Saincheisteanna Tráthúla - Topical Issue Debate

Pharmacy Regulations

I am sharing time with Deputy Butler.

Pharmaceutical assistants comprise a small group of professional people who have done their jobs in a very professional manner over many years. It is difficult to understand why changes in their work conditions and responsibilities are being proposed. There has been no public outcry looking for such changes to be made. No errors have been made by those working in this profession. As I consider this matter from the outside, it seems to me that large chains are at work here. Pharmaceutical assistants are absolutely vital for pharmacies that are operating on their own as small sole traders. Such businesses depend on pharmaceutical assistants. The number of people working as pharmaceutical assistants is shrinking. The youngest pharmaceutical assistant is in his or her mid-50s. It is baffling in the extreme that changes in pharmaceutical assistants' responsibilities and working conditions are being proposed at this stage. There are many questions to be answered. Why is the Pharmaceutical Society of Ireland, PSI, bringing forward these proposed changes? Many questions need to be asked. These changes are completely unwarranted and unjustified. There is absolutely no justification for them.

The PSI recently approved rules that will restrict the work practices of pharmaceutical assistants. Under existing codes of practice, pharmaceutical assistants are entitled to cover short absences such as lunch hours. They can cover two half-days or one full day per week, as well as any unscheduled short absences. In the case of a temporary absence resulting from the holiday entitlements of a pharmacist, the assistant is entitled to cover two working weeks per annum. As we know, this system has worked very well for the past 128 years. Even though these practices have been in place for a very long time, it is proposed to limit pharmaceutical assistants to covering temporary absences of one hour each day. If the new rules are signed into law, a pharmaceutical assistant will no longer be able to provide professional cover for a pharmacist on his or her day off. The effect of the implementation of these changes would be to diminish the role of pharmaceutical assistants. It could also jeopardise the provision of pharmacy services around the country, especially in parts of rural Ireland.

I thank the Deputies for raising this issue. The Pharmacy Act 2007 established the PSI. The functions of the PSI are set out in the Act and are carried out on its behalf by the council of the PSI. The council comprises 21 members who are lay members and pharmacists. Section 30 of the 2007 Act provides for an exception to the general provision in the Act which requires the sale and supply of medicines at a pharmacy to be conducted under the personal supervision of a registered pharmacist. It specifies that no offence is committed when "a registered pharmaceutical assistant acts on behalf of a registered pharmacist during the temporary absence of the registered pharmacist". Section 30 of the 2007 Act also permits the council to make rules governing "what may or may not be done by a registered pharmaceutical assistant when acting on behalf of a registered pharmacist" and "what constitutes the temporary absence of a registered pharmacist".

On 21 June last, the council of the PSI approved for issuance for public consultation the proposed draft Pharmaceutical Society of Ireland (temporary absence of pharmacist from pharmacy) rules 2018. The public consultation, which commenced on 17 July and ran until 14 August, afforded any interested party the opportunity to make representations on the matter directly to the PSI. On foot of this, the council of the PSI approved the proposed draft rules at its meeting on 20 September last. Rules made by the PSI under the Pharmacy Act 2007 are subject to the consent of the Minister for Health. The Minister has not yet received the draft rules from the PSI for his consideration. I understand that the draft rules approved by the council define the temporary absence of a registered pharmacist as any period, not exceeding one hour per day, during which the registered pharmacist is not physically present at the premises where a retail pharmacy business is carried on. I understand that the draft rules state that the council shall approve a professional task list setting out what may and may not be done by a registered pharmaceutical assistant while acting on behalf of a registered pharmacist in the temporary absence of the registered pharmacist. This list has not yet been established.

I thank the Minister of State for his reply. The Minister, Deputy Harris, told me yesterday that he has not received the submission. The Minister of State has outlined the difficulties that exist. Both the Irish Pharmacy Union and Fianna Fáil have made submissions to the PSI, but neither of us has received a reply. There is no explanation or rationale for the PSI's proposal to downgrade the role of pharmaceutical assistants. I propose that the PSI should be brought before the Joint Committee on Health and the Committee of Public Accounts to explain why it wants to downgrade a professional service provided by people who have done their jobs professionally over many years. As I said in my opening remarks, it is baffling that these changes are being proposed at this time. As my colleague, Deputy Butler, said, this measure will put rural pharmacies and sole traders under extreme pressure. I ask that representatives of the PSI be brought before the two committees I have mentioned to explain why this approach is being adopted.

