Mary Seery Kearney (Fine Gael)
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The debate will follow the normal pattern with ten minutes for the Minister, ten minutes each for the groups spokespersons and five minutes for all other Senators. The Minister will then be called to reply not later than 2.05 p.m and will be given no less than ten minutes to reply to the debate. The Minister is welcome.

Stephen Donnelly (Wicklow, Fianna Fail)
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It is good to be back in the Seanad. I am pleased to introduce the Health (Miscellaneous Provisions) Bill 2024 to the Seanad. The legislation, when enacted, will have four main aims. The first aim is to provide an exemption on up to €14,000 of rent a room income. That income will be a disregard for medical cards and GP visit cards in any income assessment. The second aim of the Bill is to clarify regulatory powers concerning the supply and administration of medicinal products and, critically, will provide a basis in primary legislation for community pharmacists to begin prescribing for common conditions. The third aim is to enhance the oversight powers of the Pharmaceutical Society of Ireland, which is the pharmacy regulator, to support pharmacy prescribing. The fourth aim of the Bill is to provide for the establishment of regulations to help to deal with shortages of medicines.This will include a framework for therapeutic substitution by pharmacists in line with a clinically approved protocol. There is also a technical amendment to the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023 and I will set that out.

I would first like to focus on the exemption of rent-a-room income from the medical card and GP assessment process. The rent-a-room tax relief allows participants on the scheme to earn up to €14,000 per year, tax free. That is if they rent out a room or rooms in their home for use as accommodation by others. Currently, income eligible for rent-a-room is included in the medical card and GP assessment processes, even though it is tax free. Exempting this income is an important addition to a much wider set of measures the Government has already introduced to respond to housing challenges. We know there are homes which are well located but currently underoccupied. This legislation, we hope, will bring more of these into further use. It will do this by providing more options for people, both those seeking to rent out a room and those looking for rooms to rent. The measure will assist in removing some potential barriers to people benefiting from the rent-a-room scheme.

Mary Seery Kearney (Fine Gael)
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I am loath to interrupt the Minister but I need to greet our visitors. I apologise to the Minister, but he will get whatever time he needs.

I welcome the members of the Ballyduff Lower bridge club, who are guests of the Minister of State, Deputy Butler. We also have two private guests who are here as guests of Deputy McDonald.

I thank the Minister. He has the floor.

Stephen Donnelly (Wicklow, Fianna Fail)
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I, too, welcome our guests to the Seanad today. They are from the area Senator Clifford-Lee comes from. I am sure she will be responding shortly.

Martin Conway (Fine Gael)
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Senator Clifford-Lee could have been a Deputy for that area, if she had wanted to.

Stephen Donnelly (Wicklow, Fianna Fail)
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I will now outline the proposed changes to the Irish Medicines Board Act 1995. This Act makes broad provision for arrangements for the control of medicinal products, including in respect of manufacture, sales, supply and distribution. The first amendment concerns access to certain approved prescription medicines. During Covid-19 we widened the pool of health professionals who could administer Covid-19 vaccines with the appropriate training and supports. This will be retained and extended so that we have a permanent ability to call on a wider range of healthcare professionals.

When it comes to the expanded role of pharmacists, we would all agree that pharmacies are accessible services, embedded in their communities throughout the country. Empowering pharmacists to provide more care will give people throughout the country more choice and more access to care, critically, closer to their homes, in their own communities. Pharmacists can play a much-expanded role in our health service. I therefore propose the introduction of further steps to support this.

I established an expert task force on the expansion of pharmacy last year to advise me and the Department. The task force is examining the introduction of different forms of pharmacy prescribing and I expect to receive its final recommendations on this in the coming weeks. Pharmacy prescribing will be a major change for health services in Ireland. Critically, it will be a major change for people in all of our communities who might have a simple condition, such as conjunctivitis or a very low-level rash, that requires a prescription medicine. At present, such people have to go to a GP. The GP does not really need to see them, so it is taking up the time of both GPs and patients. A person might have to pay €50, €60 or €70 to see the GP to get the prescription, and then bring it to a pharmacist. The reality is the pharmacists are highly trained healthcare professionals. With additional training, they will, in respect of a very specified set of ailments and conditions, be able to state that it is a skin rash or conjunctivitis, and provide what the person needs. It is going to be a better use of healthcare resources generally. It will be quicker for the public. It will be less expensive because, rather than having a GP and a pharmacist, there will now only be a pharmacist.

