2025-12-16

I move: That Dáil Éireann: notes that: — in September, the Government accepted and published the new Community Pharmacy Agreement 2025, which was negotiated by the Department of Health; — the Community Pharmacy Agreement 2025 explicitly excluded reimbursement for monitored dosage systems (MDS), which had previously been reimbursed through the phased dispensing reimbursement mechanism, a practice which was widely known, accepted, and unchallenged by the Government; — MDS, such as blister packs, are an essential and basic tool for improving medication management and safety, and can be the difference between taking medicines safely and risking missed doses, double dosing, or dangerous confusion; and — the Community Pharmacy Agreement 2025 could have included reimbursement for MDS where they are requested by a person's general practitioner or other appropriately qualified treating clinician; further notes that: — blister packs without subsidisation can cost an individual in the range of €20 to €50 a month, even more in some cases where a person has particularly complex needs; — blister packs are an essential component in medication management, which allow for greater involvement of a person's carer or personal assistant in ensuring a person receives the right medicine in the right dosage at the right time, particularly where a person has cognitive or mobility issues or a physical or intellectual disability, which is otherwise not permitted; and — many people, in particular older people, people with disabilities, and people with multiple conditions, had come to rely on this service being provided free of charge and cannot afford the additional cost which the Government has now imposed on them, which can accumulate to several weeks' worth of income a year; considers that the inclusion of MDS in reimbursement arrangements with pharmacies is a small step towards universal healthcare which the Government should take; and condemns: — the Government's decision to withdraw blister pack supports from vulnerable people at the most expensive time of year for households and in the midst of a cost-of-living crisis; and — the failure of Government and the Minister for Health to ensure coverage of MDS in the new Community Pharmacy Agreement 2025 on the basis of need; and calls on the Government to: — urgently avert the new fees for MDS, which are due to take effect from 1st January, 2026 by temporarily permitting reimbursement as was the case to date; and — immediately engage with the Irish Pharmacy Union, to include a reimbursement mechanism for MDS in the Community Pharmacy Agreement 2025, which delivers coverage on the basis of need, not ability to pay for all people who need them on the basis of a clinical recommendation. It came as a shock to many patients when they received letters from pharmacists or were told orally by pharmacists that the blister packs that were previously funded and paid for, as they saw it, were now going to be subject to a charge from 1 January 2026 onwards. It is important to point out that these are very vulnerable patients. The vast majority of them are older people, over the age of 65. They are people with dementia, disabilities and a range of health needs, but they are the most vulnerable patients. The vast majority of people will not need blister packs, but for those who do, they are a necessity and they are important for a number of purposes. They help patients manage medicines, and they are also a very important aid and tool for carers and family members. I know from my own siblings and others who look after people that they have to make sure that the blister pack is out, the patient uses the appropriate medication and everybody benefits from it. It is really good for patients and there was an awful shock, when patients received notification formally or informally that this was going to come to an end and they will have to have to pay for it. Sometimes we lose sight of the fact that €20, €40 or €50 a month is a huge amount for some people. We cannot ever live in a bubble here in Leinster House. We have to understand that this type of charge is a loss for a person who is on a very low income, a disability payment or a low-paid pension. For those people to be hit with this additional charge really did come as a shock to them and their families and to carers. However, it was not a shock to me that this was going to happen because I raised it directly with the Minister. I also issued a press statement at the time when the new community pharmacy agreement was put in place. I recognised this as a glaring omission and I warned that this would become an issue and unfortunately, it did. I understood the importance of them for patients and families and I certainly knew that when the time came and people realised that what they were getting previously free of charge and covered was going to be to be subject to a charge, would go down very badly and rightly so. It has been described as cruel by many people who have texted into radio programmes over the past week as well. The Minister issued a statement on Friday of last week saying that she would put on hold the new community pharmacy agreement for a couple of months. The reason she gave for putting it on hold was rightly, that there is a lot of additional work for pharmacists. They are administering the flu vaccine and the Covid vaccine, which I got myself in a pharmacy last week. There is obviously additional work in managing diseases and the flu circulating in the community and other issues that pharmacists are dealing with. That was the reason the Minister gave. Nowhere in the press statement did she say she would look at this. In fact, she described blister packs as being private fees. In a response she gave in the Seanad, she doubled down as well on that.

I was not in the Seanad.

