I wish to share one and a half minutes of my time with Deputy McHugh and one minute with Deputies Kieran O'Donnell and Jimmy Deenihan.
Adjournment Debate.
Pharmacy Services.
Is that agreed? Agreed.
I raise a serious issue to which a solution is needed immediately. For the past six months there has been a stand off between the Irish Pharmaceutical Union and the Health Service Executive. Disputes are usually settled by negotiation but that has not even been attempted in this case. The Minister and the HSE refuse to negotiate. Instead, we now have threats of injunctions and as 1 May approaches real concern is being generated. That is what I want to raise tonight because people want to know where they will get their medicines and what will happen if they cannot pay for them, which is the case for many people. I have been advised that out of 48 pharmacies in Mayo, 46 are pulling out of the scheme on 1 May. It is not acceptable that those people should be put through that trauma and stress in addition to coping with their medical conditions.
I met with approximately 100 people in an active retirement group in Ballina on Tuesday morning and there was genuine anxiety among the group because with 1 May looming there is no contingency plan to allay their concerns about where they will get their medicines. Real confusion and fear is being experienced. I have received hundreds of calls from people and patients in the past few days. A 92 year old woman telephoned me today wanting to know who would tell her what tablets to take.
The pharmacy service in Mayo and other counties involves more than just a drug store dispensing medication. People come to seek advice and clarification on how to take their medication. It is a vital community service. Mayo's pharmacies depend on medical card holders for 80% of their business. If they are forced to close, it will be another strike at the heart of rural Ireland.
As a matter of urgency, will the Minister indicate what will be the contingency plans on 1 May? I tabled a question on the matter today but was told it was a matter for the HSE to answer. I am not here to score political points, nor are the other Deputies. I want to allay the fears of the people who need answers. Only the Minister can instruct the HSE to remove the cause of the panic among the sick and the less well-off about where they will get their medicines in a few weeks from now.
As Deputy O'Mahony said, we are not here to score political points. We are facing a crisis. Almost 800 pharmacists have submitted letters tendering their resignation. In addition, there is fear among the people on the drugs payment scheme and the medical card scheme.
We must provide a solution to this impending disaster. Why did a senior official from the HSE pull out of the Oireachtas joint committee meeting tonight? The answer to that question will not be in the Minister's script but an answer is required as to the reason the official did not turn up to that meeting today.
The pharmacists are in a corner because the HSE will not negotiate with their union representatives. They will not allow union representation in any negotiations. There has not been a level playing field in that regard from day one. The IPU has always indicated it is in favour of cost cutting and has put forward its own proposals.
We need a quick intervention. There is fear among the public. Pharmacists are in a corner and the intimidatory mechanisms used by the HSE in issuing High Court injunctions will not solve the issue. We are facing a crisis and something must be done about it soon.
I echo what my colleagues have said. This is probably one of the most serious issues that has arisen in terms of medical services in a number of years. Why is the Minister not here? Where is the Minister, Deputy Harney? This is a serious issue but her absence is an indication of the way she regards it. Patients are concerned about getting their medications. The livelihood of pharmacists is being threatened. They are taking an 8.2% reduction from pharmacists but many pharmacists are not getting that level of discounts. When the old dispensary system was abolished in the early 1970s, pharmacists were to set up a network throughout the country from which they could dispense. The Minister is standing over the dismantling of this service. She must demand that the HSE enter into negotiations with the IPU to resolve this issue before a disaster occurs. Pharmacists are being backed into a corner, where they are being forced to threaten to terminate their contracts individually.
That is totally unacceptable. The Minister should be here tonight dealing with the issue. She should, as a matter of urgency, demand that the HSE enter into formal negotiations with the IPU. They should sit down, engage in consultation and allow the pharmacists go on with their business, providing a very good service in all areas of the country and being an efficient part of the HSE. Many other parts are not so efficient.
According to 2006 HSE figures, 42,792 individuals — 30% of the Kerry population — depend on community pharmacies for medicines dispensed under various community drug schemes. As has been stated, local pharmacies have dispensed not just prescriptions but expert medical advice and reassurance to their customers while building up an invaluable personal relationship with the local community over the course of years.
