Thursday, 5 April 2007
Pharmacy Bill 2007 [Seanad Bill amended by the Dáil]: Report and Final Stages
This is a Seanad Bill which has been amended by the Dáil. In accordance with Standing Order 103, it is deemed to have passed its First, Second and Third Stages in the Seanad and is placed on the Order Paper for Report Stage. On the question "That the Bill be received for final consideration", the Minister may explain the purpose of the amendments made by the Dáil. This is looked upon as the report of the Dáil amendments to the Seanad. For Senators' convenience, I have arranged for the printing and circulation of the amendments. The Minister will deal separately with the subject matter of each related group of amendments. I have also circulated the proposed grouping in the House. Senators may contribute once on each grouping. The only matters that may be discussed are the amendments made by the Dáil.
I am happy to oblige Senator Browne. Many of the amendments were made in the Dáil on the basis of suggestions by Senators. These include the name in Irish of the Pharmaceutical Society of Ireland, substituting "pharmacy school" for "faculty" and ensuring that when pharmacists are elected by the society, they are automatically nominated by the Minister, which was always the intention. All these matters were addressed in Dáil amendments on foot of the Seanad debate. A number of other amendments are technical in nature, involving commas and spelling changes. For example, the "e" was left out of "judgement".
Senator Ryan or Senator Henry asked whether a doctor giving evidence to a fitness to practise committee would have immunity. We have ensured that will be the case by making an amendment to that effect.
With regard to the sections pertaining to conflict of interest and fitness to practise, we would all acknowledge that the decision to prescribe should not be contaminated by any beneficial interest in a pharmacy business. After legal advice from the Attorney General, the view was taken that legal effect could best be given to this matter by way of conflict of interest provisions in the legislation. These were introduced on Committee Stage in this House, as I had indicated when the Bill was published. A lengthy debate took place and Members in both Houses of the Oireachtas were contacted.
The intention was never to stop landlord and tenant arrangements. Anybody in this country can own property and rent it out at normal market rates. We never sought to prohibit that, although it was suggested that we did. It was also suggested that we might foster ambiguity through the use of the word "economic" and that "commercial" might be a more appropriate word. I asked the Attorney General to advise on the matter and he felt "commercial" was the more appropriate word because, if somebody rents a premise, it is an economic relationship.
In a business with two partners, whether two doctors or two pharmacists, the Seanad amendments provide that both partners can be brought before the fitness to practise committee where one behaves unethically, which is clearly unfair to the person who has not transgressed. We have provided that where a partner becomes aware of unethical behaviour, he or she has 21 days to report it to the regulator. If the partner is unaware or knows nothing, he or she cannot be brought before the fitness to practise committee in respect of the activities of his or her partner. I consider that fair and reasonable.
Under the rubric of fitness to practise, we have given strong powers regarding unethical behaviour to the Medical Council and the Pharmaceutical Society of Ireland in regard to doctors and pharmacists, respectively, to ensure some of the behaviour we have heard about in this country can be properly investigated. If the behaviour is found to recur, the society can take the ultimate step of having a practitioner struck off. However, the legal bar will have to be high because the decision will have to stand a test in the courts.
What we are doing in regard to this Bill is appropriate and ethical and will ensure prescribing and dispensing are not connected through any beneficial commercial arrangement. Most people accept the Government's decision in that regard.
I welcome the Bill in general, and the Minister has clarified several issues. I am aware the IPU would have preferred a blanket ban on the collocation of pharmacies in primary care centres but I understand why that did not happen. I am happy we have clearly set out in the legislation that pharmacies must have separate entrances to primary care centres. I reiterate the need to introduce urgently the concept of writing clearly on a prescription that it can be used in any pharmacy in the country. This will remove any doubt about an obligation to use the nearest pharmacy. These are all important steps.
People ask what exactly is the purpose of the Bill, and I am still a bit confused. We all spoke about the need to prevent a scenario where a doctor gains financially from a prescription because of an economic relationship whereby a pharmacist rents property from the doctor or where the turnover of a pharmacy is related to the rental income. Clear conflicts of interest arise in these situations.
For everyone's sake, will the Minister clarify whether a blatant capitalist can get involved in primary care centres, establish a few doctors there and rent space to a qualified pharmacist? Does this Bill tell a doctor or a pharmacist that they cannot get involved in these areas? I imagine this would go against constitutional rights. I am sure everyone is entitled to own property and earn an income. Does this Bill state to doctors and pharmacists that they cannot own these centres or they risk going before the Medical Council or pharmaceutical society respectively?
It is important that we include a review mechanism to see how it works in practice. It would be worthwhile if a guarantee could be given today that we will review this in three years' time. The next Dáil, Seanad and Minister for Health and Children, who perhaps may be Deputy Harney again, can then see whether it has worked out as we envisages or requires further tweaking and fine-tuning.
I read through the amendments made by the other House, most of which are technical and deal with typographical errors. With regard to the section referred to by Senator Browne, the subject matter of the representations made to me are addressed in the Bill. As a consequence, I am satisfied. The Bill continues in the spirit of the Health and Social Care Professionals Act. Having a prescriber and dispenser doing the same job is outlawed by the Bill and the pharmaceutical profession was anxious to ensure this happened. If the Bill does nothing else, it has done fine work by doing this.
Recently, I heard a doctor being interviewed on the radio. He established a for-profit hospital but stated he did not do so for money. I tried to figure out what he meant. Pharmacists can own premises where doctors have a medical practice. Doctors can own premises where pharmacists have a business. A normal landlord and tenant relationship can exist between them and planning authorities can give planning approval for these facilities.
