Wednesday, March 21, 2007

Pharmacy Bill 2007 - Second Stage - 20th March 2007

Pharmacy Bill 2007: Order for Second Stage. ^
Mr. Norris: I am a little surprised that this speaking slot has come so soon. I am glad I came to the Chamber because this is a good opportunity to contribute to the debate. I had arranged to share half of the time allotted in this debate to my colleague, Senator O'Toole, who is not here. Can I propose that the Senator be allowed to share time with me if he materialises and wants to take half of my time?
An Leas-Chathaoirleach: The Senator has ten minutes.
Mr. Norris: That will be more than ample. I will speak at a reduced rate because I inhaled almost an entire Georgian ceiling a week or so ago, and consequently I have a lung infection.
Ms Feeney: Did the Senator not find a good pharmacist?
Mr. Norris: I have speed read the Minister's speech. I welcome some of the things she said, although I would like some of them to be spelled out. Although I have been and continue to be critical of the health service - I will probably criticise it again on the Order of Business tomorrow - I salute the Minister, Deputy Harney, for putting her head firmly in the lion's den, which was a remarkably courageous thing to do. Some of the changes the Minister has been making will not come on stream politically, in effect, until after she has departed not this life but the Department of Health and Children. The decision to which I refer highlighted the Minister's unusually altruistic attitude.
The first point I wish to make is the fact that towards the end of the Minister's speech, she addressed the question of conflict of interest. This is probably the most important element that is missing from the Bill. She said that as a result of lobbying and changes in conditions, she intends to introduce an amendment on Committee Stage that will address any possible conflicting situations of that nature in a fair and proportionate manner. It is not only a question of possible conflicting situations but a question of existing and scandalous situations in terms of conflict of interest.
For example, the fact is that health centres are being built and suites are being made available to people at knock-down rates; I am told 20% is the going rate. These sorts of inducements sometimes follow on from a situation where people are interviewed and asked what is their client base, their prescription role and the value of them. I have in my hand, lest there be the slightest doubt, a form of tender for a premises known as The Pharmacy, The Medical Centre, Knock Road, Castlerea, County Roscommon, in which it is stated that the final date for submissions is 5.30 p.m. on 30 August 2005. The Minister might be interested in what it states in terms of the nature of the offer. It is addressed to a firm of solicitors and states:
I [and there is a space for the names to be filled in] ... HEREBY OFFER subject to the conditions and provisions set out in attached conditions of tender to acquire by Lease the premises described in the attached Conditions of Tender at the annual rent of One Hundred and Fifty Thousand Euro [€150,000] (Exclusive) (subject to review in accordance with the Lease) together with any financial inducements [this is a lovely piece] that you are prepared to offer to the Landlord in the sum of [and it is rather engagingly left blank] or any other inducements that you are prepared to offer to the Landlord, which should be made in writing and attached to this Tender. As a gesture of goodwill the equivalent of 10% of the amount you are prepared to offer is to be paid over to the Landlord on the signing of the Agreement to Lease.
I regard that as completely scandalous. Of course there is a conflict of interest; there is an existing conflict of interest. It is not a potential one, a possible one or something that might happen in the future. It is something that was apparently fairly widespread two years ago. It is not only appropriate but utterly essential that the Minister introduces precisely the kind of amendment she spoke about because the conflict of interest here could not possibly be more clear and explicit.
I was engaged in other matters and I do not know if the Shipman report was mentioned. I notice the Minister is nodding to indicate it was. In that case I will confine myself to one quotation from it which addresses this matter directly. I will not give the context of it because if the Shipman report was referred to, it was probably by my colleague, Senator Henry, who knows a great deal about this matter and she probably put it into context so there is no need for me to do so. However, she may not have quoted this part which, to my mind, contains the core of the argument. The report states: "It is now generally accepted that the involvement of a pharmacist in the process of providing medication to a patient acts as a safety check against error." It goes on to state that: "[W]here prescribing and dispensing functions are carried out by the same person or within the same commercial or professional entity, there is a potential for the loss of professional objectivity or even abuse." Despite this, for reasons of commercial profit and not for the interests or welfare of the patients or citizens of Ireland, this is a situation which appears to be developing. While there are large pharmaceutical chains which we all know, there are smaller chains or businesses where considerable profit is being secured. I welcome the fact the Minister will introduce an amendment on Committee Stage. It cannot be introduced quickly enough but it must be clear, specific and obviate this unpleasant practice.