The first step, which is the introduction of prescribing for common conditions, is something we are looking to do very quickly. These common conditions are non-chronic conditions which for the most part only last for a short period and are easily treated. International experience is clear that pharmacists can play an important role in this. This Bill aims to enable prescribing activity by community pharmacists for a prescribed set of conditions. This will be a small set of conditions initially. It will expand over time, subject to appropriate clinical advice. This prescribing activity will also include oral contraceptive pills, where clinically appropriate. The activity will be governed by regulations to be set out in secondary legislation. Clinical guidance has been put in place and training for pharmacists is being developed. Pharmacists will have to participate in this training before they can undertake the prescribing activity.

I move now to medicine shortages. As Members will be aware, there is a global tightening of supply chains when it comes to medicines. We are seeing medicine shortages in Ireland, in the UK and right across the world. It is a global issue. A final set of changes to the Irish Medicines Board Act concerns the management of medicine shortages. The measures will introduce medicine substitution protocols which will help to mitigate the impact of these shortages. The protocols will allow pharmacists to therapeutically substitute a medicinal product in limited circumstances where a prescribed medicine is the subject of a shortage. This will be done in strict compliance with HSE drafted and ministerially approved protocols specific to a known or anticipated shortage and for a limited period of time. Ultimately, it will help us to be more agile in response to emerging shortages.

Additional reporting measures are also being proposed, requiring various entities in the supply chain, including manufacturers, wholesalers and distributors, to report on information. These reporting measures align with the EU approach. By strengthening access for the Health Products Regulatory Authority to information on medicines availability, we enhance our ability to introduce practical mitigations in a timely manner. That is an awful mouthful. Essentially what it means is that we do not have end-to-end sight of medicines at the moment. Different parts of the system can see different bits of it. Our regulator cannot currently predict shortages and balance and mitigate shortages as well as it would like to and is capable of doing, because it does not have end-to-end sight of where the shortages might be or might be coming, whether it is in manufacture, international or domestic distribution or in stock being held in certain pharmacies. This will allow it to see that in order to help to balance the load across the system and to predict where we are going to have a problem in order that we can quickly put a protocol in place to allow pharmacists to substitute for another medicine.

There is a key role for the pharmacy regulator, the Pharmaceutical Society of Ireland, in all of this. We are making changes to the Pharmacy Act 2007, which makes provision for the regulation of the profession of pharmacy in the State, including the regulation of retail pharmacy businesses and community pharmacies. The PSI is the regulator of both retail pharmacy businesses and the pharmacists themselves. The amendment to the Pharmacy Act will ensure that regulations made for retail pharmacies can include measures to regulate prescribing activities carried out in those settings by pharmacists. These amendments provide the framework for the PSI to regulate and support current and future developments in pharmacy, including in respect of the future evolution of prescribing functions. The final output of the pharmacy task force, which is due shortly, will be central to this. To support the provisions on the introduction of pharmacist prescribing, the Bill also contains brief amendments to section 59 of the Health Act 1970 and to the Health (Pricing and Supply of Medical Goods) Act 2013.

Finally, there is a technical amendment to the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023 in this Bill. The Department is now moving towards commencement of the patient safety Act and, as part of this process, officials became aware of two minor technical issues which need to be amended in the legislation prior to commencement. They are purely technical amendments.

I look forward to hearing the contributions from colleagues. It is a miscellaneous Bill. There are various pieces in this but, ultimately, it will serve to enhance the role of pharmacists. There is a lot of untapped potential there and we have been working closely with them. It would be remiss of me not to say the following as well. I have spoken at various of their conferences and I meet community pharmacies all the time. Although, to their great credit, they are very enthusiastic about this and we had a really positive conference with them just a few months back, they are making the point that they want an ongoing conversation about pharmacy fees. These fees have not changed for a long time. I committed to pharmacists privately when I met their executive and publicly at their conference and, in the context of this Bill, it is worth putting on the record of the Seanad as well. I have asked my Department to engage with community pharmacists on all of this but, in the round, to include a review of the totality of the arrangement between the State and the pharmacies and a review of the fees.I have not committed to any changes or increases, but I have committed to my Department and the State engaging with them in good faith on the totality of charges that are paid to the State. This will be part of that.

