Leaders’ Questions.

The provision of cancer services is a matter of very serious concern to a great number of people at the moment. In 2000, the House debated a report on the employment of locum consultants around the country. The then Minister for Health and Children, Deputy Martin, committed himself to setting up a working group to examine the structures, criteria and standards that should be in place for the employment of locums. We have heard of concerns in very high profile cases recently about the involvement of locum practitioners. I refer to the case of Rebecca O'Malley and her misdiagnosis. A locum who worked in Galway for six months and who left Galway under a cloud was subsequently employed in Cork. The individual working in Portlaoise was a locum before taking up permanent employment.

What has been the impact of that working report in respect of the implementation of the structures for the employment of locums? What changes were brought into effect? Was there contact between officials in the health services in Galway, who were so concerned about the locum who worked there that they contacted HIQA, and officials in the health services in Cork in respect of the employment of the locum in question?

What happened to the working group set up by the then Minister, Deputy Martin? What are the conditions and why was there a breakdown in communications between health services whereby a locum in one area left under a cloud and was subsequently employed in another?

Locums have always made up a fundamental part of the health service. That has been the case for decades and I am sure the system will continue to operate on that basis. It is a crucial part of providing the services for holidays and for stand-in for the period it takes to employ a consultant. In the general scheme of things, when a consultant appointment comes up many of the consultants who seek posts here are Irish doctors who have been senior registrars here and have gone to hospitals in the United Kingdom, Canada, Australia or the United States. There is quite a gap between a vacancy and an appointment. That has always been the case and I do not see how this can be done in a better way.

From where I am looking at the figures, and not being a medical expert, the difficulty with a number of these posts is that it is not attractive for locums to take up these posts, especially in the small centres. In most of these instances very few people applied for the posts. I believe there was difficulty getting somebody to take up the post in Portlaoise, but that is not unusual either. In the main centres these posts are seen as being enormously attractive.

As I understand it, there was contact with the Health Information and Quality Authority. It followed up and found out where the individuals had gone. In a number of these cases that we have looked at recently there was medical contact and contact between the HSE and Galway and Cork. In some cases the consultants might have gone further afield also. If memory serves me, one of the briefings I received stated that when the consultant went out of the country the authority endeavoured to contact the authorities in that country — I do not know if this was successful in that. The procedures are in place——

Were they carried out?

——for the control and monitoring of locums. I do not want to give an impression that the removal of locums from the system can happen. Locum appointments are part of the structure. The aim of the group set up by Deputy Martin when he was Minister for Health and Children was to make sure there were standards in place for locum services. They are in place, but that does not always mean one will get a suitable person to fill locum appointments.

I do not suggest the system can work without locums. The question related to whether the terms set out in the working group report were implemented and whether there was communication between the health service in Galway and the hospital in Cork where the individual in question worked.

Every Member has referred to the professionalism of Dr. Ann O'Doherty. I listened to the Minister for Health and Children, Deputy Harney, speak last night on the report and review carried out by Dr. O'Doherty, who did an enormous amount of work in a very short time. The Minister stated on the record last night that she is not entitled to see the report. She is the Minister for Health and Children and she requested and directed that this review be carried out. She stated that the problem had arisen due to a breakdown in communications, which appears to be the latest excuse. Can somebody explain why the Minister for Health and Children is not entitled to see Dr. O'Doherty's report? I am sure she does not require legal editing of a report. She is the Minister for Health and Children and the report is prepared for her perusal, yet she cannot see it.

The Taoiseach and the Minister committed themselves to publishing this report. Why is that not happening for the benefit of everybody? The same situation occurred in the Leas Cross incident in which Deputy O'Dowd was involved for many years. It was more than 12 months before that report was published. Both the Taoiseach and the Minister for Health and Children have given a commitment on this, yet the Minister stated in the House last night that she is not entitled to see the report. Is that in the interests of patients who have suffered great trauma?

In fairness to the Minister, Deputy Harney, I understand that is not what she said. She said that legal clearance of the report is required. In all these reports——

She said: "I am not entitled to see the report."

