I have listened carefully to the debate, the Minister's contribution, the other Deputies and my constituents and my conclusion is that this is a mess. The Minister said that there are people who are confused and frightened. That is certainly true. People have been in touch with my office and with those of other Deputies and they are genuinely concerned about this. People are struggling with bills and with the cost of living and they are really worried they are going to have to pay huge costs out of pocket. Whether it is €15 or €50, people are genuinely worried. These are people who are older, people with disabilities and people on social welfare. They will say that, while the Government cannot control all prices, it can control this price and can make this service free of charge. The Minister pointed out that she was going to do an analysis, that there would be a probing process and that she wanted greater transparency but why now? Why was this not done during the negotiation phase? Why was all of this not teased out in advance? Why did it take public pressure and motions before the Dáil for her to put a pause on this and take these steps? Like other Deputies, I raised concerns about changes in the agreement when we spoke about it back in October. I highlighted concerns around changes in respect of phased dispensing but nothing was done. It was not until there was increased public pressure that it was suddenly decided that things would change. The Minister has a huge mess on her hands. People want clarity. People have said time and again that this is a service they really need and rely on. It gives them certainty, confidence and reassurance in taking their medication. It is a service they would like provided free of charge. It is something the State can support them with. That is the outcome we need to reach in the time ahead. At the core of this is the use of blister packs, a dosage monitoring system that helps patients manage medication safely and retain their independence, which is particularly important given our ageing population. Two weeks ago today, the Department of Health and the HSE published Delivering an Age-Friendly Health System, a blueprint intended to transform healthcare for older people. The Minister of State with responsibility for older people said that "It sets out a clear and ambitious mission for Ireland to become a country where the entire health system is designed and delivered through an age-friendly lens that enhances the lives and well-being of all older adults." That is crucial. We need an age-friendly approach and that is why we need to get this right and fix the mess that has been created. The report hinges on what it calls the four Ms. One of those Ms stands for medication. According to the framework, an age-friendly health system should "prescribe medication thoughtfully and safely". Surely, blister packs are part of that. It is crucially important that we maintain people's independence and keep them at home for as long as possible. That is really important. Something that has not come up enough in this debate, in the media or in the Minister's contribution is the changes to phased dispensing and the impact that will have for some of the most vulnerable parts of our community. Deputy Sherlock made reference to that. The Minister has repeatedly cited the distinction between phased dispensing and monitored dosing systems, both of which were previously reimbursed under the phased dispensing arrangement. Strictly speaking, phased dispensing was introduced for patients to whom it would be unsafe to give their medication for the month on one single occasion. The rules around this are changing too but we have heard very little about it. Those changes will disproportionately impact deprived communities. That is not addressed in the motion and has not been addressed in media reports or in the Minister's statement. According to Deep End Ireland, which represents GPs in disadvantaged communities, there will be a profound and sudden narrowing of the list of medications deemed to be high-risk and, therefore, eligible for reimbursement under phased dispensing. There are very serious changes to the rules around phased dispensing as well and these need to be considered, looked at and changed. For patients who are homeless or whose living conditions are unstable, the risk of having all of their tablets dispensed at once is not confined to the pharmacology of the particular drug. The risk lies in the overall burden of managing multiple medicines when you have memory difficulties or poor health literacy, when you live a chaotic life or when you lack support. Blood thinners and insulin will no longer be deemed high-risk medications but they are high-risk for some. Why is the Minister shifting this avoidable clinical risk onto those least able to manage it? In her reply, I would really like the Minister to tease through and look at that matter because these changes are also really important and have not been given enough attention. They affect some of the most at-risk groups. It needs to be addressed. The Minister claims the changes to blister pack rules are just a correction but this decision is anything but correct. It is the wrong decision. It flies in the face of stated Government policy on ageing and delivering an age-friendly health and social care system. A constituent of mine called it a stealth tax and I would agree. We need to change this. The Minister needs to look at it. She particularly needs to look at the narrowing of the category of high-risk drugs because that will have a real impact on people.

Sentiment score: 0.06