Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I welcome the opportunity to speak on the Bill, which the Social Democrats will be supporting. However, I have some concerns about the approach being taken in Part 2 in terms of both health and housing. I will go into detail on those matters in a few moments.

In the context of Part 3, I very much welcome the provisions to enhance the role of community pharmacists. I will begin by commenting on this matter. In November, the expert task force published its initial recommendations. I commend Minister on the speedy way in which he acted on those recommendations. It is not so long ago that it was a struggle to get any expansion of pharmacy services over the line. When it was first proposed that pharmacists would start to administer the flu vaccine, it was a real battle for them to be allowed to do that. That was the first battle. The second battle was for them to be paid fairly in line with what GPs were being paid. Thankfully, that was resolved in time. There is huge capacity within community pharmacies. It does not make sense not to exploit that capacity as fully as possible. At a time when we are struggling with recruitment and different issues in respect of the health service, it makes absolute sense to ensure that pharmacists have an expanded role. They also have the huge benefit of being located in every town and village throughout the country.

As is so often the case with healthcare policy, existing interests resisted any change to the status quo. I am very glad that the plan for the roll-out of the flu vaccine came to fruition. We saw the huge benefits of that in the context of Covid vaccines, although there was some resistance to advertising that fact and to providing details of the pharmacists that were participating in the scheme. I noticed that at the beginning. It was corrected in time, but it should have been done at the very start. Pharmacists played a huge role in ensuring that people across the country had access to Covid vaccines. It certainly feels as though there is a real momentum around expanding the role of pharmacists. I urge the Minister to seize on the opportunity to unlock their full potential.

The main recommendation from the expert task force's interim report was to allow pharmacists to prescribe for up to 12 months. From reading that report, it is clear there was general support for the three-month prescription extension introduced during Covid which allowed for the validity of nine-month prescriptions. This measure was especially well-received by patients, but it was also noted that there was limited public awareness of it. I agree with that assessment, and I believe it also applied in the context of the awareness of Covid vaccines. As already stated, that was the case in the early days. Lessons must be learned from this poor communication with the public especially as these new changes to prescription validity take effect. However, I accept that it is difficult to draw direct comparisons between this and Covid measures, particularly in view of the environment in which the relevant decisions were taken.

It is important to note that patients stressed that the overriding concern must be patient safety. While they viewed the extension of prescriptions to 12 months as a positive measure, they said that this must be accompanied by an appropriate framework. While it is accepted that pharmacists are highly trained healthcare professionals and that they require flexibility to use their professional judgment, the task force did recommend regulatory guidance and supporting educational materials to facilitate the safe application of this new process. It also recognised that it may not be appropriate to extend the prescription of certain categories of medication and that any extension should be subject to person-centred criteria.

Again, these are very welcome and necessary safeguards, and that particularly applies to medications used in the mental health area where there are separate concerns that apply to those in terms of addiction and so on. It also avoids a situation where we are too free about providing, at both doctor and pharmacy level, medications that people may end up being dependent on or that are used as a substitute for talk therapies. That is the particular area we would have most concern about with regard to not extending those exemptions.

The next phase of the expert task force's work relates to the scope of pharmacist prescribing, including empowering pharmacists to prescribe for common and minor ailments. When the Irish Pharmacy Union appeared before the health committee in March of last year, it presented a similar proposal for a minor ailment service. Under the scheme, patients with minor, self-limiting conditions would no longer have to make or wait for GP appointments. Instead, they would consult their local community pharmacist and receive an assessment of their symptoms, followed by a combination of advice, medication and-or referral to other services. According to the IPU, such a scheme would not only deliver timely care in the community but also cost-effective, safe and desired health outcomes. One would hope that the expert task force will recommend a similar proposal, and I urge the Minister to act on those recommendations soon after they are published.