She said she was not entitled to see it.

In all these cases, when a report is prepared professionally in this way——

It is a whitewash.

——and names of people and their careers are mentioned, legal clearance is needed on those issues first.

What about the patients?

Time and again reports in which names have been redacted for legal reasons have gone to committees of the House. All the Minister said was that it required legal clearance.

It could go on for years.

I understand Dr. Ann O'Doherty's report is nearly complete. She has done an extraordinary job going through over 3,700 mammograms in a very short period of time. At the same time, she carried out this review.

You will delay it as long as you can.

Everybody has an interest in getting to the bottom of what happened so it is important that we see the report. In that context, I was advised this morning that the final special clinic was provided by Professor Arnie Hill yesterday evening for all the women who were contactable and available. Only a very small number of women did not attend and alternative arrangements have been made for their surgical review on a priority basis at the earliest date. Every effort is being made to contact a small number of women yet to be contacted, including visiting known addresses for these women. A small number are believed to have physically left the jurisdiction and a significant effort is being made to contact them.

Of the group seen last night, some need further diagnostic investigations, similar to those who were seen last Saturday. This is being organised as a matter of urgency. For the small number of women who still need to be surgically reviewed because they were unable to attend either clinic on 24 and 27 November, the HSE will ensure they are accommodated for such review at the earliest opportunity.

It took a long time to light that fire.

It will be a different story tomorrow.

On 17 September, the Health Service Executive announced new reimbursement arrangements for community pharmacists under the GMS and community drugs schemes. These new pricing arrangements are due to come into effect next Saturday, 1 December. In response, pharmacists have threatened to withdraw from dispensing medicines under the GMS scheme. If that goes ahead next Saturday, medical card holders throughout the country will be unable to fill their prescriptions in the normal way at their chemists. The problem has arisen because the HSE claims it cannot negotiate directly with the Irish Pharmaceutical Union because of the provisions of the Competition Act. I understand some form of consultative process has been put in place under Mr. Bill Shipsey, SC to substitute for direct negotiations.

Can the Taoiseach assure the House that all medical card holders in the country will be able to have their prescriptions filled in the normal way in their local pharmacy after next Saturday? Second, will implementation of the pricing arrangements announced by the HSE be deferred from 1 December to allow negotiations to take place? Third, does the Taoiseach accept that when the Competition Act was passed it was not intended by any Member of the House that it would be used to prevent direct discussions taking place between the Health Service Executive and bodies such as the Irish Pharmaceutical Union? Is he prepared to accept the Labour Party Private Members' Bill, in the name of Deputy Michael D. Higgins, which would amend the Competition Act to allow bodies such as the Irish Pharmaceutical Union and Irish Actors Equity to negotiate directly with appropriate State agencies on behalf of their members?

I wish to return for a moment to Deputy Kenny's question. When he asked me about the Minister's position, I answered as if it was the Minister's responsibility. Of course, the reason for the legal position is that the Minister did not commission the report. The HSE commissioned it, so legally the HSE must get clearance for the report. That is the point in law.

Wonderful. The Taoiseach got the word just in time.

The HSE will then censor the report the Minister receives.

In reply to Deputy Gilmore, we are making every effort to try to bring the pharmacy issue to a resolution. Members have met a large number of pharmacists and my colleagues raised the issue with me last week. We have been trying to find a resolution; there are a number of elements involved. Discussions between the HSE and the IPU have continued under Mr. Bill Shipsey, SC on a mechanism to establish the community pharmacy contract. Considerable progress has been made and the HSE management considers it appropriate to allow further time for this process to proceed. The HSE has decided to defer the implementation of the reimbursement rates on 1 December to a later date. That pressure is therefore removed. Members will welcome that decision. It is an issue my colleagues had asked me to raise.

Following the completion of the new agreements with the drugs manufacturers last year, the HSE announced the new arrangements on the margins on 17 September. That affects the basic supply of drugs and medicines. This is distinct from the dispensing fees paid to the community pharmacists under the medical card and drugs payment scheme. The new price arrangements will not come into force on 1 December.

