I welcome the Minister of State, Deputy Dinny McGinley, to the House.
Adjournment Matters
Non-Consultant Hospital Doctors Recruitment
In 2011, more than 200 doctors were recruited in India and Pakistan and brought into Ireland. We rushed through legislation to create a new supervised division and the doctors were given two year contracts. Some of those contracts will expire in July and others in December, because some doctors did not begin working until January 2012. We may, therefore, have a shortage of junior doctors in June and July this year. While we have a contract with a university in Pakistan to bring in a new group of doctors, we may lose an opportunity to retain doctors who have been working in Ireland for two years. We will not be able to give them new contracts unless they can move from the supervised division into the general division.
Little progress has been made on this matter by the Department of Health, the HSE or the Medical Council, and this issue needs to be clarified. Some hospitals are still awaiting receipt of CVs and, therefore, cannot even interview applicants for the vacancies that will arise in June and July. I seek clarification on this matter. The HSE, the Department of Health and the Medical Council should work together to resolve this problem. People who have two years experience of working in Ireland should be given the opportunity to stay here, make a contribution to our medical service and fill the gaps that will arise in our hospitals and health system.
I would like, on behalf of the Minister for Health, Deputy James Reilly, to take this opportunity to outline to the House the current position on this issue.
Given the very significant difficulties the HSE faced in 2010 recruiting suitably qualified and experienced doctors, the executive commenced an overseas recruitment campaign in India and Pakistan. This process was aimed at addressing shortages due to arise with the changeover of non-consultant hospital doctors, NCHDs, in July 2011.
The key requirement for doctors to begin employment with the HSE is registration with the Medical Council. Urgent amendments to the Medical Practitioners Act were enacted in 2011 to create a new supervised division of the register. This provided a safe, effective registration process for a two year period for doctors recruited from abroad.
This recruitment process and the introduction of the supervised division resulted in almost 290 doctors working in the Irish health service for the first time. Candidates were fully informed of the conditions of recruitment. For most candidates, the two year period in the supervised division is coming to an end. The only option open to doctors wishing to continue employment in Ireland is to apply to either the general or trainee specialist divisions. The choice of division will depend on individual qualifications and experience.
Doctors in the supervised division only practise medicine in the post to which they have been proposed and under strict supervisory arrangements. Registration in the general division involves clinical assessments to ensure the practitioner is fit to practise in a range of positions. Transferring from the supervised division involves undergoing the pre-registration examination system, PRES, which is designed to ensure doctors demonstrate competence in a general scope of practice. This is a critical measure to protect the public.
The NCHDs may also seek registration in the trainee specialist division provided relevant criteria are met. These include access to a recognised training post, holding a document which is equivalent to a certificate of experience, and being successful at the PRES unless exemption criteria pertain.
The HSE contacted doctors in relation to the process for transfer in November 2012. This process was also outlined to representatives of this cohort at a meeting on 8 March by the Department of Health, the HSE and the Medical Council. The Medical Council has received and processed applications for some doctors. The remaining doctors have not yet provided necessary documents and information to the council to progress their applications. Doctors who have received final communication from the Medical Council regarding outstanding documents and information have until 2 April to do so.
For doctors not wishing to remain within the Irish health sector, the HSE has confirmed that the president of the College of Physicians and Surgeons of Pakistan indicated his willingness to discuss with them the possibility of returning to jobs in Pakistan, recognising their time spent in Ireland. The HSE will assist those who wish to explore this option. For doctors returning to India, the HSE will also assist by providing references and further information on the time spent here in Ireland.
I acknowledge the important contribution to the Irish health care system made by these doctors over the past two years.
While every effort will continue to be made to facilitate movement to the general division in a timely manner, the HSE must have sufficient NCHD cover in July in our hospitals. Contingency arrangements are in place by the HSE to ensure continued safe and timely treatment for patients.
I thank the Minister of State. I am a little concerned by the reply because of my own experience of dealing with the Medical Council. An Irish graduate who worked in an Irish hospital went to New Zealand for two years and when that person returned to Ireland and applied for registration, it took two months to get registered with the council. Even if applications are completed by 2 April, I am a little sceptical that the necessary processing will be done by the council by July. My understanding is the HSE has assigned an additional four people to the council to assist with registrations and I am concerned that this has been left to such a late date as 2 April. I would be surprised, having dealt with the council, if applications finalised on 2 April were processed by end of June. I am seriously concerned about it.