I do not understand this approach. It may not have been the Minister who gave the speech in the Seanad but certainly it was a Minister who essentially doubled down. Nowhere did the reply say there would be any agreement. In fact, what it said was that this is a private matter between patients and pharmacists. I understand that this was funded indirectly; I said so at the time. It seems that this was funded through the phased dispensing scheme and that pharmacists were essentially offsetting the cost of blister packs through phased dispensing. Whatever about the rights and wrongs of that at this point in time, many of these people who were previously getting it funded now have to pay and they simply cannot afford to do so. We are being constructive in tabling this motion to ask the Minister to engage and to look at putting in place a scheme whereby this can be funded. There are different ways this can be done. She could allow GPs, for example, to determine whether, through the same funding pot as phased dispensing, we provide for blister packs as well. Obviously, funding into the pot could be increased. There are a lot of options open to the Minister. However, the option of saying "No" will not win over the support of those people who are now, as they see it, being left high and dry. I know the Minister is not opposing the motion but I appeal to her to listen not just to me but to all those people who have reacted very angrily. They do not really care who is right or who is wrong as to how these were funded in the past. The only thing that matters for them and their families is that they are now facing an additional cost, and that is very unfair on those patients.

We need to be frank: this is a cold and ruthless move by Fianna Fáil and Fine Gael. To announce this charge just before Christmas, at the most expensive time of the year for many families, is nothing short of cruel. While the Government has stalled it for a few months, leaving a weight of uncertainty over many families, this policy decision goes far beyond a simple financial blow to some of the most vulnerable in our society; this is an attack on their independence. For over 20 years I worked as a carer for adults with additional needs. I saw first-hand what these blister packs meant. They were not a luxury; they were a lifeline. They gave people the freedom to manage their own medication safely without constant supervision. They preserved dignity and enabled independence. The Minister can try to push the narrative that blister packs are unnecessary and that people can manage just fine without them, but the ordinary people, like the people across Carlow-Kilkenny whom I represent, can see through this spin. Most of us have had a loved one at some stage who has relied on this simple, effective system. We have seen the independence it has given our loved ones. How the Government can justify tax breaks for the likes of McDonald's and Starbucks while imposing this charge on older people managing multiple medications - people living with dementia, disabilities or brain injuries - is beyond me. This move will reduce people's independence. It will heap pressure on family carers. It risks poorer medication adherence, leading to avoidable harm and higher long-term costs for our health service. Let us be crystal clear: this decision will damage lives. This is not just poor policy; this is heartless. I urge the Minister to reverse this decision.

A minute or two ago, I could see the Minister become exasperated at my colleague describing this as cruel as "heartless", but it is important that she understands how this is being felt by people. When people went to their chemist or learned about this, it was very hard for them to understand why a government would come to such a decision because these blister packs are essential to people who have conditions such as Alzheimer's and dementia and other vulnerable categories of patient. A lot of these people are on not just one or two tablets a day but multiple tablets. Sometimes the administration of the medication to people is quite complex, so it is vital for their health that they have the ability to avail of these blister packs. People have gone into a chemist and learned about this during a cost-of-living crisis. Many of the people who were retrieving these medications from the chemist are themselves on carer's allowance or something like that, are responsible for the care of their parent, their adult child or another loved one, and are being hit by perhaps €20, €40 or €50 a month in additional charges if we are talking about two people whom they are caring for. It is therefore quite understandable why people are responding to this and believing that it is cruel and heartless in relation-----

Believing.

It is reasonable for people to draw that conclusion. There is an obligation on the Minister to demonstrate that she will find a solution to this. That is why we have brought this motion to the Dáil. The Government is not opposing it, which I welcome, but we need a solution. A lot of our community pharmacists are being stretched very thin as things are. The agreement the Minister needs to reach with the pharmacies needs to ensure that vulnerable patients who have been relying on blister packs for a very long time continue to be provided with them. They are not a luxury but a lifeline for them. That is the obligation on her. This needs to be resolved.

In the middle of a cost-of-living crisis, the very least - and I mean the rock-bottom, bare minimum - that anyone could expect from a government of any decency is that it would not make things worse. A total of 21% of households that have one or more members with a disability are materially deprived. Some 20% of those are in poverty. Some 16% of people over 65 are in poverty. The extra €20, €30, €40 or €50 per month is therefore not nothing; it is massively significant to people who have already been pushed into poverty by the decisions of this Government. As my colleagues have outlined, these blister packs are an essential organisational tool for people who are trying to manage their medication but who have difficulty doing so. Basic patient safety means that they must have access to blister packs or else they must have access to somebody who will help them to take their medication, but the latter robs them of their independence. As they get older, people with disabilities will say that their world becomes very small as they become more and more dependent and as society disables them. This will further increase their loss of independence. I welcome that the Minister is not opposing this motion but, to be very clear, the decent thing to do is to support it and to work with the Opposition to find a solution.

