I welcome the delegation from the Irish Pharmaceutical Union, including Mr. Giles Barrett, chairman of the veterinary committee, Mr. Seamus Feely, secretary general, Mr. Rory Culleton and Mr. Padraic Staunton of the Irish Pharmaceutical Union. Before asking Mr. Barrett to commence his presentation, I wish to draw attention to the fact that while members of the committee have absolute privilege, the same does not apply to members of the delegation. Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on or criticise or make charges against a person outside of the House, or any official by name, or in such a way as to make him or her identifiable. Mr. Feely may now proceed with his presentation.
Irish Pharmaceutical Union: Presentation.
Mr. Seamus Feely
I wish to begin by saying that the Irish Pharmaceutical Union represents the interests of pharmacists, predominantly community pharmacists. We represent pharmacists, owners of pharmacies and employee pharmacists, that is, pharmacists who work in pharmacies. The delegation consists of Mr. Giles Barrett, chairman of the veterinary committee and chairman of Pharmachem. He is a pharmacist in Castlecomer, County Kilkenny. Mr. Padraic Staunton is a very active member of the union and also a committee member of Pharmachem. He is a pharmacist in Athboy, County Meath. Mr. Rory Culleton is a full-time official of Pharmachem. He was a farmer in a previous existence and he is now business development manager of Pharmachem, an organisation set up to promote pharmacy involvement in the animal welfare area and provide education and development supports to pharmacists to enable them to be effective in this area. I am Seamus Feely, secretary general of the IPU. I will now hand over to Mr. Barrett.
Mr. Giles Barrett
The key message for the future success of agriculture depends on consumer confidence in the produce they consume. An important element of that confidence is the knowledge that animal medicines are used in an ethical manner and not subject to misuse.
The principle points the union wishes to put before the committee are as follows. Pharmacists play an important role in the safe distribution of animal health remedies and there is considerable potential to develop that role further. Pharmacists have the knowledge and skills to provide advice to farmers, second only to that provided by veterinarians. The POM(E) category has worked well and retains many of the safeguards associated with POM. There is clearly potential to extend the range of products that can be supplied under this category. It is cost-effective and convenient from a farmer's perspective. As a general principle, it is not in the public interest to allow individuals who are not professionally trained to be involved in dispensing animal remedies, particularly those medicines classified POM or POM(E). Agriculture is at a crossroads and the future is unclear. However, reducing costs, while not undermining consumer confidence, will be a significant challenge for the future. It may well be time to think about a new and more structured approach to the issue of animal health.
For more than 125 years pharmacists have served the veterinary and human needs of farmers and their families in Ireland. Pharmacies have been the first port of call for generations of farmers, catering for the needs of an individual sick animal and advising on dosing and vaccination programmes for herds. The distribution of pharmacies, of which there are more than 1,300 in the Twenty-six Counties, which is one of the best in Europe, ensures that there is ready access to pharmacies for the farming community throughout the country. It is estimated that there are in excess of 40 million visits to pharmacies each year. Farmers go into pharmacies seeking advice on intramammaries and medicines to improve animal health and well-being. Pharmacy makes a difference and can contribute more to the whole area of public health. Pharmacy holds at least 14% of the veterinary market, according to statistics provided by the pharmaceutical veterinary industry.
Pharmacists are unusual among those involved in the professions. Their incomes are derived from the sale of medicines, but they do not charge a fee for their advice. This duality of function has served the community well. Farmers can avail of advice on the choices and options open to them. There are, of course, many circumstances where farmers must also seek veterinary intervention. However, pharmacies are centres where certain products with inherent dangers, if abused or misused, are sold. The general public or, in this case, farmers have access to products that otherwise would not be available.
Following four years of university training to B.Sc. (Pharm) degree, and a year's apprenticeship in a community pharmacy, and entrance by examination to the Pharmaceutical Society of Ireland, a pharmacist is then qualified to commence the practice of pharmacy. It is a legal requirement that a pharmacist must always be present when a pharmacy is open to the public. Pharmacies are open six days a week, with many offering Sunday morning and rota service. As many Members will be aware, pharmacists can, when necessary, be contacted after hours.
