The Minister for Health Stephen Donnelly TD (Wicklow, Fianna Fáil), faced questions on a range of topics including the status of engagement with the IPU and the sector as a whole; plans to review and increase fees; and plans to expand pharmacy services.

Support for the pharmacy sector came from across the political divide. Questions came from high profile figures, including the leader of the opposition Mary Lou McDonald TD (Dublin Central, Sinn Féin), Social Democrats leader Holly Cairns (Social Democrats, Cork South-West), as well as Ministers of State and opposition health spokespeople.

A full summary of these parliamentary questions is available at the end of this article.

One of the more notable references to pharmacy services in recent weeks came when the subject of pharmacy fees was included as a commencement matter debate by Senator Robbie Gallagher (Fianna Fáil), who sought responses from Minister Sean Fleming (Laois-Offaly, Fianna Fáil).

Senator Gallagher stated that, “pharmacies are essential providers of healthcare in our communities and have the potential to do much more than they are currently doing in the context of a health system that is under pressure”. He also raised concerns that “community pharmacists feel they have been asked to provide more services on behalf of the State while receiving less money for doing so.”

Senator Gallagher highlighted how the community pharmacy sector has had a pay freeze for the past 15 years: “One in ten community pharmacies, mainly rural ones, is loss making. Pharmacy is becoming a less attractive career choice, exacerbating the ongoing shortage of pharmacists when we need them most.” He then outlined the IPU’s proposal for “a flat fee model, reimbursed at €6.50 per medicine.” He concluded that, “We all know community pharmacies have provided an essential service to patients on behalf of the State . . . They have been patient and deserve engagement.”

Responding Minister Fleming acknowledged, “the significant role community pharmacists play in the delivery of patient care. Community pharmacy is often one of the most accessible avenues to receiving such care, and provides a vital link in our healthcare service by ensuring the safe supply of medicines to people.”

He said, “various approaches to extending the scope of the practice of community pharmacists are being progressed by the Department. This includes the introduction of a minor ailments scheme and an enhanced role for pharmacists in the current contraception scheme for women.”

Similarly, Martin Browne TD (Tipperary, Sinn Féin) challenged the Taoiseach on the issues facing the pharmacy sector. He told him that pharmacists are the only sector in healthcare who remain the victim of FEMPI cuts: “Given the acknowledgement of the great service provided by them during the pandemic and generally in light of lengthy GP waiting lists, I have asked the Minister to fully and openly engage with the sector, which is now demanding that pay be restored.”

Jackie Cahill TD (Tipperary, Fianna Fáil) also raised the issue of community pharmacy pay with the Minister for Housing, Local Government and Heritage Darragh O’Brien TD (Dublin Fingal, Fianna Fáil). Deputy Cahill said, “Community pharmacies have had a pay freeze for the past 15 years . . . I would like the pay of community pharmacies to be realigned.” Minister O’Brien said he would raise the matter directly with the community pharmacy sector.

Deputy Paul Kehoe (Wexford, Fine Gael) questioned the Minister for Health over expanding the services pharmacies offer, asking the Minister “what additional services he and his Department are looking for pharmacists to be involved in as part of negotiations”. These negotiations refer to the consultation over pharmacy fees.

In response, Minister Donnelly stated, “various approaches to extending the scope of practice of community pharmacists are being progressed by my Department. This includes the introduction of a Minor Ailment Scheme and an enhanced role for pharmacists in the current contraception scheme for women. The implementation of these necessitates engagement with a range of stakeholders and full consideration of all the relevant legislative and operational issues involved.”

Concluding, the Minister noted that he believes “that there is a real opportunity to work collaboratively with community pharmacists, and with other healthcare providers, to make a significant difference to patient outcomes. 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.”

Minister Donnelly faced a further query from Deputy David Cullinane (Waterford, Sinn Féin) who asked, “the estimated first year and full cost of implementing a minor ailments and illness scheme in community pharmacy.”

Responding, Minister Donnelly highlighted that, “the full-year cost of implementing the MAS will be comparable to the current spend for those conditions under the General Medical Services (GMS) scheme, although it is likely that the spend will include a combination of both transferred activity and new activity. The spend under GMS in 2022 for the conditions being considered for inclusion in the MAS was approximately €15.1 million.”

In the Seanad, Senator Mary Seery Kearney (Fine Gael) highlighted the opportunity to expand the role of pharmacy, stating that, “I know from the personal experience of my family that pharmacies are the first port of call for a piece of advice if there are any changes to, or queries about, medication.”

