28th February, 2002
Dr. Henry: I am delighted the Minister of State is here to take this debate as he will know, being in general practice like me, that if one writes a prescription, there is a very good chance that one's instructions will be reinforced when the patient gets to the pharmacy. We have had a very good network of community pharmacies all over the country where individual attention was given to patients, which was extraordinarily important. They were frequently advised on health matters which was important in freeing our accident and emergency departments and general practitioners of unnecessary visits. The Minister of State will understand the value of these pharmacies.
There have been problems regarding the regulations introduced in 1996 but the road the Minister has taken, bringing in total deregulation, has been unwise. The Minister set up a committee last September to look at deregulation of pharmacies, as we have had ridiculous incidents where, because of the ruling that starting a new pharmacy could be considered a threat to existing pharmacies, such pharmacies could not be opened in neighbouring towns. That was not good.
However, the Minister pre-empted the findings of his own group by bringing in deregulation of the retail pharmacy business on 31 January this year. Unofficial statements from officials in the Minister's Department and a report in The Sunday Tribune following that announcement suggest that even they were anxious about this. The Minister said he had to bring in deregulation because it was ultra vires since 1998 and that he had to act. However, it would have been better if he had waited to discuss this with the committee. The Deloitte & Touche report stated that products supplied by pharmacies seemed good value for money. I realise the price of pharmaceutical products is dearer in some of our pharmacies here than in other EU countries. There might have been a better way of dealing with the situation, such as bringing in a prix fixée such as exists in France and Italy. We cannot just look at the price of individual pharmaceutical products.
This country has one of the lowest rates of consumption of medicines in the European Union. That is largely because pharmacists do not press people into getting extra pharmaceutical products. The same may not happen if pharmacies are based in supermarkets where the individual pharmacist may not have the same feeling for the community.
We also have a very low rate of drug reactions and admissions to hospital due to poor compliance in taking pharmaceutical products. This is very important and I do not think it has been taken into account. Good advice is needed in this area and patients get it from existing pharmacies. During the winter, when there has been such a crisis in terms of people on trolleys in accident and emergency departments, a colleague of mine contacted me, asking if anyone had taken any account of the number of people who have to be kept in hospital due to reactions of an adverse nature to pharmaceutical products. I had not thought of it at all, but he felt that a reasonable percentage of bed days in hospital were due to such reactions. If we adopt a less personalised system, more of these beds may be taken up.
Pharmacists, as I am sure Members saw, were frightened that the Minister's actions would favour foreign companies and chains at the expense of independent local pharmacies. I do not know how this point was reached. I note that Gehe, the German pharmaceutical retailers, have pulled out of buying the Unicare chain. What happened does not seem to have satisfied anyone. I ask the Minister of State to explain why he believes this is the right way forward.
Mr. Cosgrave: I thank Senator Henry for raising this issue. Could such deregulation mean that in certain areas it will be more difficult for people to get prescriptions? I am thinking of rural areas in particular where it may not be economically sound for some of the bigger chains to open branches. Increased competition might put the local pharmacy out of business and the consumer at a disadvantage. In certain areas, the local pharmacy, like the post office, is a focal point. Local pharmacists know their customers' needs very well. In the context of this debate, I ask the Minister to consider if certain pharmaceutical products can be included in the general lists. I support Senator Henry's comments on this issue. A number of people have contacted me about it.
Minister of State at the Department of Health and Children (Dr. Moffatt): I thank Senator Henry and Senator Cosgrave for raising this issue on the Adjournment. The retail pharmacy trade has not been deregulated. That is a very misleading statement and it is very important that the Seanad understands the position. The opening and operation of pharmacies has been governed by the Pharmacy Acts since the 19th century. Anyone who complies with the provisions of the Acts and regulations may open a pharmacy. However, only fully qualified pharmacists may operate a pharmacy; this is as it should be. Openings are also subject to restrictions imposed by non-pharmacy legislation such as the Planning and Development Act, 2000.
The 1996 pharmacy contractor regulations, made under the Health Act, 1970, set out the consent procedure for awarding a health board contract to provide prescription items under the community drug schemes. The 1996 regulations did not control the operation of a pharmacy, its opening or location outside that contract. During ongoing legal challenges to the regulations, the Minister sought advice from the Attorney General's office on the legal basis for the regulations. The advice received concluded that the regulations were ultra vires. Given that advice, he could neither defend the regulations in court nor make settlements under them. Therefore, he revoked the regulations on 31 January 2002.
The net effect of the revocation of the 1996 regulations is that there are no restrictions on the granting of new health board contracts in terms of location, population or viability of existing pharmacies. The revocation does not affect the operation of the community pharmacy scheme; existing pharmacy contracts still stand. The Minister has consistently supported a regulatory framework for community pharmacy services, as for the health services in general. The Department has spent four years and a considerable amount of money defending this framework in court and in other quarters. While it was not possible to continue doing so, the decision to revoke the regulations was not taken lightly.
The pharmacy review group is examining, among other things, issues raised in the OECD report in relation to the consent procedure for granting community pharmacy contracts. The revocation of the 1996 regulations resulted from legal factors and did not involve any of the issues the group was set up to examine. The group will continue to operate under its terms of reference. It is now being asked to report as quickly as possible in light of the new circumstances. The type of framework, whether statutory or otherwise, required for community pharmacy services will be considered when the group reports.
I concur with many of the remarks made by the Senators regarding the value of the pharmacies we have and the personal treatment they give to their clientele.
Dr. Henry: I thank the Minister for his reply and hope the review group moves very quickly.