As part of the access for farmers to animal remedies, the Department of Agriculture and Food introduced the 1996 regulations, which transposed the 1990 EU directive into Irish law. This legislation was a catch-all for the various veterinary medicines used in Ireland. If it was a medicine, then it had to have a category. Unlike the UK, where prescription only medicines and free sale were the only two categories introduced by the authorities, the Department introduced routes of distribution to cater for virtually every type of medicine. Instead of the one professional category of POM, the Irish Medicines Board was given the authority to categorise products as VSO, POM, POM(E) and pharmacy sale. VSO medicines can only be used by a veterinary surgeon personally, such as anaesthetics.
In regard to POM, a veterinary surgeon must personally clinically examine an animal before prescribing, administering or supplying an animal remedy. POM(E) is the new category that allows professional discretion in that it allows a veterinary surgeon personally, or a pharmacist personally to supply POM(E) remedies without a precise prior diagnosis. The POM(E) category recognises there are certain animal remedies which, by therapeutic classification, should be POM. However, because of their characteristics, there is no need to examine the animal beforehand. Examples include redwater - historically certain pastures are prone to the disease and farmers recognise the symptoms instantly; respiratory stimulants to assist neonates or young calves with breathing when born; and ringworm treatments and some vaccines are included. The licensed medical list and companion animals list complete the picture.
It would be unnecessary to call a veterinary surgeon for a condition easily recognisable by a farmer. Farmers are well trained at their business, particularly dairy, sheep and pig farmers, who have day-to-day experience of seeing common conditions. In this context, POM(E) is important because it keeps down costs and allows multiple channels of distribution. When POM(E) was first mooted almost ten years ago, it was intended and expected that calf scour remedies, topical antibiotics, etc., would be included. However, in the interim, the reports from the scientific steering committee on antimicrobial resistance in May 1999 and, latterly, WHO recommendations to cease any prophylactic antibiotics in 2002, and other sources would indicate the necessity of exercising due caution. The union has read the IMB report to the Minister on the availability of intramammary products and noted that there are few statistics, nationally or internationally, on the implications of treating animals with antibiotics.
Pharmacy is an evidence based discipline and pharmacists would never risk compromising human health. Exercising the precautionary principle, it appears that to supply intramammaries by the POM(E) route of distribution is appropriate. A professionally trained person, a veterinary surgeon or pharmacist, would personally supply the intramammaries to farmers. As the IMB report stated, there is a question over the validity of sensitivity testing and there appears to be little correlation between in-vivo and in-vitro testing. Mastitis treatment will remain empirical. In this case, a farmer's experience, a vet's practice, a pharmacist's experience in listening to farmers are valid reasons to select appropriate treatments in conjunction with available sensitivity data. POM(E) distribution provides a practical and orderly regime for intramammaries, which will meet the essential concerns of public health and also animal health and welfare, thus providing for the safe, effective use of intramammaries.
Because of the number of pharmacies and veterinary surgeon practices throughout the country, there is ready access to intramammaries. This will reduce the possibility of unscrupulous individuals capitalising on a more restrictive POM regime. We emphasise that the only difference between POM and POM(E) is the requirement for a prior examination. All labelling and recording requirements remain in place. Complete epidemiological data and assessment, together with appropriate record keeping, are possible to address some of the information deficits that currently pertain to mastitis and its treatment. Pharmacists have a high degree of IT competency and are familiar with the collection and maintenance of data and record keeping in routine practice.
The IPU recognises the contribution the co-operative movement has made to Irish agriculture over the years. However, pharmacists are totally opposed to any proposals which may emerge to amend regulations to allow the sale of intramammaries on foot of a veterinary prescription by co-op employees. It must be pointed out that the supply element is only the basic element of dispensing. Dispensing, which is a pharmaceutical function, involves complete medicine review. This includes screening for drug therapy problems, therapeutic duplication, drug-drug interactions, correct drug usage, duration of treatment and potential for abuse and misuse. A prescription review includes examination of the rationale and cost effectiveness of the medicine, including the choice of medicine's potential for wastage. It also involves an explanation to the farmer, the withdrawal interval and the safe disposal of residual medicines.
