James Reilly (Dublin North, Fine Gael)
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Question 76: To ask the Minister for Health and Children the steps she has taken to ensure the continuation of services in the dispensing of methadone to people participating in drug treatment and rehabilitation programmes; and if she will make a statement on the matter. [24454/07]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am disappointed that a significant number of pharmacists have chosen to discontinue providing methadone services to patients. This is the second time in recent years that pharmacists have targeted the methadone scheme in response to unrelated issues. It is unfortunate that community pharmacists have once again chosen to target some of our most vulnerable patients — recovering drug users who are stable enough to be treated in the community setting — in this way.

I understand that the Competition Authority is examining whether the action of pharmacists in withdrawing from dispensing methadone to patients may be in breach of competition law. Currently, the pharmacists' action is mainly in the Dublin area with threatened escalation countrywide later. As of Monday, 15 October, some 140 pharmacists in the Dublin area have withdrawn from the methadone protocol scheme. This action affects approximately 3,000 patients.

There is a significant clinical risk of overdose to patients who revert from a methadone maintenance programme to opiate use. In these circumstances, the HSE has developed a contingency plan to ensure continuity of service and to minimise any hardship to patients. Since last Monday, the HSE has been implementing that plan. The HSE has made alternative arrangements for the emergency dispensing of methadone to the patients involved in 13 centres. The HSE's drug helpline is available on a seven day a week basis to provide information to clients in relation to the contingency arrangements. The HSE has indicated that to date the contingency plan is operating satisfactorily. The situation in the rest of the country is being monitored closely and arrangements are ready to be implemented in the event of an escalation of the action nationwide.

I acknowledge the work the HSE is doing to ensure continuity of care to patients in these very challenging circumstances. I also appeal to the pharmacists who have withdrawn their service to reconsider their action in the light of their professional and ethical obligations.

James Reilly (Dublin North, Fine Gael)
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I understand a contract to take 22 patients out of the National Rehabilitation Hospital to a community facility has been cancelled because of cutbacks.

Brendan Howlin (Wexford, Labour)
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Deputy Reilly, please ask a supplementary question.

James Reilly (Dublin North, Fine Gael)
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Before I ask a question, a Leas-Cheann Comhairle, I hope you will allow me a little preamble.

Brendan Howlin (Wexford, Labour)
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That is normally permitted if it is relevant to the question.

James Reilly (Dublin North, Fine Gael)
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Many people are seriously disadvantaged because of this dispute. I do not condone the action of pharmacists in putting patients at risk although, like many Members, I recognise their frustration with the HSE. The HSE has had ample opportunity to put its contingency plan in place and it is very poorly thought out. There was no consultation with communities and the only information I have has been gleaned locally.

Only one dispensing centre has been provided for all of Dublin North. It is on the most northerly peninsula in the area and is very inaccessible. Patients who have been off heroin for some time, are holding down jobs, have families and are making their contribution to society are being put at risk. They are being corralled into small areas in Dublin North and other parts of the city and drug dealers are circling them like sharks. People who have kicked the heroin habit need help and support. I ask that the Irish Pharmaceutical Union withdraw its action, that the Minister instruct the HSE to defer its action and that an independent impact assessment take place to allow the dispute to be resolved.

Does the Minister think it is wise for officials of the Competition Authority to be visiting community pharmacies in the company of gardaí? Does she agree that this action is likely to inflame the situation rather than help it?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I welcome Deputy Reilly's statement that he does not condone the action of the pharmacists. Most people would support that view.

Methadone users are a very vulnerable group of patients and the HSE has had to put a contingency service in place very quickly. The feedback I have received from a number of people has been positive. The service is not as good as that provided by pharmacies, which are much more accessible, but the HSE has done its best, in the circumstances, to provide a facility. I am not familiar with the details of all 13 centres but I will draw the attention of the HSE to the Deputy's concerns, particularly with regard to Dublin North.

The Government does not have responsibility for the Competition Authority. We are governed by European as well as Irish competition law. This morning, I heard a reference to changing the Irish Competition Act. When the HSE was negotiating a wholesale margin, the wholesalers produced legal advice that negotiation with the HSE contravened competition law. It was the wholesalers who first brought our attention to the fact that negotiating with a group such as pharmacists — this will subsequently apply to dentists and other professions — is in breach of Irish and European competition law and amounts to cartel behaviour. It is equally the case that people cannot act as a group to prevent a service in a market. These are matters for the Competition Authority, not the HSE or me.

James Reilly (Dublin North, Fine Gael)
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Has the Attorney General given his opinion on the matter?

Mary Harney (Dublin Mid West, Progressive Democrats)
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We have received an opinion from counsel on behalf of the Attorney General on this matter. The HSE has its own opinion, as do the pharmacists. At my behest, some months ago Mr. Bill Shipsey, senior counsel, was asked to act as facilitator, which is allowed. I understand a meeting was held last week and that another took place yesterday. I hope that through this process we can reach agreement on some of the issues involved. The key factor is money. As a result of the new arrangements in respect of the wholesale margin and the new deal with the producers of medicines, we will save approximately €660 million over four years. We pay the middle range price in the European Union for drugs. However, the Irish consumer pays the highest amount in Europe for medicines. This is not acceptable. We must reduce the escalating cost of drugs in the health care system — the figure currently stands at €1.5 billion — by getting better value for money and, in particular, paying pharmacists a professional fee to dispense rather than a fee based on a 50% margin which everybody will accept is not appropriate.