As a result of the unilateral decision taken by the HSE under the direction of Government, patients will now have to pay for their medicines on 1 May. Many people will just not have the capability or capacity to pay for their medicines and will do without them. As a result, there will certainly be fatalities.
It is unfortunate the Minister of State, Deputy Brendan Smith, is here as I saw he took all the Adjournment matters in the Seanad tonight. He would not want to become Minister for the Adjournment. Will the Minister of State convey to the Minister and the Government our concerns? At this stage it is in their hands and they must intervene. I appeal to the Minister of State, and other Ministers, to get the Government to intervene before it is too late and all the consequences mentioned by the three previous speakers come into effect.
I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney, who is unavoidably absent due to other Department business. I thank the Deputy for raising this matter as it provides me with an opportunity to outline to this House the current position.
Over recent years, the Health Service Executive has reviewed the pharmaceutical supply chain with a view to seeking value for money in the State's drugs bill, in order to better fund existing and innovative therapies without compromising patient safety or continuity of supply. Following the completion of public consultation, and informed by the independent economic analysis carried out by Indecon International Economic Consultants, new wholesale pricing arrangements were announced by the HSE on 17 September. The report by Indecon was published by the HSE on 13 November 2007.
In response to demands from community pharmacists to address what they see as the impact of the new wholesale pricing arrangements, the HSE offered a voluntary interim contract with a flat rate dispensing fee of not less than €5 for all dispensing under the GMS and community drugs schemes. Pharmacists and the Irish Pharmaceutical Union did not see this as a positive gesture and have not taken it up.
Following engagement and discussion with the Irish Pharmaceutical Union in February, the Minister established an independent body to assess an interim, fair community pharmacy dispensing fee to be paid for the medical card scheme, the DPS and other community drug schemes. This initiative is aimed at supporting pharmacists in rural or inner-city areas with predominantly medical card patients, as the Government is concerned to support community pharmacy services particularly to less well-off patients and areas. This body is being chaired by Mr. Sean Dorgan, former head of IDA Ireland. It has been asked to make its recommendations by the end of next May and I understand it is on course to produce its report and recommendations in that time.
Both the HSE as the contracting body and the Irish Pharmaceutical Union as the representative organisation for community pharmacists, along with other stakeholders, are entitled to make submissions to the independent body. I understand the Irish Pharmaceutical Union has made a submission to the independent body and that it had a detailed and comprehensive engagement with Mr. Dorgan's group last week on a wide range of matters pertinent to his terms of reference.
I reiterate that the Government recognises the IPU as the representative body for pharmacists and wishes to maintain its longstanding relationship with the union as a key stakeholder in health care.
Unfortunately, the HSE has reported that it has, to date, received notification from over 500 community pharmacy contractors indicating their intention either to cease providing services from 1 May 2008, or otherwise reserving their right to do so.
It is now 800.
It is 800 as of today.
Community pharmacy contractors are required under the terms of their contract to give three months' notice of their intention to withdraw. This is a serious obligation to ensure continuity of dispensing services to patients.
The HSE has written to each of the contractors concerned, seeking formal confirmation of their intentions and pointing out that three months' notice of cessation of service is required. As of now, only two contractors have given formal notification of termination in accordance with the requirements in the contract.
The HSE has been obliged to develop a national contingency planning framework which will inform and provide direction to local operational management for the development of local area-specific contingency plans. As service provision, geographical and demographic circumstances will vary from area to area, each local health area is developing its own area-specific contingency plan within the context of the overall national framework.
However, I emphasise that it is the Minister's and the Government's earnest hope such contingency arrangements will not prove necessary and a withdrawal of services by pharmacists will not take place. The process engaged in by the Dorgan group is under way, as the IPU can attest, and it offers a real prospect of a way forward in this dispute.
Its reference should be extended to include discounts.
It should be allowed complete its work——
There are two parties in the process.
Allow the Minister of State to speak.
It should be allowed complete its work in just a few weeks' time.
