IPU address Health Committee

The IPU briefed the Oireachtas Health Committee on 8 March. President Dermot Twomey led the delegation which also included Kathy Maher, Chair of the Pharmacy Contractors Committee; Sharon Foley, Secretary General; Dr. Susan O’Dwyer, Head of Governance and Pharmacy Services; and Jim Curran, Director of Public Affairs and Communications.

Dermot Twomey opened the session by outlining the many ways in which pharmacy services could be expanded to benefit patients. He also focussed attention on the need for renewed state investment in the sector, and the delivery of a fair fee for pharmacies.

The Committee responded extremely positively to the IPU proposals with Sinn Féin Health Spokesperson David Cullinane TD (Waterford) saying; “The asks are very credible and they would add significant value to the health service. They have brought an excellent set of proposals to us as a committee.”

While Green Party TD Neasa Hourigan (Dublin Central) said; “I am glad that the IPU continues to push for more services in community pharmacies and a right care, right time, right place model.”

After a wide-ranging discussion, the Committee Cathaoirleach Seán Crowe TD (Dublin South-West) thanked the IPU: “We thank the Irish Pharmacy Union members for the positive role they played, particularly during the COVID-19 epidemic. I also commend them on the fact that the Irish population are very supportive of the role of pharmacists. They are seen as the first port of call in the case of a minor illness, and even in the cases of more difficult illnesses. People go to their pharmacists because they trust them and their doors are open and they are accessible six, if not seven, days per week. Well done on that. I hope some action will come from this meeting, which is what the Irish Pharmacy Union also wants to hear. I thank its representatives for assisting the committee on this very important matter.”

 

Shortage of pharmacy education

TDs have raised a range of issues regarding the shortage of pharmacy education places. Brendan Smith TD (Cavan-Monaghan, Fianna Fáil) asked the Minister for Further and Higher Education Simon Harris TD (Wicklow, Fine Gael) if additional third level places will be made available for students wishing to study pharmacy in view of the shortage of community pharmacists.

In response, Minister Harris stated; “The Programme for Government commits the Department of Health to working with the education sectors, regulators, and professional bodies to improve the availability of health professionals and reform their training to support integrated care across the entire health service, including pharmacists.

He added that, his “Department does not place a quota on the number of pharmacy places offered by higher education institutions, and as such the number of places provided each year is determined by the institutions themselves in line with their capacity”.

Explaining the actions that have been taken to increase places, Minister Harris said; “The Higher Education Authority has completed the first stage of an expression of interest process for Higher Education Institutions interested in building capacity in Dentistry, Pharmacy, Medicine, Nursing, and Veterinary. The second stage of this process has now commenced with the recent announcement by the Higher Education Authority of the appointment of an Expert Advisory Panel to review the opportunities for new programmes covered by the process. The panel is comprised of representatives from Government Departments and regulatory and professional bodies that have direct professional experience and/or academic expertise in the relevant disciplines, or knowledge of the higher education system at a senior level. As the Expert Panel is currently reviewing the applications, it is not possible to say at this time how many places may be delivered.”

The Minister for Further and Higher Education was also asked by Thomas Pringle TD (Donegal, Independent), “if there is an underrepresentation of specific expertise from both academia and practice in the areas being reviewed by the recently appointed expert advisory panel to review opportunities for new programmes in dentistry, pharmacy, medicine, nursing and veterinary.”

In response to the Deputy’s queries, Minister Harris stated that he is “satisfied that as with all HEA processes, this process is being conducted to the highest standards and will be externally validated.”

Minister Harris was also questioned on the cost associated with increasing places by Rose Conway-Walsh (Mayo, Sinn Féin), who asked “the estimated cost of increasing the number of undergraduate new entrants in pharmacy by 25%, broken down by the number of additional new entrants a 25% increase would achieve, and the total number of new entrants following a 25% increase.” Responding to the query, Minister Harris said it was not possible to definitively calculate the costs sought.