The withdrawal of funding for medication blister packs was an ill-thought-out and cruel choice. It is disappointing that the Minister has allowed this issue to fester into the debacle we now have before us. I raised this with the Minister over a month ago, and her response, in effect, was to deny that there was or has been an issue at all until, that is, the public outcry became much too much. Pharmacists are being asked to play an ever more important and front-line role within our communities, and it is time Fine Gael treated them with respect. We had a similar fiasco at the onset of the year, when despite promising a free HRT scheme through pharmacies from January, the roll-out was delayed because the Minister simply could not get the job done on time. That was not a pharmacist issue; that was the Minister's issue, and so too is this. While the Government attempts to muddy the water, the fact of the matter is that reimbursement for blister packs was known and has been understood by the Government. The Minister sought to withdraw this crucial support, she got called out for it and she has backed down for now. Vulnerable patients who rely on these packs to manage the dosage of their medication cannot be asked to stump up as much as €50 per month arising from the inept leadership of this Government. Many will not or cannot, and that is a public health concern of the her making. Sinn Féin's motion offers the Minister the opportunity to draw a line under this. I urge her to take that responsibility, accept that she was wrong and implement this motion.

As the Minister well knows, blister packs are a medical necessity for many vulnerable people. They ensure that people can independently administer their own medications, reduce the risk of dose errors and avoid unnecessary hospitalisations. The cruel decision to withdraw the reimbursement of blister packs has caused deep anxiety, with many people receiving letters outlining that they will have to start paying to maintain this essential service. Many constituents have been in touch with me to outline their concerns, and their testimonies capture the scale of this issue. One woman wrote to tell me that this initiative makes no sense to her, as a nurse. She said that the elderly and vulnerable patients for whom she cares are most often taking multiple medications that need to be given in the correct dose at the correct time. She said that the risk of error by omission or overdose can have dangerous consequences and that this is another example of Government short-sightedness. Another professional, who works in community mental health, wrote to me to say that what this measure will do is alarming. My correspondent stated that there is a significant risk of the people they care for administering the incorrect doses, becoming unwell and needing to attend an accident and emergency department. They said that this is the last thing that a person with mental health challenges needs to deal with. This is an outrageous decision that will impact the most vulnerable in society. Nobody should be priced out of safe medicine management, but that is what will happen if the Minister does not see sense. We are in the middle of a cost-of-living crisis. It is unforgivable to target the most vulnerable in our society. We are talking about tens of thousands of people, including people with conditions such as dementia and Alzheimer's disease, facing additional charges of up to €50 per month for these packs. This issue may have been delayed by three months, but there is no certainty thereafter. The Minister needs to commit now to continuing this vital service and ensuring that these packs are provided free of charge into the future. She needs to do the right thing.

I thank Deputy Cullinane for bringing forward this motion. The value of blister packs is far beyond the monetary cost of the plastic. They provide independence, confidence, reassurance and safety for patients and their families. They bring reassurance that patients will be safe and will be able to manage their own medication. Last week's announcement has had an impact on many people across the State. It has caused huge frustration and anxiety. Numerous people have contacted my office. A good example was an elderly couple in their early 90s. They know the value of blister packs. When the lady did not have a blister pack, she overmedicated, took the wrong medication and ended up in the emergency department at huge cost to the health services and the State. It knocked her confidence in her ability to stay at home, which she can do with the aid of blister packs. I listened to the Minister on the radio at the weekend and read her press statement. We should not be in this position at all. She will say, no doubt, that it is a complicated system that contains anomalies and that some people were drawing down different funding streams that were not intended for this use. However, the reality is that she has caused major anxiety among a vulnerable population. She has provided no reassurance in her public utterances since then. She needs to act on this Sinn Féin motion and get to the negotiating table, if that is what it takes. Under no circumstances can we stand over a situation where in the middle of a cost-of-living crisis additional costs are being heaped on vulnerable people and putting them at medical risk. It is totally unacceptable.

The one word to describe the action that the Minister and the Government have taken is "cruel". It is cruelty towards some of the most vulnerable people in this State. It is mean. Will the Minister not make a decision? Will she not stand up to whoever behind the scenes is forcing her to make this call? She should decide not to let down pensioners, the disabled or the most vulnerable. How can she justify it? She has the power. People are watching and listening to the debate. They are looking to the Minister for hope. I know she will postpone the measure for a couple of months. Is she postponing it because she will not admit that Sinn Féin is right or is she doing so because this Government is so cruel to vulnerable people? That is the question people are asking. Blister packs are important to vulnerable people. This measure will put more pressure on carers and families. It will put vulnerable people at risk. Why would the Minister do it? How can she justify standing over it? In the budget, the Government gave hundreds of millions of euro to developers and speculators. It gave millions and millions of euro to the hospitality sector. When those decisions were made, the Minister knew she was going to introduce this measure. Deputy Cullinane outlined this months ago and she still went ahead. The Government promised a budget that would deliver for people with disabilities. It promised financial support. It let those people down. Not alone did the Government let them down in respect of a cost-of-disability package, it doubled down and put extra charges on the most vulnerable. There is pressure on carers again. I do not know where the Minister and the Government are living. People are mad. They are furious. They cannot understand how the Government can give money all over the place except to the most vulnerable. A person pointed out to me the other day that before the election, the Government was full of smiles and promises. It promised to do this, that and the other. It never told the people last year that it would charge them €30, €40 or €50 for blister packs. This is another one of its broken promises and hidden taxes. It is now the bones of four years until the next election. I ask the Minister to think about the harm she is going to cause. I ask her to make a decision, stand up and decide not to charge for blister packs. People deserve them.