Another area of healthcare that our community pharmacists could play a far greater role in is contraception. It is well reported that women would prefer to obtain their contraceptives from their pharmacists instead of their GPs. Furthermore, there is no clinical reason for the stipulation that oral contraceptives should only be supplied on foot of a prescription. Irish pharmacies have been providing emergency contraception without prescription since 2011, and there is no clinical reason this should not be extended to oral contraception. Not only would increasing their role in the dispensing of birth control medication ease the burden on overstretched GPs, it would also make contraception more accessible. Removing this barrier to prescription-free contraceptives would help reduce the number of crisis pregnancies and assist in reaching groups who are less likely to engage with health services. I understand the new women's health action plan will be launched this year, and I believe this proposal should be considered by the women's health task force.

Another area in which the role of pharmacists could be expanded greatly is chronic illness management. Given their expertise and the shortage of GPs, there is no reason our community pharmacists could not assist greatly in these areas. The estimate is that something like 70% of the workload in primary care relates to chronic illness. That puts a huge burden on our health services. The management of that or elements of different chronic illness could very easily be done by pharmacists. They are very keen to do that, so we need to be pushing the boundaries all the time on that. The kind of things they want to assist with in chronic illness management are things like weight management, blood pressure and cholesterol testing, for example. Some pharmacists are doing that already but it is very much a kind of pilot-type approach, whereas it could be done on a much wider basis, helping patients to have self-management of their own chronic conditions.

While the HSE has put a very welcome focus on chronic illness management in recent years through the introduction of various successful integrated care programmes, I still believe the role of pharmacists is being overlooked in this respect. After all, chronic diseases are becoming more common as the population ages and grows. While the prevalence of long-standing illnesses in Ireland is below the EU 27 average, it still stands at 25.7%. Given that Ireland's population is ageing faster than any other EU country, with the over-65 population having grown by 35% over the past decade alone, it is safe to assume there will be considerable growth in chronic disease. Therefore, we must better utilise the existing healthcare resources already at our disposal and pharmacists are a prime example of that.

Ultimately, there a number of measures that need to implemented to unlock fully the potential of our community pharmacists. The establishment of this task force and the changes contained within this Bill are a very welcome start but it should not be the end. On the subject of pharmacists, I note that there have been long-standing calls for changes to the fee structure, and I understand the Department is currently engaged in a review of fees. Will the Minister please provide an update on that review and the likely date by which it will conclude?

I would like to move on to Part 2 of the Bill, which relates to the disregard for rent-a-room income. While I have no objection to this measure in principle, I am concerned there is an inherent inequality of treatment in this policy. Arguably, anyone who has a room to spare in their home is in a far better position than, for instance, a 63-year-old with a chronic illness in single-room flat. The beneficiaries of the rent-a-room scheme can already let a room out without any tax implications and, soon, without any implication for the medical card. As I have said previously, there is nothing wrong with this measure per se. I just this Government's priorities are somewhat skewed. Sure, this policy should increase the supply of rental units, but it amounts to little more than tinkering around the edges. It is just another example of a Government that is bereft of ambition when it comes to the housing crisis. I will come back to that again later in my contribution, but in terms of healthcare policy, the Minister's focus should be on expanding the eligibility for medical cards. That would be a much more worthwhile and impactful measure than what is proposed here. It is frankly extraordinary that the income limits for medical cards for under-70s have not been increased for about 20 years.

For some reason, a policy decision has been taken to place the emphasis on GP-visit cards instead of medical cards. While access to GP care is obviously very important, people also need access to a whole range of other health services, especially people with chronic illnesses. There is currently a huge cohort of people being denied access to any of the therapies or public health nurse services. I am particularly concerned about people in their 50s and 60s. It is in those years that people tend to develop chronic illnesses and require access to services such as the various therapies I have mentioned and public health nursing. In view of this, I simply cannot understand the rationale for this policy of funnelling everyone into GP clinics. I accept that GPs are recognised as gatekeepers, but what happens when a patient is referred to a specialty service or therapy? They still find themselves in a situation where they have to stump up €40 or €50 to see a therapist. GPs themselves very much recognise the fact they are not the solution to all of a person's health problems, and very often it would be much more beneficial for somebody to go to a therapist or a nursing service.