Pharmacists are equipped with the necessary skills to know and understand the nature and causes of diseased states, the effective means of treating the disease by drug means and the most appropriate means of delivering that drug safely and effectively. Persons other than veterinary surgeons, who are experts in animal health, and pharmacists, with their specialist knowledge of the actions and usage of drugs, should not be involved in the supply of these products. To do so would constitute an unnecessary risk to animal health and public safety. With the best will in the world such persons cannot be expected to bring the same breadth of knowledge and experience to the supply of these products or to have the skills necessary to ensure that the many difficulties highlighted above are addressed.
The IPU is fully aware of the difficulties facing farmers and of their fears for the future. More than 300 pharmacists in rural areas are partly dependent on farming for their living, so any reduction in farming activity or migration from farming will also directly affect pharmacists and threaten the viability of many rural pharmacies.
It appears to the union that the Fischler proposals to decrease stock numbers by more than 30% and to decouple prices from production have implications for the health of animals. If the value of an animal is less than the price of a few boxes of dry cow intramammaries there will be no inclination to procure treatments. This will further lead to problems and reduced consumer confidence in agricultural products. We must safeguard the health status of farming, while not imposing additional on-farm costs on farmers. Perhaps consideration should be given to introducing a programme to maintain our high standards of health care of animals which could be paid for from the EU budget.
In this context, the IPU and Pharmachem have commenced a study to examine the feasibility of producing a comprehensive veterinary care scheme. Pharmachem consulted an agricultural economist who prepared a scheme using the general medical service scheme as a template. The initial report and discussions were successful enough to warrant further development of the proposal. The success and acceptance of this project would result in a paradigm shift in the delivery of veterinary health care in this country. More important, it has the potential to move animal welfare onto a new footing and boost public confidence in agricultural products. This is an issue the union would like to discuss with the committee at some future date.
Policy makers must recognise that consumers today rightly demand information on the produce they consume and ensure that policies respond to those concerns. The IPU recognises that it is difficult to regulate for a system that balances public health and consumer confidence with the provision of a safe, effective, efficient and accountable system for the use of such products. However, it is important to be always aware that it only takes one incident or weakness in the food chain supply to undermine consumer confidence, and then all parties suffer. The view put forward in this paper recognises these concerns and highlights the importance of having appropriate checks and balances in place.
The IPU and Pharmachem would like to thank the committee for this opportunity to put forward their views. We will be happy to respond to any questions that members may wish to raise.
I thank Mr. Barrett and his committee for coming this morning.
First, what percentage of a pharmacist's training is spent on animal medicines? Second, I disagree with Mr. Barrett when he refers to the possibility of unscrupulous individuals capitalising on the more restrictive POM regime. I am based in County Wicklow. There is no pharmacy or vet in the town of Roundwood, for example, and I cannot see why a prescription could not be filled in a co-operative shop. Forbidding the sale of animal medicines in co-ops will restrict access because farmers will have to travel 15 or 20 miles to a chemist or vet. I cannot see why a person serving in a co-op cannot give a farmer the item for which he has a prescription. Maybe I am missing something but that is my view.
Mr. Barrett
With regard to Deputy Timmins's first question, one could say that the entirety of the four years a pharmacy student spends in college is devoted to veterinary pharmacy. There is a module of specialised veterinary knowledge but human and animal systems are the same. We are talking about the same pharmacology, drug usage, drugs and interactions. Everything is the same. The specialist veterinary module is needed because animals suffer from different disease states and a wider range of products is available, in the case of wormers for example, than would be used in human medicine.
When the antibiotic regulations were introduced in 1985, antibiotics became freely available in the highways and byways. That led to access to Clembuterol and all the problems associated with it and to the introduction of far more stringent regulations in 1996. By putting in very strict controls, one can end up with a black market.
There are 290 licensed sellers throughout the country who are licensed through the health boards to supply intramammaries. There are 1,300 pharmacies entitled to sell them and between 300 and 400 are doing so. I cannot say how many pharmacies in the Wicklow region are supplying intramammaries.
I merely used that as a general example.
Mr. Barrett
There is no non-pharmacy or non-veterinary supplier licensed to sell intramammaries. There are many pharmacies supplying them. At the moment farmers in Wicklow procure their intramammaries either from a co-op outside the county or from the local pharmacy.
Mr. Rory Culleton
One of our pharmacists is based in Rathdrum. If he does not have the veterinary business his pharmacy will be of doubtful viability. He has a huge veterinary business.
