There is much concern among members of the public that this will happen and that there are no contingency plans in place.  I put down this Adjournment matter to establish what contingency plans the HSE has, or intends to, put in place so there will not be negative consequences for those to whom I referred who avail of the community drugs scheme and who would be in a very difficult predicament if left without this service. 

Deputy Máire Hoctor
I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.  I thank Senator de Búrca for raising this matter as it provides me with an opportunity to outline the current position on this issue. 

The Health Service Executive has operational responsibility for the management and delivery of health and personal social services under the Health Act 2004, including the provision of medicines under the community drugs schemes. 

The executive has been reviewing the pharmaceutical supply chain with a view to seeking value for money in the State’s drugs bill to better fund existing and innovative therapies without compromising patient safety or continuity of supply. 

Following the completion of public consultation, and informed by the independent economic analysis carried out by Indecon Economic Consultants, new wholesale pricing arrangements were announced by the HSE on 17 September last.  The report by Indecon was published by the HSE on 13 November 2007.  All aspects of the Indecon report were considered by the HSE in making its determination. 

In response to demands from community pharmacists to address the alleged impact of the new wholesale pricing arrangements, the HSE has offered a voluntary interim contract with a flat rate dispensing fee of not less than €5 for all dispensing under the GMS and community drugs schemes. 

The Minister has established an independent body to assess an interim fair community pharmacy dispensing fee to be paid for the medical card scheme, the DPS and other community drug schemes.  This body is being chaired by Mr. Sean Dorgan, former head of IDA Ireland.  It has been asked to make its recommendations by the end of May 2008. 

Both the HSE, as the contracting body, and the Irish Pharmaceutical Union, as the representative organisation for community pharmacists, along with other stakeholders, are entitled to make submissions to the independent body.  I understand the Irish Pharmaceutical Union has made a submission to the independent body.  The Government recognises the IPU as the representative body for pharmacists and wishes to maintain its long-standing relationship with the union as a key stakeholder in health care. 

The HSE has reported that it has, to date, received notification from 400 community pharmacy contractors indicating their intention to either cease providing services from 1 May 2008 or otherwise reserving their right to do so.  Community pharmacy contractors are required under the terms of their contract to give three months’ notice of their intention to withdraw.  The HSE has written to each of the 400 contractors seeking formal confirmation of their intentions and pointing out that three months’ notice of cessation of service is required.  At this point only two contractors have given formal notification of termination in accordance with the requirements in the contract. 

The HSE has developed a national contingency planning framework which will inform and provide direction to local operational management for the development of local area-specific contingency plans.  As service provision, geographical and demographic circumstances will vary from area to area, each local health area is developing its own area-specific contingency plan within the context of the overall national framework. 

Threats of withdrawal from the community pharmacy contract are unjustified and are not in anyone’s interest.  The Minister does not wish to see any patient inconvenienced in any way and expects community pharmacists to fulfil their professional obligations under the terms of their contracts.

Senator Déirdre de Búrca
I thank the Minister of State for her response, although I did not find it very satisfactory.  I deliberately avoided getting into the substance of the pharmacists’ dispute with the HSE and focused very much on the contingency plans.  Only one paragraph in the response dealt with that and it did not provide much information.  I suppose it made me aware that the HSE has a national contingency planning framework but that each local health area will develop its own area-specific contingency plan within the context of the overall national framework. 

I have not been left much the wiser as to what exactly the contingency plans are.  I would like a little more reassurance in this regard.  Much of the response was dedicated to explaining the HSE’s position in terms of why it made the decision to reduce the dispensing fee for the pharmacists.  I would like a little more clarity on the contingency plans. 

Deputy Máire Hoctor
I share Senator de Búrca’s concern.  We have made this known to the Minister and to the HSE. We are very anxious to see positive negotiation and discussion take place between the IPU and the HSE.  I assure the Senator I will keep her informed of developments. 

The report’s recommendations provide an important blueprint for the future care of people with cystic fibrosis in this country. I ask for an immediate implementation of these recommendations. I raise this matter on the Adjournment of the House as a means of establishing the Minister’s intentions in this matter. The main findings of the report were that staffing levels in cystic fibrosis services were seriously inadequate. The report refers to a striking absence of specialist registrars and an inadequate number of cystic fibrosis nurses, physiotherapists, dieticians and psychologists. The report also highlighted the lack of segregation and isolation facilities and it particularly highlighted those in the Dublin area which were felt to fall well below accepted standards. Unfortunately, the most well known hospital to provide cystic fibrosis services in the Dublin area, St. Vincent’s Hospital, was mentioned in the report as being in particular need of investment and upgrading. It was stated that because of the lack of these segregation and isolation facilities for cystic fibrosis patients the risk of cross-infection was high with virulent organisms such as MRSA and hepatitis C. 