Senator Kearney praised her local pharmacy saying it “has a wealth of knowledge. The pharmacists are accessible and personable and offer in-person contact and follow-up. It is not reasonable for those people to have gone so long with a pay freeze and a freeze on their services.”

Responding on behalf of the Minister for Health, Minister of State at the Department of Further and Higher Education, Research, Innovation and Science Niall Collins TD (Limerick County, Fianna Fáil), stated that the Minister, “acknowledges the vital role community pharmacy will play in the development and implementation of future healthcare service reform, especially with regard to the aims and vision of Sláintecare.”

Adding that, “the Department is open to exploring any evidence-based and appropriately governed services delivered by appropriately trained professionals which will support this aim. In that regard, various approaches to extending the scope of practice of community pharmacists are being progressed by the Department.”

Potential for Serious Shortage Protocol outlined

The ongoing problem of medicine shortages has once again been a keen focus in the Dáil this month, with some TDs pushing Minister for Health Stephen Donnelly for information on the possible introduction of a Serious Shortage Protocol, as called for by the IPU.

Deputy Cormac Devlin (Dún Laoghaire, Fianna Fáil) asked the Minister of Health for an update on efforts by officials to restore the supply of basic medications. Deputy Devlin also inquired if the Minister “will consider reviewing regulations to allow Irish pharmacists to substitute prescribed items and-or Irish residents to access the online services of UK or EU-based pharmacies.”

Minister Donnelly responded that “Ireland experienced some shortages of antibiotics earlier this year — as did most other European countries, following a surge in winter illnesses. Shortages have not disappeared, but there are factors, such as the winter surge, that can put additional pressure on a health system and on medicine supply.”

The Minister for Health, continued by stating that; “Medicines shortages are managed through the Medicines Shortages Framework and immediate actions are taken by relevant stakeholders to mitigate the impact on patients.”

However, in responding to David Cullinane TD (Waterford, Sinn Féin) the Minister provided a more specific and detailed response, indicating the introduction of such a protocol was under active consideration. Deputy Cullinane had asked Minister Donnelly, if he was “considering the introduction of a Serious Shortage Protocol regarding medicine supply”.

Minister Donnelly explained; “In other jurisdictions outside of Ireland Serious Shortages Protocols (SSP) are used to facilitate community pharmacists to supply either an alternative quantity, strength, pharmaceutical form, or medicine. Legislation in Ireland already allows for generic substitution (alterative strengths, quantity and forms) but does not allow for therapeutic substitution.”

According to Minister Donnelly “The Department of Health is scoping the introduction of a similar framework, a limited stock supply framework (LSS) in Ireland which will only be used in certain emergency situations such as shortages. This is the case in all other countries that have a protocol in place.”

Legislative amendments will be required to introduce this new process, according to the Minister. However, he did outline that “an initial proposal on implementation of this policy option is complete and work to develop the governance, legal, training and patient safety aspects of this proposal will be completed this year. The Department will engage with key stakeholders as this policy is developed.”

Elsewhere there has been renewed attention paid to HRT (hormone replacement therapy) shortages. With questions raised by Willie O’Dea TD (Limerick City, Fianna Fáil), Maurice Quinlivan TD (Limerick City, Sinn Féin), Mairéad Farrell TD (Galway West, Sinn Féin), and Duncan Smith TD (Dublin Fingal, Labour).

Minister Donnelly in response confirmed a shortage of Utrogestan Vaginal 200mg Vaginal Capsules, which he said was “impacting multiple markets due to increased demand.” The Minister continued by noting that the company was anticipating a re-supply at the end of June 2023.

Minister Donnelly did note that, “Alternatives are available. Many Hormone Replacement Therapies (HRT) are authorised for use in Ireland in various formulations and strengths.”

Deputy Emer Higgins (Dublin Mid West, Fine Gael) also raised the issue of the large number of medicinal shortages affecting people in Ireland with the Tánaiste Micheál Martin TD (Cork South Central, Fianna Fáil). Deputy Higgins said, “there are 307 medicines in short supply, including tablets people rely on for their blood pressure, cholesterol or mental health and medicines people require to regulate their hormones, their breathing or their insulin. People with medical conditions are facing a record shortage of drugs. That is causing huge anxiety for them, their families and their pharmacists.”

Upon highlighting the significance of the shortage, Deputy Higgins directly asked the Tanáiste; “What is the Government doing to bring medicine back into good supply?”

In response, Tánaiste Martin said; “In terms of the broader picture, there are global supply chain issues. We have a fairly sophisticated system in Ireland. There have been some issues post-Brexit in respect of medicine supplies. The Deputy can rest assured that the Government, the Health Products Regulatory Authority, and others are doing everything they possibly can in respect of shortages.”