   

Medicine shortages

The ongoing issue of medicine shortages have continued to be raised in the Oireachtas. Aindrias Moynihan (Cork North West, Fianna Fáil) has raised the frequent medicine shortages with Minister for Health Stephen Donnelly TD (Wicklow, Fianna Fáil), questioning the Minister on “the measures his Department are taking to ensure our competitiveness in securing medicines that are currently experiencing supply issues”.

In response to the Deputy’s question, Minister Donnelly said that the cause of these shortages was “an exceptional increase in demand for certain products to treat winter illnesses; in some cases this demand was two to three times greater than the same period in previous years.” Minister Donnelly continued to explain that this issue was not local to Ireland with the demand for medicines “seen right across Europe and around the world”.

The Minister for Health did however inform Deputy Moynihan that “the level of demand for products to treat winter illnesses has levelled off, and the problems with the supply for most of these products have eased to some degree.” Detailing the actions of his Department, Minister Donnelly stated that “a number of initiatives were undertaken via the medicines shortages framework, including extensive engagement with manufacturers to increase supply to Ireland, the provision of updated clinical guidance for prescribers, the creation of a web page with up-to-date information on shortages and, critically, alternative products being made available”.

Minister Donnelly also faced numerous questions regarding medicines facing shortages, with both Michael Collins (Cork South West, Independent) and Michael Moynihan (Cork North West, Fianna Fáil), asking the Minister about the difficulties in obtaining Rivotril.

In response, Minister Donnelly advised that; “The HPRA has offered the company regulatory flexibility” and added that “the Irish stock has been released from the Spanish manufacturer and estimated that Rivotril would be resupplied to patients in Ireland during the week of 13 March.”

Aindrias Moynihan (Cork North West, Fianna Fáil) also raised the issue of medicine shortages in a question to the Taoiseach, asking; “When the Cabinet subcommittee meets again, will it discuss medicine shortages?”

In response, An Taoiseach Leo Varadkar TD (Fine Gael, Dublin West), stated, “that alternative treatments are available for every product that is currently in short supply. Shortages of certain paracetamol, amoxicillin or penicillin products relate to individual line items and do not represent an entire portfolio. Unexpected surges in demand such as we have seen take time to resolve as the industry increases production to bring the supply chain back to normal. Medicine supply continues to improve.”

The Taoiseach continued to say, “The Department of Health is engaging closely with all stakeholders in working to mitigate the current immediate shortages. The Department has analysed products currently listed as short, and can confirm that the reimbursement price is not the root cause of the shortage for any of these products.”

   

Questions on Saxenda

Minister Donnelly has faced a number of calls for the drug Saxenda to be available to those using medical cards.

Paul Kehoe (Wexford, Fine Gael), Fergus O’Dowd (Louth, Fine Gael), and Aindrias Moynihan (Cork North West, Fianna Fáil) all questioned the Minister for Health on making the drug available to medical card users.

Responding to all three Deputies, Minister Donnelly said the HSE is responsible for decisions on pricing and reimbursement of medicines. He advised that; “The HSE has approved reimbursement for Liraglutide (Saxenda®) 6 mg/ml solution for injection in pre-filled pen under the community drug schemes from 1st January 2023.”

 

Access to contraception

A number of questions have been raised over access to the free contraception scheme. Róisín Shortall (Dublin North West, Social Democrats) first raised the issue of opening the scheme to those under 17, asking the Minister for Health, the timeline for doing so. Responding for the Minister for Health, Minister of State with responsibility for Public Health, Well Being and the National Drugs Strategy, Hildegarde Naughton (Galway West, Fine Gael) outlined the current parameters of the scheme; “The free contraception scheme for women was launched in September 2022, initially for women aged 17-25 who are ordinarily resident in Ireland. The scheme has now been expanded to include 26-year-olds from 1 January 2023, and will be expanded further, in September, to include women aged 27-30. Approximately €32 million has been assigned to support the scheme in 2023.”