Ahead of the budget, I tried to find modelling on medical card income limits but I had no luck on that at all. All the modelling from the likes of the ESRI and the Department of public expenditure related solely to GP-visit cards. A number of Deputies also raised this with the Minister via parliamentary questions, but his answers always referred to the expansion of free GP cards. If this Government is serious about providing universal healthcare based on need and not ability to pay, then it needs to provide greater access to a whole range of services in primary care in particular, not just GP services. After all, only 30.8% of the population had a medical card in 2021. That represented a 10 percentage point reduction since 2012.

In keeping with the principles of Sláintecare, that figure should have greatly increased, not reduced.

I turn now to comments I want to make about housing policy, which, rather oddly, is a major part of this health Bill. It is widely accepted that at the heart of the housing crisis is an affordability crisis. Dublin is one of the most expensive cities in Europe in which to buy or rent a home. This uncontrolled affordability crisis now extends to other cities, towns and even villages. Despite this, addressing affordability does not appear to be a priority for the Government. In fact, the focus instead seems to be on subsidising developers, the most expensive way of doing it. We are repeatedly fed the line that apartment building is not viable and that the only solution is slashed standards and subsidies. Developers say "jump" and it appears that successive Ministers ask, "How high?" Why is the approach of this Government always carrot for developers and stick for renters and buyers who are expected to pay exorbitant rents and house prices to help boost developers' bottom lines?

I would like to draw particular attention to the plight of student renters, as it is particularly relevant to this debate. While the measures contained in Part 2 are not specific to student accommodation, many students rely on digs-style accommodation, which is eligible for tax relief under the rent a room scheme. According to a recent survey by the Higher Education Authority, 19% of respondents live in digs. While there is certainly a place for this type of accommodation, I am very concerned about the lesser rights associated with these arrangements. People living in digs are regarded as licensees rather than tenants. Therefore, they do not enjoy the same legal protections as other renters. Threshold has called for a review of this category of licensee with a view to abolishing it. The USI has also been critical of the different status of digs. However, in January last year, the Minister for housing ruled out tighter regulations, claiming it would reduce supply. As ever, this Government puts the interests of landlords ahead of renters.

Taking a broader look at the student accommodation crisis, there is clearly a greater need for affordable, purpose-built student accommodation. I acknowledge that the Minister for higher education often expresses concern about the cost of student accommodation, but those words ring pretty hollow given he has sat at Cabinet since 2016, the same Cabinet that presided over, and continues to preside over, a housing disaster that has forced some students sleep in hostels, cars or tents. Last August, a Department of higher education report revealed that universities received approximately 30,000 more accommodation applications than they have beds for. That is three applications for every student bed on university campuses. According to Dr. Rory Hearne, associate professor at Maynooth University, only 15,000 student units were in the planning system last August. The majority of these were expensive, investor fund units. According to a parliamentary question reply from June of last year, of the 12,000 purpose-built student accommodation units built between 2016 and 2023, 84% were investor funded.

While I acknowledge that the Minister, Deputy Harris, has announced new funding and financing mechanisms, they are coming a bit late. According to Department projections, third-level enrolments will rise by 40,000 full-time students by the 2031-2032 academic year. In that context, far more ambitious proposals are required.

I reiterate the Social Democrats' support for this Bill. While I firmly believe this Government's priorities are not exactly in line with Sláintecare, I do not believe there is anything intrinsically wrong with the proposed changes to the rent a room scheme. However, this should not be the focus. The focus should be on expanding access to healthcare and protecting renters. It is possible to do both. I do not think we should necessarily be piggybacking on a housing crisis and trying to solve an element of that crisis by ensuring people who are already reasonably well off are further facilitated with medical cards. Access to medical cards should be on the basis of need and that should be the test. I reiterate my strong view that extending access to GP care is welcome on one level, but it just does not cut it in terms of meeting the needs of people, especially those on low incomes. There should also be the ambition to meet the full implications of Sláintecare in terms of providing access, free at the point of use, to all primary care and tertiary healthcare services.

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