Adjournment Debate.

Pharmacy Fees.

Deputy Chris Andrews

I am delighted with the opportunity to speak on this issue, which is important not only to society but also to the health system. A delicate situation has arisen involving the Health Service Executive and the Irish Pharmaceutical Union, IPU. On 14 October, up to 140 pharmacists withdrew methadone services from approximately 3,000 patients as a protest against the changes due to come into force on 1 December 2007. A pharmacy is currently paid the cost price of the drugs under the general medical card scheme in addition to a fee of €3.26. There is no mark-up on the cost of these medicines and all the costs of operating the pharmacies' GMS medications are paid for from the €3.26. It has been said the pharmacists receive fees of up to €18 on occasion, as indicated recently by the Minister, but three out of every four chemists to whom I have spoken claim they never received this payment. One chemist indicated today that he has been in business for 15 years but has never received it.

In practice, the GMS scheme is loss making for the pharmacy but is cross-subsidised by other products. From 1 December, the HSE intends to pay pharmacies 8% less than the cost price of the medicines. Pharmacists have described this as a breach of their contract with the HSE. Drugs payment scheme customers will also be affected because the HSE said it no longer intends to pay pharmacies based on the cost price of medicine.

The pharmacists have been more than willing to negotiate, they have come to the table with a very open mind and are willing to discuss virtually any issue with the HSE. In February 2007, the Minister for Health and Children and the chief executive of the HSE both indicated the need for an independent process for the setting of pharmacy fees. Discussions were held under the independent chairmanship of Mr. Bill Shipsey but he has since suspended his efforts to find a resolution. We are thus in limbo and will end up with two unhappy parties and a crisis on 1 December.

I understand Mr. Shipsey met the IPU and HSE representatives last Wednesday but nothing has happened since. It appears to me, having spoken to pharmacists around the country, that the process is really only a smokescreen and that the HSE will continue to force through its proposals without any really meaningful talks. The HSE has argued that the IPU, as a collection of business undertakings, is precluded under the Competition Act 2002 from negotiating fee-related matters with the HSE. It is not in a position to negotiate directly with the IPU. I accept that the HSE has difficulties but do not accept the complete lack of flexibility regarding its unwillingness to discuss the issue with local pharmacists. It will not engage with the pharmacists as a group or as individuals and this is very unfair.

Pharmacists provide a vital service to the community and work long hours. In many ways, they represent the last bastion of local retail outlets and are genuinely local. More often than not, they are involved in the local community and provide what the old corner shops used to provide some years ago, namely, a means of interaction with members of the community. Pharmacies are now part of the social infrastructure and provide medicine to GMS scheme patients and those who are eligible under the drugs payment scheme. They provide this service on behalf of the HSE and this should be recognised rather than punished.

It is simply not realistic to demand that pharmacists dispense medicine at a loss. In many cases, they are small businesses with high overheads and must compete with new entrants to the market. A pharmacy with a high GMS turnover will be particularly affected if the proposed change comes about. Pharmacies should be supported and, in order to increase competition, pressure should be put on the wholesalers rather than the retailers. The HSE has not been able to negotiate sufficiently good terms with the wholesalers but the retailers and customers should not suffer as a consequence.

The HSE has not carried out an economic assessment of its proposals on the retail sector or heeded the recommendations of the Indecon report, which recommended consultation and dialogue. Why has the report not been published? I ask that this be done as soon as possible. It is not enough to hide behind the Competition Act 2002 and it is imperative that the HSE and IPU, on behalf of small pharmacists and those with a high GMS turnover, find a way to reach a mutually beneficial conclusion that avoids further action and does not put patients in further danger.

Minister of State at the Department of Health and Children (Deputy Máire Hoctor)

I thank Deputy Chris Andrews for raising this matter. I am responding on behalf of the Minister for Health and Children, Deputy Harney.

