Speech by Minister White at the Irish Pharmacy Union Annual Conference
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Good morning Madam President (Kathy Maher) and delegates. Thank you for inviting me here today to open your annual conference.
I would like, if I may, to begin by acknowledging and paying tribute to the dedication, professionalism and commitment of community pharmacists throughout the country. You are at the front line of service delivery and you play a crucial role improving health and wellbeing and in supporting and treating people in their communities.
I have met with the IPU officials on a number of occasions and I welcome engagement with you on the implementation of Government policy, in particular the implementation of Healthy Ireland. Healthy Ireland sets out the vision for delivering public health for the future, through enabling the public to make better lifestyle choices, prevention or reduction of avoidable illness and better detection, management and control of chronic illness.
The pharmacy profession has a crucial role to play in the delivery of healthcare and I welcome your continued, proactive engagement in the achievement of a better healthcare system and improved patient outcomes.
You are all well aware that the Government is engaged in major reform of the health system. The delivery of a single-tier health system, supported by Universal Health Insurance, is a central pillar of this programme, as set out in the Programme for Government and affirmed in Future Health.
Underpinning these reforms is not just the need to reduce costs but the need, indeed duty, to enhance patient safety and make Ireland a healthier place to live in
One of the fundamental aims of Future Health is to renew our focus on keeping people healthy and driving health prevention strategies across our public services.
The publication last month of the White Paper on Universal Health Insurance underpins the Government’s determination to deliver on this commitment.
The publication of the White Paper marked the initiation of a consultation process and a call for submissions on the general approach set out in the White Paper. This is an important opportunity to contribute to the development of policy on the future of the health system and I urge those present to participate in the consultation process.
We are determined that the necessary groundwork will be in place by 2016 to facilitate full implementation of UHI by 2019.
Delivering these reforms requires enhancing and expanding the capacity of the primary care sector. This is particularly important in light of the very significant challenges posed by an ageing population, significant population growth and the increase in the incidence of chronic disease.
The extension of universal GP care without fees to the entire population, on a phased basis, is a key commitment within this Government’s term of office.
On 23rd April, Government approved the Health (General Practitioner Service) Bill, 2014, which provides the basis for every child in Ireland, aged 5 and under, to access a GP service without facing the barrier of fees.
This represents the first step in introducing a universal GP service for the entire Irish population. Under UHI, every member of the population will have a universal entitlement to the core primary care services provided by GPs.
Development of the Role of the Pharmacist
Pharmacists play a very important role in the delivery of the reform agenda. Community pharmacists, who are at the coalface of primary care, are instrumental in actively promoting health initiatives and in keeping people healthy.
Key initiatives include the provision of:
- Emergency hormonal contraception;
- Advice on healthy eating;
- Support with smoking cessation and most importantly,
- Advice to help patients manage their medications.
Improvements in primary care in Ireland rely on the evolving nature of the community pharmacy and the continued development of evidence based best practice and quality patient care. Minister Reilly and I are very supportive of a further expansion of the role of the community pharmacy, in particular into areas such as chronic disease management and health screening.
Community pharmacists are in a position to play an important role in promoting health and wellbeing messages and in supporting and enabling people to adopt healthier lifestyles and take responsibility for their own and their family’s health.
The pharmacy is a setting that is suitable for this purpose.
Developments in Pharmacy Education & Training
As the role of the pharmacist expands, that is matched by the need for continued education and training.
The 2007 Pharmacy Act introduced significant developments in pharmacy education and training and in particular, introduced mandatory Continuing Professional Development(CPD) for pharmacists.
Pharmacist roles vary a great deal but as practices change and improve, it is necessary to create a CPD system that will support improvements in both professional practice and in patient care.
The new five-year integrated Masters level pharmacy degree represents an exciting development for the profession. The degree, which is provided across the three schools of pharmacy in Ireland, is in line with best international practice. It will ensure renewed focus is placed on clinical best practice.
The degree will also allow greater integration with the pharmaceutical industry and this reflects the Government’s policy approach to the forging of strong partnerships with industry and collaborative links across academic institutions.
Developments in pharmacy practice will be enabled, supported and facilitated through the work of the recently established Irish Institute of Pharmacy.
The Institute will provide a platform for future development of the profession and will ensure that developments and expansions in pharmacy practice and services in Ireland are underpinned by appropriate CPD, training and the international evidence base.