With regard to the Deputy's question about the process of dialogue established under Mr. Shipsey, that process is continuing. As the union does not appear to accept the legal position under the Competition Act, the Minister for Health and Children has been exploring, in consultation with the Attorney General and other relevant Departments, the best way of progressing the development of a new contract with pharmacists. Those discussions are ongoing. Obviously, the Government and Minister are anxious to find a way of making a new arrangement for arriving at revised pricing arrangements for a new pharmacy contract, consistent with the legal advice the Minister has received. Any new process must be consistent with competition law. As I told the House a few weeks ago, it is not Irish competition law but European competition law.

Well, the Deputy is an expert but I am told it is.

I know more than the Taoiseach and he made a commitment to change it in social partnership.

It is planned that there will be continued engagement under Mr. Shipsey as the best way for both pharmacists and the HSE to continue to discuss the matter of mutual interest. Efforts are continuing. However, the pressure whereby people were being told that after Saturday they would have to start paying or make other arrangements, which was not factual in any case, has been avoided.

I welcome the fact that the HSE has deferred the 1 December deadline. That will be a great relief for many medical card holders, pensioners and others who have been concerned about their access to prescription medicines. There was a great deal of worry about it. I hope the process under way will result in a new agreement on pricing arrangements which will avoid problems arising in the future.

However, what gave rise to this is the problem with the Competition Act. It is absurd that the Act is being used or interpreted in a way that amounts to competition dogma gone mad, where common sense is thrown out the window. It is absurd that a body such as the HSE cannot meet with the Irish Pharmaceutical Union and directly work out the pricing arrangements. Similarly, actors, for example, who do voice-overs for advertisements cannot have their fees negotiated by Irish Actors Equity. That is ludicrous.

There is a need to change the Competition Act to allow for common sense discussions and negotiations to take place in the normal way between unions and professional bodies representing their members and the different agencies to whom they provide services. Will the Taoiseach examine the Bill prepared by the Labour Party and tabled by Deputy Higgins which would address this problem by amending the Competition Act to allow for common sense discussions to take place directly? The situation with pharmacists at the moment is that the two sides cannot talk to each other directly so they must each separately send a representative into a room with Mr. Shipsey and talk through him. It is nonsense.

It is expensive.

It was devised to get around the problem of the Competition Act. I welcome the fact that the immediate threat of problems with prescriptions for medical card holders on 1 December has been lifted, at least for the time being. However, the core problem with the Competition Act needs to be addressed. I ask the Taoiseach again to consider seriously the Bill tabled by the Labour Party.

I acknowledge Deputy Gilmore's point about the urgency with regard to what will happen on Saturday. This was presented to me by my colleagues last week. The recent developments are helpful and will allow the negotiations to continue. As Deputy Gilmore will appreciate, I would be the first one to say that negotiations are necessary on every issue. It is what I believe in. The difficulty with the Competition Act not just from the point of view of pharmacists, but in other areas, is that the case was being put forward that to allow cartels or any group of people to fix their prices and arrangements was to prevent proper competition. That is where the current arrangements came from. The Competition Authority devised the system. Obviously, it creates difficulties.

The HSE is setting the prices.

I am answering Deputy Gilmore. When the HSE, the Attorney General, the IPU and the APMI sought legal advice they all received the same advice from their eminent legal representatives that this was the difficulty. That is where the current system came from. It is creating problems in a number of areas. The difficulty in finding a resolution is the need to avoid returning to the cartel-type arrangements that were creating problems——

Section 4 of the Act could be amended.

——and which were frequently mentioned in the House. To answer Deputy Gilmore's question, I have asked that this be considered because it is unsatisfactory that a representative body cannot talk to whom it would see as its people.

We are offering a simple solution.

We must find a system that is legally sustainable and I have asked the Attorney General to do that.

The Taoiseach is acknowledging that the Labour Party position is correct.

Everybody wants to take their tablets.