The report also highlighted that as a small discipline, cystic fibrosis was particularly vulnerable to the vagaries of funding and was looking for more secure and stable funding into the future. The report recommended that urgent action was needed to address staffing problems in cystic fibrosis services; that a small number of highly staffed and fully supported cystic fibrosis centres should be created around the country with good geographical access for different parts of the country; that the links between the adult and children’s units should be strengthened; that the adult provision outside Dublin should be developed urgently to create balanced services and to reduce the burden on St. Vincent’s Hospital in Dublin; that all beds for cystic fibrosis patients should be in single rooms with en-suite toilet facilities to prevent transmission of dangerous organisms; that a microbiology reference library should be established in Dublin to champion advances in knowledge and treatment in the area of cystic fibrosis; that a new funding methodology, possibly based on banded packages of care should be developed to create the stability required in the funding system; and that the cystic fibrosis registry of Ireland should be maintained and developed. 

They strike me as good and sound recommendations. Obviously they have funding implications and I am interested in hearing the Minister for Health and Children’s intentions in regard to the implementation of some of these recommendations.

Reply from Minister of State at the Department of Health and Children Deputy Pat The Cope Gallagher
I apologise on behalf of the Minister for Health and Children, Deputy Harney, who is abroad on official business. Consequently, I am taking the adjournment on her behalf. The Minister acknowledges the need to improve services to persons with cystic fibrosis. The negative experience recounted recently by some patients is a matter of much concern. 

The Cystic Fibrosis Association of Ireland commissioned Dr. Ronnie Pollock to review the existing hospital services for cystic fibrosis in the context of accepted international standards. The Pollock report identified inadequate staffing levels and a lack of adequate infrastructure, particularly in the provision of care for adults with cystic fibrosis. Following publication of the Pollock report in 2005, the Health Service Executive established a working group to undertake a detailed review of cystic fibrosis services. The group, which was multidisciplinary in its composition and included representation from the Department, was asked to review the current configuration and delivery of services to persons with cystic fibrosis. The group identified a range of service improvements required for persons with cystic fibrosis, including the need to increase thelevel of clinical, nursing and allied health professional staffing in cystic fibrosis units around the country. 

Arising from the Pollock report and the emerging recommendations of the working group, the Minister identified the development of cystic fibrosis services as a policy priority in the Estimates process. In 2006 and 2007, additional revenue funding of €6.78 million was provided to the Health Service Executive to develop services. The Health Service Executive has advised that 44 additional staff, covering both adult and paediatric services, have been appointed across a number of hospitals, including St. Vincent’s, Beaumont, Temple Street, Crumlin, Tallaght, Cork University Hospital, Galway, Limerick and Waterford. The necessary funding is available to facilitate the recruitment of a further 37 staff nationally. 

The Health Service Executive was asked to place particular focus on the development of services at the national adult tertiary referral centre at St. Vincent’s Hospital. A number of capital projects have been recently completed at the hospital and have helped to improve facilities. These include a new ambulatory care centre, the refurbishment of St. Camillus’s ward, and a new accident and emergency department which includes single room accommodation. However, these developments do not fully address the immediate needs of patients. 

The Health Service Executive has been working intensively with the hospital and with representatives of the Cystic Fibrosis Association of Ireland to progress options for further interim improvements. The Health Service Executive is fast-tracking the redevelopment of a ward which is adjacent to the main cystic fibrosis treatment area. The project is to commence in the next few weeks and will provide six single rooms. On completion, additional work will begin to provide a further eight single rooms. The Health Service Executive advises that this will result in a total of 14 single rooms for cystic fibrosis patients by the end of the summer. 

In the longer term, a new ward block is to be built and will include 120 replacement beds in single en-suite accommodation. The new facility will accommodate cystic fibrosis patients and will include appropriate isolation facilities. The Department has been advised that planning permission has been obtained, financial provision has been included in the HSE capital plan and the contract is to be awarded by the end of this year. It will be a condition of the contract that the design-build period is to be not more than 24 months from the date of contract award.  Beaumont Hospital operates as a regional centre in providing services to adults with cystic fibrosis. In the 2008 budget a special allocation of €2.5 million capital funding was provided to enable Beaumont Hospital to provide outpatient facilities for cystic fibrosis patients. The developments which I have outlined will significantly enhance the level of service provided for persons with cystic fibrosis. 

I thank Senator de Búrca for raising the issue.