In the meantime and while that work is still under way, a withdrawal of services by pharmacists is not a response that is fair to patients who, for good reasons, have——
There are two parties in the negotiations.
Could we have the common decency to listen? In the meantime and while that work is still under way, a withdrawal of services by pharmacists is not a response that is fair to patients who, for good reasons, have developed a trust and confidence in their community pharmacist to supply the medicines they need.
This is fuel to the fire. Negotiations are ongoing.
Threats of withdrawal from the community pharmacy contract in this context are surely not in anyone's interest.
The Minister has repeatedly stated she does not wish to see any patient inconvenienced in any way. She believes that if community pharmacists reflect on the position and the fully independent——
Is this before or after they get the High Court injunction?
Deputy McHugh, please allow the Minister of State to conclude.
This is ridiculous.
Will the Deputies show some common courtesy for just one second?
It is ridiculous, this is not even an answer.
Allow the Minister of State to conclude.
The Minister, Deputy Harney, believes that if community pharmacists reflect on the position and the fully independent and impartial engagement by the Dorgan group——
That is the end of May.
——they will choose responsibly to fulfil their professional obligations to their patients.
What about the confined terms of reference?
Health Services.
I thank the Ceann Comhairle for being kind enough to allow me raise this item. I acknowledge the presence of Deputy Brendan Smith, Minister of State at the Department of Health and Children. I hope the Minister of State will carefully note the concerns I will express.
Very often, I raise issues on the Adjournment and through other business which is Tallaght-based. The service I will discuss tonight is Tallaght-based but I stress to the Minister of State that this is not just a Tallaght issue but one which concerns Dublin as a whole. It involves most Dublin constituencies and I know other colleagues are as concerned as I am. I particularly acknowledge the support I have received on this issue from Deputy Darragh O'Brien, our colleague in Dublin North.
The Acting Chairman knows that not a week goes by when we do not raise issues relating to hospital services. I have always been very supportive of my local hospital in Tallaght, which I have been involved with since its planning stages and through its opening. I was a member of the board when it opened in June ten years ago.
All of us know the hospital in Tallaght, as well as St. James's, Beaumont and all the other hospitals in Dublin, are regularly under pressure. Not a week goes by when the Mater Hospital is not highlighted for its particular challenges. There is no question there is a need to find a way to deal with the crisis in accident and emergency departments and the input of patients.
Some months ago, a number of my constituents in Tallaght brought to my attention the fact that they had availed of what they described as a dynamic new HSE initiative which provided a hospital in the home service. One individual recounted being plucked from a trolley in the accident and emergency department and transferred to this programme. I took the time not only to visit Tara Healthcare at the South City Business Centre in Killinarden. As a result of the co-operation of those who work there, I was able to visit patients in my constituency who were availing, in a positive way, of this service. They told me great stories about being kept off trolleys in hospitals and out of accident and emergency departments and being provided with a service by highly professional people. Not only were the latter providing such a service, they cared about the patients' plight. I was deeply impressed by the service on offer and I thought that, for once, the HSE had come across a tremendous initiative that is well worth funding.
To my distress and that of many others — as already stated, the effects of what is happening will be felt across Dublin — Tara Healthcare was informed last week that the HSE intends to suspend the service for the summer months. The management at Tara Healthcare informs me that this will effectively mean an end to the service. At a time when we are seeking innovative ways to preserve a good health service and cater for the needs of patients in a caring and effective way, I do not understand how the HSE can say to the 2,000 patients treated by Tara Healthcare and the 70 nursing staff, six doctors and ten administration staff who work there that the service will not be continued.
I obtained access to the HSE's evaluation of the service and it makes for amazing and positive reading because it points out that the service has provided a valuable alternative to hospital care for almost 2,000 patients since its introduction in March 2007. The evaluation proceeds to state that referrals to the service have increased steadily over time and that the service has been working to capacity over the winter months. It further states that the service provided by Tara Healthcare has evolved over time to cater for patients with a number of different diagnoses. It also highlights the success of the service.
