Pharmacy Bill 2007 [Seanad]: Second Stage.

I move: "That the Bill be now read a Second Time."

It has been the intention of my Department and the pharmacy profession for many years to consolidate and expand existing pharmacy legislation in a new pharmacy Act. Proposals, however, have continually been overtaken by events and in the interim the practice of pharmacy has evolved significantly. Nevertheless, it is clear that without a comprehensive and robust framework of modern legislation the profession cannot develop and increase its input into the care of patients.

To this end, I received approval from the Government to prepare pharmacy legislation in two Bills. It is the first of these two Bills that is now before the House. In brief, this is a Bill to allow for fitness to practise regulations for pharmacists and pharmacies, and, as a consequence, the removal of restrictions on pharmacists educated in other European Union or EEA countries from owning, managing or supervising a pharmacy in Ireland that is less than three years old. It is also proposed to deal with a number of related issues such as an appropriate statutory basis for the Pharmaceutical Society of Ireland and an updated registration scheme for pharmacists and their premises.

The pharmacy review group was established in 2001, principally to examine findings from the OECD on the Irish retail pharmacy sector and the 1996 Community Pharmacy Contractor Agreement. The group consulted widely and submissions were received from a range of sources. The group considered the complex legal and other issues surrounding the OECD's recommendations as well as contractual and professional issues such as medicines management and greater use of generics. The group recommended the removal, following the introduction of new pharmacy legislation, of the restriction on pharmacists educated in other EU or EEA countries from owning, managing or supervising a pharmacy in Ireland that is less than three years old.

The group's recommendations also included proposals on a number of related issues, for example, a stronger statutory basis for the Pharmaceutical Society of Ireland, including the governance of the PSI, wider non-pharmacist representation on its council, updating regulations with respect to the registration of pharmacists, including non-EU and EEA graduates, and some matters concerning the delivery of pharmaceutical services in a community setting, such as linguistic and forensic competence, and experience for supervisory pharmacists.

The second Part of the Bill deals with the setting up of the new pharmaceutical society and the allocation of functions which the society will fulfil in its role as regulator of the pharmacy sector. In particular, the role of the society will be to "regulate the profession of pharmacy in the State having regard to the need to protect, maintain and promote the health and safety of the public". As with other regulatory legislation the Government has proposed, the public interest comes first here and it is my desire that this should be the main goal for all health sector regulators. This section also sets out in detail the duties of the society in the area of registration, education and qualifications, and the powers the society shall have to conduct its functions in these areas and other related areas.

The principal change provided for in Part 3 is in the area of representation on the council of the society. Currently, the council's membership stands at 21, all of whom are pharmacists and, in line with other recent legislation in this area, I propose to increase representation of non-elected members of the council to a majority. A total of 21 members are to be appointed, of whom nine are to be elected by the membership of the society. One academic will be nominated by the colleges engaged in pharmacy education — he or she would also be a member of the society — and the remaining 11 will be appointed as follows: one will be nominated by the Irish Medicines Board; one will be nominated by the Health Service Executive; one by the Minister, being representative of the area of continuing professional education; five will be nominated by the Minister who are not, nor have ever been, pharmacists in this or any other State; and three will be persons who have such qualifications, expertise, interests or experience as would, in the opinion of the Minister, enable them to make a substantial contribution to the performance of the society's functions.

The 11 nominated members, other than those directly elected by the society, and the nominee representing a dean of a pharmacy school will all be non-pharmacists. I have amended the Bill for this purpose in the Seanad. This approach of widening the representation on the council to include a majority of non-pharmacists is consistent with the approach being adopted for other regulatory bodies in the health sector, for example, the Medical Practitioners Bill and the Health and Social Care Professionals Act.

This Part also contains important new provisions relating to the making of rules by the society to enable it carry out the functions assigned under Part 2. In future the rules of the society, as well as being submitted to the Minister and laid before the Houses of the Oireachtas, will have to be published and comments invited from interested parties. This is an extremely progressive and new development in the opening up of the activities of regulatory bodies to wider public scrutiny and a positive step in injecting transparency into the rule-making process for regulatory bodies. Furthermore, the society will have to submit any code of conduct it proposes to the Competition Authority for its opinion on its likely effect on competition and, if the society decides not to accept the authority's opinion, it will be required to attach this opinion, and its reasons for not accepting it, to the draft code of conduct when submitting it for the approval of the Minister. This is an innovative development which will ground in the pharmacy sector an appreciation of the need to have proportionate and focused regulation, with an emphasis on patient safety and being mindful of possible disincentives to competition among pharmacy businesses in the delivery of services.

Parts 4 and 5 of the Bill deal with the registration of pharmacists and pharmacies and the conduct of pharmacy businesses. Part 4 contains sections dealing with the establishment and maintenance of registers, covering pharmacists and pharmacies, and what constitutes a pharmacy business. A modern and robust registration system, one which allows for the removal of registrants, if deemed necessary and proper, is considered essential by all bodies that have made representations to me in this area. The revised registration system will also allow for updating of the registration process for EU-EEA and overseas pharmacists, which has been requested by the Pharmaceutical Society of Ireland for some time.

The provisions in regard to registration recognise the rapidly evolving nature of the pharmacy business in recent years, as well as providing a fair and comprehensive system for assessing the qualifications and training of foreign-trained pharmacists who may wish to work in this country. In particular, the regime proposed in this Bill allows not only for the registration of the individual pharmacist but also, for the first time, the registration of pharmacies. This provision stems from the need to recognise and deal with the increasingly complex ownership structure in the pharmacy sector. The inclusion of a registration system for pharmacies is desirable and necessary as the regulation of the business of pharmacy is the last link in the chain of medicinal product control that has not been legally provided for up to now.

Alongside the registration regime, the provisions relating to the conduct of the business of retail pharmacy will ensure that the pharmacy, or the pharmacy side of any business, will be under the personal and whole-time control of an experienced pharmacist, one with at least three years relevant post-qualification experience. This provision and the requirement that registration be an annual process are important developments in patient safety and in ensuring that responsibility for the conduct of the retail pharmacy business is conducted in an open and accountable fashion. It is very important that those in charge of the pharmacy are easily identifiable to all those availing of its services and to those supervising the procedures in the sector. I am also making it clear that it is an offence to hold oneself out to be a registered pharmacist or registered pharmaceutical assistant, or to provide "skilled pharmaceutical assistance" or to allow someone to do so, knowing that he or she is not so registered. However, this will not interfere with the provision for registered pharmaceutical assistants to provide cover for registered pharmacists in their temporary absence.

Under Part 6, pharmacists will be subject, for the first time, to fitness to practise provisions. In keeping with the aim of the Bill to extend regulation to the pharmacy business as well as to the individual practitioner, both will be subject to a complementary and integrated process. Broadly, the fitness to practise provisions are based on the general template developed for the Health and Social Care Professionals Act 2005. However, the provisions under that template refer to the practice of the individual only. Both the Pharmaceutical Society of Ireland and the Irish Pharmaceutical Union have expressed reservations about such a narrow focus for their profession. They consider that such a fitness to practise system is unworkable if the practice of pharmacy, as it refers to the business of pharmacy, is not also regulated or at the very least, if a licensing or registration system for pharmacies is not also introduced. They argue it is not sufficient to deal with fitness to practise for pharmacists alone, as a problem may well arise due to practice within the pharmacy business.

The two bodies make the point that, unlike medicine, nursing or other health care professions, the pharmacist is more than likely to work in a commercial enterprise and, even if disciplined for a problem related to carrying out his or her professional duties, this may have been the result of a practice of that particular business. Removing or disciplining the individual pharmacist would not therefore deal with the underlying problem; the business could continue to operate as before, without sanction and without penalties applied. Accordingly, given the strength of feeling expressed on this matter, to the effect that pharmacy is unique in the interaction of corporate ownership and professionals in running pharmacies, I have accepted that the registration process and the fitness to practise regimes need to be linked so that remedies and sanctions, if judged necessary, can be applied evenly to those responsible for the provision of the service and not just to the individual pharmacist.

Part 7 gives the council of the society, through the appointment of authorised officers, the powers it requires to police and investigate whether any offence under the Act, any breach of a code or any professional misconduct has been committed. This section is based on similar powers given to authorised officers of the Irish Medicines Board and the proposed powers are wide enough to allow the thorough investigation following a complaint or production of evidence of professional misconduct. The Bill provides for the searching of premises and the taking of samples if necessary. These provisions will give the Pharmaceutical Society of Ireland the necessary means to fulfil its function of ensuring the proper professional practice of pharmacy and the protection and safety of the public as a result of that practice.

The remaining sections deal with largely technical and procedural matters such as the staffing, meetings and accounts of the society. These provisions are based on best practice and similar provisions contained in recent legislation in the regulatory area.

In tandem with the introduction of new pharmacy legislation, the restriction on pharmacists educated in other EU or EEA countries from owning, managing or supervising a pharmacy in Ireland that is less than three years old — the derogation under Article 2.2 of Council Directive 85/433/EEC — will be removed. This was recommended by the pharmacy review group and I am delighted to do this by repeal of the Pharmacy Act 1962. Ireland will now have one of, if not the most, competitive market for pharmacy professionals in the EU. This can only be good for the profession and will ensure that not only overseas-trained Irish graduates but also non-Irish EU graduates will find it easier to establish themselves in the Irish pharmacy sector. I am confident their different perspectives and competitive impact will keep the sector vibrant and energised into the future and all within a modern robust and progressive regulatory regime for the 21st century.

The pharmacy sector has experienced rapid growth in recent times with many possible interactions arising between prescribers and dispensers. The vast majority of professionally qualified pharmacists and medical practitioners adhere to the highest standards in carrying out their professional duties. However, occasionally unacceptable practices may arise between different professionals. The Government has accepted the view of the pharmacy review group on the issue of conflicts of interest between those who prescribe and those who dispense drugs. Accordingly, following acceptance by the Seanad of two amendments introduced by me, the Bill now contains two sections as follows.

Section 63 deals with the prohibition of certain economic relationships between pharmacists and medical practitioners, namely either party having a beneficial interest in the other's practice that would be considered in excess of standard ownership arrangements, and such as would constitute an excessive beneficial interest by virtue of these relationships. This would also involve company or corporate relationships by way of preferential leasing or tenancy arrangements.

Section 64 deals with pharmacy and medical practices using shared premises, the type of improper economic relationships which it is considered necessary to prohibit that could arise by virtue of sharing premises, and also the expectation that any recommendations by prescribers of dispensers, or vice versa, would not be beyond that which arises through normal professional practice. I am confident these two sections will achieve the fairest and most proportionate response to any possible conflicting situations, having regard to the basic legal and constitutional rights of all concerned.

The Bill has been considered by Seanad Éireann in recent days. The Seanad gave the Bill a detailed and considered hearing, reflecting the widespread interest in the Bill, and in the need for good and proper regulation of the pharmacy sector for the benefit of the profession and the public alike. I thank the Seanad for providing me with the necessary time for this purpose and for the many useful suggestions put forward. Apart from the two important sections on beneficial interest already referred to and the clarification that the society's council will comprise a majority of non-pharmacists, I also obtained approval for a number of other amendments for various procedural and technical drafting issues. In addition, I have also agreed to consider several further proposals for amendments tabled by Opposition Senators, subject to legal consideration as to their necessity. Accordingly, I will table draft amendments for the consideration of the Dáil on Committee Stage.

The provisions in the Bill are intended to put the regulation of the profession of pharmacy in the State on a firm, modern and robust footing, having regard to the need to protect, maintain and promote the health and safety of the public. The Bill, if enacted, will put the society to the forefront of the processes involved in supervising the pharmacy profession and the retail pharmacy business in Ireland. While the Bill deals mainly with these areas, concern for the public and their safety is the guiding principle throughout. The proposed repeal of all previous Acts with the enactment of this Bill means that a new, coherent and all-encompassing legal regime will now be put in place for the society, pharmacy professionals, pharmacies and the public alike. I am honoured to be able to bring such comprehensive legislation before this House and I would urge a thorough and considered examination of its provisions with a view to its early enactment.

