Mr. John Swords:

I might make a couple of points about the supply chain. The question was asked whether there is any learning from what has happened in the UK and so on. Over a year ago the UK Government issued a kind of intention, a directive, stating that it wanted to stockpile certain items as far as six months for all the companies. At that time, we had been in discussions with our supply chain people in the drugs, medical-surgical and food areas. They are the three key areas on which we have concentrated for Brexit. Nonetheless, the key to any supply chain is an even flow of product rather than stockpiling because stockpiling actually creates difficulties. This is evident now in that some hospitals in the UK are finding it difficult to get product even though there is enough product in the country. There is an abundance of product in some areas. The hospitals do not have it when they need it, though, which means there is a redistribution and a cost associated with that. Our strategy has been to keep an even flow of product. As Dr. Nolan, Mr. Breslin and Mr. Hennessy stated, we have enough stock in the country at any given time to allow us to plan forward.

To give the committee a bit of an idea of this, we have a national logistics plan in the HSE and a national distribution centre with nine hubs around the country, which we use to supply out into community and hospitals. We have six weeks' worth of stock at any given time across 6,000 stock-keeping units which supply on a regular basis the items that are required and used in the hospitals. That is one area of security, and we will monitor it as we go forward. As for drugs, we have met representatives of all the umbrella companies and are meeting representatives of the main distribution companies to see what they have in place and to reassure ourselves that the stock is there. We have been very encouraged by what we have found. As Dr. Nolan said, there is six to eight weeks' stock in wholesale. There is a further number of weeks' worth of stock in the manufacturing process at any given time, and there lies the secret to our success in maintaining that supply in an even way and not knee-jerking across the system and causing peaks and valleys, which could in fact have an effect on employment. We have manufacturing in Ireland, so we do not want to disrupt any element of the supply chain. It is a very refined and mature supply chain, and everyone is encouraging us not to overreact. If we stay sensible on this and stay in communication, which is what we are doing, we will be able to see whether there will be a break on 29 March. It is later in the year that we will see any real impact because we will start seeing the ports filling up or whatever. Even allowing for that, and looking for securities of supply, particularly in the short-life areas, we have met the suppliers of products and they have brought in enough manufacturing raw materials for three months in some cases and are upping that in some cases to eight weeks on the overall supply. We are learning all the time about our supply chains and probably getting more information than we have ever had and more education on how we will deal with any shortages. The shortages framework has worked very well.

To move from the area of drugs and more into the area of food, there are shortages on an ongoing basis in food supply. One of our main suppliers of ambient food sources products from all over the world. They bring shortages to our attention from time to time and we discuss any shortages they have with our catering officers who are on the ground providing the services within health.

We agree any changes that have to take place to ensure that a spurious product does not get into the supply chain. That is very closely monitored by our catering officers. It is a good example of day to day shortages happening within a supply chain. We have to maintain that and keep an even flow of product, and encourage everybody to be sensible about it.

There are 1,800 pharmacies which take deliveries 11 times per week on average, through the distribution service. There are numerous pharmacies in different communities. They rely on each other, and it is a very mature and well-stocked system. There is up to four weeks of supply in the individual pharmacies and six to eight weeks in the supply chain. We do not see shortages arising at the moment. There is no difficulty with that; it is well managed. It is encouraging that there is such a large amount of communication going on at the moment. We have written to more than 300 of our main suppliers and have had 70% of them write back. Much of the information in that correspondence states that they have examined their supply chain and that they are looking at six to eight weeks, and in some cases three to six months. Generic medicines were mentioned. Some smaller companies are actually stocking up to six to 12 months worth of product. They are making sure that we will not face an interruption of supply.

It is important to note that we deal extensively with distributors, and because of that we have options within our supply chain. We have been rationalising our logistics operation within health over the last number of years and are bringing efficiencies into it. We are currently extending that process into the Dublin region. We are reducing our inventory in many areas. On average we keep two to three weeks of stock in hospitals across all of our areas, but we rely on each other in the event of any shortage in any given area. We are in control of our information, and we are getting better and better at it. While Brexit poses different problems and questions for us, we are in a position to answer those questions. Our one risk, if it can be called that, is that there may be a delay of product, but there is enough in the system to sustain a shock.

On the question of drugs that might be required on a short-term basis with a quick turnaround time, customs officials have indicated to us that, where paperwork is in place, it will provide a blue light service. That is as good as it gets. We have spoken to suppliers, and instead of just using road, rail and shipping to deliver the products we will also use air freight. Those arrangements are in place with some of the companies at this point in time. We are examining the issues and going out to meet our main supplies to ensure they understand where we are coming from and to make sure that we are working together on this issue.