Dáil debates
Wednesday, 23 April 2008
Adjournment Debate
Pharmacy Services.
9:00 pm
John O'Mahony (Mayo, Fine Gael)
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I wish to share one and a half minutes of my time with Deputy McHugh and one minute with Deputies Kieran O'Donnell and Jimmy Deenihan.
Jack WallJohn O'Mahony (Mayo, Fine Gael)
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I raise a serious issue to which a solution is needed immediately. For the past six months there has been a stand off between the Irish Pharmaceutical Union and the Health Service Executive. Disputes are usually settled by negotiation but that has not even been attempted in this case. The Minister and the HSE refuse to negotiate. Instead, we now have threats of injunctions and as 1 May approaches real concern is being generated. That is what I want to raise tonight because people want to know where they will get their medicines and what will happen if they cannot pay for them, which is the case for many people. I have been advised that out of 48 pharmacies in Mayo, 46 are pulling out of the scheme on 1 May. It is not acceptable that those people should be put through that trauma and stress in addition to coping with their medical conditions.
I met with approximately 100 people in an active retirement group in Ballina on Tuesday morning and there was genuine anxiety among the group because with 1 May looming there is no contingency plan to allay their concerns about where they will get their medicines. Real confusion and fear is being experienced. I have received hundreds of calls from people and patients in the past few days. A 92 year old woman telephoned me today wanting to know who would tell her what tablets to take.
The pharmacy service in Mayo and other counties involves more than just a drug store dispensing medication. People come to seek advice and clarification on how to take their medication. It is a vital community service. Mayo's pharmacies depend on medical card holders for 80% of their business. If they are forced to close, it will be another strike at the heart of rural Ireland.
As a matter of urgency, will the Minister indicate what will be the contingency plans on 1 May? I tabled a question on the matter today but was told it was a matter for the HSE to answer. I am not here to score political points, nor are the other Deputies. I want to allay the fears of the people who need answers. Only the Minister can instruct the HSE to remove the cause of the panic among the sick and the less well-off about where they will get their medicines in a few weeks from now.
Joe McHugh (Donegal North East, Fine Gael)
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As Deputy O'Mahony said, we are not here to score political points. We are facing a crisis. Almost 800 pharmacists have submitted letters tendering their resignation. In addition, there is fear among the people on the drugs payment scheme and the medical card scheme.
We must provide a solution to this impending disaster. Why did a senior official from the HSE pull out of the Oireachtas joint committee meeting tonight? The answer to that question will not be in the Minister's script but an answer is required as to the reason the official did not turn up to that meeting today.
The pharmacists are in a corner because the HSE will not negotiate with their union representatives. They will not allow union representation in any negotiations. There has not been a level playing field in that regard from day one. The IPU has always indicated it is in favour of cost cutting and has put forward its own proposals.
We need a quick intervention. There is fear among the public. Pharmacists are in a corner and the intimidatory mechanisms used by the HSE in issuing High Court injunctions will not solve the issue. We are facing a crisis and something must be done about it soon.
Kieran O'Donnell (Limerick East, Fine Gael)
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I echo what my colleagues have said. This is probably one of the most serious issues that has arisen in terms of medical services in a number of years. Why is the Minister not here? Where is the Minister, Deputy Harney? This is a serious issue but her absence is an indication of the way she regards it. Patients are concerned about getting their medications. The livelihood of pharmacists is being threatened. They are taking an 8.2% reduction from pharmacists but many pharmacists are not getting that level of discounts. When the old dispensary system was abolished in the early 1970s, pharmacists were to set up a network throughout the country from which they could dispense. The Minister is standing over the dismantling of this service. She must demand that the HSE enter into negotiations with the IPU to resolve this issue before a disaster occurs. Pharmacists are being backed into a corner, where they are being forced to threaten to terminate their contracts individually.
That is totally unacceptable. The Minister should be here tonight dealing with the issue. She should, as a matter of urgency, demand that the HSE enter into formal negotiations with the IPU. They should sit down, engage in consultation and allow the pharmacists go on with their business, providing a very good service in all areas of the country and being an efficient part of the HSE. Many other parts are not so efficient.
Jimmy Deenihan (Kerry North, Fine Gael)
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According to 2006 HSE figures, 42,792 individuals — 30% of the Kerry population — depend on community pharmacies for medicines dispensed under various community drug schemes. As has been stated, local pharmacies have dispensed not just prescriptions but expert medical advice and reassurance to their customers while building up an invaluable personal relationship with the local community over the course of years.
As a result of the unilateral decision taken by the HSE under the direction of Government, patients will now have to pay for their medicines on 1 May. Many people will just not have the capability or capacity to pay for their medicines and will do without them. As a result, there will certainly be fatalities.
It is unfortunate the Minister of State, Deputy Brendan Smith, is here as I saw he took all the Adjournment matters in the Seanad tonight. He would not want to become Minister for the Adjournment. Will the Minister of State convey to the Minister and the Government our concerns? At this stage it is in their hands and they must intervene. I appeal to the Minister of State, and other Ministers, to get the Government to intervene before it is too late and all the consequences mentioned by the three previous speakers come into effect.
Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney, who is unavoidably absent due to other Department business. I thank the Deputy for raising this matter as it provides me with an opportunity to outline to this House the current position.