In concluding her speech, the Minister said: "The provisions in the Bill are intended to put the regulation of the profession of pharmacy in the State on a firm, modern and robust footing, having regard to the need to protect, maintain and promote the health and safety of the public." It is interesting that she used those fine words when introducing the Bill. Elsewhere in her speech she told us that this is not the final version of Bill, as she will introduce further amendments on Committee Stage. We have had similar occurrences in recent weeks. The Pharmacy Bill was rushed through the Seanad this week and I am unclear as to what is happening here this morning. The Health Bill to establish HIQA and the Medical Practitioners Bill flew through the House.

I have spent 20 years in medicine, in college, in training as a doctor and working as a GP. In the past two weeks it has taken all my skills and knowledge of the medical profession to try to keep up with what the Minister is doing in the Bill. This is the craziest way of regulating any medical profession.

We must give seven days notice of our amendments to legislation. Yesterday the Minister brought through amendments to the Bill in the Seanad. The previous day, she had the legal representatives of the Government trying to work out what was going wrong with the Bill. We do not know what the Minister is doing. Some of her proposals are fine and will probably work out all right — I certainly hope so — but nobody in the House has confidence that we know what is happening in the Bill. Even the Minister will acknowledge what she is doing is crazy.

When I am asked to discuss health matters in the House, I do not expect all Members in the House to have the same level of knowledge as the Minister or I might have of the health portfolio, but I have heard Members of the House refer to organisations such as Comhairle na nOspidéal, the Medical Council, the Royal College of Surgeons in Ireland, the Royal College of Physicians of Ireland, the Irish College of General Practitioners, the Irish Medical Organisation and the Irish Hospital Consultants Organisation as if all those organisations were interchangeable or the same organisation. I have listened to Members refer to the Irish Pharmaceutical Union as if it is the regulatory body for pharmacists, which of course it is not — the Pharmaceutical Society of Ireland is the regulatory body.

When we discussed the Medical Practitioners Bill, the Minister stated that two members of the HSE would sit on the board, but they are not sitting on An Bord Altranais because it was established 20 years ago. Yet, today I find the Minister has a member of the HSE sitting on the board of the Pharmaceutical Society of Ireland. I was not even sure if the initial legislation, as published by the Minister, allowed for someone from the HSE to sit on the board of the Pharmaceutical Society of Ireland.

There is huge confusion as to what is happening, in particular with regard to how patients are supposed to report problems. For example, what happens if someone decides to make a complaint about having contracted MRSA in the Irish health care service, for example, from using a swab? To whom would that person complain? If the person wants to make a complaint about a doctor, he or she must complain to the Medical Council. If the person believes he or she contracted MRSA in the hospital, he or she must use the Part 9 complaints procedure of the HSE. If the person feels it might have something to do with the pharmacist, he or she must go to the Pharmaceutical Society of Ireland to complain that the pharmacist might not have done the job properly. If the person has concerns that nurses did not wash their hands, he or she must make a complaint to An Bord Altranais.

The Minister might think she is doing patients a great favour, but she is doing nothing for them. When all this legislation was first being discussed four or five years ago and when it was coming to the forefront in the Dáil, one of the proposals Fine Gael and the Labour Party put forward to genuinely protect patients' interests was the establishment of a patient safety authority. If we have learned anything from the past two weeks, given the Government's messing around and rushing through of legislation — they know they have made a mess of things — it is that they have left it too late. There are probably two weeks left in this Dáil, yet the Government is regulating the medical profession, the pharmacy profession, the health services and the nursing homes in just two weeks.

There is great concern. Members on this side of the House take this matter seriously and do not flippantly rush through legislation. The Minister introduced amendments only yesterday but expects me to discuss them today as if they are now the Government's position. She does not take patient safety seriously. If she did, it is a patient safety authority——

I most certainly do.

The Minister should propose a patient safety authority.

That is baloney. The Deputy thinks a body can be established and called by some name, and it will do all the——

The Minister thinks she can do it.

The Deputy knows it is not possible.

I did not interrupt the Minister during the nonsense in her speech. It is time she accepted——

Why does the Deputy not deal with the Bill?

What is patient safety about? It is about protecting patients. The Minister asks me to deal with the legislation, but she does not even know completely what it is about. She brought amendments to the Bill through the Seanad yesterday but she tells me in her speech today there will be another draft of amendments when she brings the Bill to Committee Stage in the Dáil.

What is going wrong on the Minister's side of the House that she cannot publish a Bill without having to——

It is because I listened to the contributions of Senators Ryan and Henry. I thought they made some very good suggestions. Does the Deputy want me to ignore them? Does he want me to ram the Bill through and ignore everybody?

The Minister has changed the substance of the Bill dramatically.

I did not change it.

That is what is wrong here. The Minister is not sure what she is doing in the Bill. I have concerns with the Minister's contribution on the Bill. The profession needs to be regulated and the Pharmaceutical Society of Ireland will do a great job in that regard.

I note the Minister has no plans to introduce any form of competence assurance for pharmacists — once a pharmacist is registered, that is how it will be. The position has changed dramatically for the medical profession, which used to operate on the same lines in that once one was registered as a doctor, one remained registered for the rest of one's life and nobody would competence-assure a doctor at any stage throughout his or her life. Concerns were raised in the report of Judge Harding Clark, however, which showed a small minority of doctors fail in their duty as the years go by and that there is a need to competence-assure the entire profession. The Minister tells me she will do this some time in the next five years, if she is back in power. No such competence assurance proposals are being brought forward for the pharmacy profession — once a pharmacist is registered, that is it. Everything is hunky dory and one hopes to God nothing goes wrong after that.

Both the medical profession and the pharmacy profession have very high standards of care and strong ethical codes of conduct, and always have had. It is only a small minority which in any way abuses their position of power.

The Minister is always good with words. When she deals with the Bill on Committee Stage, we must tease out what she means by the statement: "I am confident that their different perspectives and competitive impact will keep the sector vibrant and energised into the future and all within a modern robust and progressive regulatory regime for the 21st century." She also stated: "Section 63 deals with the prohibition of certain economic relationships between pharmacists and medical practitioners, namely, either party having a beneficial interest in the other's practice that would be considered in excess of standard ownership arrangements".

When we reach Committee Stage, will the Minister clarify what concerns she has in regard to this beneficial interest? There was never to be an input from pharmacists into the primary care building, as envisaged in the primary care strategy. That strategy simply foresaw GPs coming together with inputs from other members of the health care profession in the community, such as physiotherapists, public health nurses and administrative staff from the HSE. No reference was made to pharmacists being involved. However, due to the failure to implement the primary care strategy, we have seen primary care centres develop throughout the country with a major input from pharmacy and with pharmacists to some degree anchoring primary care centres.

The Minister needs to make clear to the House what she means by this kind of regulatory function and by "excess of standard ownership arrangements". Does the Minister suggest it will be a legal requirement for the contracts between the pharmacist and owners of the primary care centre to be made public, whether the primary care centre is owned by the pharmacist, another pharmacist, the GPs or a private company? Will the contracts be scrutinised by the Pharmaceutical Society of Ireland? How does the Minister know something is in excess of——

The ownership of the building is not involved in this in any way. Pharmacists can own doctors' surgeries and vice versa. That is not affected. It is an interest in the practice——

An interest in which practice? Is it in the pharmacy?

It would be, for example, if the doctors had a beneficial interest in the pharmacy. Doctors own pharmacy buildings and vice versa — that will not be prohibited.

What will be prohibited? What are the Minister's concerns?

If a doctor has a beneficial interest in a pharmacy business — not in the building, but in the business — or vice versa, there would be concerns if circumstances did not equate with normal market conditions, for example. My understanding is the anchor tenants are the doctors, not the pharmacists. We can thrash it out on Committee Stage.

The Minister needs to say what she means by that. She also needs to state what arrangements will exist for the doctor and pharmacist if private companies are involved. The Minister and the public are well aware that one of the most senior advisers to Professor Drumm who was involved in drawing up how the HSE will be involved in primary care in the future is now working for a major player for the private sector which is involved in developing these centres. There is a considerable need for clarity with regard to what the Minister is planning. A considerable number of groups of GPs and pharmacists are in the process of developing or have recently opened these primary care centres. They need much more clarity from the Minister as to the way in which she will move this forward.

A considerable criminal element does not exist out there and most of these arrangements work out perfectly well. The Minister needs to make it quite clear what she intends to do with regard to regulating——

It is about having fair competition. There are no ethical politics involved.

As I previously pointed out to the Minister, when the public talks about the issues we are discussing, it probably does not understand the roles of the PSI and the Irish Pharmaceutical Union and the role of the Irish Medical Organisation compared with that of the Medical Council. When we talk about this and put information into the public domain, we must be crystal clear.

What was envisaged in the primary care health strategy is not the case today. Approximately 80% of single primary care centres have some association with a pharmacy with regard to their development. The Minister needs to clearly specify the way in which we are going to move this forward. The area is now very complex because the Minister never dealt with the 2003 recommendations.

Is this Bill purely about commercial concerns? Does it purely concern prescribing and dispensing? Has the Minister taken on board the fact that a number of GPs prescribe and dispense from their surgeries? Will anything in this legislation conflict with the regulation of that sector within the medical profession? Who will these doctors be answerable to? Is there any role for the Irish Pharmaceutical Union or will it remain a matter purely for the HSE?

The Minister is saying the PSI must inspect both the pharmacist and the premises. GPs also dispense medication in some rural areas. Does that mean that the PSI must also inspect these GPs' practices and their records with regard to the dispensing element of the practices or does this remain the function of the HSE? It is not clearly written in the legislation whose function it will be in future with regard to the regulation of this very small and specific sector.

The Minister made an interesting point in respect of the PSI inspecting both the pharmacist and the premises. She said that "sanctions, if judged necessary, can be applied evenly to those responsible for the provision of the service and not just to the individual pharmacist". This would be a very complex issue. Is the Minister saying that sanctions will be applied on a 50:50 basis to the pharmacist and the corporate entity which owns the pharmacy? This seems to conflict with natural justice in the sense that people would challenge those outcomes in the courts. If a pharmacist working for a corporation was asked to do something inappropriate which was reported to PSI, the PSI could sanction the pharmacist. The Minister is saying here that the PSI must also sanction the corporation involved.

Not in all cases. There must be a supervisory pharmacist in charge of every retail pharmacy. In respect of a corporation, there must be an overall person in charge who is a pharmacist.

The Minister is applying blame in the same way which would be applied in a court case. The judge decides on a proportion of blame to be applied to individuals. Does the PSI have the ability to apply blame? Can it apply blame on an 80:20 or 70:30 basis or must blame be applied purely on a 50:50 basis?

As the Deputy knows, there is a range of sanctions, which include censure and admonishment. Ultimately, these matters will be determined in the courts because like all regulation of this kind, everybody has the right to appeal the decision to the High Court where it could ultimately be determined. It is not administered in terms of a percentage allocation.

For example, if a pharmacist was struck off, but the business was going to take on somebody else to do the same thing, it would not make much sense. It is giving the PSI the power to deal with the business as well as the individual where this is necessary. I am sure it will not happen in every case.

What the Minister is saying is that if the business is ultimately responsible for doing something wrong, the PSI will say that both the pharmacist and the corporation are doing something wrong.

It may not be the corporation. It may be one or the other or both.

So this is the simple sanction applied by the PSI and after that, it is up to the person and the company involved to appeal the decision and let the courts deal with the issue?

They have a right to do that, as they do in respect of all regulations. The courts ultimately make these decisions. We cannot give those kinds of judicial powers to regulatory bodies.

Does the Minister envisage a whistleblowing section for this legislation so that if a pharmacist felt that what he or she was doing within a corporation was wrong, he or she could complain privately to the PSI that he or she was being asked to do something he or she felt was inappropriate? Could the PSI deal with this in a preventative fashion rather than sanction the pharmacist who made the complaint? Could the PSI root out bad practice whereby somebody could make an anonymous complaint, as envisaged in whistleblowing legislation, so that we can improve standards? As the Minister points out throughout this legislation——

The amendment we passed last night applies to whistleblowing in respect of all services procured on behalf of the HSE so it would apply to somebody making a complaint to the regulatory body. They are protected.

