David Norris (Independent)

I welcome the Minister to the House. She has a difficult row to hoe. I have some disagreements with her but I was impressed by what Senator Feargal Quinn had to say. He talked a great deal of practical sense and I was glad to have heard him.

I wish to raise an issue that is perhaps an unintended by-product of this dispute but one that I would like the Minister to take seriously. I mentioned this on the Order of Business and asked the Acting Leader to bring it to the Minister's attention. I received a letter from Dr. Martin Henman, professor of pharmacy and pharmaceutical science at Trinity College, in which he indicated that this dispute was directly affecting senior sophisters in the pharmacy degree course. On completion of the degree, graduates must undertake a year's supervised practice, of which at least six months must be in either a community or a hospital pharmacy. This practice is undertaken under the supervision of a tutor pharmacist and it must take place in a specified practice. Both the pharmacist and the practice site must be approved by the Pharmaceutical Society of Ireland.

These courses or training posts are funded by the community pharmacists and graduates pay the society's fees and the examination fee. They must do these courses or they cannot graduate. The majority, 90%, of the students undertake either six or 12 months' training in a community pharmacy and the remainder enter a hospital practice. While the hospital places have mainly been continued this year, Professor Henman says those in Tullamore were cut by the HSE after being advertised. There are therefore no places in Tullamore.

The situation has created considerable uncertainty for students. Many of them, probably the majority, who would have been offered a pre-registration training place are not prepared to take them. The effect of the dispute means that because of the legal challenge it is unlikely that this will be resolved immediately. If it goes to the courts, the earliest it can be heard is June. The senior sophister students in Trinity and elsewhere are faced with the prospect of being graduates who are unable to complete their professional training, and the health service will find itself without a cohort of pharmacists. That will mean further upward pressure on salaries and will make staff retention in the hospital sector, where salaries are lower, difficult. Staff will be inclined to move out of hospitals. The independent pharmacies will be disproportionately affected because they do not have excess fat in terms of finance to cope.

Professor Henman says in his letter that the situation is unique in his experience of just over 25 years in Trinity College. He knows of one student who has submitted over 45 curricula vitae and, in all but a handful of cases, has been told that no position will be offered in the coming year. He says his students are unsettled and unable to give all the attention they should to their academic work because they are intensively searching for pre-registration places. I ask the Minister to take particular notice of this matter, which could be damaging for students at a vulnerable time and also damaging for the industry and the delivery of community health.

With regard to the general situation, the competition elements are anathema to me. I believe we have made competition a false god and I strongly object to the fact that under the competition legislation, the HSE is prohibited from negotiating directly with the pharmacists. The same situation applies to Equity. In other words, the weakest people are disbarred. That law should be re-examined. It is not fair or appropriate. Competition is not the wonderful thing it is claimed to be. Look at the impact it has had in spreading the plague of drink in this country, with every huckster shop piled to the ceiling with gin, wine, beer and so forth, and open all night. This happens in the name of competition. Let us not pretend competition is the be all and end all.

Reference should also be made to the letter to The Irish Times from former Deputy, Mr. Tim O'Malley. It is an interesting letter that gets the situation right; he puts the patient centre stage. He wrote it as a pharmacist. He is a former colleague of the Minister and a decent man. He referred to the clawback by the HSE. I urge the pharmacists to be very careful. The pharmacists are marvellous people but there is a notice on the window of my local pharmacy telling customers that the pharmacy will be closed tomorrow for a meeting. These meetings usually take place on Sunday, so the pharmacists are definitely using the patients and customers. They should be careful about doing so because they are in great danger of alienating the public, as they did when they threatened to withdraw methadone services. That was cruel and callous and, from the point of view of public relations, stupid.

There should be genuinely independent arbitration of this matter. I am concerned about small pharmacies going out of business. Like other Members, I have received a sheaf of letters from pharmacists throughout the country, and they cannot all be wrong. They suffer under the economies of scale and the fact that the larger pharmacy chains are in a far stronger position to negotiate with the pharmaceutical companies.

Another point should be made. There are plenty of people around here who will suck up to the pharmacists for their votes. I am not one of them. I have supported the pharmacists over the years, when others would not, on ideological grounds. However, where there is a wholesale services mark-up of 17% on medicines in this country and it is only 7% in Europe, there is something wrong. We must examine it and we are being dishonest if we say otherwise. It may be the case that the smaller pharmacies should be cushioned in some way against this, and I would support that. However, I am not in favour of profiteering. There are large pharmacy chains in this country but the number of pharmacies has increased by 26% in the last couple of years. That does not suggest that all pharmacies are on the margins. I am prepared to believe that the rural and community pharmacies are but why should patients pay twice the price their European counterparts pay? Why not go to Europe and return with suitcases full of drugs?