Mary Harney (Dublin Mid West, Progressive Democrats)

It is not a gender thing either. I hope I am big, brave and honest enough to accept good amendments from wherever they come. I accepted quite a few in the Seanad or said I would have them checked. The amendments introduced in the Seanad concerning conflicts of interest have caused a lot of interest from all kinds of people. Deputies and Senators have spoken on them, which is the wonderful thing about this democracy. If we all accept as an ethical principle that there should be no beneficial interest between prescribing and dispensing, the question arises as to how one can give legislative effect to that. That is what we sought to do and we took the advice of the Attorney General. In that respect, we did not prohibit co-location, other than that there have to be separate entrances for any new facilities. We did not prohibit any landlord-tenancy arrangements, nor did we say it should be a planning issue. I accept that much confusion and ambiguity have arisen. That is why I am proposing two amendments, one of which is to say landlord and tenancy arrangements are not affected. The other concerns a commercial relationship by way of an owner of a property renting. I was asked by Deputy Sherlock, who did not answer it himself, about normal rent. If one goes to the market and advertises a premises for rent, and if the person who makes the biggest bid is a pharmacist, that is not an issue. That is normal. It may be abnormal in the sense that a flower shop will pay less, I presume, than a pharmacy. Everybody would pay more to be co-located with doctors but it was never envisaged in the primary care strategy that pharmacies and doctors would be located together for a very simple reason. In an average town there is a number of pharmacies, but whatever about bringing a number of doctors together it would be a minefield to have four or five pharmacies in the one location. I could not see that working very well. Therefore, the normal landlord-tenancy relationship will not be affected by this legislation. It was never intended that it would be affected.

We are giving the regulators, under the rubric of fitness to practise, power to ensure no unethical behaviour occurs. That means nobody is prescribing to get a benefit from dispensing or vice versa, if it could happen.

I am also proposing another amendment concerning partners, whether medical or pharmacy partners. A valid point was made to me that if two people are in partnership and one is involved in unethical behaviour, but the other is not aware of that, it would be unfair that the latter person could be before a fitness to practise inquiry. However, there will be a requirement on the other person if they become aware of the unethical behaviour to report it to the regulator within 21 days. That is reasonable. It was never intended, by virtue of a partnership, that the other person would be affected by the unethical behaviour of one of the partners. That point was made to me and I felt it was a good idea to take it on board.

That is the essence of the two amendments. Landlord and tenancy arrangements are not affected, and where one partner is involved in unethical behaviour and the other is not aware of it, obviously it is not a fitness to practise issue for the latter, unless it can be shown they were aware and within 21 days did not report it to the regulator.

I will not go into all the issues that were raised earlier but if I had a crystal ball I probably would not be here. If I could predict all the things that were going to happen with the certainty of the crystal ball, I would probably decide to be somewhere else. Legislation is always amended and inevitably legislation is tested in the courts. Circumstances evolve and change and both the medical and pharmaceutical professions have changed. I am a strong fan of encouraging people to invest in health care. Professionals do well in any developed society. I said this to solicitors a number of years ago when we were introducing the Personal Injury Assessment Board and many of them thought they would go out of business. In any developed society of which I am aware, highly educated and highly skilled professionals always do well. I believe in encouraging people to invest in new facilities. We have many strategies — the buzz word — in the Department of Health and Children. In fairness, I do not think anybody contradicts that fact that they were never all costed and put together. If they were everybody would realise it would be an almost impossible task if the State was to fund it all. The primary care strategy is essentially about bringing health care professionals together in a network working for patients. It would not be possible for the State to pay for all the facilities. If it did so it would be at the expense of something else. We currently spend €14 billion, a considerable sum, but it cannot do everything.

I was a fan of tax incentives for general practitioners but it would have to have been cleared by the EU and that is why the idea has not been pursued. If I thought it could be cleared by the EU I would have been keen to push the idea. Perhaps that can be pursued in the new Government but it cannot be done at the moment because it could not happen without EU clearance. There are more stringent rules at EU level concerning tax allowances than a couple of years ago. That is why it is much more difficult and challenging to introduce tax breaks for worthy things like primary care facilities or health facilities generally.

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