Are they protected if it only deals with issues in which the HSE is involved? Would the same whistleblower legislation apply to private prescribing to private patients because they will not be in a position to——

It applies when they are reporting to the regulatory body. I will check if this is correct.

It also applies if a pharmacist making——

People reporting to regulatory bodies are protected. I have checked and that is correct.

Could the PSI inform all its members that they can make this complaint to the regulatory body if they have any concerns about sharp practices which might be happening in the companies for which they work and not fear that any sanction would be imposed on them?

Under civil or employment rights law, they cannot be victimised or discriminated against.

Are they protected if they make the complaint to the regulatory body, regardless of whether the issue concerns medical card or private prescriptions? Does it cover any practices that might happen within the pharmacy or does it just apply to prescribing and dispensing in which the pharmacist might be involved?

It applies to the business of the pharmacy.

The pharmacist might also be involved in selling commercial products like cosmetics.

That obviously does not apply if one is selling make up. We do not regulate the sale of make up, lipstick and other cosmetics. One can buy very good stuff in many pharmacies, as I did this morning.

What would happen if the pharmacist was responsible for running the pharmacy and was involved in a practice of this sort? If they were prosecuted under competition law, for example, could they then be sanctioned by the Pharmaceutical Society of Ireland?

The Pharmaceutical Society of Ireland is regulating the profession in terms of professional practice. It would not be a matter for the PSI if members have a problem with their planning permission or an issue arises with the Competition Authority about the sale of make-up.

If, for example, a pharmacy was prosecuted under competition law for whatever reason, which would involve a criminal prosecution against the pharmacist concerned, would he or she not be open to sanction by the Pharmaceutical Society of Ireland?

Only in regard to the practice of pharmacy.

These are the kinds of issues we would have teased out if more time were available. The Minister introduced a significant number of amendments in the Seanad last night. I believe the Bill was only concluded in that House at approximately 7 p.m. In regard to the good parts of this Bill——

In fairness, they were well received by Deputy Twomey's party, as well as the Labour Party and the Independents. We did not introduce any measures with which Members there took issue. The Bill was not guillotined either.

Previously, we were able to table amendments to legislation the night before Committee Stage of a Bill commenced, but a change was introduced with the effect that Opposition parties are obliged to give seven days notice of their amendments to proposed legislation. That was done to facilitate the proper scrutiny of the Opposition's amendments by the Department involved. The Minister is now introducing Bills and having all Stages passed into legislation within seven days. No opportunity is provided for proper scrutiny. It is possible this Bill contains some grenade which none of us has noticed yet. On occasion, when legislation is given proper scrutiny in this House, concerns are identified.

A significant number of amendments were introduced in the Seanad and the Minister plans to introduce further amendments in this House. It is extremely difficult to properly fulfil our role. With the impending election, our attention may not be fully focused on the work of this House. We would like to think, however, we are still committed to what we were elected to do, namely, to properly scrutinise legislation. The manner in which the Minister is rushing the Bill through the House is unreasonable. Far more time should be provided to go through it.

The regulation issues with which we are dealing are extremely important. The pharmacy profession has been seeking an update of the legislation for years. It sought to have both pharmacy Bills introduced at the one time to provide a comprehensive regulatory system for the pharmacy profession. The Bill has been a long time coming. Significant concerns have been expressed about what is happening here. We are trying to work out exactly what the Minister is doing.

The manner in which we have dealt with legislation in the past week highlights the need for the introduction of a patient safety authority. The HIQA legislation, which was passed by this House last Tuesday night at 9.30 p.m., covered the standards and regulation of nursing homes. The Minister referred to how she will introduce a regulatory body that might decide on whether patients will be valued sufficiently to receive medical treatment in the future.

Committee Stage of the Medical Practitioners Bill was dealt with on Wednesday last. Concern was expressed about ministerial powers and the potential problem with funding for the teaching and specialised training of doctors. This gives rise to the danger that standards in the training of specialties may drop. We are now dealing with the Pharmacy Bill. I am somewhat at a loss as to where this proposed legislation is going. I am generally supportive of the provisions in the Bill, but important issues still require to be teased out. I would have preferred if the Minister had taken her time so we could have discussed it more fully.

I have placed my trust in the Pharmaceutical Society of Ireland that it will do what is right for the future. However, there is a danger we might create more problems for ourselves given the number of concerns that have been raised with the Minister about the way the profession has developed in recent years. One issue that arose when the Bill was in the Seanad was the close connection between the roles of the prescriber and the dispenser in the development of primary care centres and what effect this will have in future. Many amendments arise from those concerns but, equally, other concerns may arise among staff working in the pharmacy profession. Such issues often crop up in the course of proper discussion on proposed legislation in the House. We should take time to reflect on what is happening and make sure we do not make an error.

I support the positive aspects of the Bill. We will need to have a more in-depth discussion of many aspects of it on Committee Stage.

The speed that health legislation is coming through this House is so rapid that for a moment this morning with the engagement across the floor I thought we had moved on to Committee Stage. I must be careful about making a Second Stage speech.

I welcome the Bill. It is important that at long last we have the provisions in this Bill to debate. There has been a shocking lack of regulation in the pharmacy sector. It is indicative that some of the Acts being repealed in the Bill date back a considerable period. The main one dates back to 1875, but there is reference to an Act of 1790. That is telling. The public would be shocked to discover no proper regulatory framework is in place for the pharmacy sector. Looked at coldly, animals have more protection than humans. What we need now is to ensure this Bill is processed.

I compliment the Minister, the staff in her Department, the Pharmaceutical Society of Ireland and the Irish Pharmaceutical Union, all of whom have played a part in reaching this point. Some time ago, the IPU set out quite a good yardstick for assessing whether the Bill would come up to scratch. First, it stated that legislation was urgently needed to safeguard the pharmacist's role in ensuring the health needs of the patient would always take precedence over commercial considerations; second, that it would facilitate the development and the professional role of the pharmacist; and third, that it would bring a strategic and professional focus to the sector. They are good ambitions by which to judge the Bill. I suspect when we go through the process, we will find parts of those challenges have not been met but, in the main, the Bill is a welcome step forward.

I will try to give the Bill the attention it deserves but I cannot give it the attention it requires because the Government has failed to ensure we have adequate time to give proper consideration and reflection to an important Bill such as this one. I regret that greatly because it deserves better. I have no doubt we will create problems in the long term because of the hasty approach the Government has adopted.

However, I will do a better job of it than the nincompoops in the Progressive Democrats press office yesterday who set out to tarnish my reputation as a public representative. Without bothering to check the facts, they ran around the media telling tales based on nothing. Regrettably, even though we were trying to deal with an important Bill, and my attention should have been focused solely on that, I spent much time yesterday on a damage limitation exercise. At least the media had the good sense to check their facts, unlike those in the press office of the Minister's party. I do not blame the Minister but I blame her indirectly for the fact that this happened yesterday. It is most regrettable, and I intend to do my best to meet the obligations, despite the circumstances, which is practically impossible. As Deputy Twomey has said, it is impossible to deal properly and fairly line by line with amendments that are coming in thick and fast at the same time as assessing a Bill that requires due scrutiny. It is important to acknowledge the substantial Seanad amendments to the Bill, which were tabled primarily by the Minister for Health and Children. I give her credit for improving it.

However, it is a little late to begin dealing with issues that in the main stem from her ideological position, which is to privatise as much of the health service as possible. Predators are constantly circling to make as much profit as possible from patients' health needs. They are able to do so for the most part without regulation or licensing provisions to protect the public good, which is the Minister's responsibility. She opened the stable door and has now half-closed it, but when it comes to this aspect of the health service, the horse is in the process of bolting.

That is hardly safe or good governance regarding the general principle of ensuring patient safety. Amendments are coming through now to deal with an issue that, to ensure that the legislation was robust, should have been addressed at the outset. When the Minister introduces amendments at the 11th hour, no one can be absolutely certain that the result will stand up to scrutiny or to the courts, which will also be a consideration. Legal challenges have a way of showing up the paucity of ministerial capability. We saw that happen very effectively with nursing homes. The Minister blithely introduced legislation in an attempt to deny elderly people their rights retrospectively, but it flopped. The new law collapsed almost immediately and she had to come back to the House with her tail between her legs.

While I am concerned, I welcome the Minister listening to people like me and Senators Ryan and Henry. We have raised important issues regarding conflict of interest. I have brought this up several times regarding the Medical Practitioners Acts and I would like to refer to it once again. We are witnessing a commercialisation of general practice that is not viewed by the public in the same way as the privatisation of the hospital sector. However, it is happening nonetheless.

One could argue, as the Minister tends to do, that general practice is privately provided, but there is an enormous difference between professionals, whether pharmacists or doctors, providing services and for-profit developers concerned with commercial priorities, which have nothing to do with a patient's health needs. As far as they are concerned, it is simply another market to exploit, and that is happening owing to a lack of regulation. We must be aware of that.

I have raised the case of Dr. Maguire, the HSE adviser who, before coming to work with Professor Drumm, had maintained connections with the Touchstone Healthcare Group. I have no problem naming these players. Dr. Maguire left prematurely, having earned a significant salary, the size of which startled many people. While the Minister constantly refers to value for money, how could anyone believe her in the context of such advisers' pay? In this instance the adviser left and, the next day, was admitted to Touchstone's board of directors. It is very worrying how easily that can happen. There is nothing illegal about it and I have no quarrel with Dr. Maguire regarding the legality of his actions or his adherence to any code of conduct, but that is just my point, the codes of conduct and laws are not in place to protect the public good.

The Touchstone Healthcare Group alone has invested €800 million in primary care. The sum represents a great deal of loot if one translates it into profit. We must establish the principle of a clearer separation between pharmacist and doctor in dispensing and prescription. We need clear water between the two. The Minister's comments about unfair competition in an exchange with Deputy Twomey was very revealing. Unfair competition is a very small part of what we are talking about, which is patient safety.

I refer the Minister to the report on Dr. Harold Shipman, which showed how the public's trust in a professional led to the most horrific crimes being committed. However, because the public trusted the professionals, those ghastly crimes could be committed over an extended period. One issue pinpointed in the Shipman report was that the relationship between doctor and pharmacist was too cosy, and we must deal with that. When I get a chance, I will certainly consider the amendment the Minister tabled. I welcome it because doubtless she is under severe pressure on the issue. I have no doubt that it will end up before the courts owing to the substantial sums that can be won or lost in denying such an arrangement.

I brought up the salaries paid to Government advisers and suggested that they be subject to a value-for-money audit by the Comptroller and Auditor General, but I have changed my mind on that, now believing that we must look much further. I will write to the Comptroller and Auditor General suggesting that we consider what is happening with the primary care strategy regarding penetration by private commercial interests at local level.

What deals have been done with local HSE managers on individual primary care centres? The change is occurring in a subterranean fashion worthy of investigation. I noted Dr. Maguire's proposal that all primary care centres be run by Touchstone, or something equally bizarre. It is now clear that there is a very unhealthy relationship that needs to be assessed and exposed. We must learn the lessons and stop undue commercialisation and unhealthy relationships developing. The amendment helps significantly in that regard, but we must also have a very clear view of the future and how we intend to develop primary care.

We are all aware that primary care is the key to health reform. Our hospitals are overcrowded, overloaded and overstretched, and one reason is that too many people are attending unnecessarily. They go to hospital for genuine reasons and in the main it is the only place where they can get the required care. I am not talking about people who head straight to the accident and emergency department because they do not want to pay the family doctor — although there is an element of that, it is a fairly small one — I am talking about the thousands of patients who end up in hospital because they cannot get diagnostics, tests or treatment closer to home, as they would if we had a well developed primary care service. That must be our goal, but to reach it we must be secure in the knowledge that it will benefit patients rather than profiteers. The issue of whether the Minister has gone far enough in terms of the location of pharmacies in primary care centres, or close to medical practices, may have to be teased out further. I want to re-examine that matter. If a pharmacy and primary care centre share a premises, although with separate entrances, it is not that different to having a doctor's surgery on a high street with a pharmacy across the road. They can be in close proximity but we must ensure there is no conflict of interest and that patients are fully protected. That is crucial. The ownership of a pharmacy business must be 100% transparent and I think this legislation will ensure that is so. We need to have a clear understanding of who owns what, and ensure that shadow owners are not fronting for criminals.