We are not opposing the motion and we are grateful for the opportunity to clarify what has been a very confused and inaccurate set of comments over the recent period. It is really important that we take the opportunity because a lot of people have been very frightened by this debate. I note from the comments that have been made in the first 20 minutes of the debate that not one of the Deputies referenced the many constituents who have been paying for blister packs for some time. I know they have that information because my colleagues also represent those constituents. I also know from their social media accounts how many people have contacted them to tell them they have already been paying for blister packs for some time. They have been paying fees of €10 or €20 for some time. This is, and always has been, a private service. It was never funded by the State and there has been no removal of that service by this State. The Irish Pharmacy Union, IPU, confirmed that in a statement on Friday. I will outline what is different. There have been three groups of people. The first is those people who know they have always been paying for blister packs as a private service. They know that, we know that and Sinn Féin knows that because much of the commentary on Deputies' social media posts have told them that if their constituents have not. They have not taken the opportunity to reference that during the debate. Those people have been paying for blister packs as a private service. Another group of people have been getting blister packs for free because their pharmacists are giving them blister packs for free. I thank those pharmacists. There is a third group of people whose pharmacists have been giving them blister packs for free but charging the State under a different heading, as Deputy Cullinane referenced. They have been charging under the phased dispensing scheme, which is a very different scheme. Charging like that is wrong, inappropriate and contrary to numerous circulars that the HSE has issued. There is litigation to this effect against a sizeable private company that was wrongly doing this. There have been two sets of litigation and the State won on both occasions. It is wrong to give a service to someone and to charge the State wrongly under a different scheme. That is wrong, and I am glad that we have the opportunity to highlight that very wrong practice that some pharmacists in the State have been carrying out. This afternoon, I spoke with the regulator. It, along with the HSE, will be looking at this issue very clearly. They will be looking at the primary care reimbursement service, PCRS, data. People have received letters. There should be no change for those first two groups of people. If you have already been paying for blister packs, there will be no change under the community pharmacy agreement. If it has been free, I ask people to go in and speak to their pharmacists. Will it continue to be free? If it has been free, it will probably continue to be. If people have received letters, perhaps they want to share them with the regulator. It might be a scenario where a pharmacist who had previously been claiming under the wrong scheme is now trying to put the cost on the patient. As everybody here has correctly said, that is wrong. We are responsible for the money that taxpayers pay the State, which is then given to pharmacists. We are giving new funding of €50 million for pharmacists, as well as the funding within the pharmacy scheme. It is wrong for taxpayers' money to be used in a way that is not allocated. It is really important for me, even though it might not be as glamorous as simply just solving the problem, to take the time to get to the bottom of the issue and fix it over time, as I did with hormone replacement therapy, HRT. The many women who are enjoying their completely free HRT are the beneficiaries of that little extra time it took to do the job properly. In the same way, we will get to the bottom of the information here and find out who has been charging this inappropriately and how the regulator or others purport to deal with that. There are many people who have been charging. Phased dispensing is a really important protection for people, particularly those getting psychotropic drugs, opioids and codeine. Those drugs are dispensed, and pharmacists are paid to dispense them, on a weekly basis or even in some cases on a daily basis. That is for the safety of the patient. Although we assumed together and I certainly assumed in relation to blister packs that it was a patient safety measure and a convenience - a whole range of different good things - actually the evidence is quite different. That is something we could talk about if we had more time or if we were more committed to the details of science. I really hope we have that conversation. We all agree here as public representatives that where somebody has gotten used to having a blister pack or chooses to have a blister pack, I can completely see how that has been a good and positive thing, even if some of the medical perspectives are very different. The groups we would be most concerned about are already the groups that pharmacists and GPs are most concerned about. If someone is getting phased dispensing, for example, as Deputy Cullinane has said, it is already the case that a GP has to sign off on that. There needs to be evidence in a pharmacy that it is being correctly done on a weekly or daily basis as appropriate. That body of evidence should be there if phased dispensing is being used correctly. That might sound very technical to people watching tonight, and I totally get that, but it is taxpayers' money. We cannot have any profession using taxpayers' money in a way that has not been allocated, especially where that has been repeatedly communicated to them. It is an important marker. It is the responsibility of the Government and everybody here who is responsible for taxpayers' money. It is a different thing from making sure we continue to reassure people. Of all of the constituents who got in touch with the Deputies opposite on their social media, not one of them said they were already paying €50, because I checked. That is something that came into the vernacular last week, which was frightening for people and it was wrong. Whoever had an incentive to put figures like that into the media or into the debate knew what they were doing and knew it was not reflective of the practice that exists currently, where we are seeing fees of between €5 and €20, as reflected on the Deputies' own social media. That was a wrong thing for those people to do; it was frightening and wrong. I can completely understand why people would be so upset about that, especially when times are hard, especially in the winter and especially where it is perceived to be a new charge somebody is imposing and people do not have the information as to what has gone on in the backdrop. I am very glad for this opportunity to clear this up; I think it is the right thing to do. I am also glad we have taken the opportunity to put a pause on this to get the best information and to work out with the clinical community which people need blister packs and for whom they should be provided, and how we as a State make sure our resources are going to protect the most vulnerable and not everybody. Some of the commentary and what has been said already may imply that we should reward those pharmacists who have been using the State's money wrongly for this by simply covering it off. I would rather show the Irish people what was going on first and then protect the vulnerable. Some of the commentary refers to people who are already paying it. What is going to happen to them? What have they been doing for some time? That was a private service. It was never a State-funded service. There was nothing to withdraw. There was no Fine Gael and Fianna Fáil withdrawing from anything because it was never funded by the State. We have to have transparency in a developed State. We have to have the ability to set things out clearly and honestly. I am very glad for the opportunity Sinn Féin Deputies have provided with their time for us to be able to do that and place real clarity on it. I thank the Deputies for their engagement and for highlighting this important issue so that we can get to the bottom of what is truly a risk to people who are vulnerable and something that has perhaps been inflated by those who might have an incentive to cover what was done in the past and create very scary figures for private services for the future. I had a very important conversation with the regulator today. There will immediately be an analysis by the PCRS which the regulator may be involved with at any stage, and then we will lean into it in a much deeper way as the process goes on with an analysis of the phased dispensing claims that have been made to the HSE in a specific timeframe. This will be to examine what the criteria might be for any outliers in the phased dispensing scheme that may help to highlight those pharmacies that are in difficulties, and to have a very suitable, targeted probity process and targeted interventions and actions as may be appropriate, to be determined by the regulator. If there is a person in this House who disagrees with that course of action, I would like to hear about it. It is very important. Separately, the Pharmaceutical Society of Ireland, as the regulator, will support with any necessary follow-up actions. We are introducing transparency in pharmacy. There are so many good pharmacists who are going above and beyond for their patients every single day. We all know who they are. They are absolutely brilliant. Their first concern and one of their obligations is to put patient safety first. That is what they do. They are obliged by their profession to take care of their patients. They are obliged to make sure that patients understand their medication and receive their medication in a way that is capable of being understood and is going to keep them safe. That is their obligation. There are so many pharmacists who are doing that well. It is also true to say that there has been too much hidden in the charging in pharmacies, whether it is dispensing fees, as was shown through the HRT debate, or transparency on other things like private services that are reasonably paid for, like blister packs, BMI and a whole range of different things. That is why, along with the pharmacy regulator, I have required detailed receipts outlining the cost of every professional service that pharmacists should be allowed to charge for their expertise, including dispensing fees and a whole range of other things that Deputies Cullinane, Sherlock, Rice and I have discussed a number of times. Pharmacists are entirely entitled to charge for their expertise, but it should be transparent to their customers. This debate has helped to shine another light on the need for transparency in pharmaceutical services and I thank the Deputies for bringing this motion tonight.

