asked the Minister for Health the reason psychiatric patients attending hospitals as outpatients are not entitled to free drugs and medicines; and if he will make a statement on the matter.
Ceisteanna—Questions. Oral Answers. - Free Drugs and Medicines.
9.
In all health board areas persons covered by medical cards who attend outpatient psychiatric clinics obtain their medication free of charge. Depot injections are also provided free. These arrangements cover the great majority of patients. Practice varies, however, between health boards in relation to persons who are not covered by medical cards. In two areas the drugs are provided free of charge. In the rest of the country the patient is given a prescription which he has dispensed in the ordinary way, as is the case with patients attending any other outpatient clinic. I have arranged for officers of my Department to raise these variations with the chief executive officers of the various health boards.
Is the Minister aware that the practice actually has changed in some areas, that patients attending St. Dympna's Hospital in Carlow and patients from that hospital who are visited in their homes by the nurses, have recently been refused free medicines and have been given prescriptions? Would the Minister agree that the policy of bringing such patients — a highly desirable policy — into the community and keeping them there is being attacked or undermined by the fact that medicines will no longer be available to them free of charge? Would he consider giving such patients a special medical card to cover the cost of the particular drugs, and the regime of drugs required, to enable them to stay in the community?
I accept what Deputy Stagg said that there has been a change in the practice in particular health board areas and, indeed, over the years there has been a change in many health board areas in regard to the supply of medicines. I suppose there is no area of medicine that has changed as much as psychiatry over the years. It is a matter of clinical judgment what particular system is adopted: in one psychiatric catchment area one psychiatric hospital decides to provide the drugs and in another they do not. As I have pointed out to the Deputy, we will discuss the variations with the chief executive officers of the health boards.
Now that the Minister is aware that there are two different methods of dispensing drugs, what are his views on the two methods and does he intend to have them standardised? He said he would investigate the position nationally. Does he intend giving a direction to the health boards to have a standard method adopted throughout the country?
My own view is that it is a matter of clinical judgment. It raises a fundamental question as to whether the general practitioner or the doctor from the psychiatric hospital, a psychiatrist, assumes responsibility for the ongoing management of the patient. The trend in psychiatry has changed very much over the last 20 years when it was a hospital based service. With the advent of modern drug treatment, the service has become very much community orientated. In the context of the working party report Planning for the Future subscribed to by all Members of the House, it would appear that the general practitioner service will play a greater role in the management of patients. Against that background a decision has to be made as to who will be responsible for the dispensing of the drugs.
I am calling Deputy Richard Bruton.
I am somewhat confused. The Minister seems to accept Deputy's Stagg's point that this is undermining community care and then he says it is a matter of clinical judgment. May I ask him what will be raised with the chief medical officers if he is saying to us that their reply "It is a matter of clinical judgment we have taken," will be accepted by the Minister? What is the point of raising it with them if the Minister says they can do what they like?
At no stage did I suggest that what was happening was undermining community care.
I understood——
What I agreed with Deputy Stagg is that there is a variation and that changes have been taking place over the years in various health boards.
Is that a bad thing?
For example, in my own health board, it must be ten years ago since they ceased to dispense drugs directly to the patients and gave them prescriptions. What I am going to discuss with the chief executive officers of the health boards is the variation between the boards to see if there is some common ground which would be beneficial to the patient.
Can the Minister——
Even after——
Order, please. Deputy Stagg for a final supplementary.
I am puzzled. May I ask the Minister how clinical judgment is involved in whether a patient pays for drugs? Is the Minister aware that for the first time ever in the areas I am talking about specifically that patients are now being charged for drugs and that arising from that they are going without drugs? Is the Minister aware that this will undermine the whole community aspect of psychiatric care because the public are now afraid of patients who are not getting the drugs they require for their treatment and they are out in public?
We will raise with the chief executive officers of the health boards the issue of the variations and of what is in the best interest of the patient.
What is the Minister's view?
As I see it the question is whether the psychiatric hospitals continue to dispense drugs directly from their supply to the patients——
I am talking about the payment.
——or whether the patient receives drugs in the normal way through their general practitioner and pharmacy. That is related to the clinical judgment as to whether the psychiatrist should assume responsibility——
The problem is that the patient has to pay for the drugs.
That is the issue.
Please, let us hear the Minister's reply.
The patient——
Please, Deputy Stagg.
What is the Minister's view.
Let us proceed to Question No. 10.