Mary Seery Kearney (Fine Gael)
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I know from tabling Commencement Matters on this issue that the Minister has been working on the legislation for a very long time. Well done to him on delivering it.

Mary Seery Kearney (Fine Gael)
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I welcome the Enniscorthy active retirement group, whose members are here as guests of the Minister of State, Deputy James Browne.

Victor Boyhan (Independent)
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This is very progressive legislation, so I can confirm that I will be fully supporting all aspects of it. The rent-a-room scheme is clearly an issue in terms of medical card criteria. I would have some concerns about the scheme but this is not the Committee on Housing, Local Government and Heritage. Someone rocked up recently and said to me "The person across the road can take €14,000 and a whole set of circumstances, and I'm not in the same position" but that is a matter for debate at another forum. We have to have equity across housing delivery in terms of rent. That is not a matter that I will burden the Minister with at this time. I recognise that it should not affect medical cards. We are in a housing crisis and there are many benefits to having people who can live in houses - whatever the arrangement is - so it is all very positive. Clearly, we do not want to prevent people from having access to full medical cards where they are entitled to them. I accept and acknowledge that.

The expansion in the role of pharmacies is the issue on which I wish to concentrate, because it is important. I acknowledge that the Minister established the task force. There was an interim report, a summary of which I have in front of me, in November 2023. As the Minister confirmed to us today, the final outcome is due shortly. I acknowledge the calibre of the people on the task force because that was really important. The remit of the task force was to identify and support the delivery of specific objectives that would serve to align services and practices that can be delivered by pharmacists and pharmacies with the needs of the health service for patients. That is important.

As I read it, the kernel of this legislation is to empower pharmacists to offer prescriptions and other ancillary services. That is important. The Minister and the task force have placed a heavy emphasis on the safety of people and patients who use medicines. That is reassuring. High standards of governance are dealt with by the task force recommendations to the Minister. Again, this is important. These are the reassurances we must give patients and the people who use our community pharmacies. I like to see the "community" appear before "pharmacies". That is really important. I can walk into my local pharmacy in Dún Laoghaire and talk to a qualified pharmacist. I do not have to go around the back. Pharmacists are dispensing at the coal face. There are concerns and complications, and patients need reassurance. Patients may have an allergic reaction. They have genuine concerns. Our community pharmacists are almost community workers. They do many things and allay many fears. They interface with patients who may present with mental health issues, including anxiety. They may suggest alternatives for people or suggest that they need to go back to their GPs because they have on a particular medication for what may have been too long a period. There is a good, well-established relationship with pharmacists who work in communities, which is important. The Minister spoke about high standards of governance. Regarding access to expert patient advice and advocacy, that is what pharmacists offer. Qualified pharmacists are very experienced and capable people.

The legislation deals with safety, quality and the efficacy of medicines in pharmacies, which is important. It is a very better use, as the Minister said, of healthcare resources. That is a really valuable point. People do not need to go back to their GP and pay €75 for a top-up prescription after three months. If a GP sees that as significant or important, he or she can write that on the notes. We see how technology has developed. Most GPs dispense prescriptions directly to pharmacies, so we see a consistency of relationship in the context of pharmacies, GPs and the medicines being prescribed. We see less of patients going to a number of different pharmacies, which is a good thing.

The Minister mentioned the key role of the pharmacy regulator. For those who may have concerns about this legislation, pharmacies are clearly subject to oversight by the pharmacy regulator, which is important. I have touched on the expert task force supporting the expansion of the role of pharmacies. I acknowledge the meaningful role of pharmacists and the owners of pharmacies. Many pharmacies are now owned by groups, but we still have strong family pharmacies, which is quite unique because you do not see many of these on the Continent anymore.

Community pharmacies play a unique and important role and this is important because it is a patient-centred approach. Sláintecare spoke about this before and the significance and role of pharmacies within a module of Sláintecare. We must constantly keep chipping away at Sláintecare. I know the Minister is committed to Sláintecare. It is important that we acknowledge the high quality and expertise of the cohort of healthcare professionals who are very knowledgeable in this area.

I know someone who on 13 May graduated from the pharmacy technician course. The ceremony happened at the Royal Dublin Society down the road from here. It was organised by the Irish Pharmacy Union. There is a valuable role for pharmacy technicians. Being a pharmacy technician is a career in itself. They are at the coal face in pharmacies, which is important.