I would like to reiterate what my colleague has just said. It is strange that the Minister has not received the draft rules, given that this matter has received quite an amount of traction. Like Deputy Cahill, I would like representatives of the PSI to come before the Joint Committee on Health to explain where they are coming from with this idea. Many pharmacists are already struggling to get enough cover to keep their pharmacies open and to provide traditional services to their customers. I understand that the youngest pharmaceutical assistant in the country is 56 years of age. This means that all pharmaceutical assistants will have been phased out nine years from now because they will all have reached the retirement age, or ten or 11 years from now if the retirement age has increased. I estimate that 99% of pharmaceutical assistants are women. Common sense needs to prevail here. These people have provided valuable services to their communities. The knowledge and experience they have gleaned over many years should not been thrown aside because of an over-zealous desire to regulate.

I thank the Deputies again for the points they have so well made. As I have said, the role of the Minister for Health in this process, as set out in the Pharmacy Act 2007, is limited to the consideration of any rules that are submitted for his consent. The Minister must consider any rules that are presented to him from a fair and impartial perspective and without prejudice or prejudgment. Although the draft rules that have been approved by the council of the PSI are publicly available, under the 2007 Act the Minister must await the receipt of those rules from the PSI for his consideration.

Unfortunately, I will not be in a position to discuss the matter any further until the Minister has the rules. The concerns of the Deputies are noted, however.

The Minister of State will note our request to the bring representatives from the PSI before the committee.

As the Acting Chairman, Deputy Durkan, will know, neither the Minister nor I would have a role in such affairs. It would be a matter for the Chairman and members of the Joint Committee on Health. The Members opposite would be quite free to make the request to the Chairman and members of the committee. It is not in my gift or that of the Minister to decide who appears before any Oireachtas committee.

Suicide Prevention

I welcome the opportunity to address this matter with the Minister of State. I acknowledge he is concerned about suicide and self-harm. He takes a personal interest in these matters. They are all too common across the State. Statistics show that, last year alone, there was an average of one suicide per day in the State. This means one life too many was lost per day.

Save Our Sons and Daughters, SOSAD, Ireland, which has six branches across the State, provides a valuable service and does so at a time when people need it. The organisation provides the service to people who are very vulnerable. It is an important service that is easily accessed by people. SOSAD Ireland has been in existence for over 11 years. The Tullamore office has been in place for five years. The six branches do not receive HSE funding. An average of 60 people per week attend the service in Tullamore. The service is provided voluntarily. This week, 15 hours of voluntary counselling will be provided in Tullamore by accredited councillors. This is important. The councillors do not charge for the service and depend on contributions and fundraising to keep it going. The Minister of State will appreciate the difficulty. No matter what little service one runs, once one rents any premises at all and opens the front door, one faces costs of a couple of thousand euro per month.

Medics and other professionals are referring people to SOSAD. The referrals show that the service has a value. Attendees are not just from County Offaly but also from across the midlands. The Tullamore office will not be open after Christmas, however. It may not last until Christmas. It has sought HSE funding. SOSAD Ireland, the overarching body, has sought funding in the past from the HSE. It has been unsuccessful.

We know from the domestic violence groups and various other agencies providing valuable services in all our communities that they cannot rely solely on voluntary fundraising efforts. They need a core of funding to be able to provide their services. This State and all public representatives, at local and national levels, have seen money being spent. Sometimes we get a good return and sometimes we get a very poor return. Hand on heart, I would not have submitted this matter for discussion if I did not believe the service is providing value for money. If it saves one life, it will be worth it. The service could save a number of lives. Countless examples have been recounted to me, even in recent weeks, of clients with whom the service has dealt. I was told how the service has intervened and how people have received counselling and a sympathetic ear, and how they were referred to other services. In the approach to the budget, there will be a huge number of demands. Even those of us on this side of the House, Opposition Deputies, realise there is considerable lobbying and competition for funding. We are interested in mental health, and I know the Minister of State is also. He knows my party is genuine about this. Others in this House are also genuine about it. It is an issue that we need to deal with and help out with. I hope we can do something to put some little package of funding in place for the organisation in question.

