Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank the Deputies for tabling the motion on what is a very serious issue. The issue before us highlights the challenges the HSE and all public bodies face in the procurement of services from private contractors and the importance of investing in probity and control functions to protect the taxpayer and service users. I echo the comments of Deputies Dara Calleary and Billy Kelleher on the work of community pharmacies. I know where their motion is directed. I also agree with Deputy Billy Kelleher on the expansion of the role of community pharmacists. The issues outlined by the Deputies are deplorable and unacceptable, as I am sure Deputies on all sides agree. The question is what will we do to ensure we get to the bottom of the matter and minimise the chances of it happening again.

While Deputies are right to challenge and question the systems in place within the HSE - that is their job and mine as Minister for Health - we must ensure moneys are spent appropriately. I will address these issues. We must also be cognisant of the obligation on private contractors to comply with the terms of their contracts with the State. Clearly, that did not happen in this case.

The HSE's primary care reimbursement service, PCRS, pays primary care contractors, including GPs, dentists and pharmacies, for goods and services supplied to eligible public patients under community health schemes such as the medical card, long-term illness, high-tech and drugs payments schemes. This is an enormous undertaking. There are approximately 7,700 contracts, with annual payments of more than €2.5 billion. Under the drug schemes alone, pharmacies make claims and are reimbursed for over 74 million separate items every year, or almost 1.5 million items every week. Pharmacists are reimbursed for medicines dispensed to patients in previous months, with a mix of electronic and paper claims. In 2015 the PCRS reimbursed €1.9 billion under the community drugs schemes to cover the cost of medicines and pharmacy fees. This included €1.38 billion in drug costs, including €116 million in wholesale mark-ups and €390 million in pharmacy fees. That sets the scale of the operation. This colossal level of activity is engaged in to a very high level by a single agency. I have visited the PCRS and seen at first hand the hard work, dedication and enthusiasm of the staff who undertake this volume of work on behalf of patients.

The matter raised involves a commercial contractor claiming fees for phased dispensing to medical card patients in community pharmacies. Phased dispensing was established in 1996 for patient safety reasons under the new pharmacy contract. It is a clinical process to help certain patients to manage their medicines. It may be specified by their doctor; they may be starting a new medicines regime or using medicines that are unsuitable for monthly dispensing or, in exceptional circumstances, they may be unable to safely manage their medicines. That is the sole purpose of the scheme. A key part of the process is that medicines are dispensed at regular intervals, for example, once a week, in order that both patient and medicines are monitored. Where phased dispensing is appropriate, pharmacies are paid per dispensing for their professional services.

While the Government is not opposing the motion because of the seriousness of the issue, a number of points need to be appreciated. They concern the instigation, operation and success of the PCRS investigation in this case.

I have been briefed in detail by the HSE about this matter. I understand an HSE data review of phased dispensing in 2014 raised concerns about activity and claiming levels. In early 2015, based on this analysis, the HSE began investigating claiming by the Lloyds Pharmacy group. The investigation involved complex analysis of activity for the period from 2010 to 2015 and detailed pharmacy inspections. Such a forensic approach is the only concrete way to establish mis-claiming under current systems. Of course, it was supported by information provided in confidence later in 2015 from former employees and media sources. I acknowledge the role both played.

I am further informed that the investigation was completed in August 2015 and that disciplinary proceedings were being prepared against individual pharmacies within the group under clause 15 of the pharmacy contract. This process can lead to termination of a contract. Following protracted negotiations, Lloyds agreed to a settlement that included full repayment of over-claimed fees. The PCRS continues to monitor phased claiming by the Lloyds group, with further payments suspended until compliance with phased dispensing rules is fully established. The HSE considers that this was the best possible outcome in this case, with full return of moneys owed to the taxpayer. The PCRS is also examining other claiming issues and conducting investigations into claiming by a number of other contractors.

The HSE has advised that, during the Lloyds investigation, it sought advice from the Garda Bureau of Fraud Investigation and the Pharmaceutical Society of Ireland which regulates pharmacists and pharmacies in Ireland. The HSE will make any appropriate referral required concerning investigations. That may well still happen.

The Lloyds fees investigation was a successful operation, set in motion by an HSE PCRS audit of business activity and one that reached a positive conclusion - the full return of all moneys owed to the taxpayer. I agree fully with the Deputies that it was a most serious matter. However, irregularities were detected by, and the investigation was initiated on foot of, the HSE’s own reviews, although also helpfully supplemented by media reports and a whistleblower.

In all payment structures there must be a significant element of trust between contractor and payer. A well functioning probity and control function underlines this and protects the taxpayer, patients and legitimate operators who make up the majority of contractors. In a health setting it also helps to ensure resources go to the people who need them and that maximum value for money is achieved. The purpose of the PCRS audit and probity role is to ensure payments are claimed for services provided. Reviews such as these, in particular pharmacy inspections, are detailed, forensic and time and resource intensive.

Following analysis and restructuring, the PCRS audit function has been, and continues to be, strengthened with the development of dedicated resources. This is a message to the House that we need to do more in this area. That is why we are beefing up the audit function within the PCRS. This objective has been pursued as a matter of urgency and includes the appointment of a head of schemes control, supported by specialist staff, a control steering group and a probity and governance group.

I am pleased to note that the PCRS has, this year, appointed four full-time pharmacy inspectors, two data analysts and two dedicated case managers. A third data analyst and two more case managers are being recruited. This will strengthen the ability of the PCRS to carry out investigations, follow the audit trail and improve its audit function further.

The PCRS probity and control function is also developing a work programme with specific measures for community pharmacy, dental, optical and general practice to ensure claims comply with relevant schemes. The PCRS probity programme is on target to recover €20 million this year as a result of its operations. I am confident that this increased level of activity will set the tone for proper engagement by contractors in providing services for patients.

The House will note the proposed amendment to the Fianna Fáil motion tabled by Deputy Louise O'Reilly on two other issues: reclassifying medicines to over the counter; and transparency in pharmacy prices and services. While I am in a position to accept the Fianna Fáil motion, I cannot accept the proposed amendment. These issues are the responsibility of the relevant statutory authorities, the Health Products Regulatory Authority, HPRA, for medicine classification and the Pharmaceutical Society of Ireland, PSI, for professional practice and conduct.

In general, a medicine supplier applies for a change in status for its product. I understand the HPRA actively seeks applications from suppliers and gives ongoing consideration to the issues surrounding this matter, in Ireland and elsewhere.

The PSI deals with patient queries on pharmacy medicine pricing. Patients are entitled to ask for a breakdown of their medicine costs and the person in charge of the pharmacy should provide that information. The PSI has advised pharmacies that this should include an itemised receipt.

While I accept the principles involved in the amendment, I oppose the amendment on the basis that the issues are matters for the relevant statutory authorities. I do not propose to intervene in their roles at this stage.

I thank the Deputies for tabling the motion and look forward to the rest of the debate. The motion raises very serious and important issues on how we expend taxpayers' money and how we ensure resources this House votes to expend on health services get to citizens and are not in any way misused or fraudulently obtained. I am pleased with the outcome of the HSE PCRS audit which has recovered every cent of the money owed arising claims wrongly made by Lloyds Pharmacy Group. I look forward to seeing the beefed-up audit function within the PCRS operating with the additional staff I outlined to the House.

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