I am glad the Minister has recognised that there has been confusion, a lack of clarity and three different types of scenarios in the way this money has been dispensed. I received an email from one constituent informing me that on her last visit to the chemist to pick up her 80-year-old mother's prescriptions, she was informed that the blister pack charge would be increasing to €7.50 per week from 1 January 2026. She was shocked at the extra €5 per week, an increase of 200%. She said that she currently pays €10 a month for the packs but from 1 January, it will be €30, an extra €20 per month. She felt that this was scandalous. If ever there was an issue where the Department did not know on a practical level that the facts of the situation were that the phased dispensing scheme was being used to pay for these, it was this. I could instance hundreds of different ways where I feel the HSE is paying too much. It recently purchased a building in Tralee. The site was previously purchased for about €160,000 two or three years ago, and the HSE recently purchased it for €4.2 million. I know they are paying hundreds of thousands in rent for the primary care centre in Tralee. When I ask how much they are paying for it, they refuse to confirm the amount, probably because they are embarrassed as to how much they are paying. It is not a good use of taxpayers' money. It is a fact that these blister pack monitored dosing systems have been widely used. Whether it is part of the scheme or not, the Minister accepts that there is confusion. Nearly everyone here knows someone who has used it, is using it or should be using it, particularly older vulnerable people with dementia, brain injuries and disabilities. The monitored dosing systems were historically reimbursed in practice through phased dispensing, as the Minister has admitted, which was in reality known to everybody who was involved in the system. We raised the concerns in October. They were ignored and it is only now the Minister is dealing with it. I am glad to hear she will be addressing it in the future.