I acknowledge that the Deputy and his party always co-operate and take a positive approach to mental health issues. I have never found Members of the Deputy's party to be partisan or politically opportunistic in any shape or form regarding mental health. I include his party leader, Deputy McDonald, and Deputy Buckley in that. They have always been very constructive and co-operative.

I wish to raise a couple of issues concerning the Deputy's query, which concerns Tullamore. I am informed by the HSE that it does not have any record of an application for funding from SOSAD in Tullamore. My Department officials have made contact with SOSAD since the Deputy raised this issue in order to advise it that there are two ways to apply for funding. SOSAD Tullamore has been in existence for five years. The HSE is aware of its existence but does not have any record of any funding application from the charity. There are two avenues for an organisation such as SOSAD to apply for funding to the HSE. Both would be on the HSE website. One involves a section 38 or section 39 funding application. This would be the most substantial. There is also national lottery funding, administered by the HSE. It is available in small amounts. The application forms for both processes are available on the HSE website. My officials have made contact with SOSAD to advise it on both avenues but the HSE has informed me it has not received any application for funding to date from the organisation.

I acknowledge the bona fides of the organisation, which the Deputy has mentioned. I absolutely accept them. I appreciate the work that organisations such as SOSAD do. Effectively, they fill the gaps where they exist. Organisations such as SOSAD are organic, ground-up organisations. They do a power of work, particularly in such a sensitive and important area. We have the National Office for Suicide Prevention, the funding for which, I am glad to report, is increasing exponentially year on year. That funding stands at approximately €12 million per year. A total of 17 local Connecting For Life plans have been developed throughout the country and 15 have been launched. I am launching the sixteenth on 16 October in Kilkenny. There will be only one left to launch, namely, a localised plan whereby all the agencies will come together to combine their efforts to work towards the prevention of suicide. While one life lost to suicide is one too many, I am thankful that the number of lives being lost to suicide has been decreasing significantly year on year recently. We are having some success but I assure the Deputy that this does not encourage complacency on my part or that of my officials, or in the HSE or the National Office of Suicide Prevention. I welcome any opportunity discuss mental health issues, particularly those relating to suicide prevention. I thank the Deputy for his interest and for his contribution.

I thank the Minister of State for his response. There is a positive note in it. My information is that the national organisation applied for funding. From what the Minister of State outlined, I believe the local branches need to apply through the HSE locally for lottery funding. Section 38 and section 39 applications might be difficult because they tend to relate to the bigger organisations and agencies. Obviously, if funding can be secured through a section 38 section or 39 application, so be it. From my limited knowledge, I am not sure that is how it is going to go. Perhaps the Minister of State will come back to me on that. He gave some hope that genuine applications from genuine organisations at local level, such as SOSAD, will be considered sympathetically. I welcome the fact that he has accepted the bona fides of organisations. There are organisations that spring up whose bona fides may be questioned, along with the work they are doing. From what I can ascertain and from the feedback on the ground, however, SOSAD has really made a difference to a number of people's lives.

Many factors affect mental health. One is housing, on which we had a fairly heated debate this week. Employment is another. All these factors feed into mental health. Clinical medical health issues obviously have to be dealt with but societal issues can feed into mental health also. Unfortunately, when people get to the end of their tether and reach the point at which they are likely to self-harm, it is vital to have the grassroots organisations - this is the phrase the Minister of State used - at the front line to intervene. There is a very informal approach for people who visit the service. Not dealing with the problem has social, community and family costs. The rate of self-harm among young people and children soared by 22% in the past ten years. That is considerable so we really have to get to grips with the issue.

I welcome the Minister of State's response and will be taking back his message to SOSAD Tullamore. If he has further information, he might send me a written reply. If there are any other opportunities to secure funding for this organisation or others like it, the Minister of State might send me information in the next week or so. I thank him for his reply.

I do not have any further information other than sections 38 and 39 and the national lottery funding. Both application forms are available on the website. There is no reason that a local organisation or a local branch of an organisation such as SOSAD could not apply for section 38 or section 39 funding. I saw recently that 1,027 organisations in the State that specifically help with mental health issues are receiving funding. That is one of the challenges we have because people do not know where to go when they have a mental health issue. For that reason I aim to establish a single access point for all mental health queries, be it a telephone line, text line or email, so people can be referred appropriately. If one is in the Tullamore region, for example, one will ring a single national telephone number. The person at the other end, who would be appropriately qualified, will say: "SOSAD is an organisation on our list, it is in the geographical area and it can offer the service", rather than SOSAD trying to make itself known to everybody. ALONE, Aware, Jigsaw and Pieta House are trying to do the same thing. They are all trying to sell their brand, as it were, and make people aware of their existence. We are trying to streamline a single access point for all these organisations, provided they have the appropriate level of governance be they clinical.

