Dara Calleary (Mayo, Fianna Fail) | Oireachtas source

I move:

"That Dáil Éireann:

notes:

- the recent €12 million payment made to the Health Service Executive (HSE) in settlement of a dispute over incorrectly claimed pharmacy fees;

- the failure of the HSE to notice irregularities in the pharmacy fees it was being charged by a leading chain;

- the fact that other pharmacies are now being pursued for similar practices; and

- that these developments only came to light following media investigations;

agrees that:

- the fact that a leading pharmacy chain could over claim to such an extent is a serious indictment of the HSE’s monitoring systems;

- there are grave concerns about how many other pharmacies may have been operating similar practices;

- it is incumbent on the HSE to ensure that it is carrying out proper checks and balances when dealing with taxpayers’ money;

- urgent action must be taken to recruit auditors; and

- €12 million could have a major impact in funding other areas of the health service where there is significant unmet demand; and

calls on the Minister for Health to:

- outline what action the HSE is taking to investigate this issue;

- ensure that the HSE conclude its investigations without delay;

- detail how those accountable will be held responsible;

- guarantee that more robust procedures are put in place to restore confidence in the system;

- prioritise the proper expenditure of taxpayers’ money; and

- put in place proper auditing systems."

I congratulate the RTE investigations unit on its work in this regard. The unit has done some outstanding work in recent times and it is a shining advertisement of what public service broadcasting can be. I also pay tribute to the whistleblower within the LloydsPharmacy group who showed significant courage in shining a light on this sorry mess.

The Minister will surely agree the HSE has serious questions to answer for failing to notice irregularities in the pharmacy fees it was being charged by a leading chain. I emphasise the word "chain" as it seems that the problem centres on pharmacy chains rather than the important, independent community pharmacies throughout the country that are struggling to keep their doors open. This sorry episode has undermined them and their work and that should not have been allowed happen. However, the fact that a leading pharmacy chain could over-claim to the tune of £12 million without anyone noticing is a damning indictment of the HSE's monitoring systems. The HSE needs to outline what action it is taking to get to the bottom of this issue. I look forward to the Minister outlining to the Dáil this evening exactly what the response has been.

This is taxpayers’ money going into a service that is under enormous financial pressure. It is incumbent on the HSE - and the Minister - to ensure that the proper checks and balances are carried out when dealing with taxpayers’ money, not just for pharmacies but also in terms of agency fees and for any service involving a third party. When one sees what has occurred in the pharmacy sector, it does not give one much confidence about how the HSE manages its other debtors. Now that a number of investigations are under way, I would like the Minister to be specific in detailing the progress made in respect of them. I also ask him to outline the checks that are now in place to ensure there will be no recurrence of what happened in this instance.

The waste of public money cannot be tolerated. The amount is not negligible. A total of €12 million in the health service could mean 600,000 home help hours. There are currently no home help hours available for any case, including palliative care, in County Mayo. The existing waiting list will subsume all of the extra resources - if they become available - that the Minister allocated during the year. Families are under the most dreadful stress and pressure at present and €12 million would go a long way to alleviate the problem around the country. The sum of €12 million would provide 500,000 additional personal assistant hours for people with disabilities. It would enable the recruitment of some 350 nurses, speech and language therapists or occupational therapists. It would provide 12,000 medical cards. There has been a tightening in the allocation of discretionary medical cards in recent weeks and months. Such money would provide 1,500 home-care packages, which are essential to alleviate the crisis in hospitals. It would fund a network of community neuro-rehabilitation teams four times over or employ armies of hospital consultants. That is what €12 million would do yet the HSE did not seem to notice it was missing.

One should also bear in mind that the HSE was initially warned about the possibility of such a situation arising in 2012 and 2013. That is apparent from documents to which the RTE investigations unit had access. That was at the high point of the very dangerous budgets being introduced by the then Minister for Health, now Senator James Reilly - a time when 30,000 discretionary medical cards were being taken away and when there was a €113 million probity drive in respect of medical cards.