The Institute will join with the other professional bodies as a key partner in the HSE Clinical Care Programmes.
CPD and the new Institute should support building closer links with other healthcare professions and more effective, integrated healthcare delivery so that pharmacy practice is well-placed to deliver services as part of the Government’s new universal healthcare system.
Reference Pricing and Generic Substitution
As Minister of State for Primary Care, I am committed to ensuring that we deliver better, more effective care for every patient in a cost-effective way. It is important, in the current economic climate, to limit costs to the greatest possible extent, and to involve patients in better understanding the value of medicines and their appropriate use.
At the same time, we must not lose sight of the primary focus of ensuring patients continue to have access to the medicines they need.
In this context, I am pleased to say that the Health (Pricing and Supply of Medical Goods) Act 2013 (the 2013 Health Act), which was commenced in June of last year, introduced a radical new system of generic substitution and reference pricing for prescribed medicines under the publicly funded community drug schemes. These reforms will promote price competition among suppliers and ensure that lower prices are paid for these medicines resulting in savings for both taxpayers and patients.
The Irish Medicines Board (IMB) has made significant progress in relation to the implementation of generic substitution. The IMB has to-date published 18 Lists of Interchangeable Medicinal Products – the most recent on the 8th May for the active substance Memantine.
In addition, as of May 1st, the HSE has implemented reference prices for 10 Lists of Interchangeable Medicinal Products and will continue to implement reference prices for the remaining Lists published by the IMB in accordance with the timelines set out in the Act.
By end of 2014, it is expected that approximately 80%, by value, of active substances reimbursed under the community drug schemes will have been assessed for interchangeability by the IMB. This process, coupled with the implementation of reference prices by the HSE will generate savings in the region of €50 million in 2014, with further significant savings being generated for the taxpayer and patient in the years ahead.
However, while the objective is to maximise the savings achievable from the reference pricing process, I want to re-iterate that in setting reference prices the HSE must have regard to the criteria set out in the 2013 Health Act, including the ability of suppliers to meet patient demand at the set price. It is therefore the HSE’s policy to set reference prices that maximise the savings for the State and patients consistent with protecting continuity of supply for essential medicines in the Irish market. Consequently reference prices will not be set so low as to jeopardise the supply of the relevant medicines.
It must be remembered that this Act provides for significant savings for the State, in terms of the cost of prescribed medication reimbursed under the community drug schemes, but also for the patient who will also benefit from a greater penetration of generic medicines and reduced prices.
It is important that the reduced prices available to the State under this legislation are also passed onto the patient and I am confident that this will indeed be the case.
I want to express my gratitude for the effort and cooperation by the IPU to ensure the successful implementation of this crucial new system and to assure you that Government is fully aware of this contribution.
The Government recognises the importance of the eHealth agenda and its value as a key enabler of change and supporting the reform agenda. It has the potential to modernise the way we treat patients, particularly in providing care in the most appropriate setting and at the most appropriate level within our health services.
Last December the Department published Ireland’s eHealth Strategy. This strategy demonstrates how the individual citizen, the Irish healthcare delivery systems – both public and private – and the economy as a whole will benefit from eHealth.
A key enabler for eHealth is the Health Identifiers Bill 2013 which was also published last December. The Bill, which has made significant progress in the Oireachtas in recent weeks, will allow for the assignment of individual health identifiers for patients and identifiers for professionals and organisations, to underpin both patient safety and efficiency, while ensuring privacy and confidentiality.
Health identifiers will be crucial in both primary and acute care in helping to ensure that the right information is associated with the right patient. It will assist in the implementation of other key eHealth initiatives such as ePrescribing and the developing of summary care records.
In implementing ePrescribing solutions we are aware of legislative issues we need to address and, of course, the application of common data standards is very important.
It is also important that we involve and address the concerns of all the stakeholders and improve the experience of the patient with regard to medication management and safety as well as reducing cost.
Undoubtedly, 2014 and the years ahead will continue to be challenging for everyone involved in the delivery of public health services. Implementing the major reform programme planned for the health system will not be easy in these circumstances. However, the reform programme will bring about real change, the benefits of which will be experienced by every citizen and every person working in the delivery of healthcare.
As health professionals with a pivotal role in the delivery of a modern, high quality and patient-centred primary care services, I look forward to your continued support and cooperation as we progress along the reform journey.