I was merely using Roundwood as an example. I am not trying to be specific.
Mr. Feely
The theme of our paper is that the consumer is demanding proper checks and balances in the system. The pharmacists' network is very good. We acknowledge the Roundwood type situation but in terms of availability and distribution, pharmacies are better and more convenient than the co-ops in most counties. There always will be the exception to that. Pharmacists have the skills and knowledge to provide checks and balance in the system. Why not use that channel of distribution if it brings further checks and balance and improves consumer confidence?
I thank Mr. Barrett and his colleagues for their presentation. To follow up on what Deputy Timmins asked, what real difference or impact would it make if the prescription available on professional advice from a veterinary surgeon was to be delivered by the co-op rather than by a pharmacist? In section 6 of the information provided it says that complete epidemiological data and assessment with appropriate record keeping are possible to address some of the information deficits currently pertaining to mastitis and its treatment. Can we have a comment on what this involves and what improvements need to be made? It seems that what is being said here is that there is little epidemiological data available and there is inadequate record keeping. Is that a correct interpretation?
Mr. Barrett
I will take the second part first. In the IMB report to the Minister the data used to make the assessment of the situation in Ireland all dates from the early 1980s. If there was current data available it would have been used. In order for a co-op to sell intramammaries it must have a mastitis control programme. As far as we can make out this is pretty much in name only. There is no check by the Department of Health and Children, the co-ops do not seem to be registered with the pharmaceutical society, which is a provision under the regulation, and the actual data, if it is there, certainly does not go anywhere. The collation of data, the manipulation of information and IT technology are very much the province of pharmacists. We are dealing with record keeping all the time, both for human medicine and for veterinary medicine. There seems to be a deficit in terms of the epidemiological data that is there. There is nothing for the IMB report, as far as I can see, to actually work on.
In regard to the record-keeping, is it the case that there is no information on the amount of antibiotic product that is distributed or delivered via the co-ops?
Mr. Barrett
It is certainly not centralised. Any information there has to be determined from industry sources. Certainly if one rang the Department it does not appear to have any access point to know the volume of antibiotic usage. We would have some knowledge of it as pharmacists but it is really only the industry who keeps that information and it is commercially sensitive. We know there is quite a volume. Mr. Culleton might like to add something on this question.
Mr. Culleton
When I sought information from the Department on somatic cell count levels they were not available centrally either. They relate to a level of sub-clinical mastitis which is a significant worry. One would feel there was a dramatic reduction about four or five years ago under EU regulations as the maximum standard was established. Since then there has been a steady rise but the information is not available through central office.
Mr. Padraic Staunton
A question was asked about the difference in access between co-ops and pharmacies. Convenience is not a major issue on this point. Medicines are kept in pharmacies because they are not free-sale items. If they were free-sale items they would be available on the shelves of supermarkets. That is not the way we treat human medicine and not the way we should treat veterinary medicine either. Consumers demand a high level of assurance and it is not until we approach a crisis where a time bomb literally explodes consumer confidence, as has happened in the past, that we appreciate how much reassurance consumers need. When medicines are supplied by a pharmacist he has a secondary professional opportunity to speak to a farmer and impress on him the importance of correct usage, withdrawal and so on. Every opportunity for that is important.
I welcome the delegation and thank it for its submission. I acknowledge the valuable contribution made by local pharmacies and pharmacists to the health and well-being of communities. I take the point made about accessibility, notwithstanding the situation in Roundwood. I know our pharmacists are accessible.
Whatever about the regulations surrounding mastitis and its control there is a perception among farmers that the intramammary purchased in a local co-op will cost much less than the same product from the local pharmacist. Price is the issue for many farmers. May we have a comment on that? The study done and the proposed veterinary care programme, as described in the submission, is fascinating. It seems we can expect a proposal on medical cards for animals, and I do not mean to sound facetious on that. It is suggested that the EU might fund that initiative. May we hear some more on that proposal?