If a group of doctors come together and advertise for someone to collocate with them and in a normal market situation the highest bidder is a pharmacist, no issue arises. However, it would be prohibited for somebody to demand extraordinary amounts of money for a pharmacist to locate there. It would not be normal market conditions and therefore outside the scope and would facilitate the Pharmaceutical Society of Ireland or the Medical Council having an inquiry into fitness to practise.
The Bill will not allow any unethical behaviour or any benefit to the doctor from having the pharmacist on the premises and vice versa. A pharmacist, apart from those who sell other products, depends for his or her pharmacy business on prescriptions from doctors. Being close by, whether beside one or in the same shopping mall, is a huge convenience and a bonus factor. Other than those normal conditions, nothing can happen.
With regard to a review, this is new and pioneering legislation. It will give powers to the regulators, which is appropriate, to deal with these issues on the basis of fitness to practise and ethical guidelines. The society must draw up such guidelines on foot of this Bill. I am a strong fan of those being regulated having an understanding of what is required and permitted. This will be a challenge for the Pharmaceutical Society of Ireland and I have great confidence in its capacity to be able to do it.
I thank the House for facilitating the speedy passage of this Bill. It has been passed by the Oireachtas, completed its parliamentary process and within the next ten days will be signed into law by the President. It is truly an historic moment for pharmacists, the pharmacy profession and the Pharmaceutical Society of Ireland.
I especially thank Members of the House, the Bills Office which was put under enormous pressure, the Office of the Parliamentary Counsel and, last but not least, Mr. Colm Desmond and Mr. Tom McGuinn, who sat behind me during the debate, and Mr. Tom Monks who is not present today. These three officials worked extraordinarily hard under a very tight deadline to ensure this became law.
I gave a commitment that this Bill would be passed into law on my watch, which is not to state I do not intend to have a watch after the rendezvous with reality in a few weeks' time. I was determined this would be done and I am very pleased it has been. It provides a modern framework for the regulation of the pharmacy profession in Ireland. It is long overdue and it is terrific we now have it. It will be a cause of great solace to the Pharmaceutical Society of Ireland. I thank it and the IPU which made invaluable contributions to the formation of the Bill at many stages. Their contributions were insightful, well informed and helpful and the Bill is the stronger for their co-operation and input.
I thank the Minister, her officials and the Bills Office for their assistance. I have a greater understanding of the health services after four weeks of debating health Bills in the House. I thank the IPU, the Irish Pharmaceutical Society and the hospital pharmacists for their assistance. I acknowledge the role played by the Irish Pharmaceutical Society during the past 135 years and wish it continued success in its new guise and role. It has plenty of work ahead of it. The legislation has put a great onus on it.
I am not 100% convinced we did the right thing in the Bill and it remains to be seen how it works in practice. My main concern is that when patients go to a doctor, they are not prescribed drugs because of commercial interest. I hope this never happens and I hope no one is prescribed or over-prescribed drugs he or she does not need. The main aim of the Bill is to ensure patient safety.
The business world is unusual and it is difficult to prove matters after a while, which was proved recently by tribunals of inquiry. Although we may have heard innuendo about politicians in the past, many of us in the House have been flabbergasted by the truth, which was much worse than any of us ever suspected. I hope the Bill will go some way in regulating this area. Although I would have been happier to see a built-in review, perhaps we will ensure it happens when Fine Gael is in Government and Deputy Twomey is Minister for Health and Children.
The Senator may as well dream here as in bed.
As the spokesperson for health and children on this side of the House, I am very pleased to have been associated with the passing of this legislation. I compliment the Minister, as others have done, who has been very pioneering with legislation in general, and not just this. I also compliment the IPU and the Pharmaceutical Society of Ireland, who could give lectures on how to appropriately make representations. Their representations were very balanced, well researched and very well informed. I know many of them and only in the past few days I have spoken to a number of them. They are happy with the legislation in the main.
This legislation is long overdue and in the fullness of time, although there may be doubt from some quarters over its potential effectiveness, I am convinced it will present itself as very well informed and useful legislation. It will not alone serve the pharmaceutical profession well, but society in general. The latter group is what it is all about.
I add some words of congratulations. The Bill is very comprehensive and was clearly not simple. It takes the place of Acts dating back to 1875. I congratulate the Minister for the manner in which it was taken. The heart of the Bill was patient safety and health, and the officials and content of the Bill have taken this into account very capably.
I join with previous speakers in offering my congratulations to the Minister and her officials in bringing forward this piece of legislation. The points made are valid and great recognition is due to the commitment shown by the Minister in bringing forward this legislation and honouring the promise she has given since she took over as Minister for Health and Children to replace legislation which was lacking.
Senator Browne is not sure that we have got it right, but I have not seen any amendments suggesting it would have been any different if it had come from Fine Gael.
The prescription of drugs is done by doctors, not by pharmacists, who would dispense the drugs. That is the difference between them.
I compliment the Pharmaceutical Society of Ireland and the IPU for approaching this legislation in the manner that they did and the contributions they made behind the scenes in informing people and stating the case, as Senator Glynn noted. It was very difficult legislation in that it had to acknowledge the commercial realities, company law and the Constitution while affording people the rights to trade and enter into business. It equally seeks to protect the interests of patients and ensure their safety.
With this legislation we now have recognition of the role of pharmacists and pharmacies as an integral part of our health service. For all those professionals working and in contact with so many members of the public on a daily basis, the legislation gives them the due recognition they deserve. By building on this I hope we will see far greater use of pharmacists in delivering a comprehensive health service in this country which the public so richly deserves.