Pharmacies are good businesses. The Minister referred to cosmetics that she bought this morning. Allowing for the fact that much of the pharmacy business is involved in the cosmetics trade, it is fair to say nonetheless that 1,600 pharmacists are providing a service for 420,000 people every week. That is a large number of people and constitutes a lot of commercial activity. A serious percentage of that turnover relates directly to health care, whether for prescription drugs or other health products. We do not hear of many complaints about pharmacists. It is clear, however, that there are rogue pharmacists and the lack of regulation means the Pharmaceutical Society of Ireland cannot deal with them. Such rogue pharmacists are in a minority and this Bill will deal with them. Generally speaking, however, pharmacies work and people can access such services without cause for complaint. In addition, the medical card and drug schemes provide safeguards for the public. The medical card scheme may be too restrictive as regards some drugs. Over the last couple of years, although not recently, there have been shortages of medicines. It was quite surprising for a patient to be told that a pharmacy had run out of a certain product and that the pharmacist did not know when it would be available again. I have not heard any such complaints recently, but it certainly was an issue at one stage.

When we complain about the privatisation programme unleashed by the Minister, she may say that private provision has always been part of the health care system, which is true. However, it is naive to think that what has been provided on a private basis in the past is the same as what would be provided by the kind of developers and others who invest in hotels or health care, and who are now involved in rich pickings as a result of ministerial ideology.

There should be three simple principles for private providers. First, they should be properly regulated, which the Bill will do in the pharmacy sector, and that is why I welcome it. Second, they should be accessible to all, which pharmacies are for the various drug schemes. Third, they should not be feather-bedded by the taxpayer. I do not think anybody would say that pharmacists are feather-bedded, although the same cannot be said for developers who co-locate at hospitals — they are being feather-bedded to an enormous degree. The yardstick set by those three principles applies to pharmacists in a manner which acknowledges that private health care providers can meet the public good. This regulatory framework is the last part of the picture. It has taken much work and time to finalise, but it is both important and welcome.

I wish to make a couple of general points about pharmacies. There is a strategic approach which is not included in the Bill, although it is not really a matter for legislation of this type. It would be remiss of us not to consider what a pharmacy is for or, more importantly, what it can be used for to bring about changes in the health service. If I have an opportunity to assist in that process in future, I would act to provide for a greatly expanded primary care system.

The Irish Pharmaceutical Union referred to a couple of points which neatly outline the relevant issues, including the question of generic brands. Currently, there is no incentive for a pharmacist to develop and encourage the use of such brands. I spoke to a pharmacist a while ago, who was keen to promote generic brands but said it was against the pharmacist's interests to do so. We should ensure that as far as possible the use of such brands can be developed.

The IPU also referred to a medicines management programme assisting people, particularly the elderly, to manage their medicines. That is an important idea for the future. A couple of years ago when Mr. Richard Collis was president of the IPU, a pilot scheme enabled people to return unused medicines to their pharmacy. The resulting haul was enormous and showed how much unused and expired medicines were in private homes. Such medicines pose a danger for other family members. There have been instances where a family member will attempt suicide, or even succeed in committing suicide, by taking an overdose of tablets. It is a worry therefore if unused drugs are left lying around. We should work on finding a solution to that problem.

Pharmacists are in a pivotal position to assist in health promotion which is important, given the lifestyle problems associated with alcohol, drugs and obesity. We must change the way we are consuming things. Pharmacies are accessible and thus provide an opportunity to encourage the public to take responsibility for improving their health. The methadone scheme is a good example of this. Many pharmacists and doctors initially resisted the scheme and that may still be the case in some areas. Overall, however, the methadone programme linking pharmacists, doctors and patients was a worthwhile venture, which I hope we can develop further in future.

The IPU has also raised the interesting question of pharmacists having the ability to prescribe. We need to examine that matter. The Minister has already raised the possibility of nurses having a greater role in dispensing medicines. However, this raises issues which revert to the original point that where doctors and pharmacists have a close relationship, patients can end up losing out or being over-prescribed. If pharmacists prescribe and dispense, conflicts of interest may occur. That is a matter that concerns me greatly and we must consider it carefully.

The pharmacy is a good, untapped resource in primary care and we should consider the way forward in this regard. Pharmacies tend to be an overlooked element of health care, partly because they are tied in to other services that are provided that have nothing to do with health. The resource exists, as does the professionalism, and we will now have the regulations that will guarantee professionalism, though competence assurance must also be developed. We must examine the resource more imaginatively and proactively than in the past, as has been done in Northern Ireland and Britain.

To get value for money we must keep people out of hospital. If we can reduce hospital attendance significantly we will ensure better health care with better value for money. This is not a cheap option but is an efficient option that has not been properly considered.

Hospital pharmacists have expressed concerns as to whether they are within the remit of the legislation. The Minister yesterday reassured them that they would be included but I am not convinced because the area seems somewhat vague. The hospital pharmacy tends not to be a retail outlet and I want to make sure that this area is covered in an appropriate fashion, but we will see what emerges from the debate.

I do not oppose the idea of EU graduates operating without limitations in Ireland. We are, I hope, on the brink of a new deal with a new Executive in Northern Ireland and we all encourage North-South co-operation. I believe we should extend the possibilities of North-South co-operation as far as we can in a proactive way and there are many opportunities to do so in the area of health. It seems extraordinary that suitably qualified people from Northern Ireland can operate here when suitably qualified people from south of the Border cannot operate in the North. An all-Ireland or, preferably, EU based solution is necessary and I am surprised this matter has not been addressed already as I thought that was the purpose of the services directive. We might develop this issue at a later stage. Linguistic ability is an issue I want to return to.

Regarding structural linkages, there are many different authorities, including the Health Information and Quality Authority, the Medical Council, the Pharmaceutical Society of Ireland and the Health Service Executive, and we seem to gain a new authority with each passing day. They do not link well together. Even within the HSE the silos are higher than before and people do not know who to link with. It is difficult to see how things operate from within the HSE, let alone from outside the organisation, as communication is poor and connections are often non-existent. We must ensure that the system and structures are streamlined, otherwise we will end up weighed down by bureaucracy with ineffective administration.

The Minister sneered at the idea of a patient safety authority, but she was wrong to do so. She should consider what happens when patients want to complain. Should they use the HSE's complaints procedures? Should they approach the Medical Council, HIQA or the Pharmaceutical Society? Where should they go? There are so many options that patients will end up bamboozled and going around in circles because there is no clear line on complaints. We know from the case of Dr. Neary that things go terribly wrong when proper systems of complaint and accountability do not exist and the Minister has spoken often about that case. However, the reality is that she presided over the establishment, without proper preparation, of a monolith to manage the health service called the HSE that is not open and not accountable. In such a climate things that should not happen can happen.

I seek to share time with Deputies McHugh and Crowe.

Is that agreed? Agreed.

I welcome this Bill. It is clear that there has been much consultation during and prior to drafting of the legislation. The amendment that was introduced in the Seanad was appreciated by the Irish Pharmaceutical Union as it was the major issue that concerned it. The Minister acknowledged in her contribution and in the legislation that pharmacists are part of the health system and I think the local chemist has played a more important role in this regard than is often recognised. I have seen local pharmacists go well beyond the call of duty in cases involving people with long-term and terminal illnesses. It is important to maintain a balance between local retail pharmacies and large chains which provide a degree of anonymity. It is important that the local chemist shop remains a feature of communities and that people feel confident when talking to their pharmacists who can give good advice.

The high cost of medication is a major criticism that pharmacists here often face, although the matter is not entirely in their hands and there is often a limited mark-up involved. Indeed, some medications have no mark-up. I understand that we use other northern European countries as a benchmark in this regard, though this may change. All this has a bearing on how people, particularly those who travel and those with chronic illnesses, will acquire medication. People with asthma, for example, and their family members may go to Spain and Portugal to buy inhalers. Asthma is an example of the type of illness people may self-medicate because of price differences in medication. I do not believe this could happen in the context of an acute illness which necessitates the immediate use of an antibiotic, but it is possible with chronic illnesses. People with chronic illnesses who do not qualify for a medical card and who can buy medication in this way for €20 rather than €100 will make this choice. This is a factor of which we must be aware. Those who do not have a spam filter on their Internet connection will be aware of the large number of companies offering medications on-line at reduced prices. We cannot ignore this practice although I am aware that a considerable amount of these medicines is seized by customs officials when they are shipped in.

It is important to identify trends such as the link between over-prescribing of antibiotics and the incidence of the MRSA superbug. While it may not yet have caused an epidemic, we must gather information on this link to control the problem. To this end, the type of illnesses included on the long-term illness list must be reviewed and the eligibility criteria for medical cards adjusted. As the Minister is aware, self-medication has consequences.

The Irish Medicines Board is highly regarded and its advice is frequently sought in other countries. Although its decision to reduce the number of tablets in packets of over-the-counter medicines has saved lives by preventing people from intentionally or unintentionally misusing such medications, the higher cost of smaller packets results in people buying in bulk while abroad. We need to monitor and gather information on this trend. For example, an examination of the products seized by customs officials would determine what types of medicines members of the public are purchasing on-line or while abroad.

Will doctors' surgeries and chemists which share a premises be required to change this arrangement within a specified timeframe? I am familiar with several chemist shops which share premises with a GP surgery. This could be construed as having prescribing and dispensing alongside each other but in many cases it is a long-standing arrangement. In addition, it may well be the most appropriate arrangement in some areas with a small population.

Under the legislation it will be easier to establish a pharmacy here than in any other European Union member state. I understand some of our European partners are examining the possibility of re-imposing regulation in the pharmacy sector. We need to monitor the arrangements, particularly as Irish pharmacists will continue to be prevented from establishing a pharmacy in certain other countries.

I welcome the initiative to appoint to the council of the Pharmaceutical Society of Ireland five persons who have never been pharmacists in the State or another jurisdiction and are representative of the public interest. These persons must be selected using an appropriate procedure. For example, individuals involved in patient rights or advocacy groups should be appointed to the council. While I do not accuse the Minister of political patronage in her appointments to State boards, the power of appointment can be abused. For this reason, clarity is required on the type of persons who would be appropriate for appointment to the council. The appointment of laypersons can bring balance to a board and is welcome provided it is done properly.

I welcome the opportunity to speak to the Pharmacy Bill 2007. The Government decision to approve the Minister's proposal to prepare pharmacy legislation in two Bills is regrettable because it is almost universally accepted that a comprehensive approach to pharmacy legislation is required. The most comprehensive way to proceed would be to consider all relevant issues in one Bill. I say this in the knowledge that an inordinate length of time was required to bring this legislation before the House. If it takes as long for the second Bill to see the light of day, many of the pharmacists who seek its introduction will be no more or, worse still — and this is my suspicion — the second Bill will be forgotten about once this Bill is passed and important issues will remain unaddressed.

When one realises the slow progress made in pharmacy legislation since the original Pharmacy Act of 1875 it is understandable that pharmacists fear the worst as regards the second Bill. The legislation has been updated just twice — in 1890 and 1962. I understand the Pharmaceutical Society of Ireland worked on the legislation with the Department as one composite Bill and that a number of issues requiring attention will not now be dealt with because we will have two Bills.

We have been promised that the second Bill will legislate for pharmacy practice and the delivery of pharmaceutical services. Issues which will remain outstanding include the regulation of pharmacy and pharmacy services, for example, the definition of the terms "pharmacy services" and "community pharmacy"; enhanced provisions for the inspection of pharmacies; and provision for regulation of pharmacies in respect of matters such as physical condition, standards and record-keeping. These are issues of great importance and it is highly regrettable that they will not be addressed directly. Normally, when a second Bill is promised one asks the Minister when the Bill is expected. However, owing to the impending general election questions of that nature are futile in this instance.

