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Dáil Éireann debate -
Wednesday, 20 Feb 2002

Vol. 549 No. 1

Other Questions. - Community Pharmacy Regulations.

Liz McManus

Question:

35 Ms McManus asked the Minister for Health and Children further to his decision to revoke the health (community pharmacy) regulations, his views on the impact of the decision on the viability of small pharmacies or on standards in pharmacies; the steps he intends to take to ensure that large corporate retailers and foreign-owned multi-nationals do not take over pharmacies leading to consolidation and rationalisation in the medium to long-term; his plans to meet the Irish Pharmaceutical Union to address the issue of its contract; and if he will make a statement on the matter. [5760/02]

Monica Barnes

Question:

68 Mrs. Barnes asked the Minister for Health and Children the reason the pharmacy regulations, 1996, were revoked before the pharmacy review group had completed its work; and the steps he intends to take to ensure a continued spread of community pharmacies in centres large and small throughout the country. [5855/02]

I propose to take Questions Nos. 35 and 68 together.

Following legal advice from the Office of the Attorney General, I revoked the Health (Community Pharmacy Contractor Agreement) Regulations, 1996 (S.I. No. 152 of 1996), which set out criteria and procedures to be used by the chief executive officer of a health board when determining applications for granting community pharmacy contracts. The effect of the revocation, for the awarding of new community pharmacy contracts, is that there are no restrictions on granting new contracts in terms of location, population or viability of existing pharmacies. The revocation does not affect the operation of the community pharmacy scheme and existing contracts still stand. All existing contract applications and appeals lapsed with the regulations. Those affected should contact the health board directly concerning re-applying.

The opening of new pharmacies continues to be governed by the Pharmacy Acts, subject to restrictions imposed by non-pharmacy legislation, such as the Planning Act. The pharmacy review group, established by my Department to examine the pharmacy issues raised in the OECD report on regulatory reform in Ireland, is now being asked to report as quickly as possible, given the new situation. The type of framework, whether statutory or otherwise, required for community pharmacy services will be considered when the group reports. I am considering a number of options pending the completion of the work of the group. I have already met representatives of the Irish Pharmaceutical Union to discuss their concerns following the revocation of S.I. No. 152 of 1996. A further meeting will take place shortly.

As Minister for Health and Children, my responsibilities centre on the provision of a high quality health service and this includes ensuring, in so far as possible, that adequate and accessible pharmacy services are generally available. The decision to sell a pharmacy is a matter for the proprietor concerned. However, I am aware of a recent transaction which was brought to the attention of my colleague, the Tánaiste and Minster for Enterprise, Trade and Employment, Deputy Harney, who subsequently referred it to the Competition Authority. I understand the authority has recently recommended that the sale should proceed.

The overall increase in community pharmacy contracts under the 1996 regulations was approximately 50. Of these, about half are outside urban areas. However, applications for rural areas were also refused by health boards under the population, distance and viability restrictions of the 1996 regulations. Therefore, the effects of the 1996 regulations are not clear. The pharmacy review group will be studying the extent to which the 1996 regulations achieved the objective of a wider geographic spread of pharmacy services. An assessment of the effects of revocation of S.I. No. 152 on geographic spread, without data on the achievement of this objective under S.I. No. 152, would be merely speculative.

What time elapsed between obtaining the legal advice from the Attorney General and making the announcement on deregulation? Will the Minister accept that the regulations which were in place needed to be changed but that in terms of health care needs nobody had been pushing for total deregulation? Will he accept that the present situation leaves open the possibility of major multinationals, multiple chains, taking over the pharmacy business, which is not necessarily a good thing, and there is nothing to prevent that happening? The time frame for providing a new regulatory framework, even if it is ahead of the review group reporting, presumably will be fairly lengthy. Meanwhile one can presume the horse will have bolted and by the time a new regulatory framework is in place it may be inappropriate because of changes that have occurred. This will be the free market gone crazy.

I was not pushing for a deregulated market. That was the reason I set up the pharmaceutical review body to deal with the issues that emerged in Ireland in the context of the OECD regulatory reform report. I was quite satisfied to go along with that. On the question of the time frame, the Dame Street case arose in October. During November I saw the notes on the file from my senior counsel on that case which indicated that these regulations were ultra vires. I then sought an opinion from the Attorney General which I received in January on the Monday of the week I decided to revoke the order. The reason for the pressure was that on the Friday following the Monday on which I received the Attorney General's opinion, the Dame Street case was back in the High Court. I had to make an immediate decision on whether to continue with a position which I knew in my heart and soul was untenable given that I had been advised these regulations were invalid. The advice was as strong as one could get, so I decided to be up front and say that, as far as I was concerned, the regulations were invalid and I would revoke them. That was our response to that deadline of the court on the Friday. We were in line to be sued by the person concerned. I realise there is a time frame issue. I do not expect to see multinationals coming here this month or next month. From a personal viewpoint, I do not want multinationals to be—

Will it stop them?