The changes to the wholesaler arrangements for the supply of drugs and medicines to community pharmacists for dispensing under the relevant schemes, as announced by the Health Service Executive, were informed by a comprehensive consultation process. On foot of this, it became clear that the HSE could not negotiate with pharmacists or wholesalers for legal reasons. Under section 4 of the Competition Act 2002, the Pharmaceutical Distributors Federation, PDF, representing wholesalers, and the Irish Pharmaceutical Union, IPU, representing pharmacists, may not negotiate fees, prices or margins collectively on behalf of their members since both bodies constitute undertakings under the Act. Accordingly, it is not possible for the State to negotiate with the PDF or IPU on fees or margins as such negotiation would place these bodies at risk of prosecution. The Minister for Health and Children has already outlined in detail how the legal issues evolved in recent replies to several Deputies and in her remarks in the Seanad.

Following the completion of public consultation by a HSE-led negotiating team, and informed by independent economic analysis carried out by Indecon Economic Consultants, new reimbursement arrangements were announced by the HSE on 17 September 2007. The new price arrangements involve revised rates for community and hospital supply. On community supply, the reimbursement of the cost of drugs and medicines to pharmacy contractors is to be reduced from the ex-factory price plus 17.66% for wholesale supply — this is the previous mark-up — to the ex-factory price plus 8% from 1 January 2008 and 7% from 1 January 2009. On hospital supply, there is to be a new interim mark-up of 5% for wholesale supply from 1 January 2008, with further discounts for efficient ordering and supply in that sector.

In its examination of the issues involved and in determining the new arrangements, the negotiating team considered a re-imbursement level that reflects the market value of pharmaceutical wholesale services and security and continuity of supply at current levels to patients. The evidence on which the decision is based, following examination of the issues, direct consultation and independent economic analysis, all indicates that the State is currently paying a premium for the services in question. It is possible and necessary for revised arrangements to be put in place without a substantial impact on the delivery of such services.

I also point out that pharmacists' arrangements with wholesalers for the supply of drugs and medicines is a private commercial arrangement and that the HSE's role is confined to setting the most appropriate re-imbursement rates for community pharmacies. The basis for the new re-imbursement arrangements was set out in detail by the CEO of the HSE on 17 September 2007.

To address concerns expressed by the IPU on behalf of community pharmacists about the implications of the legal advice on competition law on their right to negotiate fees through the union, a process of dialogue was established chaired by Bill Shipsey, SC, to explore ways in which these concerns could be addressed, having regard to the legal position. Following a recent suspension of the process due to the withdrawal of methadone dispensing by certain pharmacists, there is renewed engagement between the IPU and the HSE under the auspices of Mr. Shipsey.

The Department of Health and Children and the HSE continue to recognise the IPU as the representative body for its members. There is, and will continue to be, ongoing dialogue with the IPU, in compliance with competition legislation, and the HSE will consider all available options for advancing the process for the review of the pharmaceutical supply chain. The next stage of this process will involve separation of the price of drugs and medicines dispensed in community pharmacies from re-imbursement for professional services through the introduction of a flat fee arrangement across all the GMS and community drugs schemes. The HSE aims to ensure that such an arrangement will be a fair and transparent reflection of the service provided and will be arrived at following further consultation with all stakeholders. I also point out that the service provided by community pharmacists is highly valued by the Government and I hope that it will be possible for pharmacists and the HSE to continue to engage in matters of mutual concern in a positive and forward looking manner.

Hospitals Building Programme.

Deputy Seán Barrett

I thank the Ceann Comhairle for affording me the opportunity to raise this important matter. It was with deep regret that I learned of the content of a recent planning brief drawn up on behalf of the management and board of St. Michael's Hospital in Dún Laoghaire. This hospital has been part of the fabric of the greater Dún Laoghaire area for many years and has provided, and continues to provide, a wonderful service for thousands of people, including myself, over that period.

It appears that this report was carried out as a result of a recent inquest being told that there had been instances in St. Michael's of a virulent new strain of a hospital-acquired bug which is fatal in one in 12 cases. I will outline some of the disturbing facts stated in this report. The hospital building is at the end of its useful life. The operating theatres, their direct support and the day ward are functionally, spatially and technically obsolete. They offer patients and staff an inappropriate environment for the delivery of contemporary elective surgery and other investigations and treatments. The physical layout is inefficient. Existing space is grossly inadequate and environmental control systems are either absent, inadequately provided or obsolete.

