Mr. Jim Breslin:

Coincidentally I signed off on a communication on medicines to go to a range of stakeholders last night. Included in that is the ICGP. It is important that networks of GPs are given the knowledge so that when a patient attends, the GP is able to tell them key things about it. We will look at this issue. We have a communications team in place to do that. At the moment we are getting great free messaging out because people are asking questions, like the members present today, and the newspapers are writing about it. As we come closer to the time we will think about putting our own public messaging out. We have to think about the best way to do that. If we tell people what we do not want them to do, they think that is perhaps what they should do. That is why working through professionals is really important. We must involve the Irish Pharmacy Union, IPU, and the ICGP so that the local community pharmacist is able to discern the real situation and tell clients what it is. We will be doing more and more of that.

The point about medicine shortages already being a feature is absolutely correct. There are 45 medicines on a current list at the moment, but with the HPRA and stakeholders we have put a medicine shortage framework in place to address those. The last thing we want to happen - but which probably will happen in the period ahead - is that shortages in the near future will be blamed on Brexit. There is every chance that the problem will be due to a manufacturing issue or an issue that has arisen for a completely different reason. We must remain clear on what the source of the delays is and to work with stakeholders to explain it, while not allowing erroneous information to make its way into our system.

I will ask Mr. Swords or the HPRA to talk about the critical medicines assessment process, but we are interested in building on the overall message we have received from manufacturers and wholesalers that there is a plan for this and that there is a sufficient amount of medicine.

In the case of medicines where, because of their characteristics there could be a critical issue if they were not available, we want an additional layer of verification. We are doing that by category. It is important that one has a medicine within the category one would be able to prescribe in that situation. There would be some interchangeability. The health professionals are doing this. Doctors, through clinical programmes, and pharmacists are identifying, say, four medicines of which we need a supply. If there was a problem with one, we would still be okay with the other three. That involves more detailed conversations where one is looking for an additional layer of reassurance and verification. We are going through this process. It is not completed and we will keep refreshing it as we go along.

The important point is that just because a medicine is critical, does not mean that it is one about which we are concerned. It could be critical in coming directly to Ireland from the Continent and there could be no disruption. It could have features to it which mean even a short delay of a week or two might not impact our supply. We must not just examine ones that are critical but also examine the current supply chain. That is the level of analysis we are bringing to bear on this.

I am not certain if the travel vaccination is in this process. It is probably in the more general process of checking levels and working with manufacturers.

It is not just about medicines which end up in hospitals but those that the public will need. That includes medicines dispensed through retail pharmacy and prescribed by GPs. We have to take a public health view of this, not just looking at the ones which we order. We have to understand that some medicines will be critical but will be dispensed in the community. They can be just as important as medicines dispensed in hospitals.