Liz McManus (Wicklow, Labour)

The speed that health legislation is coming through this House is so rapid that for a moment this morning with the engagement across the floor I thought we had moved on to Committee Stage. I must be careful about making a Second Stage speech.

I welcome the Bill. It is important that at long last we have the provisions in this Bill to debate. There has been a shocking lack of regulation in the pharmacy sector. It is indicative that some of the Acts being repealed in the Bill date back a considerable period. The main one dates back to 1875, but there is reference to an Act of 1790. That is telling. The public would be shocked to discover no proper regulatory framework is in place for the pharmacy sector. Looked at coldly, animals have more protection than humans. What we need now is to ensure this Bill is processed.

I compliment the Minister, the staff in her Department, the Pharmaceutical Society of Ireland and the Irish Pharmaceutical Union, all of whom have played a part in reaching this point. Some time ago, the IPU set out quite a good yardstick for assessing whether the Bill would come up to scratch. First, it stated that legislation was urgently needed to safeguard the pharmacist's role in ensuring the health needs of the patient would always take precedence over commercial considerations; second, that it would facilitate the development and the professional role of the pharmacist; and third, that it would bring a strategic and professional focus to the sector. They are good ambitions by which to judge the Bill. I suspect when we go through the process, we will find parts of those challenges have not been met but, in the main, the Bill is a welcome step forward.

I will try to give the Bill the attention it deserves but I cannot give it the attention it requires because the Government has failed to ensure we have adequate time to give proper consideration and reflection to an important Bill such as this one. I regret that greatly because it deserves better. I have no doubt we will create problems in the long term because of the hasty approach the Government has adopted.

However, I will do a better job of it than the nincompoops in the Progressive Democrats press office yesterday who set out to tarnish my reputation as a public representative. Without bothering to check the facts, they ran around the media telling tales based on nothing. Regrettably, even though we were trying to deal with an important Bill, and my attention should have been focused solely on that, I spent much time yesterday on a damage limitation exercise. At least the media had the good sense to check their facts, unlike those in the press office of the Minister's party. I do not blame the Minister but I blame her indirectly for the fact that this happened yesterday. It is most regrettable, and I intend to do my best to meet the obligations, despite the circumstances, which is practically impossible. As Deputy Twomey has said, it is impossible to deal properly and fairly line by line with amendments that are coming in thick and fast at the same time as assessing a Bill that requires due scrutiny. It is important to acknowledge the substantial Seanad amendments to the Bill, which were tabled primarily by the Minister for Health and Children. I give her credit for improving it.

However, it is a little late to begin dealing with issues that in the main stem from her ideological position, which is to privatise as much of the health service as possible. Predators are constantly circling to make as much profit as possible from patients' health needs. They are able to do so for the most part without regulation or licensing provisions to protect the public good, which is the Minister's responsibility. She opened the stable door and has now half-closed it, but when it comes to this aspect of the health service, the horse is in the process of bolting.

That is hardly safe or good governance regarding the general principle of ensuring patient safety. Amendments are coming through now to deal with an issue that, to ensure that the legislation was robust, should have been addressed at the outset. When the Minister introduces amendments at the 11th hour, no one can be absolutely certain that the result will stand up to scrutiny or to the courts, which will also be a consideration. Legal challenges have a way of showing up the paucity of ministerial capability. We saw that happen very effectively with nursing homes. The Minister blithely introduced legislation in an attempt to deny elderly people their rights retrospectively, but it flopped. The new law collapsed almost immediately and she had to come back to the House with her tail between her legs.

While I am concerned, I welcome the Minister listening to people like me and Senators Ryan and Henry. We have raised important issues regarding conflict of interest. I have brought this up several times regarding the Medical Practitioners Acts and I would like to refer to it once again. We are witnessing a commercialisation of general practice that is not viewed by the public in the same way as the privatisation of the hospital sector. However, it is happening nonetheless.

One could argue, as the Minister tends to do, that general practice is privately provided, but there is an enormous difference between professionals, whether pharmacists or doctors, providing services and for-profit developers concerned with commercial priorities, which have nothing to do with a patient's health needs. As far as they are concerned, it is simply another market to exploit, and that is happening owing to a lack of regulation. We must be aware of that.

I have raised the case of Dr. Maguire, the HSE adviser who, before coming to work with Professor Drumm, had maintained connections with the Touchstone Healthcare Group. I have no problem naming these players. Dr. Maguire left prematurely, having earned a significant salary, the size of which startled many people. While the Minister constantly refers to value for money, how could anyone believe her in the context of such advisers' pay? In this instance the adviser left and, the next day, was admitted to Touchstone's board of directors. It is very worrying how easily that can happen. There is nothing illegal about it and I have no quarrel with Dr. Maguire regarding the legality of his actions or his adherence to any code of conduct, but that is just my point, the codes of conduct and laws are not in place to protect the public good.

