely on the health service. And all of our citizens want this service to be better.
What became obvious to me from the outset was that the people who work so hard to deliver our public health services have no lack of appetite for reform. In fact they were the ones leading the calls for better health services. However, it was also clear there is a sense of fatigue with piecemeal reform and a deep sense of frustration that grand plans are announced but then changed when the Minister or the Government changes.
To meet the rightful demands of our citizens we need a single long term vision for the future of healthcare in Ireland. A long term vision that is agreed by political and societal consensus. A long term vision that will not change with a change in Government. A single long term vision that delivers on the goal of universal healthcare.
The establishment of a Committee on the Future of Healthcare is a vital first step to delivering on this vision. The overarching objective of the Committee, chaired by Deputy Roisin Shortall, is to achieve cross-party consensus on a ten year strategy for health care and health policy in Ireland. The Committee has been holding meetings and receiving submissions from the public and stakeholder and is due to report in January. Importantly, the Committee will make recommendations to guide us on the journey to universal healthcare.
The Government is committed to the goal of universal healthcare. The Programme for Partnership Government makes that clear. The concept of universal healthcare is endorsed by the World Health Organisation, the UN, the OECD and the EU.
As an overall goal to improve our health services, universal healthcare involves four main objectives:
- reducing unmet health needs;
- reducing inequalities in access to health goods and services;
- improving service quality;
- improving financial protection – this means that patients do not face catastrophic or impoverishing levels of health spending as a result of seeking healthcare.
The WHO notes that no country fully achieves all the universal health coverage objectives, for 100% of the population, for 100% of the services available, and for 100% of the cost – and with no waiting lists. But it does believe that every country can improve efficiency, reduce waste, and increase value from its health spend.
The Healthy Ireland framework is central to the achievement of our goals. There are many factors outside of the health service that impact on universal healthcare. My colleague, Minister for State for Health Promotion, Marcella Corcoran Kennedy, is driving a whole-of-Government “health-in-all-policies” approach as I’m sure you know as I understand you heard from Marcella at your conference today.
We also have to make a decisive shift towards primary care within the health service. I want patients to have access to safe and clinically effective treatments early, as close to their home as possible and at the lowest level of complexity. The effective delivery of primary care services in every community not only leads to a better and more cost effective service for patients but it also reduces pressure elsewhere within the health system.
And I am certain that your industry can contribute to better achieving these objectives. IPHA companies continue to play a central role in improving the health of the nation and supporting the achievement of universal healthcare.
Your industry can do this in many ways including:
- By continuing to innovate and develop treatment to meet unmet health needs;
- By innovating to develop more cost effective treatments that can be delivered with minimum complexity with identical or better benefits than products currently on the market;
- By seeking a fair and affordable price for your medicines. The WHO defines an ‘affordable and fair’ price as one that can reasonably be funded by patients and health budgets and simultaneously sustain research and development, production and distribution within a country.
The WHO notes that promoting affordable and fair prices and cost-effective interventions is central to the achievement of universal health care.
Improvement in the Health Service
While all of us who work in the health arena are always extremely conscious of the challenges we face, I think it is also important to highlight areas where the health service has been changing to deliver better outcomes for patients in Ireland:
- Since 2004, life expectancy in Ireland has increased by two and a half years and is above the EU average;
- Between 2005 and 2014 mortality rates for all circulatory system diseases fell by 31.5%, for cancer by 7.9%, and for respiratory system diseases by 20%;
- Between 2004 and 2013, there has been a 40% reduction in the in-hospital mortality rate following admission with a heart attack;
- Between 2000 and 2013, the average length of stay in Irish hospitals decreased by 19%;
These improvements are real, are transforming people’s lives and, demonstrate how many aspects of the health system are working for our citizens, even though, unfortunately, these are often overlooked.
The Irish Health Survey 2015, published yesterday by the CSO also gave a very interesting insight into the health of the population with 83% of population aged 15 and over reporting their health as good or very good.
Role of Pharmaceutical Industry
Advances in modern medicine have made a major contribution to the improvement of our nation’s health. As a result of innovations from your industry, patients have access to life-changing treatments. The HSE will dispense and reimburse over 70 million prescription items alone in the community in 2017. This does not include medicines administered in hospitals or to patients who are not covered by the community drug schemes.
Through your innovations, diseases which were once fatal are now successfully managed and in cases such as Hepatitis C, cured.
I note that the theme of your conference earlier today was “Achieving Value and Performance in Healthcare”. I think you would struggle to find a single individual who would argue against that goal.
From my perspective, value and performance means better services for our patients and better value for the taxpayer. I want to see results for patients from the very significant investment in the health service.
