Peadar Tóibín (Meath West, Aontú)
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Should I not wait for the Minister for Health?

Finian McGrath (Dublin Bay North, Independent)
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I am here.

Peadar Tóibín (Meath West, Aontú)
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I thank the Minister of State for coming along to take this Topical Issue debate. Non-aligned Deputies do not get any guaranteed speaking rights at all in this Chamber. As any speaking rights that we get are purely on the basis of a lottery, when we manage to get a lottery question or Topical Issue addressed to the Minister for Health, it would be very useful for that Minister to be in the Chamber to answer it. In fairness, the Minister of State, Deputy Finian McGrath, has his own portfolio and objectives and may not be able to answer all of the questions. If we are going to have this idea of a Topical Issue where questions are asked of the Minister, it would be really useful if the Minister would show up and answer the questions.

For years, the Government has spoken about getting patients out of hospitals and into primary care. Pharmacies can play a significant role in the delivery of primary care. It is very obvious that pharmacies are not being utilised to the full extent in what they can deliver to patients. If we can get doctors' surgeries to take patients out of hospitals and pharmacies to take patients out of doctors' surgeries, it would make it far easier for the system to work. The Irish Pharmacy Union, IPU, was given a commitment by the Minister for Health that he would enter into negotiations and that a new contract would be signed in 2020. He also committed to unwinding the financial emergency measures in the public interest, FEMPI, among pharmacists. Pharmacy is the only sector in which FEMPI is not being unwound. Every other sector is in the process of unwinding FEMPI. Why is the pharmacy sector excluded? In October this year, the IPU was told at a meeting with the Department that €40 million to €50 million of cuts would be expected from the sector. No justification for that was given.

Given that we are looking for the pharmacy sector to take a bigger role in the delivery of primary care, why are we going down a route of threatening €40 million to €50 million of cuts for the pharmacy sector? If one contrasts the pharmacy sector with the dental sector, the dental profession was not told that cuts were expected from it. The pharmacy sector is equivalent to the GP and dentistry sectors combined in numbers employed. I recently heard that there may be some rowback with regard to these cuts and some preparation for negotiations and a contract. Are these cuts completely off the table? Is it the case that the Government will not proceed with the cuts in this sector? Will the Minister of State guarantee that? Has the Government taken a new position just because there is a general election in the offing and it realises that the Government will be gone before any contract or negotiations are complete at all? The nature of the pharmacy sector has changed radically in recent years. Pharmacies are doing more administration and dispensing than they did ten years ago but with less money. Business costs, including rates, rents and insurance are radically increasing. We heard from a Deputy earlier that insurance costs are affecting many different parts of society. The Government's inaction in this regard also has contributed to it.

The cost of full-time security is increasing for pharmacies around the country, especially in Dublin with the cocaine epidemic there. There is demand-pull inflation because workers are dealing with higher rents and they are forced to look for higher wages to be able to cover those rents. Pharmacists are anxious to engage with the Government to reduce wastage in drugs, especially with the new higher costs of drugs that are absorbing increasing amounts of the drugs debate in the State. This can be done in negotiations too.

Finian McGrath (Dublin Bay North, Independent)
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I am taking this debate on behalf of the Minister, Deputy Harris. I thank Deputy Tóibín for raising this important matter.

The Minister for Health values the important role community pharmacists play in the health service in the delivery of holistic patient care. The Minister is obliged, 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. Prior to the making of new regulations, the Minister for Health is required to consult the representative body for pharmacy contractors, the IPU. To that end, engagement between the Minister, the Department of Health and the IPU has to date been consultative in nature. Department officials wrote to the IPU on 10 October inviting it to discussions on the making of the new regulations. Subsequently, meetings were held in the Department on 24 October and 7 November, following which a detailed submission was received from the IPU. The consultation process has now concluded.

The Minister, Deputy Harris, met the IPU on 5 December and indicated his intention to commence a substantial review of the pharmacy contract in 2020. In this context, the Minister also communicated his intention to maintain the current fee structure from 1 January 2020. The comprehensive review of the pharmacy contract in 2020 will address the role to be played by community pharmacy in the context of Sláintecare. It will consider all aspects of pharmacy service provision, including delivery of a multidisciplinary model of service delivery for patients, ensuring clarity of roles and achieving optimum value for money. However, any publicly funded pharmacy service expansion should address unmet public healthcare needs, improve access to existing public health services or provide better value for money or patient outcomes. Accordingly, any measures to be considered must be evidence based.

Peadar Tóibín (Meath West, Aontú)
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This is one of the reasons why I made the complaint at the outset. I asked specific questions and the Minister of State has a script which does not deal with any of the questions that I asked. We are unfortunately talking at cross-purposes. There is no commitment with regard to the threatened cuts of €40 million or the unwinding of FEMPI. The Government and HSE have pointed out many times that there needs to be investment in primary care to deliver lower costs. Sláintecare talks about 70% of healthcare being delivered in the local community without a need to go to an acute hospital. The Government is only investing about 4.5% of its current health budget in primary care. If the Government seeks to pivot the healthcare system away from overdependence on the acute system, would the Minister of State not agree with Aontú that at least 10% of the health budget should be invested in primary care and communities?

GPs are in a great space to do that. They should be at the heart of a responsive, proactive, cost-effective healthcare system and should be incentivised to offer a wider range of services, either in a direct fashion or as part of an integrated group practice. In order to do that, we need pharmacists to take patients out of GP surgeries. Pharmacists must be given a greater role in providing services in the healthcare system. They can, for example, carry out blood pressure tests, blood readings and many other practical services for patients. We are asking for a broad negotiation and a redesign of the pathways between doctors, pharmacists, and hospital services in primary healthcare. We need to make sure FEMPI is unwound, that there are no threats of any cuts, and that further money is given to primary healthcare provision as a proportion of the total healthcare budget.

Finian McGrath (Dublin Bay North, Independent)
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I again thank the Deputy for raising these issues. I reiterate the Minister for Health's appreciation of the contribution of community pharmacists in delivering care to patients and re-state his intention to commence contractual discussions early in the new year. The issues the Deputy raised within the debate will be dealt with during that process. However, the Minister is also very cognisant of the fact that the regulations made under the 2009 FEMPI Act expire at the end of 2019, and that a new set of fee regulations will be needed in order to maintain a statutory basis for pharmacy payments from 1 January 2020. The issues the Deputy raised are very important. He spoke of wastage, insurance, security, and primary care, on which I agree with him. Those matters have to be - and are - a huge part of Sláintecare, as is the redesign and reform of all services. I will bring the Deputy's concerns back to the Minister.