The first statement that funding for blister packs was being withdrawn sent shock waves into the hearts of the most vulnerable section of people in society, their families, carers and close relations. The second statement, that the Minister is pausing them until 2026, has added further to the confusion for thousands of people who mostly subsist on disability pensions and occupational injury pensions. The severe impact of withdrawing funding for blister pack medication is quite evident in the many emails and complaints I have received in my office from across County Wexford. I received correspondence from an 82-year-old woman's daughter, who is her carer. This woman is blind and has Parkinson's disease. She is on six different medications a day. The daughter has a genuine fear of her mother ending up in hospital or being harmed due to taking the wrong medication. It is genuinely creating a high-risk health and safety issue for both mother and daughter. Another woman, Mary, wrote: My husband has been diagnosed with terminal brain cancer which ultimately went to his brain in 2024. My husband was quite unreliable about taking his medication. I asked for trays for three reasons: one, to ensure he was taking his tablets correctly; two, to reduce the mental load of being carer for myself; and three, to reduce conflict in the home. My husband was an intelligent man, but his illness affected him mentally and physically as all illnesses do to everyone. The decision to postpone funding for blister packs is a diabolical one and must be reversed, not postponed or put on the back burner. What most of our vulnerable citizens need now is clarity, protection and a guaranteed assurance that their blister packs will continue to be funded on a permanent basis. I urge every Member of the Oireachtas to support this motion.

I am lucky enough to be here a long time. I have seen stuff before, but this one can walk under a snake's belly with a bowler hat on. It is so embarrassing what the Government is doing. I had a gentleman on to me last week who is on a waiting list for meals on wheels. The Government is on about a cost-of-living crisis, and it brings in this extortionate disgusting charge on blister packs for people. It was brought in originally in 1996 as a health and safety issue. Now, everything is after getting fixed. I was in Market Green in Midleton last Saturday and Santy was there, believe it or not. Santy pulled me aside and asked me what the bloody hell is happening with the blister packs. This is a fact. We had a good conversation. He told me that he and his wife, Mrs. Claus - they are pushing on now - are disgusted at what is happening. On top of that, I can guarantee that the Minister is definitely on the naughty list this year anyway when it comes to them.

Did the Deputy not hear what I said?

There are no words for what the Government is doing to people. It is one of the most dangerous things. I have spoken on the radio about this. People have a system because, as I said at the start, this was brought in as a health and safety issue.

No, it was not.

People will die. There is misinformation-----

Sorry, a Leas-Cheann Comhairle, this has gone too far.

-----misdiagnosis, overdoses, underdoses, you name it.

It is not accurate in any sense.

The Minister is playing a charge here. Please do not talk me down. I am giving her respect, and I have always been respectful to her.

That is true, but that is just not accurate.

She needs to withdraw this.

Withdraw what?

This temporary measure. She has spoken about a pause, but a pause on what? A pause on death? That is what is going to happen. The Minister had better reverse this because it is an utter disgrace.

Hear, hear.

It is a basic set of facts.

When the story first broke about the blister packs, my office was inundated with calls. People contacted me not only asking why but expressing their disgust and anger and a deep sense that once again the most vulnerable in our society are being left behind, forgotten and treated as an afterthought by this Government. Whatever way they get their blister packs, it is not their fault that they were getting them for free and now they may have to pay for them.

Hear, hear.

We talk about the bike shed and the security hut as examples of taxpayers' money being wasted, but I would not call this a waste of money. It is a lifesaving device. What we are seeing here is all too familiar. The most vulnerable people in Clare and across the State are being given a small rise on one hand, only to have to have it taken straight back on the other. That is not progress. It is not fair. It certainly is not protecting those who rely on these vital lifesaving supports. I have listened carefully to those who came to me. This decision does not just affect those who use blister packs; it affects carers, families and loved ones who depend on this lifeline to keep people safe. These supports help elderly people, people with physical disabilities and those living with cognitive impairment of all ages. Imagine coming home to find your loved one collapsed or incoherent. You ring an ambulance, and you are asked a simple but critical question, "Have they taken their medication?" but you cannot answer because their blister pack is not there. You do not know if they have double dosed, triple dosed or taken none at all. Blister packs provide answers to those questions that can save lives. Imagine trying to live as independently as possible with a disability only to have a simple lifesaving support priced out of your reach. The loss of independence forces people to rely on others and even they may not have someone to rely on. It is not acceptable. Sinn Féin believes people should be able to live in dignity and safely. I implore the Minister to give some people hope this Christmas that they will not face the cost of funding for a device that is not a luxury but a necessity.

Hear, hear.