I take this opportunity to thank the Irish Pharmacy Union. It publishes a magazine on a regular basis. Every Member of the Oireachtas receives a copy. It contains a section on the contributions of Members, so no doubt we may very well be featuring in it soon. If not, I am prompting that here and now. It is a really good and educational magazine. I certainly learn a great deal from it. Community pharmacies are very important.

The measures relating to patient safety, notification of incidents and open disclosure are really important. I welcome them. I also welcome the fact that there is a technical amendment in this regard. The Minister covered that. I welcome the amendment, because it is significant.

The final issue I want to discuss relates to community pharmacy fees. The Minister has been honest and frank enough, as he always is, that there will have to be some discussion about this matter. I am not saying he has given a commitment, but he has listened. Clearly, this will be an issue. Given that the Minister has put us on notice, all we can say is that we must be sensitive when it comes to fees. Pharmacies are businesses. If they providing additional services, clearly someone has to be paid. However, it is important that we are kept briefed about that as the negotiations with pharmacies evolve. When someone is unwell and has health issues, he or she is vulnerable for a variety of reasons. When people talk about fees, and, in fairness, we have a very good medical card system, they get anxious about increases.I will finish with the point that I visited an elderly person the other day whose GP has prescribed paracetamol, a whole box of pills. I asked her why she had got all of them and she told me the pharmacy says she has to take them. Why has this person got 700 or 800 pills she is not using? The answer is the prescription said so. That is a real concern and we need to get the word out to GPs about boxes and boxes of paracetamol. People can say that if they pop three or four of them a night they will sleep well. The pharmacy is of course not going to turn down the business because it is on the script. We have to be constantly careful. We must be vigilant about how we monitor the levels of particular drugs and where they are being prescribed. There is a league table kept of all the GPs in the country, and I am sure consultants too, and we can see very high prescription rates in certain parts of the country and very high prescription rates with certain doctors. Popping pills is not the answer. Good healthcare is holistic in nature and covers a whole range of issues. I am concerned because I have come across it quite a lot that people are continuing to have all these add-ons and they are costing the taxpayer and costing people. It is not good for us where our taxes are concerned, but more importantly it is not good for the healthcare of the individuals for whom these are being prescribed. What do people do with the excess medication in most cases? They hand them around to their neighbours, which is not very satisfactory. We need to be vigilant. I thank the Minister; he has my full support.

Martin Conway (Fine Gael)
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The Minister is very welcome to the House for the debate on this very important miscellaneous Bill. I was listening very attentively to Senator Boyhan and the overprescribing of what could be described as some over-the-counter medications could be a problem, and certainly a cost one. It is definitely an issue when it comes to people's health. It is funny how people feel a certain reliance on taking tablets unnecessarily. Certainly, the word needs to be got out to GPs to be careful. In most cases they know their patients and the personalities of their patients. We really need to see a collective careful thinking with these boxes and boxes of medication that are in people’s drawers and so on.

On the rent-a-room scheme, there are of course issues with it, but one of the unintended consequences was it was going to be considered income when it came to medical card eligibility. That is not what anybody wanted, but unfortunately there are always unintended consequences and this is just going to tidy up one such issue and that is very welcome. It is sensible and I encourage people out there who have a room and are living alone to consider renting the room out. It is not going to interfere with their social welfare, pension, medical card or any other State benefits they are getting. What is more, it will be nice income, great company and do us all a favour by assisting in finding homes for people who are struggling to get one at the moment. I put that call out and this legislation just underpins the nature of the scheme and what the Government is trying to achieve with the scheme.

It is very welcome we are now looking at increasing the role of pharmacists. I have been calling for that to happen for years and during the pandemic we saw great benefit in what they can do. They are doing vaccinations and all that type of work now. Any piece of legislation that enables us to increase the role of our community pharmacists is very welcome.