I visited Tallaght hospital in recent days and the acting chief executive stressed that the service provided by Tara Healthcare has been a great boon to the hospital. Having checked with colleagues, I am aware that it has also been of tremendous value to other hospitals. The HSE has been the subject of many bad news stories in recent times. This is a good news story. The HSE stated in its evaluation that this service is effective and first class. However, it is now stating that it will no longer fund it through the summer months. Effectively, this means that the service will no longer be provided for those who benefit from it and who it keeps off trolleys and out of hospital accident and emergency departments.
I am informed that Beaumont is the largest catchment area for this programme at present and, therefore, this matter relates not only to Tallaght. I want to fight on behalf of people throughout the Dublin region who will be deprived of a first-class service. I ask the Minister of State to reply to the matter I have raised and to make it clear to the Minister, Deputy Harney, that the service must be retained.
I thank Deputy O'Connor for raising this important issue, to which I will reply on behalf of the Minister for Health and Children, Deputy Harney.
One of the key challenges facing the Health Service Executive is the need to ensure that services are planned and provided in line with the clinical need of patients. A number of experimental initiatives were put in place by the HSE with a view to providing, where appropriate, care in community-based settings instead of hospital settings. The hospital in the home service, with the introduction of primary care teams, community intervention teams, a rapid access service for the elderly and the GP out of hours service, is one of these initiatives.
The hospital in the home service was delivered by the service provider in question on the basis of a service level agreement with the Health Service Executive and for a period of one year. This agreement came to an end on 16 March. However, it was subsequently extended to 18 April.There are approximately 400,000 presentations to accident and emergency departments in Dublin annually. Some 100,000 of those who present are admitted. During the period of the agreement, the hospital in the home service treated in the region of 2,000 patients at an annual cost of €6.83 million. The hospitals benefiting from the service are Beaumont, Connolly, the Mater, St. James's, St. Vincent's and Tallaght hospitals.
A review of the service was carried out between January and March of this year under an independent chairman. The review made a number of recommendations. The main recommendation in the report, which has been adopted by the HSE, is that the concept of hospital in the home be retained and that it should be repatriated within existing HSE post-acute care and community services. The HSE is considering the manner in which it can best mainstream the service, previously offered by the service provider, into the executive. There is capacity within the community intervention teams in the greater Dublin area to absorb this service. Accordingly, the HSE is not in a position at this time to commit to a further 12-month contract. However, it is considering a number of points put to it by the service provider. The HSE has emphasised that no patient will be disadvantaged by this decision.
I assure Deputy O'Connor that the points he raised will be brought to the attention of senior management in the HSE tomorrow.
Summer Works Scheme.
I thank the Ceann Comhairle for the opportunity to raise this important matter. The summer works scheme relates to minor projects involving gas, electrical and mechanical works, roof replacement or repair, window replacement, toilet upgrades, structural improvements and access works. On her Department's website, the Minister for Education and Science refers to the benefits of these projects to local areas and schools.
Summer works projects are managed by the schools to which they relate and have had a major impact since the scheme was first introduced. I am aware of schools in my constituency that benefited from the scheme. It is amazing that I have been given the opportunity to raise this matter on the day when it emerged that students at a school in Glenville, County Cork, were obliged to attend classes in a converted toilet. There was major concern about this matter in the media today and the parents of the children involved outlined their plight on television news programmes this evening.
Several schools in south Tipperary were hoping to carry out remedial works this year. I know that arguments have been put forward that the economy is not doing so well and that there is not as much money available. A review is taking place but if we are obliged to wait for the results of this it will be too late. I ask the Minister for Education and Science to consider reintroducing the scheme on an emergency basis. I am aware of no other scheme which was administered in such an easy fashion, without the need for checks and rechecks.
I ask the Minister of State to bring the issues I have raised to the attention of the Minister for Education and Science. This is a great scheme and its reintroduction warrants consideration by the Minister. I hope the Minister of State is in a position to provide a positive reply.
I am taking this matter on behalf of the Minister for Education and Science, Deputy Hanafin, who is unavoidably absent. I thank Deputy Tom Hayes for raising it because it provides me with the opportunity to outline the Government's strategy for capital investment in education projects and the current position in respect of the 2008 summer works scheme.