With the fall of the Government imminent one fears the promised second Bill will not materialise. In keeping with his style, the former Minister for Health and Children, Deputy Martin, established a review group. He did not disappoint us when he proceeded to set up a second review group which was asked to do important work. The pharmacy review group was given many terms of reference, including some which were relevant to constituencies such as Galway East. It was mandated to ensure a high quality pharmacy service in remote and deprived areas, take account of the opening hours of pharmacists in order that consumers would be facilitated and all reasonable health needs of the population met. It was also asked to examine and report on how a universal service and public service obligation could be identified and met and assess any funding consequences which might arise. While these issues may not be of great concern to the residents of Dublin 4, they are important to my constituents in Galway East. However, they are being ignored.

I do not want to take a totally negative attitude towards the Bill because it addresses issues of great importance. It does not, however, address any of the areas I have outlined, which is regrettable. Speaking on the Criminal Justice Bill 2007 yesterday, I stated that I deplored the rushing of legislation through the House. Unfortunately, I must repeat my comments in regard to this Bill. A raft of amendments will be introduced in this House following a plethora of amendments introduced in the Seanad. It is possible that some amendments may have been introduced in the meantime to address some of the areas I have highlighted. However, with the legislation being processed in such haste and with so many amendments, it is impossible to examine it in a few hours.

On the issue of the separation of prescribing and dispensing, how will professionals, for example, a registered general practitioner who is also a qualified pharmacist and has been prescribing and dispensing for a number of years, be accommodated? Will it be done by way of a "grandfather" clause or some other measure? Some form of accommodation is required because legislation should not impact adversely on businesses which have been operating professionally and legitimately for many years.

On behalf of Sinn Féin's health spokesperson Deputy Ó Caoláin, who is unable to attend, I will set out our views on the Pharmacy Bill. I agree with other speakers that this is extremely important, necessary and long overdue legislation.The profession of pharmacy is currently regulated in legislation dating back to 1875. The pharmacy review group published its report in 2001 and recommended major legislative change. The Irish Pharmaceutical Union has been calling for proper regulation for years.

We now have this key legislation before us and a second Bill is promised. I share the concern of Deputy McHugh that we are unlikely to see the latter in the lifetime of the Dáil. It is a pity the two Bills were not published together so we could have a proper overview of the legislation and to help ensure it is as comprehensive as it needs to be.

The introduction of this Bill is overshadowed by the dispute between the IPU and the HSE and Department of Health and Children over the negotiation of fees for the drugs scheme administered by pharmacists, including the medical card scheme. It is claimed by the HSE and the Department, on legal advice, that the Competition Act prevents them from negotiating with pharmacists as they have done up to now. The same advice led to the suspension of negotiations with the Irish Dental Association, which could lead to the total collapse of the free dental treatment scheme for medical card patients. This is a serious situation and there seems to be little or no action from the Minister to address it. I call on her to intervene directly and to ensure these key elements of the primary health care system are not further disrupted.

Pharmacists fulfil a vital role in our health services and are an integral part of primary care. The IPU argues that its members' services are not used to their full potential and has called for the expansion of that role. This would include the introduction of medication reviews where pharmacists would be able to check on an ongoing basis with patients on the effectiveness or otherwise of medication supplied to them. At present, the pharmacist's role ends once the medicine is supplied to the patient. These reviews have been introduced in other jurisdictions. The Minister might clarify the position on this as I do not see direct reference to it in the Bill. Will it be provided for in regulations or in the second pharmacy Bill?

One of the difficulties I have encountered in my own and other areas is the abuse of cough medicines. This arises in the context of the preponderance of drug abuse problems in many communities. The drugs task force in my area has heard of pharmacists persistently dispensing cough medicines to people who abuse drugs. It is not illegal to do so but the problem is that it facilitates addictive behaviours. The Bill provides for complaints to be made to the council of the Pharmaceutical Society of Ireland, but I am not sure if this is sufficient to deal with the problem. Gardaí have called to several pharmacies in my area to express concern about the dispensing of cough medicines to addicts and others. Although such actions are not illegal, there is a moral obligation on pharmacists not to engage in them.

I do not know whether it has been raised in the Seanad but no Member in this House has mentioned the difficulties heroin addicts encounter in accessing services and support. There is a number of community-led and HSE-supported clinics in Dublin but no such services exist for those outside the capital. There are heroin addicts living in every county. Heroin abuse seems to be a growing phenomenon outside of Dublin whereas cocaine seems to be the new drug of choice in the capital.

Many heroin addicts experience difficulty in obtaining methadone. In many cases, people are obliged to travel from Limerick, Cork and elsewhere to Dublin to access treatment. The refusal of many pharmacists to operate a methadone scheme for addicts is a problem. These are seriously ill people who require assistance, but pharmacists can choose not to offer the support they require. There must be some discussion during this debate of the difficulties in this regard and how they might be resolved.

The Minister stated in the Dáil last September that the Government accepted the pharmacy review group recommendation that there should be "no beneficial ownership or business interest of any kind between dispensing and prescribing". Concerns have been raised that this principle may be breached in private health centres that also contain pharmacies. Will the Minister clarify the position in this regard? Will this be dealt with in regulations or in the second Bill?

I seek a response from the Minister to the several serious concerns raised by the Hospital Pharmacists Association of Ireland, HPAI. This association represents pharmacists directly employed in hospitals, who provide a vital public service to patients. They seem to have been overlooked in this debate. The HPAI is extremely concerned that under this Bill, hospital pharmacists may not be able to continue to provide the care they are currently providing to a number of key patient groups such as cystic fibrosis patients, patients with schizophrenia, HIV positive patients and paediatrics and cancer patients. The hospital pharmacists have asked that several issues be clarified before this Bill is enacted to ensure patient care is not compromised.

Is it the case that a hospital that wishes to continue to supply medicines directly to the above patient groups on an outpatient basis or to any other patient on discharge from hospital, as it is currently doing, must register its pharmacy department as a retail pharmacy business? As hospital pharmacists are employees and not pharmacy owners, to register the hospital pharmacy department as a retail pharmacy business, the hospital itself will have to be recognised as a corporate body. This must be clarified.

Section 3 of the Health (Corporate Bodies) Act 1961 empowers the Minister of the day to establish a body to perform functions in regard to the provision of a health service or two or more health services. A body so established shall be a body corporate with perpetual succession and a seal and with power to sue and be sued in its corporate name and to hold land. Several questions arise in this regard. Has the Minister issued orders under section 8 of the Health (Corporate Bodies) Act 1961 conferring body corporate status on all or any hospitals? If so, when and for which ones? If she has, does this order make such hospitals corporate bodies for the purpose of section 17 of this Pharmacy Bill?

What is the position of the Health (Corporate Bodies) Act with respect the Health Act 1970, the Act establishing the HSE in 2005 and the Companies Acts 1963-2005? If the Health (Corporate Bodies) Act 1961 is of bearing to the Pharmacy Bill 2007, why is it not cited in the Bill and listed on page 5? If hospital pharmacy departments must be registered as retail pharmacy businesses in order to continue providing services as outlined above, it will follow that they must, according to section 25(2)(a) of the Bill, be under the personal control of a registered pharmacist who must have three years’ retail pharmacy experience. This does not acknowledge established rights of practice of the hospital pharmacist. In the absence of a grandfather clause or recognition of a hospital pharmacist’s experience it would make it an offence for hospital pharmacists to supply directly to patients. For example, a hospital pharmacy manager may not have three years retail pharmacy experience, but could have spent three or more years of his or her career in hospital pharmacy practice and have years of experience in managing a pharmacy. However, he or she would be considered to be committing an offence under the definition provided, “3 year post-registration experience”, in Part 5, offences, section 25(2a). There is a need to amend this section to acknowledge established rights of practice.

Under the Bill, if a hospital pharmacy department, in either a public or private hospital, does not supply directly to patients, either through out-patients or through discharge prescriptions, it does not need to be registered with the Pharmaceutical Society of Ireland. Therefore, its premises will not be regulated or inspected. This is not in the interest of patient safety. All premises from which pharmacy services are provided, regardless of whether in a private hospital, public hospital or community pharmacy premises, should be registered to ensure continuity of care and guaranteed standards of care for patients. This should not just apply to some premises as proposed in the Bill.

I hope the Minister will address all these concerns and ensure that the legislation is amended as appropriate.

I welcome the opportunity to contribute on the Bill. We often tend to describe Bills as coming to the House not before time. It is appropriate to say the same in this instance. It must be hard for the public to comprehend that in the process we are repealing Acts related to the profession which date back to 1790 and 1870. This is the first major overhaul of the regulation of pharmacies in 130 years. I accept an effort was made in 1962 to overhaul the sector, but it was not far-reaching.

This legislation will deal with the modern reality of pharmacy services and hopefully will prove a tonic for a sector ailing from the lack of regular diagnosis over a long period. Many of our constituents have raised complaints and issues with us that should have been dealt with. This is the 21st century and updating of legislation dating back two centuries is long overdue. The Bill will underpin the long-term health of the sector. It sets out to properly regulate the pharmacy sector. Among other things, it provides for the recognition of some foreign education pharmacists and the removal of restrictions on them from owning or managing a pharmacy outlet less than three years old.

The Bill will open up the sector and allow for more competition in what tends to be a monopolist situation. It will mean, in particular, that Irish graduates who studied and gained experience abroad will now be catered for at home. This is a step forward. Many of us are aware of individuals who had to study abroad who find it difficult to start up or become involved in business here as a result. While the changes are necessary, as with all medicines, we need to read the label carefully. No doubt some people may find some of what is involved hard to swallow, but we must deal with the issues.

I acknowledge the good work of the Pharmaceutical Society of Ireland and the role it played in helping to keep up standards in the industry. I will come to the issue of possible conflicts and monopolies, but we should recognise how well the industry has been run, notwithstanding the complaints we may have heard. The PSI is the regulatory body for the industry and maintains discipline in the area. It has done significant work in that regard. There is concern that the PSI is also a representative body and that this could raise a potential conflict. I am sure the Minister will bear this in mind in the debate and on Committee Stage.

We have seen rapid change in other areas, for example, politics, the Garda and the legal and medical professions. These are all caught up in the thinking that self-regulation is no longer an option and separation of regulative and representative aspects of these areas is taking place. Most people subscribe to this concept of change. Relations were difficult and incestuous and changing the situation is difficult. There is no benefit in rehashing the cases that led to the call for change, but they happened across the board, whether in politics, the Garda or the medical area. These cases highlighted the need to get rid of self-regulation.

With such a potential for a major mishap, nobody wants to see in place anything other than the highest standards in all areas of the pharmaceutical business. For that reason, it is important to include in the Bill the issues of competency in the English language and other requirements for qualifying persons. There are some dangers in this regard. It has often been said that only a doctor or chemist can read a doctor's writing, but at least doctors were writing in English. We must be aware of the danger involved with regard to prescriptions and ensure requirements are in place to safeguard patients receiving or filling prescriptions. These requirements can be included without making things difficult for any group in particular.

While welcoming the changes proposed, we must ensure as far as possible that small pharmacies can continue to operate successfully in communities. Often, these outlets, like other local services, provide a service of comfort and advice to customers as well as fulfilling their primary role. Achieving the correct balance should be foremost in our minds. We debated this issue previously when there was a difficulty when some companies were buying existing pharmacies to create more or less a monopoly. There was a danger, until a cap was set, that we would finish up with two or three companies running the whole business.

Without getting into a row on competition, it is important to try to protect small outlets. One way of protecting such businesses is to have proper regulations in place that will encourage small outlets to broaden out and expand business. This is happening. It is a pleasure now to visit most pharmacies as they are well laid out and well run.

As with reform of other sectors, patient safety must be paramount and any proposed changes must be tested in that context. We must consider how changes in a service that is a vital cog in our health infrastructure will affect public confidence, which is crucial. Almost every chemist with experience in a local community service is willing to provide advice to people without charge and do their best to facilitate customers. This service is important as part of health provision and it is important that the public have confidence in this regard. In this respect it is important that we deal with the issue of fitness to practise in as open and transparent a fashion as possible.