Tugann scannal na spuaicphacaí léargas soiléir ar mheon an Rialtais reatha. Is Rialtas é nach bhfuil clú aige céard atá ag tarlú i saol an ghnáthdhuine agus atá sásta an costas a bhaineann le seirbhísí bunúsacha sláinte a bhrú ar dhaoine nach bhfuil in acmhainn íoc astu. Nuair a fhaigheann an Rialtas an deis, déanann sé iarracht an t-ualach a chur ar an ngnáthdhuine go ciúin, i ngan fhios d’éinne, agus gan aon mheas ar an tionchar daonna. Ní ghlacfaimid leis sin. Beart daonna a bhí i gcóras na spuaicphacaí in am na flúirse, ach is cinneadh cruálach agus iomlán mífhéaráilte atá i gceist anois. Caithfidh an Rialtas athbhreithniú práinneach a dhéanamh ar an gcomhaontú cogasaíochta pobail agus aisíocaíocht a thabhairt bunaithe ar riachtanais, ní ar ábaltacht íocaíochta. These monitored dosage systems are not a luxury. They are a core patient safety service relied on by older people, people with disabilities and those managing complex or multiple medications. The decision now to target the pharmacies exposes how out of touch this Government is. Constituents contacted my office shocked and afraid about what the new year will bring. One man wrote to me. Michael and his wife are both pensioners. Each of them takes seven tablets a day for conditions, including blood pressure issues, mental health needs and recovery from a recent heart attack. Their pharmacist has now told them that they will face an extra €50 per month. This is money that they simply do not have. At the most expensive time of the year in the middle of a cost-of-living crisis, patients now find themselves having to pay for a safety-critical service regardless of income. There is no justification for that. The evidence is clear: removing access to monitored dosage systems will worsen medication adherence, increase hospital admissions and deepen health inequality. Community pharmacists are uniquely placed to prevent that harm, but they cannot continue to provide this service at a loss. Healthcare should be based on clinical need, not ability to pay. This House should stand with the most vulnerable and not abandon them.

Hear, hear.

I thank Sinn Féin for bringing forward this motion. I stand here frustrated that we are having this conversation at all. We should be spending time talking about improvements to the health service but instead we are talking about a service that is effectively going backwards. The reality is that when we were talking about the community pharmacy agreement in October in this House, I raised issues about phased dispensing and blister packing. There was no action from the Minister or her Department. It is only when uproar has arisen in the past week that she has responded to say that she has to try to work things out. We all know that blister packing is separate from phased dispensing, but the reality is that many pharmacists were using the money they were receiving for phased dispensing to put together blister packs for their patients. Blister packing is the dinosaur of medical technology, but it works in terms of ensuring that vulnerable patients and patients with a disability get the appropriate medication. It prevents unnecessary hospitalisation, it gives peace of mind to families and it is utterly consistent with the perspective that we should try to keep people at home. As I said in this Chamber two months ago, it is a real backwards step in the new community pharmacy agreement that the Government would reduce from four to two the number of criteria to be eligible for phased dispensing. As many pharmacists will not be getting that money for phased dispensing, the free blister pack service that many patients were availing of is coming to an end and they will have to pay for it. The consequences are potentially very real for many patients. I am struck by research that was done after the introduction of prescription charges in 2011. Obviously, they were not popular at the time but were done for a particular reason. Professor Charles Normand in Trinity College Dublin undertook significant research to show that there was a significantly higher number of strokes and heart attacks among the population who should have been taking their medication. Due to the introduction of prescription charges, these people failed to take their proper prescriptions. I worry that people who should be getting blister packing will not pay €10, €20, €30, €40 or indeed €50 - whatever the amount the pharmacist is going to individually charge - to get the blister packing service and then we will end up in a situation where health outcomes deteriorate and not improve. The reality here is that older people and those with a disability have become pawns in a game being played out between the Department of Health and pharmacists. Phased dispensing has become a pawn in the game being played between the Minister and the IPU. That is really to be regretted. It is the antithesis of all the messaging that has been coming from the Minister and the Department over the past year as to how to improve our hospital system, prevent unnecessary hospitalisations and ultimately ensure more people are looked after at home. I will speak to where we are now. There are lines within the community pharmacy agreement that talk about a saving arising from the withdrawal of the two categories of phased dispensing. I have a question for the Minister. What has she done since the agreement was made in September to determine how that saving is to be used? Has the Department of Health done anything with pharmacists in that time? I am not hearing about anything having been done. What I am hearing is that it was wrong and not transparent of pharmacists to use phased dispensing money to provide a blister packing service. That is completely the wrong message. Many pharmacists have been doing this for the right reasons and have not been making money from the phased dispensing service. They have been doing it because they can see the impact on their patients. What is the Minister going to do in the time she has given herself to ensure appropriate measures are put in place so that any patient who needs and wants blister packing or phased dispensing, which are separate but related, can access those services? We need to do more of it in future and not less. It is really regrettable that we have to spend any time debating the matter this evening when it should never have been included in the community pharmacy agreement. We also raised it on the floor of the Chamber when we were discussing the agreement back in October.

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.