The existing regulations did not stop them nor did they stop multiple ownership. There is evidence under the existing regulations that multiple ownership was happening in any event and clusters of pharmacies were being collected by big interests. The one I referred to in terms of the Competition Authority, was well in train long before the decision to revoke. I do not buy the argument that because of deregulation many multiples will come in. Nonetheless, we want the issues of quality and public health foremost in a policy of pharmacy provision and access to pharmacy services. That is what would inform our position from the perspective of the Minister for Health and Children in the context of the pharmacy review. We want built in guarantees in respect of quality and protections for public health because it is medicine that is being dispensed, not sweets or anything else. I hope that can be done as quickly as possible.

The Minister appeared to take umbrage when I suggested earlier that he had been "got to". Will he tell the House what happened to light this fuse? The decision to revoke the order was announced on the same day as the major decision on the "Bertie bowl" so as not to catch much attention. The Minister established the review group only last November on which the Competition Authority and the Consumers Association were represented. Will the Minister agree that deregulation of the taxi service has been a fiasco? Fares have increased and no more taxis are available because they work only limited hours given that the licence costs only £5,000? Will he agree there is a danger that pharmacies will be deregulated in the same way? What plans has the Minister to ensure a service is available in every village and town and at weekends? Is it not a fact that he controls the cost of drugs because he gives the pharmaceutical companies the UK price plus a mark-up? The cost of drugs is not the issue. Will he tell the House if it is correct to say that a multinational coming into the market here can take over many pharmacies but would not be allowed do so in their home state?

Why did the Minister not allow the review group to report? Will he agree the best approach would be to rescind the deregulation statement he made and to give the review group four to six months in which to report? The Consumer Association and the Competition Authority are represented on the review group.

The Deputy's time is up.

I have a family interest in the pharmacy business . Will the Minister accept that one of the outstanding issues that needs to be resolved in terms of pharmacy legislation, which deregulation does not address, is the entitlement of pharmacists who qualify outside this jurisdiction to manage pharmacies in the State? There continues to be discrimination under legislation or regulation that militates against their entitlement in that regard. What steps does he propose to take in that area?

I am concerned at the effect of the Minister's decision on rural areas. Services, such as pharmacies, will have to close because supermarkets will provide a service. As I said to the Minister on Monday morning the "bull's eye" counter will be on one side and the drugs can be picked up on the other. Is the Minister taking into account depopulation of the west and the withdrawal of services? I am sure his relations in west Cork will not be too happy with these decisions either.

I cannot break the law and I should not break the law. Neither should I stand over something that is legally invalid. That is the net question and is the only basis on which the decision was taken. I have explained to Deputy McManus how this arose. It arose directly out of the Dame Street case and advice I received. I put that formally to the Attorney General and asked for a comprehensive legal opinion which I got. It was stark and certain in terms of advice to me which left me with no option but to do what was morally the right thing to do—

Why did the Minister set up a review group last November—

It was set up before last November. That is why it was not tenable for me to continue with the regulations. I refer the House to what happened under the nursing homes subvention scheme. For years, the Department and others, for whatever reason, stood over regulations which were subsequently found to be invalid.

The Minister was either incompetent or had no judgment.

Everybody across this side of the House pilloried the Department for that and every newspaper pilloried health boards for standing over regulations that had no legal basis. Neither I nor the Department would do that when it became clear to us that regulations were invalid.

Why did the Minister not tell the review group—

On the question of multinationals coming in and multiple ownership, they will not come in immediately. We do not have a huge number of pharmacists here. They are not there because of the restrictive nature of access to which Deputy Creed alluded. People who are educated outside this country cannot enter and open a new pharmacy. This is one of the issues we asked the pharmacy review body to examine. If I was to move on it now, it would open the floodgates in terms of pharmacies in the counties concerned. While people may be worried about having some degree of regulatory framework in the system, I would prefer to leave the pharmacy review body to deal with this in the fullness of time. One of the greatest barriers or impediments to pharmacies everywhere is—

I guarantee the Minister will change his mind outside the House before the election.

Under the 1996 regulations, many pharmacies in rural areas were turned down, the most notorious being Knock. For once, we heard Deputies Ring and Kenny attacking me because they could not get set up.

New ones were set up in my constituency.

We have to evaluate the degree to which the 1996 regulations were affecting access to services in rural areas. We want pharmacies in rural areas and are committed to ensuring people in these areas have access to them.

Why did the Minister put the cart before the horse?

Written Answers follow Adjournment Debate.

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