A gentleman, who will be well known to the Minister, a senior adviser to Professor Drumm whom I will not name as that would be unfair, left the Health Service Executive and took up a new position in one of these groups, Touchstone. With engaging frankness, he said the following: "In our project in [a certain midland town] ... we were faced with the opportunity of being able to get suites at a cost of 20 per cent of their value, so from an investment opportunity it was something we couldn't match by doing things privately." That says it all. Who is handing out something at 20% of its value? I have heard of below cost selling but, to use another midlands expression, that beats Banagher.
I turn to another question of conflict of interest, that of independent regulations, which is a bee in my fairly capacious bonnet. I have been pursuing this issue with disastrous results for myself, as I have suffered the treatment I received from the news media for daring to speak out on the Defamation Bill, but I propose to continue to do so. The more it annoys them, the more I like it. For example, the newspapers claim there should be independent regulation of everybody else, including the medical profession and architects, except when it comes to newspapers. It wants to nominate half the board and to pay for it, but how independent can that be?
With regard to the question of regulation and representation, I notice that the Minister in her speech spoke about a new pharmaceutical society. Does that mean it is proposed there will be a second one? I see the Minister shaking her head to indicate "No". It should mean that because these functions should be separated. That is not only my view but a view I take as a principle. If the Minister wants to check the record, she will find that I have said this about every profession in every Bill that has been introduced.
It is also the view of the University of Dublin whose graduates I have the honour of representing. I received a letter from a distinguished academic in the pharmacy area which states:
The Pharmacy Bill published last week retains the existing structure of a combined regulatory and representative body. This is not a proper structure for the governance of a healthcare profession. A single professional body with a multiplicity of potentially conflicting purposes, including both the regulation of and advocacy for the profession of pharmacy is neither in the best interests of patients nor of the profession.
Again we have advice from the top that there should a separation and independent regulation.
In Ireland there has been a tradition in this area, and we understand that. The Pharmaceutical Society of Ireland has served this country well. I am not making negative comments on its historical contribution. However, we must look to the future. As legislators, it is our responsibility to improve the position. If we look across the water to the United Kingdom, the position here used to prevail there but it is moving away from that and a new position has been recently proposed, namely, the creation of a separate general pharmaceutical council, which is similar to the General Medical Council, and another body to take on leadership. It is essential to have a separate body to regulate the profession. This is the point I wish to make on that issue.
I wish to make a final point on a matter which I hope was mentioned. It concerns people who get their pharmacy qualifications abroad owing to the lack of places in Ireland and who are discriminated when they return to this country. I wish to cite the case of a Dubliner who attended Trinity College. She is married to a pharmacist who qualified in Nottingham but is from Northern Ireland, which is not a million miles away and is part of the territory that was until recently claimed by this Government. He has been working as a pharmacist for four years and would like to open his own pharmacy in Ireland, but the problem is he would have to raise approximately €1 million to buy a pharmacy that is more than three years old.
The Minister may be addressing this issue and perhaps she will refer to it. This pharmacist would have to employ an Irish qualified or New Zealand or Australian qualified pharmacist because he would not be allowed to work in his own pharmacy. These pharmacists usually charge about €80,000 a year. The maddening aspect of the law as it stands, which I hope has been addressed in the Bill, is that although his qualifications are good enough for him to be employed as a locum or supervising pharmacist in any pharmacy over three years old, he cannot be employed in a brand new one. It is a bizarre situation. It is Kafkaesque. There are a series of contradictions here. I appeal to the Minister, if she has not addressed them in the Bill, a subject about which I am sorry to say I am not completely clear, I ask her to do so.
The major point concerns the conflict of interest, while a related point concerns the independence of the regulatory body and the body which deals with fitness to practise. I suggest we deal with the points relating to definitions when amendments are being considered on Committee Stage.

1 Comments:

At 1:24 PM, Anonymous gary smyth said...

well done sen norris.i was looking for info re. touchstone and read your speech.its refreshing to have someone who'll speak up and not ponder to vested interests in this country.i run a pharmacy in the west of ireland and can see a future where the independent pharmacy will become a thing of the past due to the unfair advantage touchstone and others have in their ability to work the system.keep up the good work.gary smyth

 

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