While I welcome all the primary care centres that are being opened around the country, the number of them that have pharmacies in them is a concern. Pharmacies on the main street have been providing care to patients for decades, but if a pharmacy suddenly opens in a primary care centre around the corner, what is going to happen? Half the business is going to go. While a one-stop shop principle is a good idea, it is not good if it displaces another business. An example where this could potentially happen is my town of Ennistymon, County Clare. We used to have three pharmacies and now we have two. They are two great pharmacies. They and their teams do great work. There is a primary care centre we hope to see open within the next two to three years. I believe it is going to be advertised towards the end of this year. My understanding is it could potentially include a pharmacy. If a pharmacy opens in the primary care centre in Ennistymon, it is going to close at least one of the other pharmacies in the town. The Minister has been in the town and he knows it and we do not want to see that happen. We need a commonsense approach to providing pharmaceutical and pharmacy services in primary care centres.

Overall, everybody will welcome what the Minister is trying to achieve in this legislation. I have no doubt it will receive unanimous support across the House. I hope we will see it pass in a short space of time and have it signed into law very quickly.

Lynn Ruane (Independent)
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I will not take too much time. I want to outline a couple of things I may seek amendments on when the Bill gets to Committee Stage. Some of them are probably for this Bill and some not, but I would like the Minister to comment on how they fit into the Bill.

The amendment to the Irish Medicines Board Act could probably also include the expansion of nurse prescribing in respect of opioid substitute treatment, OST. When we look at the role of pharmacists, we consider the role they can play given their high level of education and training. I wonder what "uncomplicated common conditions" means. What is an uncomplicated common condition? One thing I am hoping it does not include is access to over-the-counter nasal naloxone. There is a good opportunity within this legislation to name access to overdose antagonists. Has that been considered when we are looking at the pharmacies’ role? Pharmacists could provide this in the same way that they would provide an EpiPen. We have seen in the past how not having over-the-counter access to an EpiPen has led to deaths. The exact same can be said in a huge regard with respect to overdoses, but people are still slow to make that connection and to see just how successful something like naloxone can be in saving lives. It is a question of being able to access that at a local level in our community from a pharmacist the community knows. I am wondering whether there have been conversations on that.

I have another thing to mention, but it is more that I am thinking aloud. It relates to the GP contracts in general. Senator Conway mentioned the primary care centres and the idea of a one-stop-shop. When some brand-new modern buildings have been built, they still give people who use methadone and need to get a methadone prescription a completely different entrance from the one they use for every other health-related appointment they may attend. In our communities right now, we are still building buildings that tell people they need to use a separate entrance if they are there to access methadone. That is hugely concerning given that we are in 2024. We are all having conversations about addiction being a health issue, yet there seems to be some sort of health apartheid when we think of what entrance somebody may come through. That seeps down into the GP contracts when it comes to who can and cannot prescribe methadone from a GP level. I suppose it is about needing the approval of one or two individuals in relation to the central methadone list to determine whether someone can or cannot prescribe methadone at a local level, or at a GP level. Again, it is about the fact that a GP cannot be the person who prescribes the methadone, in the same way that he or she would in the case of benzos, if he or she is working with the person and he or she understands addiction.A GP does not have to get special permission to do a benzo detox in the community, but he or she needs to get special permission to prescribe or to help somebody to detox or to maintain on their methadone. There is still a kind of siloed approach in relation to some medicines. It is creating a division and giving the impression that it is not really a health issue. We are still saying that it is a health issue, but we are putting in place all these other conditions surrounding it. This Bill does not address the GP contracts, but there is space within the Bill to look at nurse prescribing and at over-the-counter access to naloxone in the context of pharmacies.

Mary Seery Kearney (Fine Gael)
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Before we move on to the next speaker, I welcome the guests of the Minister, Deputy McConalogue, and Deputy Martin Browne to the Seanad.

As naloxone has been mentioned, I note that the members of both the Joint Committee on Drugs Use and the Joint Committee on Children, Equality, Disability, Integration and Youth will all undertake training here in the coming weeks on the administration of naloxone.

Aisling Dolan (Fine Gael)
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I welcome the Minister, Deputy Stephen Donnelly, to the House to talk about the Health (Miscellaneous Provisions) Bill 2024.

The rent-a-room relief scheme is crucial. That programme has been brought in for people to have additional income, of course, and to be able to give a space to others. I see it in my home town. Nurses and doctors who come to work in Portiuncula Hospital for six-month stints find it impossible to find accommodation. At a basic level, I do not know if the Minister is aware that the Aircoach service from Dublin to Galway was removed some time ago. The removal of the 20 and X20 service, which was an hourly transport service from Galway to places like Ballinasloe, was removed. Only a little while ago, nurses could not make their morning shifts at 7.45 a.m. The challenges associated with not having accommodation mean that more people are relying on transport. This Bill can give additional accommodation. It can help to support income in towns like Roscommon, which has a university hospital. It is so important. The scheme will be in place when the Bill is passed. What is the situation for people whose cards have been removed in the past 24 months? I refer to those who indicated, when they submitted assessments, that they were looking at the rent-a-room relief scheme. The Minister might wish to comment on that.