I agree it is important to have an adequate number of NCHDs available in our hospitals and the Senator's concerns on this matter will be conveyed to the Minister and, ultimately, the HSE or the Medical Council.
Medicinal Products Prices
I thank the Minister of State for attending. I would like the Minister for Health to outline the further action he intends to take to address the large variations in drug prices nationwide as revealed in the recent survey published by the National Consumer Agency, NCA. The survey reveals significant differences in the cost of prescription medicines. The cost of a prescription can vary depending on the chemist a person chooses. The NCA survey highlights that for 39 frequently prescribed medicines, there are major differences in price, both locally and nationally. The key findings were that, nationally, the percentage difference in prices of individual prescription medicines ranged from 37% to 199% and the average percentage difference across all products nationally was 56%. Losec is a prescription medicine used by many people who suffer from stomach ulcers. There was a 122% difference in the cost of a 20 mg tablet in Waterford with prices ranging from €22.43 to €49.69. We are not talking about wine, spirits, meat or vegetables; we are talking about medicines people need. Surely the Minister for Health can find a way to flatline this situation for the citizens of this country.
The NCA's survey found substantial variation in the prices charged for prescription medicines in pharmacies. At national level, the percentage difference found in the prices of 39 individual prescription medicines ranged from 37% to 199%, the average percentage difference being 56%. The HSE reimburses pharmacists for products dispensed under the general medical services scheme and other community drug schemes, for example, the drug payment scheme, DPS, in accordance with the reimbursement rates set out in the list of reimbursable items.
Under the Financial Emergency Measures in the Public Interest Act 2009, the fees and allowances paid by the HSE to pharmacists were reduced in 2009 and again in 2011. These reductions resulted in cumulative savings to the HSE of approximately €154 million per annum. These measures included a reduction in the wholesale mark-up on drugs from 17.66% to 8%. In addition, the retail mark-up payable under the DPS and the long-term illness scheme was reduced from 50% to 20%. The reduction in the cost of medicines should be of benefit to all patients who hold a DPS card, whether they reach the €144 threshold per month. I would be disappointed if all pharmacists were not passing on the benefits of lower prices and mark-ups to patients.
I urge customers to consult the HSE website to check the prices of their prescription medicines. If they are being charged more than the price listed - that is, if they are being charged more than a 20% retail mark-up - they should raise it with their pharmacy. It is open to patients to move their custom to a different pharmacy if they are dissatisfied with the prices being charged by their current pharmacy. The Department of Health is also raising the issue of price transparency with the regulatory body for pharmacists, the Pharmaceutical Society of Ireland, PSI. While it would not be possible to display the price of each of the approximately 7,000 medicines currently on the market in Ireland, the PSI is being asked to examine how greater price transparency can be achieved.
In addition to the measures I have outlined, the Health (Pricing and Supply of Medical Goods) Bill 2012, which passed Committee Stage in the Dáil on 19 March, provides for the introduction of a system of generic substitution and reference pricing. It is important to note that the top two products identified by the NCA as having the largest percentage price variation nationally are Losec, which was mentioned by the Senator, and Zoton. Both of these products belong to a group of drugs known as proton pump inhibitors and this group will be one of the first to be assessed for interchangeability and reference pricing once the Health (Pricing and Supply of Medical Goods) Bill 2012 is enacted. This legislation will promote price competition among suppliers and pharmacists and ensure lower prices are paid for these medicines resulting in further savings for both taxpayers and patients.
On behalf of the Minister, I thank the Senator for raising this matter, which is of concern to many people.
I take great comfort from the Minister of Health's reply and, in particular, his statement that "The Department of Health is also raising the issue of price transparency with the regulatory body for pharmacists". I cannot stress how strongly I feel about this issue. While it is not comparable, I work in the food industry. Would it not be wonderful if we could agree a recommended retail price with pharmacists and the drug companies for Losec of, say, €5.99 or €9.99 in order that a pharmacist could not have control over prices? They can do what they want with the Christmas gifts and frippery they sell depending on location but we must achieve a flatline for drugs that people who are suffering need. A recommended retail price for the top 50 drugs used in Ireland would be a simple way to control prices because they are difficult to control.
I thank the Senator for her comments and hope the Health (Pricing and Supply of Medical Goods) Bill 2012, which will be brought to the House, will address most of the difficulties she has outlined.
The Seanad adjourned at 6 p.m. until 10.30 p.m. on Wednesday, 27 March 2013.