Wednesday, 20 November 2019
Saincheisteanna Tráthúla - Topical Issue Debate
I welcome the opportunity to raise this issue with the Minister for Health, Deputy Harris. Every pharmacist in the country has been up in arms since it first came to light last week. I will cut to the chase. In recent years, I have interacted with the Minister and his Department in this Chamber and in committee, both privately and publicly. The Minister, in his interactions with the Irish Pharmacy Union, IPU, gave strong indications that he was willing to engage with the pharmacy sector to make headway in rolling out what is now an underutilised service, getting better value from pharmacists, negotiating a new contract and commencing the reversal of the financial emergency measures in the public interest, FEMPI, in 2020.
I should point out at this stage that, as a pharmacist and owner of a pharmacy, I have an obvious conflict of interest, but I am here representing the pharmacists of the country. The announcement last week of a further three potential cuts to payments made to pharmacists flies in the face of every discussion the Minister and I have had. I have always taken the Minister as a man of his word and an honourable person. I simply cannot believe what happened last week. What is being proposed will take a minimum of €25,000 from the bottom line of every pharmacy in the country. That is on foot of cut after cut. There has not been an increase in fees for more than ten years. Pharmacists are working night and day trying to keep our businesses viable and this is the straw that will break the camel's back. As the Minister knows, pharmacists as a group are non-antagonistic and non-confrontational. They are co-operative and willing, as is their representative organisation, the IPU. On this occasion, however, things have gone too far.
Regarding the reversal of FEMPI, the Minister has often stated that changed practices are needed. In the previous three years, pharmacists have taken 12 different actions that have saved the system money. We have done that without getting one cent extra in payment. For example, non-oral anticoagulants are provided to hundreds of thousands of patients every week in our pharmacies. We do all of the associated administration work and when patients come in with unsanctioned prescriptions, we do all of the work and give them their medication. In many such cases, we do not even get reimbursed for the first month until the patient gets sanctioned. There would be chaos if we sent those patients back to their consultants and doctors.
Dealing with the high-tech ordering, monitoring and management hub and sanctioning high-tech and critical medication for thousands of patients takes hours of pharmacists' time every week. All this additional work has been taken on by pharmacists free of charge. The Department now proposes to cut the high-tech fee for medications such as Entresto, Fampyra and Prolia. Three months ago, there was a major cut in what is allowed in the area of oral nutritional supplements. We have been working with patients and their doctors and consultants to let them know what is reimbursable so that patients can go out the door with their vital medication.
This is not the way to commence negotiations on reversing FEMPI or agreeing a new contract for pharmacists. The Minister addressed the IPU annual conference and gave a firm assurance, which he also gave me at a committee meeting, that he wants to work with pharmacists and wants to roll out a new contract that will bring about a better system and fairer payments. The Minister cannot allow this proposal to proceed. I do not want to hear from him that the Department is doing this. He is the Minister and this is his Government. We have put our faith in him and I expect him to honour his commitments.
I always endeavour to honour my commitments. I thank Deputy Brassil for raising this important matter. I genuinely note his keen interest in this area, not just as a pharmacist but as an advocate regarding the role pharmacy has to play from a public health policy point of view in delivering Sláintecare. I have had good and sincere engagements with the Deputy during my time in office and I genuinely acknowledge that and thank him for it.
As the Minister for Health, I value the role pharmacists play in the health service in the delivery of patient care. Community pharmacy is rightly recognised as the most accessible element of our health service, with an unequalled reach in terms of patient contact and access. That is why, as Deputy Brassil correctly states, I have given a clear commitment to commencing a thorough review of the pharmacy contract in 2020. In broad terms, the review will address the role to be played by community pharmacy in the context of Sláintecare and in delivering a multidisciplinary model of service delivery for patients, ensuring clarity of roles, avoidance of duplication and achieving optimum value for money. I recognise already that the IPU has brought forward ideas, proposals and suggestions that it has concerning how pharmacy can do even more in helping to shift services from the acute setting to the community setting, and perhaps ensuring that pharmacists can do more in respect of their scope of practice.
A contractual agreement that is fit for purpose in a health care system that is increasingly seeking to tilt the balance of care towards a strengthened primary care system is now much required. The vision and approach which underpin Sláintecare need to be mapped out for community pharmacy. A primary care model, integrated with other health policies, will require the expansion of both the scope of practice and the range of public services provided in community pharmacy. I am thinking specifically of the successful pilot we had for a minor ailments scheme. That could well be an area of expansion.
