Marcella Corcoran Kennedy (Offaly, Fine Gael) | Oireachtas source

I have examined the amendment proposed by Deputy Clare Daly and there are a number of points I wish to make in outlining the background to the section.

The purpose of section 9 is to allow the HSE to consider the inclusion of over-the-counter products in the list of reimbursable items, where appropriate. The section, as I have proposed it, corrects an anomaly in existing legislation in which current rules only allow medicines that are prescription-only to be supplied under the community drug schemes. This affects a number of products that were prescription-only but are now over-the-counter, as well as some over-the-counter items that have long been available under the schemes.

The legislation gives a temporary reprieve in supplying over-the-counter medicines until 2018. The amendment, as I have proposed it, will make this permanent. The effect will be that some very useful medicines such as emergency contraception and nicotine replacements will continue to be available under the drug payment scheme, the medical card scheme and other schemes. Patients will still need a doctor's prescription to obtain an approved over-the-counter product under the various schemes. This applies to all schemes and both over-the-counter and prescription-only items. This is a very important control, both clinically and for the financial operation and governance of the schemes.

Specifically regarding access to emergency hormonal contraception, there are a number of issues I have considered carefully. Medical card holders already have access to emergency contraception which is currently available free under the general medical services, GMS, scheme to medical card patients provided they obtain a prescription first. It is also available as an over-the-counter treatment. Therefore, anybody can go into a pharmacy and buy it without a prescription. The most up-to-date figures show that in the 12 months to August this year, just under 13,000 emergency hormonal contraceptive prescriptions were dispensed across all schemes, of which more than 12,000 were under the medical card scheme. The barrier, therefore, for medical card patients in obtaining emergency hormonal contraceptives as soon as possible is not access. More than 12,000 people a year go to their doctor and then the pharmacy. The issue arises when people need emergency hormonal contraception but cannot obtain a prescription in time to receive treatment. It might be the weekend and they cannot get an urgent appointment or they might not be able to afford to buy it. I share Deputy Clare Daly's concern about timely access to treatment for medical card holders and fully accept that there should not be unnecessary barriers to receiving this treatment. However, while I agree with the principle of the Deputy's amendment, I do not propose to accept it for the following reasons. The Minister for Health has instructed officials to remove this requirement as a matter of urgency.

Work on the development of services and clinical structures is under way. A minor ailments pilot scheme was run over the summer, allowing pharmacies to treat medical card patients with over-the-counter medicines for minor conditions without a doctor's prescription. Much of the IT infrastructure needed has been trialled under the minor ailments pilot scheme. In line with the Minister's instructions, the HSE is developing the operational structures to implement this service safely and effectively, including the clinical standards required to ensure patient safety; procedures for identifying pharmacies in compliance with these standards as for the vaccination programmes; and the infrastructure required to provide a secure claiming and verification process. Service development will be built on work already done, including the Pharmaceutical Society of Ireland's professional practice guidelines for dispensing over-the-counter emergency hormonal contraception and existing structures for providing specific services in pharmacies such as the vaccination programme.

The amendment is not legally necessary. There is no legal barrier to the proposal other than that being corrected in section 9. The amendment which prescribes the supply of a single treatment in a specific manner through primary legislation raises a number of challenges, including that it could undermine the requirement placed on the HSE to provide treatment in line with patient safety and cost constraints, for example, to get the best price or refuse individual products. Crucially, it might remove the ability of pharmacists to make clinical judgments and decisions, in particular, a decision not to supply where it may be unsafe for a patient for clinical reasons. This is a professional clinical service set out by the Pharmaceutical Society of Ireland which the amendment does not reflect and which would make it unsafe.

Discussions will be required with the Irish Pharmaceutical Union on implementation and officials will pursue this aspect. The Irish Pharmaceutical Union has previously indicated a willingness to expand into this type of professional service and was involved in the minor ailments pilot scheme for over-the-counter products. The Pharmaceutical Society of Ireland has issued professional practice guidelines on dispensing emergency hormonal contraception and advising patients. Deputy Clare Daly and other members of the committee will appreciate that significant steps have been taken to remove barriers to timely treatment for medical card holders in the case of both emergency contraception and over-the-counter products in general. The principle behind the amendment is worthwhile. I thank the Deputy for raising the issue and Deputy Billy Kelleher for raising it in her stead. The amendment makes a valuable contribution but is actually not necessary in addressing this health need. In fact, it could have unintended consequences. In addition, given the operational challenges to be addressed, it would not speed up implementation which is already under way.

There are other issues that have been raised about cases in which pharmacists would not provide treatment. They may not have been able to provide treatment or may have had personal reasons for not wishing to do so. The statutory code of conduct for pharmacists requires that, where they are unable to provide a service, they take reasonable action to ensure the patient's care is not jeopardised. In practice, the patient should be referred to another pharmacist, pharmacy or health service. All pharmacists must prescribe to this code. If a patient is unhappy with the conduct of a pharmacy or a pharmacist in this or any other matter, he or she should contact the Pharmaceutical Society of Ireland which regulates the profession.