Address by Minister Tim O´Malley TD, Minister of State, at the Hospital Pharmacists Association of Ireland´s Annual Educational Gala Dinner

Colleagues, ladies and gentlemen. I am delighted to be here this evening at the Hospital Pharmacists Association of Ireland´s Annual Educational Conference Gala Dinner. It hardly needs to be said that it is always a pleasure to meet with fellow pharmacists, particularly on occasions such as this.

While I appreciate that you have had a busy conference, and I don´t propose to delay you for too long, I would like to comment briefly on some important issues facing hospital pharmacists.

Firstly, I would like to congratulate hospital pharmacists for successfully raising the profile of the whole profession. I can remember a time, not too long ago, where the pharmacy in many hospitals was stuck down in the basement, sidelined, and marginalized. Nowadays, the situation is much different and much improved, with many hospital pharmacies employing between 5 and 7 pharmacists and occupying a key role in the life of the hospital as a whole.

But while pharmacy has evolved as a profession and pharmacists are occupying a greater role in major acute hospitals, unfortunately this role has yet to be fully recognised by the wider public. I believe there is a responsibility on the part of both the Department of Health and Children and pharmacists themselves to push forward their profession, assert themselves to the general public and ensure that their important and demanding role is recognised. For too long when we hear people paying tribute to hospital staff, it is normally just doctors and nurses that are referred to. Unfortunately, there tends to be an omission of all the ancillary professions, including pharmacy. We need to open up the whole pharmacy business to wider public debate, to stimulate discussion and ensure that pharmacists get the public recognition they most keenly deserve.

I have been somewhat shocked and surprised recently by figures I have received concerning the incidence of iatrogenic diseases: with people in hospital either wrongly prescribed or given the wrong dosage. I don’t want to bore you with statistics but one example from the US is particularly telling, where there are four times as many drug related deaths as they are road fatalities. It is estimated that up to 70% of these drug related deaths could have been prevented.

In the UK, similar figures emerge, with 1,100 people dying from the adverse effects of medicines in 2000, while nearly 200 people died as a result of medication errors. In a major study carried out in the UK it was also discovered that nurses make mistakes in administering almost half the drugs they give to patients intravenously, with a third of errors potentially harmful. While no such figures are available for Ireland, it can be assumed that the practice is not uncommon here. As the range of medicines available continues to increase in number and complexity, the likelihood of error will also grow. While pharmacists have moved towards a more central role in hospitals in recent years, members of the profession must continue to exert as much influence as possible and increase the part played by them in decision making, advising on medicines, their indications, contra-indications, drug interaction profile, route of administration, pharmaco-economic value, selection, review, purchase and storage. As the pace of medical and technological continues to increase, hospital pharmacists will have to prove themselves even more adept at continuing to learn and remaining at the forefront of developments, expanding and improving services to keep pace with change.

Hospital pharmacists also have a key part to play in ensuring that the drugs administered in our hospitals are chosen on the twin basis of cost and efficiency. As a pharmacist and as a government Minister I think it is incumbent on the profession and on the public to demand the best possible service and the best possible value for money. This is why I make no apology for saying publicly that pharmacists will have to play a greater role in the clinical area of decisions regarding drugs. Hospital pharmacists need to continue to push beyond the barriers of being dispensers of medicines. As highly trained health care professionals, pharmacists must be centrally involved in decision-making.

I have recently discussed this issue with Professors of Medicines in the various Universities in Ireland and I have discovered that while there are valiant attempts to use formularies in hospitals, often these attempts are being thwarted by the vested interests involved. These vested interests, unfortunately, attempt to ensure that the formularies are not adhered to and that house doctors are allowed to prescribe whatever drug they chose. I think as pharmacists we should question the wisdom of this from two standpoints, best practice number one, and a cost benefit number two. There is strong body of opinion that asserts that tried and trusted drugs should be used before new and more expensive alternatives that have just come on the market. The cost benefit I think is self-explanatory to us all.

As pharmacists, you are the only persons solely trained as experts on drugs. You have all studied in great depth the efficacy and safety of drugs. It is therefore incumbent upon you to ensure that your opinions and listened to and observed when it comes to selecting and administering drugs in your hospitals. Patient care has become and must continue to be more of a shared care between the various health professions. Doctors should not be the sole arbiters in this matter. Patients deserve your involvement and so does the general public.

I was pleased to see recently that a debate has started in the psychiatric field about the use of medicines in the psychiatric area. There has been and will continue to be debates about the greater use of generic medicines and also the clinical role of pharmacists in hospitals. I am aware that in many large hospitals in the UK and USA there may be 30 or 40 pharmacists practicing, and I certainly would be all in favour of that happening here in Ireland. I think that there is a huge role to be played by pharmacists in the whole area of clinical decisions. I think the state would be very remiss not to utilize your expertise to the utmost. I certainly can assure you that I will keep supporting this premise. But pharmacy is no different to any other profession, pharmacists have to continually publicise the importance of their role.

Before I finish, I would like to touch on the Pharmacy Bill. As a profession, I know you have long campaigned for this legislation. There is an urgent need to consolidate and update the various Acts referring to pharmacy, which date back to 1875, and to ensure that legislative provisions set a policy framework to deliver a modern and efficient structure. In particular, the necessity to ensure fitness to practice is paramount, obliging pharmacists to keep pace with changes within the profession and continuously update their knowledge.

A new Pharmacy bill is likely to include the accountability of the profession through Fitness to Practice provisions, as well as education and training, and the provision of community pharmacy. In this context the Report of the Pharmacy Review Group (PRG) is an important element in the development of a policy framework for the community pharmacy sector in Ireland. The Minister is currently considering the Report´s recommendations.

I am aware that there are also other key areas of policy such as the registration of pharmacists and pharmacies, protection of titles and the role and scope of hospital pharmacy. I am sure your Association has views on these issues and the Department looks forward to exploring these further in the months ahead.

I would find it easy to continue speaking on any of the issues I mentioned this evening. As I said at the outset, however, I am conscious that people may be keen to relax at this point of the evening. I would like to end therefore by wishing you all a very pleasant evening.