Many practitioners in the field of mental health and I are big supporters of organisations such as SOSAD. Lower levels of intervention can be very powerful. Not every young person needs to go into the child and adolescent mental health services, CAMHS, which are led by a consultant psychiatrist. In some cases younger people just have anxiety issues and they do not need to be seen by a specialist service. That is why organisations such as the one the Deputy mentioned are so vital for early intervention, to ensure we can stop people going into the specialist services and the queues that build therein.

Special Educational Needs Staff

I thank the Minister of State, Deputy Stanton, for attending this debate. I wish to highlight the lack of special needs assistant, SNA, support for children with autism and other special needs in my constituency of Roscommon-Galway. I and many of my colleagues are dealing with cases every week in which parents of children with special needs are struggling and fighting for services for those children in a bid to meet their educational and psychological needs. Like other parents, those parents only want the best for their children but they are constantly encountering obstacles.

I will outline the story of a ten year old boy in my constituency. This boy is non-verbal and presents with autism and associated intellectual disability. He previously had access to resource teaching hours and SNA support on a full-time basis for a number of years in a primary school setting. However, the SNA support has been removed from September 2018, which is having a detrimental effect on his schooling and development. This child needs constant supervision. He has issues with self-care and safety and he is at risk of running out of the classroom or the schoolyard if not properly supervised. The little boy is non-verbal and was making very good progress with his SNA. The family has provided all the assessment reports and the psychology report outlining his case in detail. I have submitted a parliamentary question on this matter. I would be grateful if the Minister could assist this young boy and reinstate his SNA as soon as possible. It is vital for his future educational and psychological needs.

I am aware of another boy in a national school, a neighbour, in the same situation. He needs the full-time care of an SNA but that has been withdrawn. An appeal for that boy has been submitted and I sincerely hope it will be successful.

In a reply to a parliamentary question from me in June last it was indicated that 800 additional SNAs were to be allocated from the beginning of the school year, with 140 expected to be allocated by the end of 2018. I would be happy if the Minister of State could provide an update on those figures even if he does not have it with him today. Have the additional 800 been allocated and, if so, how many have been allocated to the Roscommon and Galway area? I hope we can look after these vulnerable children. I have a nephew and a niece who suffer from autism. They are looked after quite well by the authorities, it must be said, but when I watch their parents I can tell it is a challenge and a struggle. I have fantastic time for the parents of such children. They make such an effort. It falls to us to make every representation possible on their behalf so they receive the supports.

I thank the Deputy for raising this important issue and I acknowledge his sincerity in doing so. The Minister for Education and Skills also thanks the Deputy for raising this matter and sends his apologies for not being here to reply. The Minister wishes to assure the House that the education of children with special educational needs remains a key priority for the Government. The Government now invests €524 million in the special needs assistant scheme annually, as part of a total €1.75 billion investment in special educational needs overall.

There will be a total of 15,000 SNAs working in our schools, providing support for approximately 36,000 pupils, by the end of this year. This is a 42% increase on 2011 when the number of SNAs stood at 10,575. The Minister welcomes the fact that we have been able to continue to meet the needs of children with special educational needs attending our schools and to increase provision to address emerging needs in this area. The SNA scheme, in particular, has been a major factor in both ensuring the successful integration of children with special educational needs into mainstream education and the provision of support to pupils enrolled in special schools and special classes. The Minister assures the House that schools which have enrolled children who qualify for support from an SNA will continue to be allocated SNA support in a manner appropriate to their needs.

The House will be aware that the National Council for Special Education, NCSE, which is an independent agency, is responsible, through its network of local special educational needs organisers, for allocating a quantum of special needs assistant support for each school annually, taking into account the assessed care needs of children qualifying for SNA support enrolled in the school. Importantly, each school’s allocation of SNA support can change from year to year and may be increased or decreased as students who qualify for SNA support enrol or leave a school. New students with care needs may or may not enrol to replace students who have left, for example, or SNA allocations may be decreased where a child’s care needs have diminished over time.