In May of this year, as the Deputy rightly reminded me, although I certainly have not forgotten, I addressed the Irish Pharmaceutical Union at the national pharmacy conference in Galway. In my keynote speech, I made a clear commitment to move beyond the arrangements underpinned by the Financial Emergency Measures in the Public Interest, FEMPI, Acts 2009 to 2015, as I have done for other professions, with a view to optimising the role of pharmacists in the years ahead. I stand by that commitment, not to move back to pre-FEMPI arrangements but to move on "to a higher terrain", as I said at the time. I am satisfied that we can agree a new contract next year that will do precisely that. However, in the meantime I am obliged, under law, before the end of this year, to put in place a new framework to maintain a statutory basis for contractor fees as the existing regulations will be revoked from the end of this year, in accordance with the Public Service Pay and Pensions Act 2017.
That is not new information. It is a statement of fact based on an Act that this House passed.
Prior to the making of the new regulations, I am required to consult the representative body for pharmacy contractors, the IPU. In that respect this statutory consultation is under way. My officials wrote to the IPU on 10 October inviting it to attend discussions on the making of the new regulations. Meetings were subsequently held in my Department at an official level on 24 October and 7 November, following which a detailed and welcome submission was received from the IPU. That submission is being considered by my Department and I have agreed to a request from the IPU that I would meet it directly in the coming weeks. I assure Deputy Brassil that no decision has yet been made in this regard. The Deputy will, I hope, understand and appreciate that while a statutory consultation process is under way I am somewhat limited in terms of what I can say. However, we have received the detailed submission from the IPU. It is being given the most serious consideration. I am conscious of the fact that we will be entering contract negotiations at the start of 2020 and that the sequencing of these issues needs to be considered.
I expect to see discussions on a new contract begin early in the new year. I fully believe that community pharmacy contractors have an important contribution to make in realising my future vision - indeed, it is the Deputy's also - for community care which needs to be enabled by a modern fit-for-purpose contractual relationship with the HSE.
I thank the Minister. I am aware that a statutory framework needs to be put in place. The Minister should leave it as it stands and commence the negotiations for the new contract and new fees under the existing arrangement, which, I would add, has already taken 33% from payments from pharmacies over the past ten years. We carried more than our fair share of the burden in the difficult times. There is also the additional work we have taken on outside of our contract.
I am trying to express to the Minister, in as calm a way as I can, the anger that is out there among pharmacists. I would not be surprised if they withdrew their co-operation in the high-tech hub, withdrew their co-operation for the National Oversight and Audit Commission and brought about chaos in a system that is already overburdened. That is coming from a group of people who have never been antagonistic. They have never been confrontational, they have always been co-operative and willing.
Dentists are moving into 2020 with the same framework. There will be no change for them. The Minister is reversing the financial emergency measures in the public interests, FEMPI, for GPs, which we welcome. They are not being asked to accept further cuts. As a matter of fact, payments they received previously are beginning to be restored to them. I ask the Minister not to treat pharmacists differently. We do not deserve it. We are honourable and hardworking of people who provide a fantastic service to communities. The one thing the Minister will not hear about in the context of the health service is the pharmacy system being in chaos. We do a good job and we do not deserve this.
I will take the Minister at his word to the effect that when he meets the IPU in the negotiations in the coming weeks, the first thing that will happen is that what was put on the table last week will be taken off it. I also take it that we will sign what we have already and that in 2020 we will renegotiate for a new contract and for the reversal of FEMPI.
I again thank Deputy Brassil for raising this important matter. I share his view that pharmacists are always honourable and constructive in their engagement with the State. I referred on previous to our Brexit preparedness, an matter in respect of which there has been significant leadership shown by Darragh O'Loughlin, CEO of the IPU, in particular but also by pharmacists in general. Perhaps we are better prepared than other jurisdictions as a result of that constructive engagement and collaboration.
I want pharmacists to do more. Pharmacists want to do more. In order for them to do more, I accept that we need to provide more resources to them. That is why I want to start contract negotiations similar to those that led to a successful agreement with GPs. Some 95% of GPs voted in favour of the new agreement.
The law of the land revokes the existing regulations at the end of this year. The law of the land obliges me to put a new framework in place. The law of the land obligates me to consult representative bodies before doing that. That consultation is well under way. Letters have issued and meetings have taken place. A meeting with me will take place. A detailed and constructive submission has been received from the IPU and is being actively considered. We believe that there are efficiencies to be made. Pharmacists do not disagree with that. However, I am conscious of the fact that we will hopefully be sitting down in a few weeks' time to discuss a new contract. How those two interact is something to which I am giving a great deal of careful consideration.
The document submitted by the IPU is being actively considered at the most senior levels within my Department and by me. I will meet the IPU and we will decide how best to proceed in due course. It would not be constructive to go further than that today, particularly as the consultation process is ongoing, but I hear Deputy Brassil's compelling arguments clearly.