Mr. Feely
I will deal with the first aspect of the question. In regard to prices, back in the early 1970s it was convenient for farmers to obtain animal remedies through co-ops as the cost could be set against their milk cheques. At that time there was quite an incentive for co-ops to supply these products. As a result of that we saw a drift out of animal medicines in many pharmacies in the early 1970s. What has happened since then is that the veterinary committee has established the organisation Pharmachem which Mr. Deasy will be better able to talk about. The primary purpose of setting that up was to ensure that community pharmacists could compete on price with all other outlets. We fully recognise that if we are not competitive on price farmers will not come into the pharmacies. Now generally the prices in pharmacies would compare favourably with most other retail outlets.
The other point we would make strongly is that pharmacists have the ability to provide advice that is not available in the co-op in terms of checking for drug interactions, drug therapy problems and advising on the particular ailment or problem. They are in a position to advise which is an important added value from the farmers perspective and from the consumer welfare point of view. We are attending to the price. We are satisfied that our prices compare favourably with all other outlets and that we can provide the added value of the extra advice that would not be available to the co-op stores.
Mr. Staunton
On the issue of prices I can add that pharmacists now compete with co-ops in dealing with farmers in purchase groups. Farmers are extremely cost conscious and the only way they have of making their business pay more is by reducing inputs. They have recently formed purchasing groups and pharmacists tender to supply of medicines and win tenders. They are every bit as competitive as the other players in the market.
Mr. Barrett
In the 1980s there was a tax incentive given to the co-op movement by the Department of Finance where they could offset the profits of one section against another so there was some predatory pricing which pushed pharmacies out of the market at the time. Now that special uncompetitive rule is gone. It was removed by the Department of Finance so we are back on equal terms. We account for at least 14% of the market, the vets account for nearly half of it and the co-ops account for about 25%. We are in there with them. If we did not have good prices we would have no business. All veterinary medicine is price sensitive.
Mr. Staunton
The veterinary care scheme is a germ of an idea. It is an idea that we felt was necessary to continue good husbandry and good animal welfare. If, as was pointed out, the cost of treatment of the animal exceeds its value, it very quickly becomes apparent that there is little point in treating the animal. In Australia and New Zealand where sheep are farmed on a large scale they are shot if they get foot rot, not treated. I do not know if that is what we want to do here as a routine treatment. I would not like to see animals being shot for the sake of an injection but rather see the injection used correctly. We are not proposing to the committee today that medical cards be issued immediately for animals but it certainly has value in being investigated as a potential for improving consumer confidence, animal husbandry and reducing the cost of animal care to the farmer.
I welcome the deputation and apologise for my late arrival. It crossed my mind when Mr. Staunton was talking about issuing medical cards or shooting animals that perhaps the farmer would be better off if that were the outcome because between the vet's call-out charge, prescription charges and the cost of the medicine, the farmer would end up saving money if the animal were disposed of early.
In the second page of the submission, it is stated that a professionally-trained person, a veterinary surgeon or a pharmacist, would personally supply the intramammaries to farmers. That is a load of nonsense because even if one is given a prescription by a doctor, one deals with an assistant in the pharmacy. If the vet is doing his job he will be busy out testing cattle or looking after animals. I have rarely gone into a chemist's shop and been dealt with by the pharmacist; it is usually the assistant who deals with customers. This is being exaggerated out of all proportion.
Farmers nowadays are professionals and their main concern is the production of high quality food for consumers. The regulations include an animal health register which is subject to an annual check and, on a number of occasions during the year, by Department inspectors in relation to premium payments etc. Farmers cannot afford to lose money so they will make sure that things are right. There is also a check at co-op level where a register of medicines is dispensed to farmers. The motive behind this is to set up another cartel that will make millions for a minority at the expense of the farmer. I am very worried about what is being proposed. In effect, the proposal will do away with competition and competition governs price and is the life of trade, as we are told. I do not accept the view that there is no difference between the price paid in a pharmacy and that in a co-op. I speak from experience because I am a practising farmer and I know the differences in the prices. If the co-ops cannot dispense medicine it will automatically create a cartel for the IPU and there will be no price control. I am worried about the proposals and I believe the IPU is exaggerating the effect they will have.
If a person goes to a doctor with a sneeze, he will come out with a prescription for antibiotics. This is a serious business that has to examined beyond the realms of farming. I am concerned about the stance being taken.