The proposals in the Bill, including the review of the fitness to practise regime for the sector, can only benefit the public. Much work was done on this area in committee and regulations are in place to ensure certain material cannot be published etc. While I accept the right of individual practitioners to fair treatment at all times, it is important the public is made aware of the outcome of any hearings. There has been disquiet recently about secrecy in the medical field. Most professional bodies subscribe to the view that it is necessary to be open. It is a case of getting the rules right.

Our registration system will be brought into line with EU best practice and extended to the retail pharmacy business. High standards must be employed when we consider that the retail business is the last filter between the prescription drug makers and takers. There are many questions to be discussed on Committee Stage about whether the Bill covers pharmacists in the industry, regulations, removal of medication from hospitals and so on. There will be a serious outcome if we get this wrong but it is a welcome part of the overall change in the health care regime from having 27 different bodies making an input into the service and over 1,000 separate contracts and agreements between health boards.

It is necessary to have a fully-trained pharmacist on the premises at all times. In the past people have suggested that this standard was too high, citing the amount of non-prescription items sold in a pharmacy. That is fine until something goes seriously wrong and there are calls for tighter regulations and inquiries. I read recently that Senator Henry asked whether the regulations should cover trainees. They probably should so that trainees learn best practice from the outset. The Minister will consider these points on Committee Stage. This legislation achieves the highest standards at the upper level.

Some fear the conflict of interests between those who manufacture, prescribe and, to a lesser extent, dispense drugs. There is concern too about profit margins on some products. More will be done about this on Committee Stage which I welcome. This is of great importance to the health and financial well-being of the general public, as well as to pharmacists. The difference between generic and prescription drugs is so great that a separate monitoring regime is needed. The talks between the Government and some major pharmaceutical companies has led to significant savings, and the potential exists for much more if properly handled. The general practitioner is the first in line, being the prescriber. All sectors, however, need to work on this aspect of the business. We have seen comparative figures for the products in Spain and elsewhere and heard arguments about where companies are based and their need for research and development. It is a difficult area, involving large sums of money. The companies' practice of sponsoring golf classics and taking people on trips needs to be examined and kept in check because the State pays too much for this activity.

The Pharmaceutical Society of Ireland has largely welcomed the publication of the Bill, particularly the updating of the regulatory framework, which is hardly surprising given that it repeals 130 years of legislation. There is also concern, however, that the enactment of new legislation can lead to unexpected problems elsewhere. There is a danger we could box ourselves into a corner, for example, section 4 of the competition Bill raises a problem between pharmacists, the Department and others.

I questioned Professor Drumm about this at the Committee of Public Accounts when he indicated the pharmaceutical sector sought legal advice on the issue of talks being held with the various groups and it was found that this was contrary to section 4 of the competition Act. That could have a serious effect on dealings between the Minister and members of the pharmaceutical society.

I am not sure how that can be resolved. We have traditionally conducted discussions with interest groups as we do in the national agreement process. They never like being called trade unions but being a trade unionist I am used to that term. It would be a matter of concern if discussion was no longer possible. They are usually people who are experienced, practical, have been through the mill and are capable of negotiating and discussing their members' interests. That might no longer happen if what I read is correct. I dread to think that it would be necessary to make a separate contract with every pharmacist in the country and that we could not discuss this at any level.

Other Members will raise interesting issues. I have little experience of the pharmacy sector but have a working knowledge of it having chaired health boards three or four times. When this issue arose I met people who have pharmacies and who expressed concern about this issue. Other factors need to be discussed such as contracts and the supply and price of drugs, although they lie outside the scope of Bill. I look forward to the Minister's response and the Committee Stage discussion.

I welcome the opportunity to speak on this Bill. The Health Service Executive has indicated to the Irish Pharmaceutical Union, the representative body for pharmacy contractors, that it could not negotiate fees or remuneration with the union for pharmacists operating State schemes as this would contravene the terms of the Competition Act 2002 in regard to price fixing.

I have received representations on this matter, as I am sure has the Minister, and on the basis of these I believe the HSE should engage fully with the IPU. The IPU has traditionally negotiated fees on behalf of pharmacists for services provided under the publicly funded drugs scheme over the past 34 years. The HSE is being over-zealous in its approach and it should take seriously the very constructive proposal of the IPU to establish a group of representatives from both sides with an independent chairperson. A negotiating process could then be agreed. If this is not done, the existence of community drugs schemes could be put at risk.

The role of the pharmacist has not been developed properly in Irish society. I agree with Deputy Dennehy, who said the pharmacist is often the person to whom we speak about an ailment and often the very first point of contact. The pharmacist is a highly qualified health care practitioner and is readily accessible in a familiar and informal environment. Recent studies have shown that 75% of patients use the same pharmacy on a regular basis. Community pharmacists can help to remove the pressure from hospitals, including accident and emergency units, and help support general practitioners. Pharmacies should be integrated fully into our primary health care service and this can be done in a responsible way.

The pharmacist can play a very constructive role in administering a structured medicines management regime. Pharmacists themselves have proposed this. It would reduce the wastage in the current system and save the State some money. It would not only benefit the patient but also the HSE.

The IPU has made proposals on medication reviews, with which proposals I am sure the Minister is familiar. Clause 9 of the pharmacy contract requires pharmacists to review each prescription, prior to supply, for potential drug therapy problems, interaction, side effects and incorrect dosage or duration of action. However, once drugs are supplied there is no follow-up. We need to check compliance and for this reason, and others, the IPU has been advocating the introduction of the medication reviews. They are now a normal part of the work of pharmacists in other jurisdictions and they have been shown to have benefits, particularly in the United Kingdom. Preventable drug reactions are implicated in up to 17% of hospital admissions in older patients and many of these admissions could be prevented if patients had a better understanding of the medication they are taking.

The IPU commissioned some independent research in August 2006 which found that one in five Irish patients is on two or more medicines. Some 23% of these patients are concerned that they are not taking their medicines correctly. A study in the United States has shown that a structured medication review practice can reduce the cost of drug-related morbidity and mortality in the order of 60% due to the reduction in GP visits, drug costs, accident and emergency unit visits and hospital admissions. Research in Sweden and Denmark shows that medication reviews resulted in savings of €129 million and could save up to 174 lives per annum. We therefore ought to consider them.

Some of my proposals could be implemented on a pilot basis. I was talking to a general practitioner yesterday evening and he said there was potential in so many areas to address the issue of prescriptions. In this regard the Minister quite rightly raised the issue of the prescription of antibiotics at the Joint Committee on Health and Children. The general practitioner suggested that initiatives in this area could be implemented on a pilot basis to see how we get on and that we would not have to introduce them in full immediately.

When the Minister stated some days ago that we must change people's mindset regarding prescriptions, she was correct, but she stated it would be 12 years before we could get to grips with this problem. This seems like a very long time. We should run a pilot scheme for two years, for example, and consider some of the innovations in other countries. The Minister saw what was being done in Sweden recently. Let us examine this and determine whether we can do the same on a pilot basis. Perhaps we can involve pharmacists in this process.

Responsibility for all these matters extends across the board. The mindset of the patient must be borne in mind in this regard because some patients simply expect to be prescribed an antibiotic when they go to the doctor. General practitioners also pose a problem in that they often dispense antibiotics because, as one general practitioner said to me very candidly some days ago, people will vote with their feet. If they do not get their antibiotic from one doctor they will go elsewhere and the first doctor will lose custom. How do we deal with this problem? The role of the pharmacist, who is the last in the line, is also part of the equation.

There is a pilot medicines disposal scheme called Disposal of Unused Medicines Properly, DUMP. We need to consider disposal because there are so many unused medicines languishing in medicine cabinets in people's homes. These include tranquilisers, paracetemol and antidepressants and some of these drugs have been used in suicides and parasuicides. They are quite dangerous to leave around and this is why the DUMP scheme, which has been piloted by the HSE in the south west since January 2004 and which has collected 13.5 tonnes of medicines to date, needs to be expanded. The HSE Dublin mid-Leinster area, has recently undertaken to fund DUMP schemes through community pharmacies. I do not know the extent to which the scheme is up and running but it should be encouraged and expanded.

The location of pharmacies in health centres was discussed in the Seanad and amendments have been made to the legislation in this respect. I do not know what they cover and will have to consider them on Committee Stage. A real threat is posed to community pharmacies by some of the bigger chain pharmacies, which seem to be more interested in locating in health centres. While this may be convenient for the patient, it results in the squeezing out of local, community-based pharmacists. It also leads to a conflict of interest because, if a general practitioner has a share in the health centre, he or she would be encouraged to prescribe, thus leading to over-prescription. The Minister is trying to address some issues in this regard but there is still a problem. The IPU is of the opinion that we cannot stop this happening — there may be constitutional difficulties in doing so. We must, however, address this so perhaps we could examine it in depth on Committee Stage.

The Green Party feels strongly that pharmacists have a role in health promotion. They already do a great service within the community advising people, but that advice could be expanded to include areas such as diet. The advice is usually concentrated on medication but the pharmacist has an important role to play in health promotion as a source of education for patients and as a means of improving lifestyle.

The IPU has run many health promotion campaigns through pharmacies over the years. In March 2005, the IPU ran a campaign with the IPHA called "ask about your medicines", which was designed to encourage patients to ask the pharmacists for more information about their medicines. A copy of that campaign leaflet was distributed and I was impressed by it.

A survey was carried out that showed that 50% of people do not read the information leaflet contained in non-prescription medicines before taking them. This is a matter of concern and that is why it is important for pharmacists to give advice. Only 30% of those who take other medicines at the same time as non-prescription medicines check the label or even ask the pharmacist if it is appropriate to do so. The pharmacists ran a similar campaign in 2003 followed by a survey that showed an increase of 20% in the number of patients asking about their medicines following the campaign. Such campaigns succeed if they are properly promoted.

In 2006 the IPU focused in its promotions on the management of chronic diseases, particularly heart disease and diabetes. The main aim of the campaign is to make people aware of the risk factors associated with these diseases and to encourage them to adopt a healthier lifestyle, with a view to preventing heart disease and diabetes instead of waiting for them to occur and treating them. Clearly, given the rise in heart disease, type 2 diabetes and childhood obesity, which leads to both conditions, there will be enormous strain on the health services.

Primary health care can work across all sectors, from the GP to the pharmacist, giving people advice and going into the schools. The task force on obesity report is gathering dust but that was a good report that covered all aspects of the problem. It makes sense to start at school level and advise kids about diet. We must have joined-up thinking in all Departments because if children cannot run around in the playground because of the litigious nature of Irish society, or even do not have a playground, problems will build up for the future. Such a sedentary lifestyle is unnatural for children. They do not walk or cycle to school and this will lead to further problems in the future.

The IPU has mentioned the substitution of one medicine for another when it is safe to do so. This is restricted at present and pharmacists, who are highly qualified, should be allowed to substitute a generic medicine, which is often cheaper than the branded drug. Pharmacists should have greater autonomy because they are qualified to make decisions in this regard.

We should empower pharmacists and grant them greater autonomy in decisions on community health care. Doing so can only result in better outcomes. Increasing the role of pharmacists by allowing them to use their knowledge and training is important and removes pressure from GPs. Their know-how would only be used where a visit to a GP is not required. The IPU has pointed out that pharmacists in Northern Ireland are engaged in the minor ailments scheme and pharmacists here can make an enormous contribution in the primary health care network in this way.

We currently do not have a chief dental officer or a chief pharmacist. These positions should be filled as soon as possible. Vacancies of this type only create a vacuum that results in a lack of direction in the sector. I urge the Minister to fill those positions.

Sections 63 and 64 of the Bill deal with the conflict of interest between prescribing and dispensing. I hope we can reach a conclusion on that on Committee Stage because this is what pharmacists worry about most. They feel they will be squeezed out and the multiples do not have the same contact with the community. I take the IPU view on the role of the pharmacist but many of them are also talking about their livelihood. They feel that once the super-duper health care centre is set up with a pharmacy in place, the town pharmacy will no longer be viable. I have seen some of the contracts offered to pharmacists to entice them into the centres and some of the larger companies are playing hard ball. We have a liberalised market and many pharmacists fear that Ireland will be seen as the place to come to and the community pharmacists as a result will go by the wayside.