The NCSE policy advice on supporting students with autism spectrum disorder found that students are generally well supported in schools with: appropriate curriculum; extensive teacher and SNA supports; improving range of educational placements supported by improved accommodation and equipment; improved teacher knowledge and understanding and a generally good standard of provision at primary and post-primary levels. The NCSE policy advice noted that ASD is a spectrum condition, so some students with ASD require little support in school and are relatively independent in their learning while others require significant levels of support. The Department’s policy is to ensure that every child who is assessed as needing SNA support will receive access to such support.

The NCSE has an appeals process, to which the Deputy alluded, which may be invoked by a parent or a school where it is considered that a child was not granted access to SNA support on the grounds that Department policy was not met. Schools may also appeal a decision where the school considers that the NCSE, in applying Department policy, has not allocated the appropriate level of SNA support to the school to meet the care needs of the children concerned. Where a school has received its allocation of SNA support for this school year, but wishes new enrolments or assessments to be considered which were not taken into account when the initial allocation was made, it may continue to make applications to the NCSE.

The Minister for Education and Skills is pleased to advise that schools in Roscommon and Galway have had an increased SNA allocation over the last number of years. Roscommon has been allocated 186 SNA posts for the start of this school year, an increase from the 171 posts allocated for the 2017-2018 school year. The SNA allocation for Galway has also increased from just over 778 posts for the last school year to over 819 posts for this school year. This is an increase of 9% and 5%, respectively, for Roscommon and Galway for this school year.

As part of budget 2018 funding is being allocated for the recruitment of more than 1,000 new SNAs in 2018. There were 70 allocations made between January and June, 800 additional SNA posts were made available for allocation to schools in September 2018 to meet the demands for the new school year and there is an additional allocation of 140 posts expected between September and December 2018, bringing the total to 1,000.

I thank the Minister of State for his detailed response. In fairness, extra SNAs have been appointed. All of us agree that, in general, they do a fantastic job. They build up a great relationship with the children and their parents. They give the children much care, love and attention.

In most circumstances, it works out well. My concern is the increasing number of cases being brought to my attention by parents. The number is greater than it has ever been in the time since I became a Deputy. I am dealing with five cases, two of which have progressed to appeal stage. The others will be a little more difficult to address. Often a child will have a SNA full time in primary school and progress well only for the goalposts to change when he or she moves on to secondary school. In one such case the child comes out of school crying, is unsettled and has difficulty in sleeping at night. Everybody does not fit into the same category. Circumstances can be different. In two of the cases with which I am dealing children received one-to-one attention in primary school, but they are not receiving it in secondary school and are as a result regressing. I hope that when this is pointed out in the appeals process, it can be rectified. As I said, parents of children with disabilities are struggling. As we all know, dealing with a child with autism is very trying. We need to provide every support we can. I acknowledge the role of school principals, teachers and SNAs.

I will convey the Deputy's concerns to the Minister. SNAs are provided to assist recognised schools in catering for pupils with disabilities who have educational and significant care needs in an educational context and where the nature of these care needs have been outlined in medical and professional reports as being so significant that a pupil will require additional assistance in order to be able to attend school and participate in education. In considering applications for SNA support for individual pupils the special educational needs organisers take account of the pupil's needs and consider the resources available to a school to identify whether there is a need for additionality or whether the school might reasonably be expected to meet the needs of the pupil from its current level of resources. The Minister wishes to emphasise that SNAs are allocated not to individual pupils but to schools as a school based resource. The Government is committed to ensuring children with special educational needs are supported and given every opportunity to fulfil their potential. The Department's policy is to ensure every child who is assessed as needing SNA support will have access to such support. Special needs assistants play a key role in supporting children who have additional care needs to attend school and participate in education. More children with special educational needs are participating and we are investing more than ever before to support them. As I said, the NCSE appeals process may be invoked by a parent or a school where it is considered that a child was not granted access to SNA support on the grounds that departmental policy had not been met in accordance with Circular 0030/2014. Schools can also appeal a decision where the school considers that the NCSE, in applying departmental policy, has not allocated the appropriate level of SNA support to the school to meet the special education or other care needs of the children concerned.