The community pharmacy provision is fantastic. I am delighted to see it. We expanded the role during Covid. Of course, there were many difficult things that we had to deal with, but necessity was the mother of invention in ensuring that the community pharmacies were able to deliver, develop and protect people. They were able to deliver vaccines. It was crucial. We have really skilled people. Anyone who comes through pharmacy has an amazing training qualification. It is so diligent and robust.

I suppose I would like to see more pharmacists coming through in the west of Ireland. The Minister will probably be aware that the University of Galway is looking at a course for its proposed school of pharmacy, which would be the very first school of pharmacy in the west of Ireland. Maybe we can look at supporting the roll-out of that course for graduate intake in September 2025. I do not know if the Department is reviewing how we can support the development of these courses but placements will be important in this. I am sure there are placements in community pharmacies. The Minister might comment on how we can make sure we have more skilled people coming through. We have an opportunity because the University of Galway has a course. The Minister spoke about the pharmacy regulator. It is important that we have the support of all of the groups that fall within the Department to be able to have those courses. As a Seanad spokesperson on further and higher education, I am conscious that so many areas cross so many Departments for us to be able to develop and deliver courses such as this. As the Minister will be aware, placements are part of that as well. It is about how we can support encouraging and making sure we have more skilled pharmacists coming through and coming into community pharmacies, particularly when the role is being expanded as the Minister foresees here. It is important for the Minister to be able to rely on this.

I might highlight another course as well. I am sure the Minister will be aware of it, but I am passionate about this one. I refer to the rural and remote GP graduate medical course that is being considered for Galway. Part of the selection criteria around that graduate course is GPs and graduates coming from rural backgrounds. That is part of the eligibility. In doing this course, they will have placements in hospitals in rural areas, such as Roscommon, Letterkenny and Castlebar. They will be able to do their training in those locations but we need to see that course getting rolled out. It is important that there is support from the Department of Health in terms of the placements within the hospitals and the primary care centres, maybe as a pilot stage within the west, within what formally was Saolta and is now the brand new regional executive of the west and north west. How will we see that happen?

This Bill, in its essence, is fantastic. I very much support the initiatives the Minister is encouraging to ensure there will be more prescriptions. He mentioned the oral contraceptive pill in particular. There will be a smaller number of conditions that community pharmacists will be looking at.

The challenge I see in towns and rural areas is the lack of GPs. We are looking at nurses coming in to support that as well. Sometimes it is merely a lack of skilled people who will consider working in more rural and smaller towns. It is an issue that does not apply to Ireland only. One will see that Canada has extremely isolated rural areas. The course I spoke of has seen success in the likes of Canada. I would appreciate the Minister's support through the Department of Health to see something like that being rolled out from September of next year.

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Senators for their support. It is very much appreciated.

I will go through some of the points raised. Senator Ruane raised various points around prescribing for those in addiction. She mentioned prescribing opioid substitutes such as methadone. I do not have a detailed note on this here. However, one of the measures in this Bill seeks to expand the ability of different clinicians or a broader range of clinicians to prescribe. There may well be an opportunity to look at that. I will ask my officials to check in with the HSE and the relevant line units and revert directly to the Senator with a note. If the Senator sees something in that note about which she would like to continue the conversation, she need only let me know and we can meet up and do that.

As for "uncomplicated common conditions", the wording has changed. We started off by calling it a minor ailment scheme. The chair of the fantastic group that was set up, Professor Pat Healy, said at this year's IPU conference that the use of language like "minor ailment scheme" was being banned and the reference now would be to "uncomplicated common conditions". It refers to things like a rash, conjunctivitis or regular non-severe, non-chronic conditions. Professor Healy and his group are stipulating exactly what those things are. A really good group of people has been put together and they are moving at pace.

Lynn Ruane (Independent)
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Does the pharmacist decide that it is uncomplicated?