Mr. Feely
I will make a response and my colleagues may wish to join in. I wish to make clear that pharmacists have a contractual obligation to check for drug interactions and drug therapy and to get the history of the medication that is being supplied to the individual. Pharmacists clearly have to make choices regarding who they provide with their services. A person with a long-term illness or on high-tech medicines or an elderly person on six or seven medications values the service he or she receives from a pharmacist. Carers are also key users of the professional services of pharmacists and they are the people to whom pharmacists devote a lot of time in terms of counselling on the correct use of medication, ensuring that the correct dosage is being taken and that there is no misuse or abuse, intentional or otherwise, of the products that they supply. I would not accept the Senator's point for one moment that pharmacists are not providing that counselling and advice service. They do it every day and this is recognised by the Department of Health and Children. One of the reasons the high-tech medicines scheme was put into pharmacies was that health boards were incapable of delivering the scheme in the same confident and efficient manner as the pharmacies. I do not accept the Senator's assertion that pharmacists are not providing that type of service. I will ask my colleagues to deal with the wider issue of price.
I reiterate that there is more involved in the supply of a product; a product must be dispensed and the patient must be advised. The elderly consume 50% of the medicines dispensed and they rely very heavily on the advice of pharmacists. Anyone spending a few hours in a pharmacy would be amazed at the amount of professional input provided to these patients.
That is in relation to humans but not in relation to animals.
Mr. Staunton
I am very disappointed to hear the Senator's experience with pharmacies. As a working pharmacist who works in a pharmacy which has two pharmacists and other competent professional staff working six days a week, I am very disappointed to hear that he does not get to see a pharmacist more often. It would improve his health if he did which is not to say that he does not look well. It is disappointing that he has that impression because that would not be the general rule. Pharmacists are available to consult with people, whether for a cold remedy or a prescription——
Could I just say one thing that I omitted to say in relation to somatic cell count? The farmers' milk is checked on a daily basis and if the cell counts are not within a certain reading they are penalised heavily. That in itself is a sufficient incentive to the farmer to get it right.
Mr. Staunton
With regard to pricing, it is a fact that pharmacists win those pricing contracts I spoke about earlier. They compete with and beat co-ops and other merchants in that market. I compete in that market myself and I have buying groups which come to me and buy from me in preference to other co-ops. I can show Senator Coonan the purchases if he wishes to see them.
I can show Mr. Staunton the opposite.
Mr. Staunton
Perhaps the pharmacist in the Senator's locality has little interest in veterinary medicine.
Competition is good for trade.
Mr. Staunton
In the UK, for example, it is the case that veterinary surgeons alone prescribe and supply veterinary medicine and the cost of medicine is much higher than here. As a result, farmers in the UK come over here to buy medicines. They buy the medicines in our pharmacies. I cannot accept that pharmacies are not competitive. The profit margin pharmacists enjoy on veterinary medicine varies with the use and volume of the item being sold. It ranges from selling it on at cost price to selling it at 16% or 20% maximum gross profit margin. The Senator may smile but that is a fact. I can show him my price list as evidence. If one goes into a particular pharmacy or co-op in any part of the country and asks for a particular item and they do not sell volumes of that item, one may find that their price is uncompetitive when compared with somewhere else that sells a large volume of that product. Generally, pharmacy prices are very competitive.
Mr. Barrett
Internationally, if we look at the 2001 review, take it at face value and take the implication that everything should be POM and dispensed, this is all under discussion at the moment and that is why we are all in a vacuum in terms of regulations in this country and in other EU countries. If it were just to come down to that, it would mean the vet would have to see the animal, make his or her decision and then dispense in a pharmacy. We are saying that route is not needed. We can have a prescription-only medicine that is exempt. That would have all the standards that are set in terms of recording and the advice that is there for POM without the necessity for the farmer to employ his or her veterinary surgeon to come to the farm, examine the animal, write the prescription or supply or have a monopoly. The farmer can go to the veterinary surgeon, use the product under advice within the light of mastitis control, cell counts and sensitivity testing he or she has. Taking that into account if the farmer does not like the price of the veterinary surgeon, he or she can go to a pharmacist. If the farmer still does not like the price he or she can go to another pharmacy. As Mr. Staunton said, there are cut-throat businesses out there. The farmer can then make his or her purchase. This is another option to allow access, accountability and more freedom for the farmer.
