Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I support this motion which I come at from a couple of perspectives. In tabling this motion, we are trying to send out a very strong message to the HSE that it has an obligation and a duty to ensure that it has proper auditing systems in place and that it is fully accountable both to the Committee of Public Accounts, through the Comptroller and Auditor General, and to this House generally, to ensure that there is confidence in it and that the public sees that there is not wastage, particularly in difficult times, when there are huge challenges across the broader health budget in the provision of care and when budget after budget over the last five to six years cut back services and pared supports for the people who most need them. To read about this case of €12 million being overcharged by LloydsPharmacy and a settlement of this magnitude undermines the confidence of the public in the HSE to be on top of its brief in ensuring that there is full accountability and proper auditing in place.

One or two issues have arisen on which I would like a bit of clarity and they have all been referred to by Deputy Calleary. In regard to the €12 million, is that a settlement figure that was offered by Lloyds and arrived at through negotiation or was that after a full trawl of Lloyds pharmacies and their interaction with the HSE regarding the MyMed dispensing and pillbox system that was in place? The reason I ask that is that organisations across this country, which provide wonderful services daily in the area of physical and intellectual disability, are consistently audited, are having their block grant cut on a continual basis and are finding it increasingly difficult to fund their services to the extent that we now have fund-raising efforts across the country by large organisations just to try to provide basic health care for very vulnerable people. It sticks in the craw to a certain extent when they see these kinds of figures, such as an overcharge of €12 million, coming out. It is equally important to find out whether this was a settlement figure offered by Lloyds or whether it followed a full and detailed analysis and audit of all dispensing fees charged by Lloyds over the last number of years.

What is also important is the fact that a whistleblower came forward. That is healthy in the sense that there are now people out there who see that they can, with a certain element of confidence, come forward when they see wrongdoing taking place or when they have suspicions that it is taking place. In this case, it was important that this whistleblower came forward. The difficulty in all of this was that it was the "RTE Investigates" programme which really brought this to a head, even though the HSE had suspicions and it had been brought to the attention of senior management in the HSE that there were potential problems with the dispensing fees and how they were being charged to the HSE.

It is important that I read a circular from Lloyds itself, a notice from its head office to its pharmacies, entitled MyMed Profitability. The notice read "Wondering why we're obsessed with MyMedding?!" and included a graphic which stated "should show you why it's so important to hit your target. And why it's even better to hit your target early so you can make a real dent on your overall profitability for the year." It goes on to explain how to manipulate, in a way, the MyMed charging system that was in place, whereby normally there would be a €5 dispensing fee per prescription item. When they phased it and put it into the pillbox, they were able to charge multiples of that.

It is very important that we put on the record that we are not disparaging every pharmacist and community pharmacist out there. That is critically important and has already been referenced by Deputy Calleary and others. Pharmacists do wonderful work daily. We all know that many of them are struggling at present in the economic downturn. They provide a very valuable service in communities and villages across this country. I have consistently raised the need for pharmacists to play a more meaningful role in interacting with the primary care system that we are trying to develop. They should be given a much greater role than they have at present. Sometimes when I say that I draw the wrath of general practitioners and others on me but we have wonderful highly qualified personnel in almost every town and village across the country. They should be used in a very effective way in primary care and in alleviating the burden on GP services and systems that are also overburdened at present.

The broader issue is that of accountability in respect of public funds. The HSE and any other arm of the State cannot be seen as some form of cash cow that can be milked regularly by any individual or by an organisation. In that context, the HSE must do a full evaluation of its internal auditing systems because they have been found wanting on numerous occasions in dealing with some organisations, particularly section 38 and 39 agencies, as was instanced at the Committee of Public Accounts previously. They need to be robustly assessed as to whether they have the capabilities and the wherewithal at present or whether they need further assistance and support in terms of personnel and finances to ensure that the amount of money being dispensed by the HSE on contracts and services represents full value for money and that the taxpayer is getting full value for money. In the context of the taxpayer getting value for money, we have been, as I said, diverting funds from the most vulnerable in budget after budget over the last six, seven or eight years. It rests very uneasily with people when they see this type and scale of overcharge, wittingly or otherwise. It is important that all these issues be clarified in the context and the course of the debate.

However, the broader issue, as I said, is that we must ensure that this cannot happen and that there is a further assessment of the internal capability of the HSE to perform its duties in ensuring that it is not only purchasing a service but also getting value for money for the taxpayer and for the people who depend on the HSE itself. Over the next number of weeks, we will be engaging as a political party with the broader issue of budgets for the HSE and the health services across the board. Again, it would undermine our confidence if we believed that this was just a settlement, that the matter was swept under the carpet and that there was no due diligence done on the capacity of the HSE to observe and assess the number of contracts in the pharmacy area and the broader provision of services. When one looks at the overall budget of the HSE, there are huge agency staff numbers and short-term contracts coming into being. It purchases many services from the State that it would have to ensure that it has that capability. The reason I say that is because this did not come as a surprise in view of the fact that the HSE was warned as far back as 2013 that there were issues around the dispensing fee and how it was being broken down and the pillboxing system that was being used by Lloyds in multiplying out a prescription fee fivefold and, in some cases, by more.

This motion is important in that context to bring a bit of clarity from the Minister on what actions he is taking, what actions the Department of Health and the HSE are taking and whether there is a requirement by somebody to refer this to other authorities. That is something that should also be looked at. We must send out a very strong, clear message that public funds must be used in the manner that they were voted for in the Dáil and dispensed or paid out by the HSE. If there is a requirement to do that, then it should be done. I concur with everything said by my colleague and I hope that certain issues that have been raised will be addressed by the Minister.

I hope the Minister will answer the questions that have been raised.

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