Pádraig Rice (Cork South-Central, Social Democrats)

Absolutely. We talk a lot about productivity in healthcare. We also need productivity in Parliament.

Returning to the topic at hand, the community pharmacy agreement, first I want to say that I welcome the investment in community pharmacies. In recent years, we have seen a real and tangible expansion of the services on offer in community pharmacies and that should be acknowledged. The Minister and her predecessor are to be commended on their work to date in progressing the recommendations of the expert task force, which was established in 2023.

It was not too long ago that such changes were extremely difficult to get over the line. A prime example of that was the introduction of the pharmacy-provided flu vaccine over a decade ago. At that time, there was considerable pushback from the sector but thankfully it is now standard practice for community pharmacists to deliver the flu vaccine as well as Covid vaccines. In fact, community pharmacists now administer one in every three vaccines in the flu and Covid vaccine programmes.

I welcome the news that community pharmacists will begin administering the PPV23 vaccine under this agreement. However, my understanding is that this vaccine will only be provided free of charge to medical card patients over 65, unlike the flu vaccine which is free to anybody over 60. Is this the case? One dose of the PPV23 vaccine is recommended for all people aged 65 and over but uptake is low, at below 36%, according to the HSE. Prevention of pneumococcal infection through vaccination should be a priority. According to the HSE such infections are responsible for 50% of community-acquired pneumonia, with an overall mortality rate as high as 25%. It should be a no-brainer to offer this vaccine to all those over 65 and high-risk groups free of charge. The expansion of the PPV23 vaccine into pharmacies is welcome but it should not come with a means test.

Speaking of charges, I have concerns about the arrangements for common condition service, primarily the consultation fee. Just last week I asked about this by way of a parliamentary question to the Minister. In her response she said that the common condition service will be a fee-paying service with pharmacies entitled to charge a consultation fee which will not be reimbursed by the State. There are two issues here. First, there appears to be no agreed maximum rate for consultations and second, the fee will not be reimbursed by the State. I cannot understand why medical card holders, at the very least, are not covered by this new service. The common conditions service is a positive development but to realise its full potential and to maximise the potential of the entire pharmacy sector, medical card patients should have access to this new service free of charge. I accept that for eligible patients under the HSE drugs scheme, the medication dispensed will be reimbursed. However, one of the main arguments for the common conditions service was to divert medical card holders away from overstretched GPs, where possible. Why would medical card holders with a common condition go to a pharmacy at a cost when they could go to their GP for free? When the Irish Pharmacy Union first proposed this scheme, it estimated that nearly 1 million GP consultations with medical card patients could be dealt with more appropriately by pharmacists. I cannot see how this will be the case under this scheme because although it may no longer be necessary for medical card patients to go to their GP surgery with common conditions, that will still be the only place where they can do so free of charge.

Another major issue with this agreement is the ending of phased dispensing for certain groups and the limiting of eligible medicines, as reported in the Irish Examiner last week. Phased dispensing was put in place in 1996 and is now being discontinued to cut costs, seemingly. This will impact some of the must vulnerable patients who should not have been used as a bargaining chip. We are talking about patients who need help to safely manage their medication such as those with reading difficulties, mobility issues, the very elderly and those living with addiction. This cost-cutting measure risks patient safety. The Minister needs to go back to the drawing board if this is the case.

There are so many aspects of this agreement that I would like to speak about but I want to prioritise the issue of access to the free HRT scheme. It is completely unacceptable that trans women are being excluded from the scheme. There can be no excuse or justification for this decision. I and others have been raising this with the Minister for a couple of weeks now and I am disappointed with the response. Instead of accepting that the exclusion of trans women is wrong and changing course, the Minister has dug in, further disadvantaging one of the most marginalised groups in society. It really is simple. Trans women should be included in the scheme. To employ one interpretation of the scheme for trans women and another for cis women is wrong. It is particularly galling this week when we had representatives of the trans community in the Oireachtas to celebrate the tenth anniversary of Gender Recognition Act. Free HRT should mean free HRT and I urge the Minister to do the right thing and reverse that decision.

Another issue I want to speak about is free contraception. The role of pharmacists in providing free contraception could be expanded. Great progress has been made in recent years and I hope this momentum continues. The IPU has been making a compelling case for prescription-free contraceptives and pharmacies have been providing emergency contraception without prescription since 2011. There is no clinical reason for not extending this to oral contraception, as recommended by the World Health Organization. We should be making contraception more accessible, particularly for hard-to-reach groups. We should be streamlining the free contraception scheme so that patients can visit a pharmacy for oral contraception without having to go to their GP first. This new agreement was an opportunity to remove that barrier to prescription-free contraception and ease operations.

As I said, overall, great progress has been made and I hope this momentum continues. With continued political will, we can further enhance the role of community pharmacists and maximise their potential across every village, town and city. This would be in keeping with the principles underpinning Sláintecare and the Minister will have my support in advancing these aims.

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