Opening address by Minister for Health Simon Harris TD at the Irish Pharmacy Union Conference

I am delighted to join you this morning, and I thank your secretary general, Darragh O’Loughlin, for the invitation to address the 2017 IPU conference.

The theme for this conference – Raising the Bar for the Future of Healthcare – is one I can clearly subscribe to. Given the range of speakers, national and international, the focus clearly extends beyond Irish clinical practice in community pharmacy. I am sure that the discussions will produce robust views on professional and commercial directions in Irish pharmacy, and the place of Irish pharmacy in primary care – which is as it should be.

The theme also reflects a principle that many of you have heard me talk about consistently – that we need a decisive shift of health services to primary care, to deliver better care close to patients and their home communities. I want Irish patients to be able to get safe and clinically effective treatments early, at the lowest level of complexity and as close to their homes as possible. Community pharmacy has a core role to play in addressing health needs in this way, for both private and public health services.

Future Developments in Community Pharmacy
You will all be familiar with the Future Pharmacy Practice Project, published last year by the PSI and building on previous work such as Pharmacy 2020.

The project provides a comprehensive picture of the potential for clinical expansion of community and hospital services.

This is a key document for both yourselves and for state policy. We are very keen, as I have said on more than one occasion, to expand community pharmacy services to our patients, particularly with the challenges we are facing, such as an aging population, the need for earlier hospital discharge and the increasing range of community-delivered treatment.

This is something we are all very interested in. However, there are two points we must recognise. The first is that the provision of community pharmacy services on behalf of the HSE is primarily a contracted service. Irish pharmacy services have always been provided through private contractors and this has served us very well – but it does mean that service expansion, for public patients, has significant implications for limited health resources. Accordingly, there must be a measurable element of better patient outcomes in any development.

The second point is that our priority must be on services where the public health needs are not addressed elsewhere, or on services that could be demonstrably better delivered by community pharmacy provision, through, among other things, better access, better health outcomes or better value for money.

With these caveats, expansion of community pharmacy services will be a cornerstone of any structured shift to greater primary care provision. You are the medicines experts and we need to harness your expertise.

However, in doing this we must not lose focus on the core function of community pharmacy – the dispensing of medicines to patients in a safe and professional environment.

New Service Developments
This journey to expand the range of services has begun. This is evident in individual pharmacies throughout the country. The extension of these services, which in many cases are already offered to private patients, to public patients through contractual agreements with the HSE, is also underway.

To date, we have seen the very successful introduction of vaccination services, and there may be further potential in that area. Last year’s minor ailments pilot established operational viability, and I would expect the next step to be more comprehensive trialling to demonstrate the benefits of such services in an Irish context.

I am also pleased to announce that I have decided to expand the GMS service to include the provision of emergency hormonal contraception services to medical card holders on the same basis as private patients – that is, without the need to go to a GP first. I expect regulations to be in place to allow this extended service to begin from July.
I understand that there has also been considerable work and investment in upgraded electronic interaction between contractors and the PCRS, in particular around the clarification of claiming for owings and phased dispensing, issues which have historically been unsatisfactory for all parties.

As I have outlined, the key test for any new service must be that it delivers one or more of better access, better outcomes and better value. There is also an investment cost for the taxpayer in developing new services and the safety and governance frameworks we need for our patients.

Given these changes, it is timely to consider the current range of contractual services. The focus, from my perspective, needs to be on the services we need for our public patients. We must also take the opportunities to improve patient care that will come through modern information and communications technology, and reflect the variety of commercial models within community pharmacy in Ireland.

A major opportunity presented by ICT lies in access to clinical data, as a tool for better treatment and greater safety for individual patients. It is critical to have the right information about the right patient in the right place and at the appropriate time.

I am sure that in the (hopefully, not too distant) future, our pharmacists will have routine, real time access to all the information they need to advise patients and prescribers, and that this interaction will be the norm.

Another opportunity is in improved governance and probity for public funding. There have been a number of high profile cases in recent times, and I wish to note the IPU’s support and assistance in working towards resolution of these issues. I don’t need to tell you that a profession’s integrity and reputation is invaluable in maintaining public confidence and trust in its services. I understand that the IPU and the HSE are working towards advances in verification and claiming systems and I very much welcome this.

Needs of an Aging Population
I don’t wish to put a dampener on proceedings with my next remark but it is an inescapable fact – we are getting older. Diseases which once consumed vast shares of health resources, such as TB or polio, are largely defeated. More recently, investment in new medicines is helping to cure or contain conditions such as Hepatitis C or HIV, something that was once unthinkable.

As a result, we are living longer, healthier lives. Add in the increase in the number of older citizens from changes in emigration, and the health needs of our nation have changed, without the system really following.

Accordingly, one of our greatest challenges will be in chronic disease. Because chronic diseases tend to be managed, rather than cured, we need much more emphasis on continuous care, rather than traditional episodic treatment.

This means moving from our hospital centric system. We need our hospitals to work more effectively, we need to develop primary and community care, and we need all of the system to work as one.

Achieving integrated services will require a high level of team-working across diverse professions. The challenge in achieving this is how to integrate different relationships, priorities, cultures and approaches. We also need to consider how to do this when the State’s financial support is focused on under half the population.

There are undoubted opportunities for community pharmacy contractors in the shift to primary care. There will be significant state investment in this process. With our changed economic circumstances and the future of FEMPI, we are considering our options for moving forward. I am equally clear that expanded remuneration must be tied to improved and extended services.

But commercial contractors must put themselves in a position to take up the opportunities for better business that arise from this investment. That may be in being able to deliver ICT standards to deal with the HSE, having the professional and commercial capacity to expand the range of services you can offer to public and private patients, or simply in the ability to compete for customers, particularly on service levels or through the benefits of your own particular service model.

All-Party Oireachtas Committee
Before concluding, I wish to address one more issue this morning – the all-party committee work on health care.

What was obvious to me before I took this job is that all our citizens want a better health service. To meet this wish, we need a long term vision for Irish healthcare. That vision needs political and societal consensus and it should not change with a change in Government.

A key commitment in the Programme for Partnership Government is the development of this vision over a 10 year period, through cross party consensus.

The Future Healthcare Committee, chaired by Deputy Róisín Shortall, has been considering this vision and the direction of health policy, the implications of projected demand, a preferred care model and how to achieve and fund this.

I have recently met with the Committee and I am confident that primary care, and the enhancement of it which we all wish to see, will be key to its recommendations.

As I know you have a full programme today, I will conclude by reaffirming that the Government shares the commitment to a decisive shift to primary care. We are all in agreement here and we have a shared priority – the delivery of enhanced primary care in every community – a primary care service that is fit for the 21st century. Your conference today will contribute to the important debate of how that can be achieved, and your role in it.
Once again, my thanks to the IPU for the chance to state our intentions and my best wishes to all participating in the conference.