A recent decontamination review observed that processing facilities incorporate no physical barrier between areas in which soiled instruments are received and washed and those in which clean and sterilised material are handled. There is no clear system to dispose of contaminated material. The scrub area attached to the main theatre can only be approached through the theatre or via a staff rest room. Room surfaces are finished in materials now considered inappropriate. The second floor day ward is not directly adjacent to either operating theatre which creates difficulties because of a lack of a bed lift. These are only some of the items specified in this recent report.

I am aware that the management and board have plans to upgrade this very important facility, which carries out just under 6,000 mainly routine surgical procedures annually. They plan to expand on the services currently offered, including an increase in the capacity of the day ward so that day cases can account for 70% of all surgery instead of the current 50%. This target is consistent with trends in Ireland and health systems in most advanced countries.

In light of the disturbing facts contained in this report, I am looking for a commitment that the Minister for Health and Children and the HSE will provide the financial support to allow the management of this hospital to proceed immediately with the upgrading and construction works. Unfortunately, the Minister is not here. It is not acceptable that these necessary works are put on the long finger and that we will have to wait a number of years before this hospital is restored to its rightful place as one of the leaders in the provision of first-class medical services.

The Acting Chairman and I have been Members of this House for a long time. Important issues are raised on the Adjournment. I wish to put a protest on record. I have nothing against the Minister for State, who is not responsible for the Department of Health and Children, but the preceding speaker also raised a very important matter in the health area when no Minister from the Department of Health and Children was present.

Deputy Máire Hoctor

I am here.

Deputy Seán Barrett

In terms of the items that are being raised, I do not blame the Minister of State for having to take this Adjournment debate but, as I said to my colleague, Deputy Ring, this is becoming a bit of a joke. One wishes to raise serious matters and, in my constituency, this is a very serious problem. As I said at the outset, this hospital is an essential part of the fabric of the greater Dún Laoghaire area and complements the very worthwhile services provided at St. Vincent's Hospital. As I also stated, over 6,000 operations are carried out in St. Michael's each year. The fact that it is increasingly moving towards day ward services is an essential part of the infrastructure in our health service.

If anything happens to this hospital, it will be a very serious matter in respect of the proper advancement of St. Vincent's as one of the key centres of excellence for the Dublin area so I appeal through the Minister of State. The funds are necessary. I understand that the board is in a position to go to tender in the very near future. There is talk about work commencing in October but given the current mess in the finances of this country, I am afraid that this matter will be put on the long finger. Having listed some of the matters contained in the report, everybody would agree that, in the interests of patient care and to prevent further illnesses arising from the lack of facilities, it is vitally important that this matter is dealt with urgently.

Deputy Máire Hoctor

I will be taking the Adjournment on behalf of my colleague, the Minister for Health and Children. The Department has been advised by the HSE that the report to which the Deputy refers was prepared by management at St. Michael's Hospital. In order to address the issues outlined in the report, the HSE, as part of its ongoing capital programme, has recently approved in principle a capital project which will allow for the development of facilities at St. Michael's. It will involve new operating theatres and recovery facilities, a new theatre sterile supply unit and a new day procedures unit, including facilities for day surgery, endoscopy and minor surgical and medical procedures

The HSE has indicated that the selection of a design team for the project will commence shortly and it is expected that design and detailed planning will commence in early 2008. The decontamination review and hygiene audit referred to in the newspaper article are national initiatives to address quality and risk issues in service delivery.

A decontamination review and assessment took place in St. Michael's Hospital in November 2006. The HSE has advised that the hospital has taken steps to address the issues raised and this is reflected in the planning brief. Similarly, an assessment of hygiene services took place in the hospital during August 2007. Measures have now been put in place to address concerns that were identified. The HSE has assured the Department that patient care is not being adversely affected in the interim.

Foreign Conflicts.

Deputy Leo Varadkar

I thank the Ceann Comhairle for allowing time to discuss the important unfolding political crisis in Pakistan. Pakistan and Ireland are connected through bonds of history. Both countries once formed part of the British Empire, both were born out of partition, both made a rapid transition from dominion status to a republic, both have struggled to escape from the uncomfortable embrace of a larger neighbour and both share a common language, English, while preserving languages of their own.