Mr. Feely
I wish to make one final point regarding the role of the pharmacist. We made it clear in our submission that when we talked about the checks and balances in the system, one of the critical checks when dispensing human medicines is the fact that a pharmacist checks that prescription. Quite frequently a large part of a pharmacist's time can be spent trying to speak to a doctor in a hospital who wrote the prescription, which may have contained the incorrect dosage or prescribed the wrong drugs. The person prescribing may not have been aware of other medication the patient was on. That is a critical check and balance from the point of view of protecting human health. It can be the wrong dosage or it can be purely that when the doctor wrote that script he or she was not aware of the full facts or the full range of products that patient was taking. All pharmacists spend a considerable amount of time sorting out scripts like that. We see it as a critical check and balance in the system and the same should apply to animal remedies.
Mr. Culleton
We would all support the idea that competition is important. We feel that pharmacies would provide competition and, if the regime changes, could continue to provide even more competition. The choices for the Minister are to make them prescription-only medicine and, given the attempts of the World Health Organisation to try to ban the use of intramammaries in 2000, that is one of the worries at EU level. There is pressure to make them into a prescription medicine where they are totally under the control of the veterinary surgeon. We are offering professional backup and pharmacists will be involved in monitoring the health of the consumer on that basis.
I know of one pharmacist in Dunshaughlin, where there has been the onset of urbanisation, who has gone from being competitive, where he carried high volumes and could afford to do so. He now carries a small amount of products to service those customers who still want to buy from him. Although he does not provide them on a competitive basis, his customers are happy with it. In a town like Cappoquin we have two pharmacists running a cut-throat business. In a town like Listowel there are four vets running a cut-throat business and there is no pharmacist in the town. Those factors will determine whether individual pharmacists are more or less competitive.
I agree that farmers are closely monitored on their individual cell count results. However, as that information is not in the overall domain it is not easy for us to deny the suggestion that seems to be out there that, when the cell count ceiling of originally 500,000 and now 400,000 was introduced and there was a massive cull of cows, we saw cell counts drop significantly. However, it has crept back up. While the gross figure of an individual producer might still be below 400,000 it might be creeping back up towards that level. That kind of information is not in the general domain.
With regard to somatic cell counts, one of the issues is that there is a new product on the market. This new product requires a close level of monitoring at the point of sale. For instance, if a farmer is not going to have a high standard of hygiene over a 13-day period involving eight days treatment with a mastitis tube and five days withdrawal period afterwards, there is no point going into that product. However, it will address cell count levels. That is a whole new programme for which people at the point of sale need to be trained. The level of counselling is important. That is the way new medicines are coming on board. It is important for the safety of the consumer who is key to our milk industry. Ireland is selling its milk produce in the most aggressive markets in Japan and America. On the world market our food ingredients are being sold so it is important we retain the highest standard as a support for our highly professional farmers.
I welcome the delegation from the Irish Pharmaceutical Union. Like Senator Coonan, I agree with having at least some competition. Pharmacies are not all that accessible in some rural areas. In those cases, there should be some competition. I have to consider the welfare of the farmers who believe price is the biggest issue, followed by accessibility. On a daily basis farmers check their animals. Farmers are highly trained and carry out much of the diagnosis. They have tremendous experience handed down from their forefathers. It is not like a mother and child where a child is taken to the doctor when sick. In most instances the farmer knows exactly what is wrong with the animal. He or she may then have to wait hours for a vet and depending on how busy the vet is, it could be too late when he or she gets there. Diagnosis and treatment are key to farmers, followed by price.
Does the Irish Pharmaceutical Union hear of problems concerning the treatment of animals in Border counties? A farmer has only to step over the Border where there is free availability. I have yet to hear any complaints about it.
I too welcome the delegation. The presentation stated that veterinary surgeons and pharmacists with their specialist knowledge should be the only people involved in the supply. The point was made that the pharmaceutical function involves a complete medical review. At the first incidence the veterinary surgeon is closest to the source of what needs to be diagnosed. If he or she writes a prescription that is pre-prepared and that can be bought at a chemist shop, what is the difference between that and going to a co-operative store with the same facility and service available? The delegation has a strong argument as regards dispensing a prescription that needs to be made up. However, with pre-prepared items bought on prescription, the argument is devalued and seems to be anti-competitive as mentioned by other speakers.