Medicines on the medical card scheme

Minister for Health, Stephen Donnelly TD (Wicklow, Fianna Fáil), has faced a variety of questions on the medical card this month. Deputy Cian O’Callaghan (Dublin Bay North, Social Democrats) queried why Muro, an eye drop medication, has been removed from the medical card scheme and “if he plans to reinstate its coverage in the scheme”.

Minister Donnelly explained that “Sodium Chloride Hypertonic (Muro) is not licensed with the HPRA in Ireland. However, Sodium Chloride Hypertonic (Muro) (ULM) Eye Drops 5% 15ml is listed as an Exempt Medicinal Product (EMP) under the community drug schemes.”

Deputy Paul Donnelly (Dublin West, Sinn Féin) further questioned the Minister on aspects of the medical card, asking the Minister of Health “if he will commit to a right to a medical card for all heart failure patients, removal of prescription charges, and the national assessment of the economic impact of the condition on patients.”

In response, Minister Donnelly outlined the challenges associated with granting medical or GP visit cards based on having a particular condition. According to the Minister, this “was previously examined in 2014 by the HSE Expert Panel on Medical Need and Medical Card Eligibility. The Group concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility.”

Minister Donnelly did however note that “every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines.”

Minister Donnelly, faced a further query regarding the medical card from Patricia Ryan TD (Kildare South, Sinn Féin) who asked if the Minister “is aware that Solpadine and its generic equivalents can only be dispensed in capsule form, usually in 60 capsule packs, and not in soluble form to medical card holders to whom it has been prescribed, which is causing problems among those for whom swallowing capsules/tablets would be difficult.”

According to Deputy Ryan “pharmacists, having informed the medical card holder of this issue, are saying to the person that they can sell the soluble version to them over the counter at a cost of approximately €14 per pack of 24.”

In response, the Minister stated that, “The HSE advise that Solpadeine capsules in packs of 32 and Solpadeine Soluble tablets in packs of 60 are currently on the reimbursement list. Medical card holders should be able to access both of these products subject to the payment of the statutory prescription charge.”

Increase in pharmacy education places praised

Senator Aisling Dolan (Fine Gael) has praised an increase in third level education places for pharmacy. Welcoming the establishment of a new programme at the Atlantic Technical University, Senator Dolan said, “It would be the first time in the West a university would deliver pharmacy courses. In pharmacies and prescribing pharmacists, there are shortages in regional areas and hospitals.”

Thanking the Senator, the Minister for Further and Higher Education, Research, Innovation and Science, Simon Harris TD (Wicklow, Fine Gael) highlighted that “the Department of Health is looking at how to upskill pharmacists, where appropriate. It has to be about everyone working to the maximum of their scope, their licence and what is appropriate to do. There is enough work in healthcare and healthcare demands, so we need everyone working to the optimum level.”

Minister for Health questioned on state schemes

Minister for Health Stephen Donnelly TD (Wicklow, Fianna Fáil), has been questioned on a number of aspects of state schemes.

Deputy Michael McNamara (Clare, Independent) first asked the Minister; “if HSE statistics for 2022 on the volume of medical items dispensed under State schemes are, or will be, available to him before the said statutory deadline of 30 June 2023”.

In response, Minister Donnelly stated that it would, noting that data in respect of the number of items dispensed by community pharmacists under the community drug schemes is available online.

Minister Donnelly was later questioned by Thomas Pringle TD (Donegal, Independent) on “the estimated cost of abolishing prescription charges”, which the Minister advised would cost approximately €60 million per annum.

Update sought on eHealth

Fergus O’Dowd TD (Louth, Fine Gael) has asked the Minister of Health for an “update on the Programme for Government commitment to develop and support eHealth and the increased use of assistive technologies, supporting people to live independently across each of the CHO areas, since the establishment of the current Government.”

In response, Minister Donnelly stated that; “the provision of digital health solutions is a fundamental enabler for the reform of the health service and the implementation of Sláintecare.”

The Minister continued by noting the key role digital health solutions played during the COVID-19 pandemic, with solutions developed to facilitate monitoring and managing the spread of infection as well as the administration of vaccines when they became available.

Providing an update on the implementation of digital solutions, Minister Donnelly said; “To develop a clear direction for future years, the Department of Health, in collaboration with the HSE, are currently developing the Digital Health Framework (2023-2030), which is intended as a refresh to the existing eHealth strategy that is now almost 10 years old.”

Donnelly concluded, “The refreshed strategy will leverage lessons learned from the pandemic, the 2021 cyberattack, and will benefit from what we have seen work successfully in other countries.”

Summary of Parliamentary Questions