However, the similarities stop there. Ireland has embarked on the path of democracy, economic progress and peaceful relations with our neighbours. Pakistan has not been so fortunate, its democracy and economy have been held back by military coup and military rule. Given our shared history, Ireland should not be silent about the events that are taking place in Pakistan. We must be forthright in our opposition to President Musharraf's declaration of martial law and the crackdown on the free press and we must demand a rapid return to civilian rule, free elections and a return to democracy. I call on the Minister of State to encourage the Minister for Foreign Affairs to use his bilateral contacts and multilateral contact through the European Union to ensure that maximum political and economic pressure is put on the Musharraf regime.

The future of the world may well be linked to the future of Pakistan rather than Iran, Israel or Afghanistan. Pakistan is probably the most dangerous country in the world. It is a large country of 150 million people, most of whom are Muslim. It is located at the geopolitical fault line of India, China and the Muslim world. It is a nuclear power, a military power and its tribal areas are a haven for terrorists including al-Qaeda and perhaps even Osama bin Laden. Democracy is the right course for Pakistan's people. It will bring about a more secure world and will set a good example for other Muslim countries struggling with modernity.

Moreover, the suppression of democracy, the press and civil society will have the inevitable effect of making radical Islam the only viable opposition to the current regime and the only political outlet for younger people. We have allowed this to happen in the past in Iran by supporting the Shah against Mosaddeq and also in Egypt. This cannot be allowed to happen again.

I call on the Minister for Foreign Affairs to make our support for democracy clearly known to the Pakistani ambassador and use our multilateral contact through the General Affairs and External Relations Council to ensure that maximum political and economic pressure is put on the Musharraf regime without delay.

Deputy Máire Hoctor

The Government is deeply concerned about the situation in Pakistan. We join those in the international community, including the EU, the US and the UN Secretary General, who have expressed similar concerns and demands for an end to the emergency provisions at the earliest possible time.

Yesterday, following the events over the weekend in Pakistan, the Minister for Foreign Affairs, Deputy Dermot Ahern, issued a statement expressing serious concern about the declaration of a state of emergency by President Musharraf on 3 November, the suspension of Pakistan's constitution and fundamental freedoms and the imposition of wide-ranging restrictions on the media and the Supreme Court. The Minister also stated that it was essential that every effort be made to reinstate the constitution, to lift restrictions on the media and the judiciary, and to return to the democratic process and hold early elections in order to pave the way for a peaceful transition to democratic government in Pakistan. The widespread arrests and detention of opposition members, human rights defenders, journalists and lawyers are deeply disturbing.

In our contact with the Government of Pakistan, we have long expressed our strong hope for a return to democracy and civilian rule through free and fair elections. Pakistan is a country of real strategic importance and, particularly if it can return to civilian rule and democracy, a country with which we are interested in further strengthening our relationship. Indeed, the promise by General Musharraf to withdraw from his military role and the work of the Pakistani elections commission to set up systems for free and fair elections had raised hopes that Pakistan would finally return to this path. This makes the events of the past few days all the more disturbing.

The Irish Government's position is clear. We recognize the real threats to peace and security in Pakistan from the subversion and havoc that militants and extremists can create. We have already seen this in the appalling massacre that greeted Benazir Bhutto's return to her country, which sought not just to assassinate her but also to undermine the democratic process. In responding to this, the authorities must accept that stability and development can only be achieved through democracy and the rule of law.

It is only through accountable representative government, which carries the support of the people of Pakistan, that the real challenges that Pakistan and its people face can properly be addressed. These challenges include the very poor conditions that exist in some remote rural and tribal areas, and the corruption at various levels which affects almost every aspect of life, including the political system.