In 2012, senior HSE managers were told that pharmacy fees were open to abuse and misunderstanding but no action seems to have been taken.The Sunday Business Postalso did some work in this area and in 2015 it showed that HSE managers were concerned about phased payments, which are at the centre of the dispute. A unit in the HSE identified phased dispensing as a payment risk in 2012. At the time, the unit proposed that rules relating to phased dispensing should be clarified. HSE managers drew up circulars to advise GPs and pharmacists how to operate and claim appropriately for medicines that were dispensed on a phased basis. However, it appears those circulars were never sent. I would like to know why.

The difficulties concerning phased dispensing have been identified and the irregularities centre in particular in this case on the LloydsPharmacy group and on the weekly medication management system known as My Med, which is the modern day equivalent of the old pill box, segregating drugs into weekly packs for those on large doses of medication. The RTE investigations unit, using documentation supplied to it by the whistleblower, shows that LloydsPharmacy staff were actively encouraged to widely promote the My Med system to its customers but additional paperwork supplied by the RTE investigations unit showed that My Med generated substantial additional profits for the LloydsPharmacy group. Branch managers in the LloydsPharmacy chain were advised in an internal memo that they could boost their fee income by almost two thirds by using a system developed within the company. It is important to note that LloydsPharmacy has rejected any suggestion of fraud in its practice of claiming up to four fees in a month in respect of a single prescription. However, its settlement with the HSE to the tune of €12 million must reflect some admission of wrongdoing on its part.

I query the figure of €12 million. Was it a settlement figure or was it the actual amount of money owed to the HSE? Was the figure arrived at following negotiations between the HSE and the LloydsPharmacy group? I would appreciate if we could have clarification on the matter this evening. The opening up of the argument provokes a number of questions which I would like the Minister to answer this evening. The first is to outline the response of the HSE to the specific issue under discussion and, second, to indicate the new checks that are in place. Is the figure of €12 million that has been agreed with LloydsPharmacy a settlement or the specific amount that is outstanding? How many more pharmacy groups or individual pharmacies are being investigated by the HSE? How much money is understood to be at issue at this time?

Does the Minister believe appropriate checks are in place for all supplier relationships with the HSE? Is the Minister confident that agency fees charged to hospitals, hospital groups and various other elements of the HSE are routinely and correctly monitored? Is he satisfied that GP fees are routinely and correctly monitored? Is he happy that the fees paid for those who hold medical cards are routinely and correctly monitored? How many auditors are currently working within the HSE to manage the system of payments which relates to so many contractors throughout the country? Is the Minister happy that the level of internal audit within the HSE is appropriate for the amount of customers it handles?

This is a public expenditure issue as well as a health issue. I have outlined what €12 million could be used to provide in the health service. The health service is facing a huge crisis for the want of money. However, when we look at the money that is invested in it, which seems to be unchecked, it is enormously frustrating for those of us who are fighting every day for resources for constituents and for people who want to use the service.

There is a crisis with regard to home-help services. We also have a crisis in emergency departments and in terms of waiting lists. Those areas could all do with an additional €12 million. The sum of €12 million would have gone a long way to reduce the stress felt by the many thousands who lost medical cards in 2013 and 2014 and had to endure the stress of applying for their cards and then reapplying for them.

The HSE response, as outlined, has been weak. It must be seen to take the issue seriously and show there is an audit chain in place for all of its payments in order that we can have confidence in its ability to manage its own internal finances and customer relationships with contractors. It is unfortunate that a chain would bring this damage down on the pharmacy profession, which does excellent work and is, in fact, under-utilised in terms of its members’ skills and ability as primary care providers. Again, I say that this should not reflect on the integrity of community pharmacies around the country which are struggling to keep their doors open. Once again, big business is damaging not just small operators but also the internal conditions relating to the health budget.

Let this be a warning that we cannot depend on the RTE investigations unit to do the work of the HSE's internal audit division or the Comptroller and Auditor General. We need to know why it took the RTE investigations unit to do the courageous work of highlighting this issue and we need to know from the Minister that work is under way within his Department to stop this happening in any other section of the HSE budget. I would appreciate if he could give an assurance to the House this evening that he has checks and balances in place already regarding all the supplier relationships within the HSE and the management of those contracts.

See this speech in context