Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

The primary reason this issue is being dealt with in this format — statements — is that the overwhelming majority of Government Deputies would not want a division on it today. That is regrettable because from working with many of them and speaking to several of them privately I know they hold the same views as voices that will be heard from the Opposition benches in the course of this opportunity. Since the resumption of the Dáil after the summer recess last year we have demanded that the Minister for Health and Children, Deputy Harney, seriously address the escalating and critical situation threatening community pharmacies. We have called for this matter to be addressed in the Dáil in plenary session, yet it is only now, as the 1 March deadline looms, that these statements and questions to follow have been scheduled.

The Joint Committee on Health and Children has dealt with this matter in detail, meeting over three days recently and hearing detailed submissions followed by a question and answer session with both the HSE and the Irish Pharmaceutical Union, IPU. The committee requested that the Minister attend in advance of those hearings but she did not comply. The committee requested that the Minister attend in advance of the 1 March deadline, but again she did not comply. I see this as shirking her responsibility and accountability to the Oireachtas for a serious situation.

The escalating pharmacy dispute has been a cause of worry and uncertainty to tens of thousands of patients, especially elderly medical card patients. It has created concern for all users of our health system, whether medical card patients or those dependent on the drugs payment scheme. I have seldom seen an issue which has led to such extensive and prolonged lobbying of Deputies yet which, in contrast, has featured relatively little in the news media. Perhaps it is because the details of the dispute are complex. Nonetheless it is unfortunate that it has not received the attention it deserves. A more general airing of the issues might have contributed to a solution before now.

The single most aggravating factor in the dispute has been the adherence of the Government and the HSE to the line that they cannot negotiate financial issues with the IPU, allegedly because of the Competition Act. This, more than anything else, has led to the current impasse. The Minister and her colleagues in Government must bear full responsibility for this. They have made no effort to address the legal difficulty by means of their own legislation. Although it is within the Minister's gift to address this, she has opposed the Competition (Amendment) Bill put forward by Deputy Higgins.

I previously raised other very negative consequences of this interpretation of the Competition Act. They include the blocking of negotiations with dentists on publicly funded dental schemes. Many dentists have withdrawn from the scheme as a result and patients have been left without dental services. This has received even less public notice than the pharmacy dispute but it is no less serious. Age Action Ireland, in commenting on the pharmacy dispute, has pointed out that the dispute with dentists has been ongoing for over a year with many older people forced to go without a service, change dentists if they can find one still in the scheme or attend already over-stretched and under-resourced HSE dental clinics.

If the imposition of new scales of payment for pharmacies goes ahead on 1 March and the IPU withdraws from the medical card and drugs payment schemes, tens of thousands of patients will be adversely affected. The HSE tells us it believes relatively few pharmacists will withdraw. That remains to be seen. There was no need for the Minister and the HSE to escalate the dispute in this way. The IPU welcomed the announcement by the Minister that an independent body would be established to review the contract issues between the HSE and the pharmacists. In welcoming the announcement the IPU had asked the Minister and the HSE to avoid making unilateral changes to existing payment arrangements pending the outcome of an agreed independent review. The Minister and the HSE carried on regardless.

In all of this there is no dispute about the fact that we require better value for money for drug purchases in the health service. Prices are far too high but the question must be asked why it took so long for the Government to address this matter and why it has been done in such a ham-fisted manner.

On today's Order of Business I referred to the fact that on the eve of the 14 February meeting of the Joint Committee on Health and Children the Cathaoirleach, Deputy Moloney, who is with us in the Chamber, circulated a motion which was set to receive all-party support at the meeting the next day. Deputy Reilly also alluded to it in the course of these statements. I wish to read the motion and hear the Minister's response. The Cathaoirleach of the committee presented four specific points as follows:

That no changes be made to contracts between the HSE and community pharmacists in advance of the setting up, and reporting, of an independent body whose remit will be to make recommendations on the reimbursement to pharmacists for drugs supplied under the State's community drugs schemes, in consultation with the interests concerned;

that the committee

recognises the vital role that community-based pharmacies play in the delivery of the health service;

further recognises that the proposed changes to the contracts between the HSE and the pharmacies should be designed to allow financial sustainability;

and that no changes in the current contract or remuneration will take place until such a body reports and likewise pharmacists will refrain from any reduction in services.

I believed then, and said so at committee, and I still believe that encompassed in that motion for which I commended the Cathaoirleach of the committee, was the basis of a solution. However, at the meeting on 14 February the Cathaoirleach withdrew this motion and the Fianna Fáil committee members proposed a bland motion simply calling on the HSE and the IPU to resolve the dispute. They divided the committee in order to pass this motion, and the Government spurned another opportunity to help resolve the dispute. The committee had previously been of one voice on this issue. It defies credulity that the committee would find itself divided at that critical point. That raises many questions, which are not for the Cathaoirleach to answer in the first instance, although I have no doubt that he will address the matter. Why was the sensibly constructed motion not put before the committee members and the opportunity given for unanimous endorsement on 14 February?

Looking on at all of this are patients who fear that their access to vital medication will be disrupted from 1 March. The IPU claims that ultimately the changes to be brought in by the HSE on 1 March could result in the closure of more than 300 pharmacies, with smaller and more rural-based pharmacies worst affected. Age Action Ireland has pointed to the rising concern among older people about how they will get their medication. The group has urged all sides to come together to assure older people that there is a contingency plan and, no matter how this dispute develops, they will continue to receive their medication. Age Action Ireland has stated it is particularly concerned that any such contingency plan would be sufficient to meet the needs of older people living in rural areas, where there are already fewer pharmacies. Such a contingency plan will not work if it involves older people in rural areas having to travel long distances to fill their prescriptions.

The IPU has welcomed the call from Age Action Ireland for both sides to come together to deal with the situation. The IPU states it believes there is still time to resolve the issue and representatives have made themselves available for talks with the HSE. I urge the Minister and the HSE to avail of that opportunity without delay. The IPU has called for a comprehensive review of current payments to pharmacists by an independent body and that no cuts in payment be made until that body has made a recommendation on this issue. The IPU has agreed to work with the HSE to agree contingency arrangements to deal with circumstances which may arise after this weekend, if the HSE proceeds to force through its plans from Saturday. Everything must be done to ensure that there will be no necessity to put such contingency plans into operation.

These issues need to be resolved by agreement and with the aims of ensuring continuity of service to patients, as well as better value for money in the purchase of medicines by the health services. These expectations are not mutually exclusive, as we can address them both. The financial aspects of this are quite complex, but it has been the absence of direct dialogue and negotiation on the generality and the detail of the issue that has led to this impasse. For that, the Government must bear a large share of responsibility.

Pharmacies play a vital role in the primary care system, but the current system is fundamentally flawed because the so-called public and private mix so lauded by this and previous Administrations is inequitable and inefficient. In theory, it involves individual HSE contracts with hundreds of pharmacists around the State. These vary in size from small independent outlets to multinational chains. As with GP services and the medical card scheme, I firmly believe that the current system should be replaced by a fully public primary care system, with free care to all at the point of delivery, based on need alone. The complex public and private system leads to difficulties such as those now convulsing the pharmacy sector, albeit difficulties unnecessarily exacerbated by this Government.

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