Professor Ken McDonald:

I will try to roll that in with answers to some of the questions Deputy O'Connell asked. In answering, I am simply going to be agreeing strongly with a couple of her sentiments. First, I think the pharmacist is a completely under-used strength of the health care system that we need to start using far more than simply as a drug dispensing outlet. At present it is a leg on the stool of health care delivery that we are simply not using effectively, given the fact that, as the Deputy knows better than I, the pharmacist involved sees the patient probably more frequently than any one other individual involved in health care.

The pharmacist has an opportunity not simply to look at reconciliation of medicines but also to be involved in increasing medicine under appropriate guidelines, linked in very securely with the general practitioner. I am in complete agreement with the Deputy that we need to do something to bring more pharmacists front and central in health care delivery.

On the diabetes issue, the national clinical programme on heart failure has looked at the prevention strategy about which we talked this morning, the Stop HF strategy, as a pilot within the diabetic programme in the midlands. I think the committee has already heard from Dr. Velma Harkins on this. She is the GP who is leading up this effort. The prevention service that I referred to earlier has now been parachuted in on top of the care processes in the midlands to try to accentuate our efforts to prevent cardiovascular disease - heart failure being one aspect of that - within the population most at risk. Obviously, as we all know, diabetics are particularly at risk for cardiovascular disease.

Finally, to come back to the initial point about the pharmacists, as we roll out a prevention strategy for cardiovascular disease, we envisage that an aspect of that strategy can be provided by pharmacists in pharmacies. Some of the initial screening tests should be done there, with patients then triaged based on results.