Directly addressing opening the scheme to those under 17, the Minister said, that these proposals are currently being considered by the Office of the Attorney General for consideration: “Should legal advice confirm there are no legal impediments to extending the scheme to 16 year olds, a legislative amendment to section 67E of the 1970 Health Act will be required, and it is my intention to bring a Memorandum to Cabinet to seek a decision in principle, followed by a decision for permission to draft, as soon as possible.”

When asking about expanding the scheme, Róisín Shortall (Dublin North West, Social Democrats) asked the Minister of State the steps the Minister for Health “intends to further expand the free contraception scheme to people aged over 30 years” and the steps the Minister “is taking to address the significant costs of contraceptives for some cohorts who are not eligible for the free scheme.”

In response Minister Naughton said, “For women who are outside the current eligible age cohorts for the scheme, those with a medical card already have access to the same contraception options at minimal cost (subject only to the prescription charge), while those with a GP visit card are also supported to some extent, as the cost of GP consultations is covered. Furthermore, the Drugs Payment Scheme, for which anyone ordinarily resident in Ireland is eligible, covers the cost of prescription items, if these exceed the monthly limit, which is currently €80. Any decisions regarding future expansion of the free contraception scheme is subject to the annual Estimates process and will require Government approval.”

 

Chief Pharmaceutical Officer

The topic of a chief pharmaceutical officer has again been raised in both Houses of Government. In the Dáil, both Aindrias Moynihan (Cork North West, Fianna Fáil) and Seán Fleming (Laois-Offaly, Fianna Fáil) have questioned the Minister for Health on the lack of a Chief Pharmaceutical Officer, with Deputy Moynihan referring to the position as “a champion across Departments who would be able to advise and offer support”.

In response to the calls for a Chief Pharmaceutical Officer, Minister Donnelly said; “My Department has professionally qualified pharmacists among its staff and does not have plans to appoint a Chief Pharmacist at the present time. The matter will be kept under review in the context of wider workforce planning considerations.”

The issue of a Chief Pharmaceutical Officer has also been raised in the Seanad by Martin Conway (Fine Gael) who spoke about the role of pharmacists, saying that, “Pharmacists are totally underutilised in relieving the pressures on the front line, particularly in general practice.”

In response, Minister of State with responsibility for Local Government and Planning Kieran O’Donnell (Limerick City, Fine Gael), said, “At this time, there are no active proposals to develop such a role in the Department of Health. There are professionally qualified pharmacists among the Department’s staff. Furthermore, a number of units within the Department have responsibility for advancing policy in key areas of our health system. They are cognisant of potential deliverables that can be realised by and through pharmacists and pharmacy services to deliver patient-centred care in line with the vision of Sláintecare.”

 

Minor Ailments Scheme

The expansion of pharmacy services, specifically a minor ailments scheme, has been raised a number of times in the Seanad. Senator Maria Byrne (Fine Gael) called on colleagues to support changes to legislation to allow for the implementation of a Minor Ailments Scheme, pledging support to pharmacies, following their key role in battling the COVID-19 pandemic; “They were to the forefront, in that they were open all the time, and they were accessible to people. You could not get into your doctor or your hospital, as everything was done on the phone, but pharmacies were there to meet and see people.”

Robbie Gallagher (Fianna Fáil), also made a strong case for a Minor Ailments Scheme being implemented; “International evidence shows that Minor Ailment Schemes now being pushed forward by community pharmacists are effective in providing accessible and timely care at the lowest level of complexity, which is the key point. They allow for access to community pharmacy services for all patients and help free up capacity in primary and secondary care for more complex cases.”

Responding to Senator Gallagher, Minister of State in Department of Health (Mental Health and Older People) Mary Butler (Waterford, Fianna Fáil) said; “The underpinning objective and rationale for enhanced services to be delivered in community pharmacy practice will be to realise enhanced patient care and access. The Department is aware of developments, nationally and internationally, which evidence an evolving and enhanced scope of practice beyond the traditionally perceived pharmacy practice framework.”