The Touchstone Healthcare Group alone has invested €800 million in primary care. The sum represents a great deal of loot if one translates it into profit. We must establish the principle of a clearer separation between pharmacist and doctor in dispensing and prescription. We need clear water between the two. The Minister's comments about unfair competition in an exchange with Deputy Twomey was very revealing. Unfair competition is a very small part of what we are talking about, which is patient safety.

I refer the Minister to the report on Dr. Harold Shipman, which showed how the public's trust in a professional led to the most horrific crimes being committed. However, because the public trusted the professionals, those ghastly crimes could be committed over an extended period. One issue pinpointed in the Shipman report was that the relationship between doctor and pharmacist was too cosy, and we must deal with that. When I get a chance, I will certainly consider the amendment the Minister tabled. I welcome it because doubtless she is under severe pressure on the issue. I have no doubt that it will end up before the courts owing to the substantial sums that can be won or lost in denying such an arrangement.

I brought up the salaries paid to Government advisers and suggested that they be subject to a value-for-money audit by the Comptroller and Auditor General, but I have changed my mind on that, now believing that we must look much further. I will write to the Comptroller and Auditor General suggesting that we consider what is happening with the primary care strategy regarding penetration by private commercial interests at local level.

What deals have been done with local HSE managers on individual primary care centres? The change is occurring in a subterranean fashion worthy of investigation. I noted Dr. Maguire's proposal that all primary care centres be run by Touchstone, or something equally bizarre. It is now clear that there is a very unhealthy relationship that needs to be assessed and exposed. We must learn the lessons and stop undue commercialisation and unhealthy relationships developing. The amendment helps significantly in that regard, but we must also have a very clear view of the future and how we intend to develop primary care.

We are all aware that primary care is the key to health reform. Our hospitals are overcrowded, overloaded and overstretched, and one reason is that too many people are attending unnecessarily. They go to hospital for genuine reasons and in the main it is the only place where they can get the required care. I am not talking about people who head straight to the accident and emergency department because they do not want to pay the family doctor — although there is an element of that, it is a fairly small one — I am talking about the thousands of patients who end up in hospital because they cannot get diagnostics, tests or treatment closer to home, as they would if we had a well developed primary care service. That must be our goal, but to reach it we must be secure in the knowledge that it will benefit patients rather than profiteers. The issue of whether the Minister has gone far enough in terms of the location of pharmacies in primary care centres, or close to medical practices, may have to be teased out further. I want to re-examine that matter. If a pharmacy and primary care centre share a premises, although with separate entrances, it is not that different to having a doctor's surgery on a high street with a pharmacy across the road. They can be in close proximity but we must ensure there is no conflict of interest and that patients are fully protected. That is crucial. The ownership of a pharmacy business must be 100% transparent and I think this legislation will ensure that is so. We need to have a clear understanding of who owns what, and ensure that shadow owners are not fronting for criminals.

Pharmacies are good businesses. The Minister referred to cosmetics that she bought this morning. Allowing for the fact that much of the pharmacy business is involved in the cosmetics trade, it is fair to say nonetheless that 1,600 pharmacists are providing a service for 420,000 people every week. That is a large number of people and constitutes a lot of commercial activity. A serious percentage of that turnover relates directly to health care, whether for prescription drugs or other health products. We do not hear of many complaints about pharmacists. It is clear, however, that there are rogue pharmacists and the lack of regulation means the Pharmaceutical Society of Ireland cannot deal with them. Such rogue pharmacists are in a minority and this Bill will deal with them. Generally speaking, however, pharmacies work and people can access such services without cause for complaint. In addition, the medical card and drug schemes provide safeguards for the public. The medical card scheme may be too restrictive as regards some drugs. Over the last couple of years, although not recently, there have been shortages of medicines. It was quite surprising for a patient to be told that a pharmacy had run out of a certain product and that the pharmacist did not know when it would be available again. I have not heard any such complaints recently, but it certainly was an issue at one stage.

When we complain about the privatisation programme unleashed by the Minister, she may say that private provision has always been part of the health care system, which is true. However, it is naive to think that what has been provided on a private basis in the past is the same as what would be provided by the kind of developers and others who invest in hotels or health care, and who are now involved in rich pickings as a result of ministerial ideology.

There should be three simple principles for private providers. First, they should be properly regulated, which the Bill will do in the pharmacy sector, and that is why I welcome it. Second, they should be accessible to all, which pharmacies are for the various drug schemes. Third, they should not be feather-bedded by the taxpayer. I do not think anybody would say that pharmacists are feather-bedded, although the same cannot be said for developers who co-locate at hospitals — they are being feather-bedded to an enormous degree. The yardstick set by those three principles applies to pharmacists in a manner which acknowledges that private health care providers can meet the public good. This regulatory framework is the last part of the picture. It has taken much work and time to finalise, but it is both important and welcome.

