Seán Crowe (Dublin South West, Sinn Fein)

On behalf of Sinn Féin's health spokesperson Deputy Ó Caoláin, who is unable to attend, I will set out our views on the Pharmacy Bill. I agree with other speakers that this is extremely important, necessary and long overdue legislation.The profession of pharmacy is currently regulated in legislation dating back to 1875. The pharmacy review group published its report in 2001 and recommended major legislative change. The Irish Pharmaceutical Union has been calling for proper regulation for years.

We now have this key legislation before us and a second Bill is promised. I share the concern of Deputy McHugh that we are unlikely to see the latter in the lifetime of the Dáil. It is a pity the two Bills were not published together so we could have a proper overview of the legislation and to help ensure it is as comprehensive as it needs to be.

The introduction of this Bill is overshadowed by the dispute between the IPU and the HSE and Department of Health and Children over the negotiation of fees for the drugs scheme administered by pharmacists, including the medical card scheme. It is claimed by the HSE and the Department, on legal advice, that the Competition Act prevents them from negotiating with pharmacists as they have done up to now. The same advice led to the suspension of negotiations with the Irish Dental Association, which could lead to the total collapse of the free dental treatment scheme for medical card patients. This is a serious situation and there seems to be little or no action from the Minister to address it. I call on her to intervene directly and to ensure these key elements of the primary health care system are not further disrupted.

Pharmacists fulfil a vital role in our health services and are an integral part of primary care. The IPU argues that its members' services are not used to their full potential and has called for the expansion of that role. This would include the introduction of medication reviews where pharmacists would be able to check on an ongoing basis with patients on the effectiveness or otherwise of medication supplied to them. At present, the pharmacist's role ends once the medicine is supplied to the patient. These reviews have been introduced in other jurisdictions. The Minister might clarify the position on this as I do not see direct reference to it in the Bill. Will it be provided for in regulations or in the second pharmacy Bill?

One of the difficulties I have encountered in my own and other areas is the abuse of cough medicines. This arises in the context of the preponderance of drug abuse problems in many communities. The drugs task force in my area has heard of pharmacists persistently dispensing cough medicines to people who abuse drugs. It is not illegal to do so but the problem is that it facilitates addictive behaviours. The Bill provides for complaints to be made to the council of the Pharmaceutical Society of Ireland, but I am not sure if this is sufficient to deal with the problem. Gardaí have called to several pharmacies in my area to express concern about the dispensing of cough medicines to addicts and others. Although such actions are not illegal, there is a moral obligation on pharmacists not to engage in them.

I do not know whether it has been raised in the Seanad but no Member in this House has mentioned the difficulties heroin addicts encounter in accessing services and support. There is a number of community-led and HSE-supported clinics in Dublin but no such services exist for those outside the capital. There are heroin addicts living in every county. Heroin abuse seems to be a growing phenomenon outside of Dublin whereas cocaine seems to be the new drug of choice in the capital.

Many heroin addicts experience difficulty in obtaining methadone. In many cases, people are obliged to travel from Limerick, Cork and elsewhere to Dublin to access treatment. The refusal of many pharmacists to operate a methadone scheme for addicts is a problem. These are seriously ill people who require assistance, but pharmacists can choose not to offer the support they require. There must be some discussion during this debate of the difficulties in this regard and how they might be resolved.

The Minister stated in the Dáil last September that the Government accepted the pharmacy review group recommendation that there should be "no beneficial ownership or business interest of any kind between dispensing and prescribing". Concerns have been raised that this principle may be breached in private health centres that also contain pharmacies. Will the Minister clarify the position in this regard? Will this be dealt with in regulations or in the second Bill?

I seek a response from the Minister to the several serious concerns raised by the Hospital Pharmacists Association of Ireland, HPAI. This association represents pharmacists directly employed in hospitals, who provide a vital public service to patients. They seem to have been overlooked in this debate. The HPAI is extremely concerned that under this Bill, hospital pharmacists may not be able to continue to provide the care they are currently providing to a number of key patient groups such as cystic fibrosis patients, patients with schizophrenia, HIV positive patients and paediatrics and cancer patients. The hospital pharmacists have asked that several issues be clarified before this Bill is enacted to ensure patient care is not compromised.

Is it the case that a hospital that wishes to continue to supply medicines directly to the above patient groups on an outpatient basis or to any other patient on discharge from hospital, as it is currently doing, must register its pharmacy department as a retail pharmacy business? As hospital pharmacists are employees and not pharmacy owners, to register the hospital pharmacy department as a retail pharmacy business, the hospital itself will have to be recognised as a corporate body. This must be clarified.

Section 3 of the Health (Corporate Bodies) Act 1961 empowers the Minister of the day to establish a body to perform functions in regard to the provision of a health service or two or more health services. A body so established shall be a body corporate with perpetual succession and a seal and with power to sue and be sued in its corporate name and to hold land. Several questions arise in this regard. Has the Minister issued orders under section 8 of the Health (Corporate Bodies) Act 1961 conferring body corporate status on all or any hospitals? If so, when and for which ones? If she has, does this order make such hospitals corporate bodies for the purpose of section 17 of this Pharmacy Bill?

What is the position of the Health (Corporate Bodies) Act with respect the Health Act 1970, the Act establishing the HSE in 2005 and the Companies Acts 1963-2005? If the Health (Corporate Bodies) Act 1961 is of bearing to the Pharmacy Bill 2007, why is it not cited in the Bill and listed on page 5? If hospital pharmacy departments must be registered as retail pharmacy businesses in order to continue providing services as outlined above, it will follow that they must, according to section 25(2)(a) of the Bill, be under the personal control of a registered pharmacist who must have three years' retail pharmacy experience. This does not acknowledge established rights of practice of the hospital pharmacist. In the absence of a grandfather clause or recognition of a hospital pharmacist's experience it would make it an offence for hospital pharmacists to supply directly to patients. For example, a hospital pharmacy manager may not have three years retail pharmacy experience, but could have spent three or more years of his or her career in hospital pharmacy practice and have years of experience in managing a pharmacy. However, he or she would be considered to be committing an offence under the definition provided, "3 year post-registration experience", in Part 5, offences, section 25(2a). There is a need to amend this section to acknowledge established rights of practice.

Under the Bill, if a hospital pharmacy department, in either a public or private hospital, does not supply directly to patients, either through out-patients or through discharge prescriptions, it does not need to be registered with the Pharmaceutical Society of Ireland. Therefore, its premises will not be regulated or inspected. This is not in the interest of patient safety. All premises from which pharmacy services are provided, regardless of whether in a private hospital, public hospital or community pharmacy premises, should be registered to ensure continuity of care and guaranteed standards of care for patients. This should not just apply to some premises as proposed in the Bill.

I hope the Minister will address all these concerns and ensure that the legislation is amended as appropriate.

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