Regarding supply, it is said that to do so would constitute an unnecessary risk to animal health and public safety. That argument does not stand up if it relates to something pre-prepared and if we are talking about a medical review or the history of the herd or animal. The closest person to the history of the herd or animal is the veterinary surgeon, whereas the chemist is far removed from that. He or she may be acquainted with it because a person deals with him or her on a regular basis and that would be a strong argument. However, if he or she is removed from that, all that is being done is the filling of the prescription made out by the vet in question. Those are my two questions.
Mr. Staunton
My organisation does not recommend a prescription supply but an exception to that. A POM is a prescription only medicine issued by a vet after diagnosis, whereas POM(E) is a product sold by a vet or a pharmacist. There is no rule that could be implemented to deal with the supply of veterinary medicines because the country is not homogenous but homologous; it is different from one parish to the next and one county to the next.
I come from Louisburgh, County Mayo, where my brother practices as a pharmacist. Farmers have sheep on Mweelrea mountain ten miles west of there, but there is no vet for 14 miles to the east of Louisburgh. Those farmers are experts whose ancestors have farmed sheep on those hills for hundreds of years. They know exactly what is wrong with the animals. They are properly trained, have their green certificates and have done farmer apprenticeships schemes. They should not have to go to a vet to get a prescription for intramammaries but should be able to buy them in the pharmacy without seeing the vet. They should be able to buy other common use items for easily diagnosed problems from pharmacies where there is expert, trained advice available if the farmer needs further advice than that written on the carton.
I am concerned that the difference in the method of supply is not fully understood by the committee. Pharmacies lately enjoy a reputation for being in a cartel and being anti-competitive or uncompetitive. They also seem to have reputation among the media and the healthy population for not having an interest in or working hard on behalf of those who present to pharmacies. That is not the case. Hours of pharmacy time are spent daily not making money but implementing good medical practice for people and animals. It is disappointing that this does not come across well and perhaps that is because those who make negative comment are those who do not enjoy the service and who are not unwell.
Most of my best customers, and those for whom I have worked hardest, are in the graveyard. Most of the animals are also long gone. People and animals die and are not here to testify as to what was done for them.
Mr Feely
On competition, there are more pharmacists per head of population in Ireland than in the other EU countries with the exception of two. There is strong competition and that tends to be on quality of service as much as on price. There is a good network of pharmacies. To answer Deputy Ferris, it is a weakness if there are not checks and balances in the consumer system. If a pharmacist can check a prescription written by a GP and verify that it is correct and does not need changing, that is important for the health of the individual involved. Why can the same rules not apply to animal welfare, given the consequences of any slip-ups for public health and safety?
There is strong competition in the market and the fact that these products are supplied to pharmacies will not in any way increase costs for pharmacies. However, it will provide an extra layer of assurance for consumers which is extremely important. It only takes one incident in terms of the food chain to damage confidence. I was recently told by a farmer about a report on the use of antibiotics in animals. The number of queries pharmacists receive as a consequence of just one report in a newspaper shows the awareness of consumers. Consumers would be reassured to hear that a script is written by a vet. However, with regard to POM(E), if a vet has not written a script, a pharmacist has dispensed it and he or she had the knowledge and skills to ask the right questions of the farmer before doing that.
Mr. Culleton
In response to Deputy Blaney, there is a network of pharmacists in the west of Donegal. That is not so great in the centre of the county but they are available, are members of Pharmachem and will be there and active if the market grows. However, they must react to the market. There is a huge deficit of veterinary surgeons in County Donegal. One recently left to go to the Department of Agriculture and Food and was lost to the county.
I know nothing about the impact of the cross-Border trade. However, the pharmacist in Raphoe is doing very little veterinary work now and perhaps that reflects the cross-Border trade. The pharmacists in County Donegal tell me that there are vets, of the few in the county, who take a whole month of holidays leaving no vet available. It is important to keep pharmacists involved in that end of the business. I hope, at some stage, that the veterinary care scheme might be deemed acceptable if de-coupling is to come in. This might be a method to fund it from the agricultural budget without impacting on farmers and it might make being a veterinary surgeon in County Donegal viable and bring vets back in.
I thank the delegation for the manner in which they responded to the questions raised by committee members.