Modernising facilities in our 3,200 primary and 750 post-primary schools is not an easy task, particularly in light of the legacy of decades of underinvestment in this area and the need to respond to emerging needs in areas of rapid population growth. Nonetheless, the Government is determined to improve the condition of school buildings and to ensure that the appropriate facilities are in place to enable the implementation of a broad and balanced curriculum.
The Government has dramatically increased investment in the school building programme from just over €90 million ten years ago to almost €600 million this year. During the lifetime of the National Development Plan 2007-2013, almost €4.5 billion will be invested in schools. This is an unprecedented level of capital investment, which reflects the commitment of the Government to continue its programme of sustained investment in primary and post-primary schools. The summer works scheme was introduced in 2004. Since its inception more than 3,000 projects costing in the region of €300 million have been completed. With so many small projects having been completed over the past few years, the concentration is on delivering as many large-scale projects as possible this year, as well as delivering improvements in the quality of existing primary and post-primary school accommodation throughout the country.
To maximise the delivery of large-scale projects — thus ensuring that sufficient pupil places are available for next September's intake of new pupils, particularly in rapidly developing areas — it was necessary to concentrate the maximum amount of funding available on these projects. On 1 February, the Minister for Education and Science, Deputy Mary Hanafin, announced the first phase of large-scale projects that will commence construction during 2008 and 2009. The Minister's announcement included details of the 18 large-scale building projects approved for construction and a further 30 primary school projects in rapidly developing areas. This is the first phase of projects that will commence construction during the course of this year and next year.
It is the Minister's intention to make a further announcement shortly to allow a further batch of schools to commence construction and to update progress on the delivery of new schools planned for September 2008 in developing areas.
In this light, there is not therefore a summer works scheme as part of the Department's building programme for this year. However, the Minister has announced that there will be a summer works scheme in 2009. I again thank the Deputy for affording me the opportunity to outline to the House the current position concerning the summer works scheme. I also thank him for his appreciation of the great work undertaken in recent years under that particular scheme. All Members of the House can agree on that point.
Dublin Bay Development Plan.
Before the Minister of State, Deputy Brendan Smith, leaves the Chamber, I have to say that his explanation that the community care service in Dublin can absorb €6.83 million worth of special programmes for people who could be kept out of hospital, defies any understanding of what is happening in community care in the city. I know he has taken note of what Deputy O'Connor wisely said to him, but perhaps he can also take note of my point.
Yes.
I am glad of the opportunity to raise this serious issue. An Bord Pleanála recently decided to designate the infill of 52 acres in Dublin Bay as a strategic infrastructure. This means that it can proceed to planning permission without going to Dublin City Council. It will go straight to the board for a decision, so it cuts out the entire democratic element of the decision process. This is disturbing for several reasons, one of which is that the Government decided that Dublin City Council should draft a development plan for what should happen in the bay. That role was given to the council under the Planning Act 2000 and it is in the middle of preparing that document.
The document would balance all the different interests, including commercial, port, community and amenity. It was going to be a vital document that would balance such interests, instead of which we have a wholly owned State company seeking to pre-empt a Government decision giving this authority to Dublin City Council. It is unacceptable and shows the lack of joined-up thinking within Government, which allows agencies to paddle their own canoe. It has happened at a time when it is pre-empting the Government's own decision to have a review of the most appropriate location for future port capacity.
The Government indicated that it will deliberate on this matter and make decisions. It recently indicated that it sees potential in Bremore Port and has sanctioned development there. It is wrong to move in this way before the Government has made its strategy clear, thus pre-empting important decisions. The Government indicated in the programme for Government that it will establish a task force for the protection of Dublin Bay to maximise its potential for the citizens of Dublin and that it will consider legislation if necessary to deliver that. However, we clearly now have a pre-emptive move by a wholly-owned State company to prevent the Government from doing what it has set out in the programme for Government. This undermines a democratic process that was decided upon by the Government.