Over recent years, the Health Service Executive has reviewed the pharmaceutical supply chain with a view to seeking value for money in the State's drugs bill, in order to better fund existing and innovative therapies without compromising patient safety or continuity of supply. Following the completion of public consultation, and informed by the independent economic analysis carried out by Indecon International Economic Consultants, new wholesale pricing arrangements were announced by the HSE on 17 September. The report by Indecon was published by the HSE on 13 November 2007.
In response to demands from community pharmacists to address what they see as the impact of the new wholesale pricing arrangements, the HSE offered a voluntary interim contract with a flat rate dispensing fee of not less than €5 for all dispensing under the GMS and community drugs schemes. Pharmacists and the Irish Pharmaceutical Union did not see this as a positive gesture and have not taken it up.
Following engagement and discussion with the Irish Pharmaceutical Union in February, the Minister established an independent body to assess an interim, fair community pharmacy dispensing fee to be paid for the medical card scheme, the DPS and other community drug schemes. This initiative is aimed at supporting pharmacists in rural or inner-city areas with predominantly medical card patients, as the Government is concerned to support community pharmacy services particularly to less well-off patients and areas. This body is being chaired by Mr. Sean Dorgan, former head of IDA Ireland. It has been asked to make its recommendations by the end of next May and I understand it is on course to produce its report and recommendations in that time.
Both the HSE as the contracting body and the Irish Pharmaceutical Union as the representative organisation for community pharmacists, along with other stakeholders, are entitled to make submissions to the independent body. I understand the Irish Pharmaceutical Union has made a submission to the independent body and that it had a detailed and comprehensive engagement with Mr. Dorgan's group last week on a wide range of matters pertinent to his terms of reference.
I reiterate that the Government recognises the IPU as the representative body for pharmacists and wishes to maintain its longstanding relationship with the union as a key stakeholder in health care.
Unfortunately, the HSE has reported that it has, to date, received notification from over 500 community pharmacy contractors indicating their intention either to cease providing services from 1 May 2008, or otherwise reserving their right to do so.
Joe McHugh (Donegal North East, Fine Gael)
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It is 800 as of today.
Brendan Smith (Cavan-Monaghan, Fianna Fail)
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Community pharmacy contractors are required under the terms of their contract to give three months' notice of their intention to withdraw. This is a serious obligation to ensure continuity of dispensing services to patients.
The HSE has written to each of the contractors concerned, seeking formal confirmation of their intentions and pointing out that three months' notice of cessation of service is required. As of now, only two contractors have given formal notification of termination in accordance with the requirements in the contract.
The HSE has been obliged to develop a national contingency planning framework which will inform and provide direction to local operational management for the development of local area-specific contingency plans. As service provision, geographical and demographic circumstances will vary from area to area, each local health area is developing its own area-specific contingency plan within the context of the overall national framework.
However, I emphasise that it is the Minister's and the Government's earnest hope such contingency arrangements will not prove necessary and a withdrawal of services by pharmacists will not take place. The process engaged in by the Dorgan group is under way, as the IPU can attest, and it offers a real prospect of a way forward in this dispute.
Kieran O'Donnell (Limerick East, Fine Gael)
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Its reference should be extended to include discounts.
Brendan Smith (Cavan-Monaghan, Fianna Fail)
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It should be allowed complete its work——
Joe McHugh (Donegal North East, Fine Gael)
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There are two parties in the process.
Brendan Smith (Cavan-Monaghan, Fianna Fail)
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It should be allowed complete its work in just a few weeks' time.
In the meantime and while that work is still under way, a withdrawal of services by pharmacists is not a response that is fair to patients who, for good reasons, have——
Joe McHugh (Donegal North East, Fine Gael)
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There are two parties in the negotiations.
Brendan Smith (Cavan-Monaghan, Fianna Fail)
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Could we have the common decency to listen? In the meantime and while that work is still under way, a withdrawal of services by pharmacists is not a response that is fair to patients who, for good reasons, have developed a trust and confidence in their community pharmacist to supply the medicines they need.
Joe McHugh (Donegal North East, Fine Gael)
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This is fuel to the fire. Negotiations are ongoing.
Brendan Smith (Cavan-Monaghan, Fianna Fail)
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Threats of withdrawal from the community pharmacy contract in this context are surely not in anyone's interest.
The Minister has repeatedly stated she does not wish to see any patient inconvenienced in any way. She believes that if community pharmacists reflect on the position and the fully independent——
Joe McHugh (Donegal North East, Fine Gael)
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Is this before or after they get the High Court injunction?
Brendan Smith (Cavan-Monaghan, Fianna Fail)
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Will the Deputies show some common courtesy for just one second?
Joe McHugh (Donegal North East, Fine Gael)
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It is ridiculous, this is not even an answer.
Brendan Smith (Cavan-Monaghan, Fianna Fail)
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The Minister, Deputy Harney, believes that if community pharmacists reflect on the position and the fully independent and impartial engagement by the Dorgan group——
Kieran O'Donnell (Limerick East, Fine Gael)
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That is the end of May.
Brendan Smith (Cavan-Monaghan, Fianna Fail)
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——they will choose responsibly to fulfil their professional obligations to their patients.
Kieran O'Donnell (Limerick East, Fine Gael)
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What about the confined terms of reference?