Minister Butler added; “Recently, the Minister for Health and Departmental officials met a delegation from the Irish Pharmacy Union and a very fruitful and positive discussion took place. Various proposals regarding extending the scope of practice offered by community pharmacists were discussed. Of course, any publicly funded pharmacy service expansion should address unmet public healthcare needs, improve access to existing public health services and provide better value for money.”  

Access to Cariban

The issue of prescribing and reimbursing Cariban has been one of the most prominent issues in the Oireachtas this month. TD’s from all parties have raised the issue with the Minister for Health. These TD’s include; Holly Cairns (Cork South West, Social Democrats); Michael Healy-Rae (Kerry, Independent); Brendan Griffin (Kerry, Fine Gael); Bríd Smith (Dublin South Central, People Before Profit Alliance); Paul Kehoe (Wexford, Fine Gael); Mairead Farrell (Galway West, Sinn Féin); Jackie Cahill (Tipperary, Fianna Fáil); Ged Nash (Louth, Labour); Michael McNamara (Clare, Independent); and Catherine Connolly (Galway West, Independent), among others.

In response to all queries regarding the prescription of Cariban, Minister Donnelly has responded; “The Health Service Executive (HSE) has statutory responsibility for decisions on pricing and reimbursement. Cariban is an Exempt Medicinal Product, i.e., it is not licensed in Ireland and, therefore, cannot be added to the formal reimbursement list. However, following the recommendations of the HSE Medicines Management Programme, and to address the unmet need of patients with hyperemesis gravidarum, Cariban has now been made available on an individual patient basis for those patients who meet the criteria and where Consultant Obstetrician initiated.”

Continuing, the Minister for Health said; “Under the community drug schemes, Exempt Medicinal Products must be Consultant initiated. However, whilst the original prescriber of Cariban must be a Consultant and specialist in the relevant field, the HSE will accept a GP prescription subsequent to the initial hospital prescription for approved patients.”

   

Veterinary medicinal products

The issue of the Veterinary Medicinal Products, Medicated Feeds and Fertilisers Regulation Bill 2023 has been raised by a number of TDs seeking clarifications. Both Michael Ring (Mayo, Fine Gael) and Carol Nolan (Laois-Offaly, Independent) have questioned the Minister for Agriculture, Food and the Marine Charlie McConalogue TD (Donegal, Fianna Fáil) on the implementation of the Bill. Both Deputies asked the same question to the Minister; “If he is satisfied that the implementation of the Veterinary Medicinal Products, Medicated Feeds, and Fertilisers Regulation Bill 2023 will not adversely affect the ability of veterinary pharmacists to work within the PSI Code of Conduct for Pharmacists and prevent them from working in accordance with the regulatory requirements for registered pharmacists and retail pharmacy businesses.” In response Minister McConalogue said; “I am satisfied that the Veterinary Medicinal Products, Medicated Feeds and Fertilisers Regulation Bill 2023 does not require veterinary pharmacists to carry out any activity that prevents them from working in accordance with the regulatory requirements for registered pharmacists and retail pharmacy businesses or working within the PSI Code of Conduct for Pharmacists.”     Richard Bruton. Fine Gael  

Pharmacy Working Group

Richard Bruton (Dublin Bay North, Fine Gael) has questioned the Minister for Health regarding an update on the status of the working group on community pharmacies.

In response Minister Donnelly said; “The Forum has now transitioned to discussing the strategic direction of the community pharmacy profession. The Forum provides an opportunity for all stakeholders, including the IPU and the PSI, to provide insights on how community pharmacy can be expanded in the context of healthcare reform. While the Forum is chaired by the HSE, my Department is taking an active role in the work currently being undertaken. This will prove invaluable in the context of future contractual reform. Any proposals arising will have to be considered on their merits, and, of course, any publicly funded pharmacy service expansion should address unmet public healthcare needs, improve access to existing public health services, and provide better value for money.”