It also undermines State policy on picking the most appropriate location. The Government should decide policy directions, rather than allowing individual agencies in pursuit of their own commercial interests, which is what is at stake here, to scuttle Government policy. Like many others, I am content to allow the process the Government has agreed upon to take its natural course. We will live with the outcome as best we can, regardless of whether people are happy with it. We need some joined-up thinking in Government whereby one can start to put teeth behind one's own intention.
My worry is that we will sleep-walk through this issue. A strategic planning application will go to the board, a decision will be made and the Government will be caught flat-footed because the task force for Dublin Bay still has not been established, the strategic plan for ports has not been decided and Dublin City Council's development plan is totally frustrated. That is not joined-up thinking. The Minister of State should say what the Government's strategy is so that we can obtain a proper balance and achieve a fair method of making this decision.
I thank Deputy Bruton for raising this important matter to which I am responding on behalf of the Minister for the Environment, Heritage and Local Government, Deputy John Gormley.
At the outset, I wish to make it clear that under section 30 of the Planning and Development Act 2000, the Minister is precluded from exercising any power or control concerning any individual planning application or appeal with which a planning authority or An Bord Pleanála is or may be concerned.
As regards the particular project proposal referred to, the Department has made general inquiries with the board and understands that the Dublin Port Company was advised on 20 November 2007, following consultation with the board, of this project's designation as strategic infrastructure. However, the board has not yet received any formal application from the Dublin Port Company.
In the event that an application is received in respect of the project referred to, the Act requires the board to notify Dublin City Council, as the planning authority within whose area the proposed project would be situated, that an application for strategic infrastructure development has been received.
The Act requires the manager of the relevant planning authority to prepare a report on the likely effects of the proposed development on the proper planning and sustainable development of the area. The views of the elected members of the planning authority must also be sought and attached to the manager's report. In making a determination on such an application, the board is required to consider this report.
Furthermore, as any proposed development may also have implications for the designated bird habitats in Dublin Bay, the Department of the Environment, Heritage and Local Government will have to be consulted on the natural heritage implications of the proposal, as set out in the environmental impact study. In the coming weeks, the Minister, Deputy Gormley, intends to publish revised and extended boundaries for the Dublin Bay special protection areas for birds.
The national development plan includes a proposal to undertake a comprehensive study of the role of Dublin Port. This is being put in train by the Department of Transport, which has advertised for a consultancy firm to undertake the study this year. This is intended to address the role of Dublin Port and its future, taking account of, inter alia, all-island port capacity, wider transport and urban development policies, the national spatial strategy and national economic policy. It will examine the feasibility, costs and benefits of various scenarios concerning Dublin Port, including relocating all or part of Dublin Port’s existing activities to an alternative location or locations; existing port activities continuing to expand with demand; and port activities continuing at current levels with growth being catered for at alternative locations.
In accordance with the Government commitment, the study will take account of the findings of the research commissioned by Dublin City Council on the role of Dublin Bay and the Dublin port area. It will also be framed in the context of urban development policy and implementation of the national spatial strategy, which fall within the remit of the Department of the Environment, Heritage and Local Government.
The programme for Government has also committed to establishing a Dublin Bay area task force to protect the bay area and to maximise the potential of the bay for the city's residents. The task force's work encompasses a broad range of environmental, economic, social and heritage issues and will build on the work undertaken by Dublin City Council and relevant stakeholders in Dublin Bay.
The Department of the Environment, Heritage and Local Government and the Department of Transport have agreed that both the NDP Dublin Port study and the task force can progress simultaneously. It is intended that the Dublin Port study will be completed before the task force finalises its work.
The terms of reference, composition and operational arrangements of the Dublin Bay task force are being finalised and will reflect the Minister's determination that key stakeholders and decision-makers will be represented to ensure that a comprehensive strategy for the bay is devised and implemented. Any relevant decisions of An Bord Pleanála on Dublin Bay will be taken into account by the task force. As I have already outlined, it is clear that the future of Dublin Bay is being considered in a holistic and sustainable way, with key decision-makers and stakeholders working together towards a shared future vision for the bay.
The Dáil adjourned at 10.30 p.m. until 10.30 a.m. on Thursday, 24 April 2008.