Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

I move amendment No. 1:

To delete all words after "unmet demand; and" and substitute the following:recognises that the switching of medications from a prescription to a non-prescription basis could reduce the expenditure on dispensing fees; and

call on the Minister for Health to:

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

- ensure the HSE will conclude its investigations without delay;

- detail how those accountable will be held responsible;

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

- prioritise the proper expenditure of taxpayers' money;

- put in place proper auditing systems;

- reclassify those prescription-only medicines identified by the Health Products Regulatory Authority to over-the-counter in pharmacy status; and

- introduce legislation to oblige pharmcacies to inform patients of a pharmacist's dispensing fees, pharmacy services and mark-ups through in-store displays in order that pharmacists would be required to use a standard, clearly, visible template and provide the patient or the patient's representative with an itemised receipt following the dispensing of medicines.

I will be sharing time with Deputy Caoimhghín Ó Caoláin.

I welcome the Minister's confirmation of a full recovery and not a settlement amount. Notwithstanding the Minister's position this evening, I do not believe there is anything that precludes the Government or other Deputies supporting the Sinn Féin amendment.

It is unfortunate that we are discussing wastage in the system, abuse of procedures and, ultimately, a cost to the taxpayer. I recognise and welcome that the full amount has been recouped. I also note that investigations are ongoing. The fact that this motion has been tabled points to a culture that has been allowed to grow and needs to be addressed. We need a plan to prevent it. We need to ensure that there are not other similar incidents or other moneys lost in this way into the future. In that regard, I welcome the measures outlined by the Minister.

Unfortunately, this is not the first time that a large multiple has been caught apparently taking advantage of the rules. In Britain, the same multiple investigated by the RTE investigations unit took advantage of a loophole in the NHS rules which allows pharmacies to bill the taxpayer for whatever a product might cost at the time. Dozens of Lloyds pharmacies dispensed packs of tablets that cost £89 instead of those which would have cost only £3. Following other investigations, the British media disclosed that drug companies were apparently colluding with pharmacists to over-charge the NHS by millions of pounds for a group of drugs known as "specials". This led to the grave concern that the NHS system was not being properly policed. We are calling on the Minister to provide an assurance that the system here will be properly and robustly monitored. It is safe to say that Irish people are sick of one might call "creative compliance", the effect of which we have seen on our banking sector and public services. We need to ensure that public services act in the public interest at all times. This means ensuring that third parties cannot abuse the system. Rather than relying on people to do the decent or the right thing, we need to put in place the mechanisms to ensure they do so.

I understand and appreciate that pharmacists are health care professionals and they are trained to work and care for their patients but conversely they are running a business. In June last year, Lloyds pharmacy announced a price reduction on a range of its prescription medicines. This led to other chains following suit. At that time, Lloyds stated that this could deliver €300 savings per annum on some prescription items. This was, according to Lloyds, part of an attempt to be competitive in the Irish market. At the time, some small community pharmacies were concerned that this could put them under significant pressure, particularly those that would have had large debts, of which we know there are plenty in communities for a whole range of reasons. There was undoubtedly pressure on them.

It is interesting to note that at the same time Lloyds was publicising the delivery of savings for consumers and patients, it was engaged in the process we are discussing this evening. Indeed, its push to be competitive in the market, which may have put pressure on smaller pharmacies, came at the cost of defrauding the HSE of moneys. There was no transparency and no oversight. It was thanks to a whistleblower that this issue came to light. Tributes need to be paid not only to the people in RTE but to those who were brave enough to come forward. It would be interesting to know - hopefully the investigations under way will shed more light on this - if phased dispensing increases revenue and if it is widespread among other pharmacies. I know that it is often recommended by doctors but, unfortunately, Lloyds appears to have been using it as a mechanism to make money and increase its revenue. As I understand it, it is a practice Lloyds encouraged in its pharmacies. I do not believe that phased dispensing, for all its benefits, can and should be used for profit. I think we can all agree on that. The fact is that not only were these chains distorting the dispensing system, they were doing it with flagrant disregard for our health service, the HSE and patients. They did so with such vigour they created targets and goals. It was not an accident, an oversight or a mistake: it was deliberate manipulation of the rules and procedures to maximise revenue for a large and profitable company.

We do not yet know in how many companies or chains this practice was rampant. We do not know if this was isolated to the large multiples or if in an effort to stay competitive with these companies other pharmacies were forced to follow suit. We cannot know that. I am sure we will ever find out. It is not hard to imagine the money that would be required to do a root and branch investigation into how the system may have been abused. It would be naive to think that this might happen because the scale of the task would be massive. The fact is the practice was rampant. We now need to ensure it is stamped out and cannot happen again. In that regard, we must ask what the outcome will be of the investigations. Those who have been found to have over-charged through an abuse of the system will reimburse the moneys but how will the culture and the practice change? Will there be a new code of practice and, if so, how will it be negotiated and how will we ensure that patients are protected?

We must be cognisant that if it was not for a whistleblower this practice may never have been investigated. This is steadfast becoming the rule rather than the exception in public life. We welcome whistleblowers coming forward and we actively encourage them to do so but if this culture was so rampant in the system, then there must be robust action taken to ensure that it does not recur.

Sinn Féin has tabled some minor amendments to this motion to enhance it and to try to strengthen it, particularly in the area of transparency for patients. In the first instance, the amendment looks at how dispensing fees could be reduced for patients. In that regard, we recognise that the switching of medications from prescription to a non-prescription basis could help in some small way. It is not a big measure but it could provide some relief. As pointed out by the Minister, the Health Products Regulatory Authority, HPRA, oversees the reclassification of drugs from prescription-only medicine to over-the-counter, OTC, in-pharmacy status and from OTC to general retail sale. In Sinn Féin's Better for Healthpolicy launched late last year, it was noted that at that time the authority had identified 32 products that could be reclassified. These include topical anti-fungal steroid creams and proton-pump inhibitors. It would be interesting to hear from the Minister if that figure has changed or if he intends to act on the recommendations from the HPRA. It is particularly interesting to note that many products currently available over-the-counter from a pharmacist in Britain or in Northern Ireland are only available here on prescription.

The second part of the Sinn Féin amendment is patient-focused. Aside from any reform that comes about as a result of investigations, there is a need to overhaul the culture that led to this situation. We believe there is a need for legislation to oblige pharmacies to inform patients of a pharmacist's dispensing fees, pharmacy services and mark-ups through in-store displays. In this way, pharmacists would be required to use a standard clearly visible template and provide the patient or patient's representative with an itemised receipt following the dispensing of medicines, as a rule rather than on request. If there is greater transparency patients will be able to determine what fees are being charged and for what item or service. This would, it is hoped, help avoid such situations as has occurred into the future.

As I have said repeatedly throughout this contribution that action is needed. I am hopeful that the Minister will follow up and ensure that something happens. Behaviour of the type we have discussed this evening diverts funds from where they are intended and undermines the provision of quality patient care. The losers in this situation are patients, despite campaigns of reduced prescription costs by pharmacies. The HSE and the Minister need to ensure that the health service is better protected into the future.

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