I welcome the opportunity to make a brief contribution on the Pharmacy Bill 2007. I compliment Deputy Gormley on his remarks. I also compliment the Green Party in Dublin South-West. As the least known Dáil Deputy in the constituency, I am always happy to get some attention. The Green Party attacked me again yesterday so I thank it for the attention. It is good it is noticing my work. I would like Deputy Gormley to pass on my good wishes.

I apologise for not attacking the Deputy this morning.

Deputy Gormley can leave it to the locals, they will look after me. I welcome this opportunity to contribute to the debate and acknowledge the presence of the Minister for Health and Children, Deputy Harney. She might expect me to ambush her and talk about Tallaght Hospital, services for children and Millbrook Lawns health centre but I will stick to my national agenda and talk about the Bill. I am glad Deputy Glennon is in the Chair because he will allow me talk about issues in my constituency.

Only if they are national issues.

As somebody who has represented Tallaght skilfully for over 20 years, the Minister will be well aware that Tallaght is all about national issues and what happens in Tallaght today can happen in the rest of the country tomorrow. I am not from Tallaght but I represent Tallaght. I also represent Brittas, Bohernabreena, Firhouse, Templeogue and Greenhills. I bring to my Dáil business my own life experiences as much as possible. I am not only a Member of the Dáil for a major population centre but am also the Government convenor on the Joint Committee on Health and Children with colleagues, including Deputy Gormley. I have a background also in local authorities and was a member of the then Eastern Health Board from 1994. I was the founder chairman of the South Western Area Health Board. I have also had other experiences which help me in a debate like this one. As I said to some people this morning, as a small child growing up in Crumlin I was always aware of the importance of the local chemist and conscious of the role chemists played. I knew if I went into a sweet shop I would get sweets but if I went into a chemist I would get a sugar barley stick that younger Members might not remember. I make the point that even in those days, and I am from a bygone age — I am not ashamed to admit that — chemists had that role and I am glad that remains the case. That should be said in the context of this debate.

My colleague, Deputy Crowe, spoke about drug services, which I will refer to, and Deputy Gormley raised the challenges facing the Irish Pharmaceutical Union, which I will refer to also. I do not want to refer to my own constituency only but the Chair will be aware that I am proud of Tallaght and my constituency. A strong pharmacy network has been developed throughout the constituency and I have made the point on many occasions in the Dáil and elsewhere that we must continue to develop that network.

The Minister and I have often discussed an estate in my parish, Fettercairn, which still does not have general practitioner services, health centre services or a pharmacy. It is important that we consider all our communities and understand the importance of the pharmacy in the life of a community. I have already mentioned the impact it had on my childhood. I live in Springfield, in Tallaght, which has three pharmacists, which is amazing. They all provide a tremendous community service. It is important we encourage that and make the point that in all areas, whether in Clondalkin, Lucan or north Dublin, those community services are important.

Colleagues spoke earlier about the conflict in terms of who should provide services and where they should be located. Deputy Gormley referred to the Minister's amendment in the Seanad yesterday, and I understand the position to be as he outlined it. I understand also from a document I read yesterday that the Irish Pharmaceutical Union has concerns about the business relationships that can develop between doctors and pharmacists. I understand the organisation has indicated it is concerned that the development of business relationships between the doctors could have the potential to put safety at risk and reduce patient choice. I am glad the IPU has welcomed the Minister's intervention during the week in that regard.

There has been a positive development in terms of health centre resources in my community, particularly in Tallaght, where I live. I have already mentioned Millbrook Lawns health centre which, eight years after the fire, is still not developed. I am putting pressure on the Department and the Health Service Executive at local level to ensure that is done. Meanwhile, Tallaght has seen major progress as far as the development of primary care centres is concerned. There is an excellent centre in Jobstown, the Mary Mercer Centre, which I understand the Minister has visited, which provides essential, first class centres. There are also GP centres in Brookfield and Killinarden. I apologise to the Chair for mentioning every estate in Tallaght——

The Deputy missed one.

——but I am very proud of my community and the developments that have taken place.

The Deputy will not have enough time to mention all of them.

I will do my best.

The Deputy is not doing too badly.

Deputy Gormley raised the issue of whether pharmacists should be in health centres or located elsewhere. I am aware from talking to doctors that there are different views on that but there are many pharmacists throughout my constituency and in particular in the Tallaght area and the interests of patients are best served if they can access GP services in the first class, modern facilities now provided in places like the Mary Mercer Centre in Jobstown, get a prescription and get it filled at the local pharmacy by professionals.

I am not ashamed to remind the House that I faced a health challenge eight years ago when I had a heart attack. It was a mild attack but it was serious for me. It interrupted my work as cathaoirleach of South Dublin County Council, and I used my politics to get back to work as quickly as possible. I am always positive about that illness but I got great support from my local pharmacy, and still do. Somebody asked me recently — I think they were trying to wind me up — if I was on many tablets but I said I was only taking an aspirin and a Lipostat, which I get from my local pharmacist who provides a first-class service. As a local politician I am often tempted to go to all the pharmacists in my area. I buy my comb and cough lozenges in other pharmacies but I get my tablets from my local pharmacy. That is the type of service I and my constituents want to access. I do not want to get my prescription filled in Tesco. Competition is important but the role of the pharmacist is important in my community and communities throughout the country.

I am aware the Minister has examined that issue and I hope she will take account of the points being made in the debate. I am aware also that she understands the role of the local pharmacist in communities. If there was a change along the lines mentioned by Deputy Gormley, we should all understand that would mean that the people in Tallaght, for example, would be deprived of what I acknowledge is easy access to our local pharmacist. That is an essential community service appreciated by people and complements the work of local doctors. One can leave the doctor's surgery and go straight to the local pharmacy where one will be looked after in a professional way. We must understand the importance of that role and there is a strong view in the community that that should be maintained.

My constituency colleague, Deputy Crowe, referred to drug services, something I am always anxious to support countrywide but particularly in my own region. We must accept that there are difficulties in that regard and families are facing challenges. On more than one occasion recently I spoke in the Dáil in support of local services, stressing to the Minister, the Department and the HSE the need to continue to support drugs services in our community. In many parishes throughout Tallaght there are first class projects, including the St. Aengus parish in Tymon North, the St. Dominic's community response project, the JADD group in Jobstown, which I visited yesterday, the Tallaght rehabilitation project of which I am a board member and the launching of which the President recently attended in Kiltalown House, and the SWAN family support group in Alderwood in Springfield. These provide great services.

I hope they are not dispensing drugs in all those places.

No. I did not say that and I hope it will not be on the record.

What has it to do with the Pharmacy Bill?

The Minister knows that those organisations provide tremendous service to the local communities. Points are often made about the role of the local pharmacist in those issues. As I have said before about Tallaght, for a while we sent our problems on the bus into Pearse Street to have these matters dealt with, which should not be the way. I am glad we have made enlightened progress in many communities in that regard. I am glad the pharmacists throughout Tallaght have been able to respond in a positive way, at times in the face of some local opposition, in providing good service. The Minister will acknowledge that is being done and it is worth taking every opportunity to put on the record our support in that regard.

I cannot stress enough how important the role of the local pharmacist is in that regard. The Minister's remark emphasises the role they can play. In considering drugs services and other services not everybody agrees with the way these matters are addressed. However, ultimately I support the role the pharmacists have taken, not only in my community but also throughout Dublin and the country, where clearly there are now challenges regarding drugs. We should acknowledge what is being done and the positive response those pharmacists have made to these issues.

Pharmacists can develop their services in a competitive environment. While it is not for me to tell them, pharmacists can be innovative in many ways. When the Square opened in October 1990, many people believed it would kill off all the local shops and services. As in many other communities, that has not happened. People will continue to access first-class effective services in the local community while also going to various shopping centres. It is a concept that is successful. While we will go to the similar centres for major purchases — of course there is only one Square — we will continue to access local services locally. Clearly the concept of a network of local pharmacies works and people continue to go to local pharmacies. I am sure I will get letters from those running the various pharmacies in the Square, to which I look forward — I have no problem with that. I go to the Square most days. I ask Deputy Durkan not to tell people that I go into the Square every day because I am keeping it a secret.

The Deputy is putting pen to paper right now, even as we speak.

Those pharmacies always seem to be packed and are finding innovative ways to overcome trade competition and attract people to their stores. I am opposed to buying my aspirin from Tesco. I am sorry for picking on Tesco; although I am sure they would welcome the odd mention. We should continue to uphold the service being provided by pharmacies generally.

I marvel at the way the Minister can deal with the many issues that cross her desk. A few weeks ago I mentioned on the record that her work is being appreciated, not necessarily just like any prophet in her own land. At a recent Oireachtas joint committee meeting, representatives of the SDLP — they are all good people — made the point that the Minister impressed them hugely with the manner in which she is dealing with the areas under her remit, which is true. It is good that her work and achievements are recognised.

I am so impressed. I am getting emotional.

It is Friday afternoon. I am trying to stay calm in order to psyche myself to go to Saggart in the Minister's constituency for the Ard-Fheis tonight and tomorrow, where I am sure there will be considerable excitement. I am glad Fine Gael realised the worth of the facilities close to Tallaght and it is having its Ard-Fheis there also. It is important to be here this afternoon dealing with important business. Perhaps the Bill should have come before us before now. People are considering the issues it raises and the matter is getting considerable debate. I have received a lot of mail. I am sure the other members in the House get more mail than I do, as they are more famous than I am. We receive much mail and considerable lobbying is going on. It is even more intense now that the election is two months away — or is it three?

Or four.

It is not four. The Deputy should not try to fool the little people.

July was mentioned yesterday.

There was a time when I might have been able to make a prediction. However, now like everybody else I have not a clue.

Somebody has.

I am sure somebody knows. It is good to remind ourselves that the Bill makes provision for the regulation of pharmacies, including provision for the dissolution of the Pharmaceutical Society of Ireland and the setting up of a new Pharmaceutical Society of Ireland, for the establishment, constitution and functions of the new society's council, a new system of registration of qualified pharmacists, druggists and pharmaceutical assistants and pharmacies and for the setting up of new procedures to ensure pharmacists and pharmacy businesses are and continue to be fit to practise, and to provide for related matters. These are matters of interest to people and they are talking about them. I am not saying that when I was in Tallaght village at 8 o'clock this morning people talked to me about the Pharmacy Bill because they did not. They talked to me about other issues, including broken lights, broken bins, Tallaght hospital etc. I am glad people are in the Gallery to hear these debates. I was speaking about democracy in my local school this morning. I went to the school, Drimnagh Castle, which I attended all those years ago. It is a scary experience going into one's old classroom.

It is not the only scary experience.

I am quite happy. Que sera sera. I have confidence in the people in my constituency. When I went into my local school this morning the youngsters reminded me that it probably had not been painted in 40 years.

I take it that this anecdote is relevant to the Pharmacy Bill.

Absolutely. I was about to make a point relevant to the Bill. When I speak in the Dáil I take example from more experienced colleagues like Deputy Durkan. If the Acting Chairman thinks I am rambling, it is because I am following his example and take advantage of the time available to me to speak about issues which do relate to the Bill.

As the Deputy has less than half a minute remaining, he should not ramble too far.

I was pleased that the children in that particular class showed an interest in politics. Everybody, particularly young people, can be cynical about politics. I was able to tell them where I was going today and that I hoped to get to speak on the Criminal Justice Bill. I was certainly able to tell them that I would speak on the Pharmacy Bill. They genuinely showed an interest in the politics of the day. In dealing with the issues the Minister is trying to address, she is on the right track and I wish her well. I hope she enjoys the next couple of months and beyond in the Department of Health and Children. I am happy to support the Bill.

Acting Chairman

I call Deputy Durkan. He has five minutes.

Five minutes is not very much to take poetic licence. I agree with my colleague about ensuring that the public interest is maintained at all times. Yesterday I tabled an amendment to the Broadcasting (Amendment) Bill to the effect that live broadcasting of proceedings in the House should be provided by way of a Dáil channel. I hope that comes to pass because it will bring the public into direct contact with their public representatives, which is nowhere more necessary than in regard to this Bill, about which we have heard for a long time. I am sad it has arrived at the end of the electoral run. Many more Members would have been prepared to debate the Bill on Second Stage and Committee Stage if more time had been made available. It is bad practice to introduce legislation at the last minute, no matter how good it might be.