Stephen Donnelly (Wicklow, Fianna Fail)
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The pharmacists will not decide. They will have a clear list and they will have training in all of these things. It will expand over time. Because we have never done anything like this, we will start with a fairly narrow list but I am pretty sure it will broaden.

I am very open to naloxone being over the counter. I am very open to as wide a distribution as possible. In other countries, it is successfully used much more broadly than it is here. Canada is a very good example. Unfortunately, the reason they have so much of it is because they are seeing so many opioid overdoses. They are dealing with a horrific situation in Canada. Many people are regularly carrying these pens now because so many people are overdosing. In fact, their equivalent of our Secretary General in the Department of Health told me that during Covid, in Vancouver, they lost more people to overdoses than they did to Covid. It is the opioid wave. It came up through the United States. It is something we must be very aware of here.

I am more than happy to look at the use of separate entrances for methadone. I have spoken to clinicians in some of the new primary care centres and, indeed, I have spoken to some of the patients.What they have said to me, but maybe they are only giving me one side of it, is that for some of them, they prefer the anonymity. Some of them do not necessarily want it widely advertised that they are on methadone. They prefer-----

Lynn Ruane (Independent)
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They are all congregating outside and are plainly visible.

Stephen Donnelly (Wicklow, Fianna Fail)
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Sure, but that is what they said to me. We certainly do not want a situation where anyone feels that they are in any way second-class citizens. I am very happy to keep it under review.

With regard to GP prescribing, it is not covered in this Bill but again, I am more than happy to look at that because the Senator made some very fair points. Senator Dolan asked if the medical card adjustment can be applied retrospectively and the answer is "Yes", in that if somebody had a medical card, rented out a room and lost that medical card, he or she can be reassessed immediately. The €14,000 would be gone and if the person qualified for the medical card otherwise, he or she would certainly get it back. There would be no issue there.

On pharmacy places, I tried to get a quick update as the Senator was speaking but that was not forthcoming in the time available. In my view, we have to double the number of healthcare college places in the country, including pharmacy places. We have made progress. I was looking for exact figures but I will ask my officials to revert to the Senator with that information on the exact position. We have been working very closely with the Department for Further and Higher Education, Research, Innovation and Science, the now Taoiseach, Deputy Harris and the current Minister, Deputy O'Donovan, to expand a lot of healthcare courses, including medicine, nursing, health and social care, pharmacy and dentistry.

I fully agree with the points made about the rural GP programme. This has been raised with me by the ICGP and others. They have suggested that we build in more rotations in practices in rural areas. Student GPs tend to be younger and those who may not have spent much of their lives in rural areas often love those areas. A lot more of them are deciding to stay because they feel they are in paradise, particularly if they are doing placements along the west coast of Ireland or in the south west. They are doing placements in beautiful parts of our country that they have not really spent any time in and they are falling in love with them. They are saying that they want to go back as a qualified GP.

Within the new GP contract, we have included measures specifically aimed at rural GPs, including improvements to the rural GP allowance. There is also a new proviso whereby a general practice in a given base can take over another practice and have GPs moving between the two, which gives the advantage of scale. Younger GPs like working in bigger teams. They are not too keen on being the sole GP in a more rural area. We are only beginning to activate the provision now but it means that they might be in a practice with five GPs, meaning they get all of the benefits of different specialisms and interests and learning from each other but they can still fully run a smaller practice in a more rural area. We will see how it goes but we have the provision in place and it is now being used. We are very aware of it.

Finally, the good news when it comes to GPs is that we have tripled the number of training places and this year we have had the biggest number of applicants for those places ever. There is a lot of interest among medicine graduates in going on to become GPs, more than we have seen for a very long time. The tripling of training places means that today, for every one GP who retires, two GPs are entering practice. It is not perfectly like for like. GPs themselves say that older GPs tended to work longer hours and did a lot of the GP-on-call work themselves. The younger GPs are far more sensible. They want far more regular hours and they want more flexibility. We are not getting a one-for-one in terms of hours worked or amount of patient care delivered but in terms of doctors we are still getting a two to one replacement rate which, over time, is beginning to take the pressure off. However, in some areas there is still is a lot of pressure in terms of getting to see a GP quickly.

Mary Seery Kearney (Fine Gael)
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When is it proposed to take Committee Stage?

Mary Seery Kearney (Fine Gael)
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Is that agreed? Agreed.