I wish to make a couple of general points about pharmacies. There is a strategic approach which is not included in the Bill, although it is not really a matter for legislation of this type. It would be remiss of us not to consider what a pharmacy is for or, more importantly, what it can be used for to bring about changes in the health service. If I have an opportunity to assist in that process in future, I would act to provide for a greatly expanded primary care system.

The Irish Pharmaceutical Union referred to a couple of points which neatly outline the relevant issues, including the question of generic brands. Currently, there is no incentive for a pharmacist to develop and encourage the use of such brands. I spoke to a pharmacist a while ago, who was keen to promote generic brands but said it was against the pharmacist's interests to do so. We should ensure that as far as possible the use of such brands can be developed.

The IPU also referred to a medicines management programme assisting people, particularly the elderly, to manage their medicines. That is an important idea for the future. A couple of years ago when Mr. Richard Collis was president of the IPU, a pilot scheme enabled people to return unused medicines to their pharmacy. The resulting haul was enormous and showed how much unused and expired medicines were in private homes. Such medicines pose a danger for other family members. There have been instances where a family member will attempt suicide, or even succeed in committing suicide, by taking an overdose of tablets. It is a worry therefore if unused drugs are left lying around. We should work on finding a solution to that problem.

Pharmacists are in a pivotal position to assist in health promotion which is important, given the lifestyle problems associated with alcohol, drugs and obesity. We must change the way we are consuming things. Pharmacies are accessible and thus provide an opportunity to encourage the public to take responsibility for improving their health. The methadone scheme is a good example of this. Many pharmacists and doctors initially resisted the scheme and that may still be the case in some areas. Overall, however, the methadone programme linking pharmacists, doctors and patients was a worthwhile venture, which I hope we can develop further in future.

The IPU has also raised the interesting question of pharmacists having the ability to prescribe. We need to examine that matter. The Minister has already raised the possibility of nurses having a greater role in dispensing medicines. However, this raises issues which revert to the original point that where doctors and pharmacists have a close relationship, patients can end up losing out or being over-prescribed. If pharmacists prescribe and dispense, conflicts of interest may occur. That is a matter that concerns me greatly and we must consider it carefully.

The pharmacy is a good, untapped resource in primary care and we should consider the way forward in this regard. Pharmacies tend to be an overlooked element of health care, partly because they are tied in to other services that are provided that have nothing to do with health. The resource exists, as does the professionalism, and we will now have the regulations that will guarantee professionalism, though competence assurance must also be developed. We must examine the resource more imaginatively and proactively than in the past, as has been done in Northern Ireland and Britain.

To get value for money we must keep people out of hospital. If we can reduce hospital attendance significantly we will ensure better health care with better value for money. This is not a cheap option but is an efficient option that has not been properly considered.

Hospital pharmacists have expressed concerns as to whether they are within the remit of the legislation. The Minister yesterday reassured them that they would be included but I am not convinced because the area seems somewhat vague. The hospital pharmacy tends not to be a retail outlet and I want to make sure that this area is covered in an appropriate fashion, but we will see what emerges from the debate.

I do not oppose the idea of EU graduates operating without limitations in Ireland. We are, I hope, on the brink of a new deal with a new Executive in Northern Ireland and we all encourage North-South co-operation. I believe we should extend the possibilities of North-South co-operation as far as we can in a proactive way and there are many opportunities to do so in the area of health. It seems extraordinary that suitably qualified people from Northern Ireland can operate here when suitably qualified people from south of the Border cannot operate in the North. An all-Ireland or, preferably, EU based solution is necessary and I am surprised this matter has not been addressed already as I thought that was the purpose of the services directive. We might develop this issue at a later stage. Linguistic ability is an issue I want to return to.

Regarding structural linkages, there are many different authorities, including the Health Information and Quality Authority, the Medical Council, the Pharmaceutical Society of Ireland and the Health Service Executive, and we seem to gain a new authority with each passing day. They do not link well together. Even within the HSE the silos are higher than before and people do not know who to link with. It is difficult to see how things operate from within the HSE, let alone from outside the organisation, as communication is poor and connections are often non-existent. We must ensure that the system and structures are streamlined, otherwise we will end up weighed down by bureaucracy with ineffective administration.

The Minister sneered at the idea of a patient safety authority, but she was wrong to do so. She should consider what happens when patients want to complain. Should they use the HSE's complaints procedures? Should they approach the Medical Council, HIQA or the Pharmaceutical Society? Where should they go? There are so many options that patients will end up bamboozled and going around in circles because there is no clear line on complaints. We know from the case of Dr. Neary that things go terribly wrong when proper systems of complaint and accountability do not exist and the Minister has spoken often about that case. However, the reality is that she presided over the establishment, without proper preparation, of a monolith to manage the health service called the HSE that is not open and not accountable. In such a climate things that should not happen can happen.

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