Your industry is continuing to invest in new research and development that is leading to the creation of new, innovative and highly specialised medicines. Much of this research and development is taking place in Ireland which is fantastic. Understandably, patients and clinicians want to have access to the new and often high tech medicines and as Minister with responsibility I too want Irish patients to continue to have access to such treatments. However, it is essential that such treatments are proven to be cost effective and affordable. In 1998 we spent just under €400 million on medicines, but by 2015 this figure had risen to almost €1.9 billion.
Balancing access to new medicines with affordability is not something that is unique to Ireland, countries across the world are facing the same issue and it is not something that can be easily solved. Ireland’s financing model for medicines needs to be both sustainable and affordable. The pricing model proposed by industry must be both sustainable and affordable, at the level of individual drugs and on a system level.
It is incumbent on all stakeholders within the health service, including the pharmaceutical industry, to drive value, reduce costs and ensure that every euro spent achieves the intended objective.
Price Reduction Agreements with IPHA
The State has introduced a series of reforms in recent years to improve the overall affordability of the health service.
Central to these measures have been the State’s agreements with industry on the pricing and supply of drugs. In July of this year Agreement was finally reached with your organisation on a new Framework Agreement for the Pricing and Supply of Medicines over the period 2016-2020.
As I discussed with your President yesterday, the new Agreement delivers better value for the State and gives certainty to the Industry. At its heart is a commitment from State and Industry to a fair and transparent process for the assessment of new medicines.
With any agreement, both sides make compromises, however, as a result of this agreement, medicines in Ireland are now more cost-effective and the HSE is now in better position to meet the increasing demand for medicines over the lifetime of the Agreement.
As outlined in the Framework Agreement “Securing the cost effective and economic provision of medicines to the health services in Ireland is vital to free up resources for continued investment in new and innovative medicines for patients; this Agreement is a key element in delivering that objective.”
The enhanced horizon scanning process is a process that I trust industry will embrace. There is also a commitment to transparency on all sides. Transparency in relation to the pipeline of new medicines from Industry. But also a commitment from the HSE to keep individual companies informed as their medicine makes its way through the statutory assessment process.
As we seek to address the issues of affordability and sustainability, it is vital that every decision on new drugs will be made on objective, scientific and economic grounds by the HSE in line with the 2013 Act.
In order to be in a position to meet the demand for new and existing medicines in the years ahead, it remains a key priority of the Government to continue to drive efficiencies in the system and to examine areas where more cost effective use of medicines can be achieved.
Other Cost Effective Measures
That is why the HSE is continuing to roll out reference pricing and generic substitution and it will continue to advance initiatives under the Medicines Management Programme including enhanced evidenced-based and cost-effective prescribing measures. These measures are critical, as every euro that is spent on a treatment where a more cost-effective treatment is available is one less euro to invest in new and innovative treatments. This is the reality.
Another area where further value can be achieved is the biosimilar market. As I outlined at the recent BioPharma conference, the development of these medicines is going to have a major impact on health systems across the world. Importantly they will enable more patients to have access to a wider range of medicines and it will lead to greater competition in the biological medicines market which will help to balance the issues of access and affordability.
A particularly topical issue I wish to raise is transfer of value. Transparency is essential and I welcome the work that IPHA has undertaken in this area to date. I have seen and I continue to see value in appropriate interaction between public bodies and private industry that delivers better value and better services. However, such interactions must take place in an open and transparent manner. As I discussed with your President yesterday I see no place for secret or confidential agreements between companies and employees of the health service in Ireland.
Before I conclude I would like to highlight Ireland’s formal bid to be the location of the European Medicines Agency – the EMA. Dublin, we believe – and I hope you will agree – would be a fantastic new home for the EMA post-Brexit.
We have a proactive and highly regarded national medicines agency in the shape of the HPRA. Given the proximity to its current home, a move to Dublin would ensure any disruption to the agency’s vital work would be kept to a minimum. As a modern capital city Dublin has much to offer as a home for such a vital organisation, such as a highly educated, English-speaking workforce; excellent air connectivity, a strong pharmaceutical sector and excellent research community.
IPHA companies can therefore play a role in stressing to partners in Europe that Ireland is the ideal new home for the EMA. We would very much welcome the support of your industry as we seek to bring this key agency to Dublin.
Finally, thank you again for inviting me to attend this dinner.
Having taken the opportunity over the past six months to meet the people that use our health services, to listen to nurses, doctors, pharmacists and others, to engage with representative bodies and groups such as IPHA, I remain convinced we can deliver on the better health service our citizens demand.
I look forward to continued engagement with you over the coming year.
I hope you enjoy the rest of the evening.