We urgently call on the Government of Pakistan to take urgent action in the following areas: to restore the constitution; to ensure that the commitments made, and restated yesterday, that free and fair elections will be held on schedule in January are respected in full and the necessary conditions to ensure these are put in place; and to release without delay all political prisoners, including members of the judiciary, lawyers, journalists and human rights defenders. In particular, we appeal for the immediate release of the distinguished human rights defender, and UN special rapporteur on freedom of religion or belief, Asma Jahangir, whose detention is totally unacceptable. We call on the Government of Pakistan to honour the President's commitment to step down as army chief of staff by 15 November, to pursue energetically reconciliation with the political opposition and to relax restrictions on the media.

All parties must exercise the utmost restraint and work together for a peaceful and democratic solution. The Minister has conveyed these views and the Government's deep concerns about recent developments to the ambassador of Pakistan in Dublin, making clear his personal interest in the situation. The Government and the EU will keep the situation under review and will discuss developments further at the next General Affairs and External Relations Council meeting on 19 November.

Schools Building Projects.

Deputy Michael Ring

On 29 November 2006, the Minister for Education and Science announced 54 major primary schools building projects. She promised they could proceed to tender and construction and that many would be constructed over the next 12 to 15 months and that most would be started in that time. The tender process for Gaelscoil na Cruaiche, Westport, has not yet been completed. The promise was made before and during the general election. Gaelscoil na Cruaiche was the only school project announced for Mayo in 2006 but to date the tender process has not been completed.

The school opened in 1996 with provisional recognition and was granted permanent recognition in 2000. It has 206 pupils and 11 full-time teachers. It has a waiting list for admission for the next four years. The school is operating from rented premises, the third rented premises since the school started. The contract expires in June 2008.

A site has been purchased for the school and planning permission was granted. What is causing the delay? Why has the project not gone to tender? Will the tender process be completed before Christmas? We were told the sod turning would take place before Christmas. The premises will no longer be available in June 2008. It is an excellent school with excellent teachers but it needs a new building.

Is funding available or must this project wait until after the budget? Does the recent chaos in Dublin, where the authorities could not plan how many schools would be needed in the future, mean that the west must wait? Will the five or six schools promised for the west be built in Dublin and schools in the west left behind?

I hope the Minister of State, who is here in the absence of the Minister for Education and Science, will indicate that the construction project relating to the school will go for tender either next week or the week after and that the sod-turning ceremony will take place before Christmas. Most importantly, however, I hope she will indicate that a contractor will be appointed immediately and that construction will proceed.

The pupils and teachers at the school are obliged to endure terrible conditions. Had someone not obliged the school in a particular regard earlier in the year, it would not be open and that would be a disgrace. When will the project go to tender? Is the funding in place? Will the Minister of State indicate that there is good news for the people of Mayo?

Deputy Máire Hoctor

I thank the Deputy for giving me the opportunity of outlining to the House the Department of Education and Science's position regarding the provision of new premises for a gaelscoil in County Mayo. It is proposed to build a new ten-classroom school, based on an existing design that was previously used in the provision of a gaelscoil elsewhere. Initially, there were problems with the site acquisition and this delayed the progress of the project in applying for planning permission. The latter and a fire certificate have been obtained and the tender documentation is being finalised.

Under the national development plan, €4.5 billion is assigned to the capital requirements of the primary and post-primary sectors. Over €540 million will be spent this year on school buildings. The level of construction alone in the primary and post-primary sectors in 2007 is such that it will deliver more than 700 classrooms to provide permanent accommodation for approximately 17,500 pupils.

The progression of all large-scale building projects from initial design stage through to construction phase is considered on an ongoing basis in the context of the Department's multi-annual school building and modernisation programme, the main focus of which is to deliver school places within rapidly developing areas. As with all large-scale projects, the progression of a gaelscoil in County Mayo will be considered in this context. I assure the Deputy that the Department is committed to providing suitable high quality accommodation for a gaelscoil in County Mayo at the earliest possible date.

Deputy Michael Ring

I have not received an answer and the Department did not even bother to include the name of the school in the Minister of State's reply. This shows that there is no commitment to the school in question.

Deputy Máire Hoctor

I notice the Deputy did not provide the name of the school either.

The Dáil adjourned at 9.05 p.m. until 10.30 a.m. on Wednesday, 7 November 2007.

Dáil Éireann díospóireacht - Tuesday, 6 Nov 2007