Several points have come to my attention. The issue of allowing professionals from EU member states to practice in Ireland has been a bone of contention for a considerable time, and countless representations have been made to Members. The Bill will ensure the wealth of talent available at present can be utilised for the purposes envisaged, which is positive.

The profession of apothecary is one of the oldest in the world — I will not say which is the oldest but apothecary ranks with the rest. Apothecaries were originally associated with hairdressing in the United States, where the barber was also the chemist and apothecary, and there were signs to indicate the relationship. I hope this proposal will update the legislation, which should have been done before now, and bring into focus the most important element in any equation, namely, the consumer. I hope, as a result of the Bill, the consumer will receive a better quality of service and will be able to access medicines and prescriptions as and when required.

A number of services here are not as available as they used to be. I compliment those who provide this service. Chemists in this city and throughout the country provide an incredible service, seven days a week, 24 hours a day in some cases. This is very important because it may not be possible in many situations which happen at the weekend for a person to wait until Monday to get a prescription. I compliment those who have provided emergency services, including in my constituency — I will not name them as I am sure the Minister knows them as well as I do. They provide an invaluable service, which I hope will continue.

The Bill is supposed to encourage and enhance competition. One of the central planks of European law at present is the theme of competition. However, competition is supposed to serve the consumer, not those providing the service. It should not operate for the convenience of planners with regard to the location of pharmacies but for the convenience of the public. Pharmacies must be in such geographic locations as to ensure all members of the public have ready and available access in so far as is possible. In the discussions she has had with the various interest groups, I hope the Minister will keep this in mind and that any regulations that apply as a result of the Bill will enhance this aspect.

The registration of pharmacies and pharmacists has been dealt with. It is a positive development that will take into account the whole operation of the pharmacy as well as those operating and presiding over the pharmacy. I note with regard to the council of the Pharmaceutical Society of Ireland that there is provision for removing those who have a direct interest and introducing those with other interests. I presume the focus groups involved will take into account, first, the needs of those directly involved, namely, the pharmacists, and, second, the need to ensure the consumer is represented in some way.

In the old days, public representatives were a necessary requirement in this area on the basis that they had a good idea of what was happening and what was required, and they would receive many representations. They have been bypassed in more recent times and focus groups have been established which are believed to be the ultimate in terms of representation and answers. I hope this is the case. The purest form of democracy is the one we all must work under. The contrived form is when one tries to improve democracy and create new situations that are not necessarily as representative as we would like them to be. I hope this will not be the case arising from the Bill.

I thank all the Deputies who contributed to the debate. I am grateful for the support of all parties for the principles underlined in the Bill. It is generally acknowledged that legislation in this area is long overdue.

Deputy Twomey in particular was heavily critical of the rushed nature of this Bill. I accept it is normally not good practice to rush legislation through the Houses of the Oireachtas. However, this legislation has been in gestation for more than 30 years. I recall at one of the pharmacy dinners two years ago the president of the society informed me that his father, when he was president of the society sometime in the 1970s, was promised the legislation would be produced on the then Minister's watch. I am not certain which Minster it was but it does not matter — I am sure the Minister intended the legislation to be produced at that time.

I put my small group of officials, whom I wish to acknowledge, under enormous pressure to produce the Bill and have it enacted before the general election — the rendezvous with reality this summer. The reality is that if we did not pass this legislation now, it would probably be almost a year before it is enacted. When the new Government takes office in June, the Dáil will adjourn until October. All new Governments, even outgoing Governments, have priority matters to deal with, sometimes as a matter of urgency. I am certain that if the Bill was not passed before Easter, it would be the early part of next year before it became law. This is why I was anxious to have a speedy passage of the Bill through both Houses.

Usually, we are criticised for not producing legislation. There are frequent inquiries as to the whereabouts of this, that or the other Bill. Yet, when a Bill is produced, some Members are critical of the fact we want to expedite its legislative passage.

We had a good, informed debate in the Seanad, without a guillotine. I committed to taking on board a number of the suggestions made, in particular those made by Senators Ryan and Henry, and to report back to the Seanad. There was no gap between Committee Stage and Report Stage in the Seanad and I gave an undertaking with regard to what I thought were very sensible suggestions. Obviously, they have to be passed by the parliamentary draftsman and the office of the Attorney General, whose advice I am obliged to take.

The small group of officials to whom I referred include Mr. Colm Desmond, Mr. Tom Monks and Mr. Thomas McGuinn, who is the former chief pharmacist at the Department. Mr. McGuinn has been working on this and other matters relating to pharmacy at the Department on a contract basis and we are fortunate to have his expertise and experience at our disposal. It was very much needed in the preparation of the Bill.

There is a reason two Bills are required. In an ideal world, it all could have been done in one Bill but very separate sets of issues are involved. The next Bill will deal with premises, services and the logistics of the pharmacy business and profession whereas this Bill essentially deals with regulatory matters. It was important this be dealt with given that Ireland effectively has no fitness to practise regime for pharmacists. The Bill will repeal 1875 and 1962 legislation which is well out of date and very unsatisfactory. The society does not have the capacity or power to regulate the profession of pharmacy appropriately for 2007, the 21st century or beyond.

Pharmacy attracts the brightest people in the country. It is extremely difficult to get into pharmacy school even with the introduction of the second school. This year, we will produce 160 graduates where we used to produce only 70. Many of our people who wanted to be pharmacists went outside Ireland to train and qualify and when they returned, could never open, supervise or own their own businesses. I felt this was grossly unfair, which is why I changed the law and accepted the recommendation of the review group to end the derogation against Irish pharmacists. Obviously, one cannot discriminate against other EU and EEA citizens. The fact that we are, I believe, the first country in Europe to do this does not mean we should not do so. We were the first country to introduce the smoking ban, a very good initiative on another health matter. Several countries have followed suit. It is the right thing to do and will ensure that our people can open a business here if they wish to do so. Obviously, there must be language and forensic competency. Those who come from the EU or EEA must be registered automatically and the society will have some time to allow them to acquire the necessary language competency and so on. Those from outside the EU or EEA must acquire the competency in advance of registration, which is an important distinction.

I will answer a few points made before I deal with one or two other issues. The issue of the contract discussions was raised by Deputy Gormley in particular and by others. It is the case that legal advice in the first instance provided by the wholesale sector during the discussions between it, the HSE and the Department on contract arrangements suggested it would be a breach of competition law to fix prices in negotiations of that kind. Clearly, one can agree prices with one's own employees, like nurses, doctors or those in direct employment with us, but it would be a breach of competition law to do so in respect of those not in our direct employment. That advice was upheld by the Attorney General, the legal advisers to the HSE and so on. A process chaired by Bill Shipsey SC has now been put in place which I was delighted to be able to encourage and facilitate. As I understand it, the profession is happy this is the case and the role of the Shipsey process is to agree the ground rules for the negotiations on a new contract of employment. I hope we can have that in place as quickly as possible.

Deputy Twomey mentioned competence assurance. According to section 7(1)(d), one of the principal functions of the society is “to ensure that pharmacists undertake appropriate continuing professional development, including the acquisition of specialisation”. To be fair and frank, competence assurance is not as well developed between the society and Department or, to the best of my knowledge, within the society as, for example, it is in the Medical Council so it will take some time. However, the power exists in the legislation to bring forward a competence assurance, which everyone would acknowledge is extremely important.

I had an opportunity to check the press briefing of my press officers, which Deputy McManus mentioned to me privately yesterday. Deputy McManus tabled an amendment to the Medical Practitioners Bill 2007 to remove all patient representation on the Medical Council. I made no issue of this and accept in good faith that Deputy McManus subsequently indicated that the amendment was being withdrawn.

My active press people decided to make the media aware of this which they thought was significant. This happens in the normal course of politics. I acknowledge that while I was dealing with the Bill at the Select Committee on Health and Children, for which two days were assigned, Deputy McManus was on the airwaves saying she did not have enough time even though one of the days was not used at all. To be fair, maybe in the cut and thrust of politics, we say things about each other——

The Minister is taking advantage of her position most unfairly. The Minister knows I was complaining about Second Stage rather than Committee Stage.

The Minister's press officers were spreading dishonest statements about me which she knows were untrue. Let us have the grace to accept that.

I do not believe anybody was spreading anything dishonest.

They were being dishonest. I accept the Minister was not doing it.

I must defend my staff.

I thought the Minister said——

I know the Deputy has not, but I checked it. We spoke about it privately yesterday and Deputy McManus raised it in this forum. I have a duty to those who work for me and their integrity and professionalism. I spoke with them. What they did was say that Deputy McManus has put down an amendment——

The Minister apologised to me this morning.

If anybody did anything to cast a reflection on the Deputy's character, I would not wish this to happen. I was told the amendment put forward by the Deputy to remove all patient representatives from the Medical Council——

The Minister knows what happened.

The Deputy withdrew the amendment. I will not make any more——

It was not even on the paper. The Minister knows exactly what happened. There was no such amendment on the paper and the Minister's press office did not even bother to check. The Progressive Democrats spun stories that were simply untrue.

This is far too important to get involved in this kind of controversy. Deputy McManus tabled all the IMO amendments. She withdrew some of them.

I did not table all of them.

I read the IMO submission and the other submissions and amendment after amendment went down.

There is nothing wrong with that.

I am not criticising that, but the Deputy cannot criticise my press people if they draw the media's attention to the fact that she did not want——

It was about dishonesty.

We will not agree on that.

I will deal with something else mentioned by Deputy McManus, namely, the privatisation of the health system. A total of 75% to 78% of the funding of health care is provided by taxpayers, while 22% to 25% is provided by private sources. That is in line with the OECD. It is not in line with the US, where the ratio is about 62:38 in favour of private funding.

I am being criticised about co-location, which was mentioned here again this morning. In our public hospitals, we have 2,500 beds which are totally funded by taxpayers. All the staff who staff those beds are paid for by taxpayers, while the diagnostics used on patients in those beds are supplied by the taxpayer. Yet only private patients can access those beds. I want to reduce the number of private beds in public hospitals by 1,000 and convert them into public beds for the use of all patients, yet this is supposed to be privatisation. It has been a long time since we heard the phrase "nationalisation", but, if anything, this measure is not privatisation. It is about converting publicly funded beds into beds for the use of all patients, not just those with private health insurance.

I want to co-locate on the grounds of public hospitals, eight of which are interested, facilities funded by the private sector with tax——

Acting Chairman

The Minister has two minutes left. I ask her to confine her comments to the Pharmacy Bill.

I must respond to this because the Deputy was talking about the privatisation of the health system and I am entitled to respond. I acknowledge that capital allowances are available for investment in these hospitals, but these allowances are available to make films with the support of all parties in this House. I do not see why capital allowances cannot be made available to support much-needed investment in health care.

This Bill is long overdue. The conflict of interest provisions introduced by me will ensure fair competition. Of course, patient safety comes first and we cannot have a business relationship between the dispensers and the prescribers. This is not to say that people cannot own properties. Deputy McManus made the point that, traditionally, pharmacies were located close to where doctors practise. This is the case and we are not seeking to prevent that. What I am seeking to do by way of amendments made by us is to ensure that where pharmacies and doctors' practices are co-located, normal market trends operate.

People talk about anchor tenants. The difference between an anchor tenant like a branch of Dunnes Stores in a shopping mall and an anchor tenant in this case is that, as one leaves Dunnes Stores, one does not get a piece of paper from it telling one to go to the bicycle shop or some other shop. I accept that using a butcher as an example might not be relevant because Dunnes Stores has its own butcher's section. There is a huge attraction if doctors and pharmacies are co-located and we must ensure nothing unethical happens in that relationship. This is why we produced the amendments we tabled yesterday.

I thank everybody who has contributed to the debate. In particular, I thank John McCluskey and Heather Mahon from the Office of the Parliamentary Counsel, as well as the officials I mentioned earlier, who have done an extraordinary amount of work in a short period to bring the Bill to this stage.

Question put and agreed to.