I support the motion. I highlight the issue of the cost-of-living crisis that is affecting a great many people across this country. In my own constituency, in areas of severe disadvantage like Ballymun and Finglas, people are literally living hand to mouth. Last week, we heard people with disabilities say that they are choosing between eating and heating. That is not just a phrase and it does not just affect those with disabilities. It is particularly affecting vulnerable groups, including elderly people. Families are also really struggling. The proposal to add additional costs to blister packs shows a disconnect between this Government and the reality of people's lives. Older people, many of them living with families, are really struggling. Any additional cost could be the one that prevents them from affording food, paying rent or covering basic costs. It is an illogical move because it actually worsens health outcomes. I know the Minister knows this. She knows that the costs of living people face may mean they cannot cover health costs or the cost of heating their homes and that this worsens their health outcomes. Elderly people are living in cold and in fear. They cannot pay anything that would cost another cent. I want to raise the wider issue of the cost of healthcare, in particular for families and children. There was a promise in 2019 by Fine Gael and the Minister, Deputy Harris, to introduce the free GP care up to age 12 by 2022. We will be in 2026 in a few weeks' time and still that commitment to free GP care for children up to age 12 has not been delivered. When will the Minister deliver that commitment that was made over seven years ago?

I also support the motion. I have received a number of emails from constituents in Dublin South-Central who are absolutely flabbergasted by this mean-spirted decision to charge vulnerable and elderly people for a pack that is life-saving to them. This is the antithesis of how this country should be supporting vulnerable people. The story of Scrooge will never be dead as long as things like this are decided, and so close to Christmas. The worry that elderly and vulnerable people and their families have now is how they are going to be able to afford this. I am not joking when I say this - I am not making this up at all - but there are people in my constituency in Dublin South-Central where this amount of money that they will have to pay is really going to put them in such a bad way. St. James's Hospital is a massive hospital, as I am sure the Minister is aware. It is my constituency. It services not only the people of Dublin South-Central but also people from around this country with acute care needs. It does an excellent job. What people who go into hospital want is to go home. Everybody wants to be at home, especially when they are unwell. The last place they want to be is in a hospital in unfamiliar surroundings. Therefore, to be at home really is of utmost importance and these blister packs are what allow people to be cared for in their homes for as long as that might be needed. If they cannot afford to do that, that pushes people out of the possibility of being able to stay in their home being cared for. It is just such an unnecessary cost. Of all the things the Minister could have charged people in this country for, this is the thing she chooses. I am literally flabbergasted that she would chose this. It is so mean and so unfair. The reality is that this is an important thing for people being cared for in their homes. I am getting emails from family members who are really worried about this. I will stop talking now but I thank Sinn Féin for bringing this motion forward.

I welcome the opportunity to speak on this motion. It is a very important issue. I am glad the Minister for Health, as the senior Minister, is here to address this. We are having this conversation in the context of us being just days away from Christmas. This is one of the last sittings of the Dáil. Here we are, discussing a measure and what is up for consideration is a very small amount of money. On the other hand, it is about saving people's lives and looking after people's health. We are also having the debate in the context of supposedly getting near the final furlong in the implementation of Sláintecare, a public health system, and we are nowhere near that, unfortunately. The importance of blister packs and the importance of having monitored dosage systems cannot be overstated. The health and safety of patients is paramount. The withdrawal of this is dangerous and I do not say that lightly. For people with complex medical needs and multiple conditions, this very basic service was provided free of charge. I heard the Minister's interview on Sunday and I know she explained how it is being funded. I get that but we are dealing with people who have multiple medical needs and who are taking multiple medications. I have seen the medications on the kitchen table in households. They are taking two of this a day, four of that and one of those. They could have seven or eight different types of medication. It is very hard for them to keep track of this and this is a simple way of doing it. The majority of them are pensioners, disabled people, or people on very low incomes. We are talking about the most vulnerable. The blister packs are simple and it is a safe way of ensuring people are taking the correct dosage at the right time at the correct time of the day and everything else. Older people, including people with a range of medical conditions, rely on them - as I said, those who have complex medical needs. Chemists can charge between €30 and €50 for them but this is on top of other medical costs. The decision by Fianna Fáil and Fine Gael, and the Minister, to withdraw this now is putting an extra burden on these low-income households and individuals and it is coming at the worst time of the year. The majority of those who are typically dependent on the packs, which as the Minister said on Sunday - and fair enough - are being funded through what is called a phased dispensing reimbursement scheme, are on low incomes. This is coming on top of increasing food and energy costs. There was another announcement of an energy increase today. These are all increasing. Wait until the bills start coming in January. We have not even hit Christmas yet. This comes on top of the high cost of living. The increases are happening right across the board and it will disproportionately hit the poor the hardest. What must also be factored into this is the low income thresholds for medical cards. If you are under 66, the income threshold for a single person is €184. The last time I remember that being increased was back at the start of the noughties, around 2002 or 2003. I am open to correction but it was well over 20 years ago. If you are over 66, it is €201. When you hit that, you are gone. You cannot get a full medical card. For a couple under 66, the income threshold is €201. A couple over 66 - between that and 70 - it is €298. I am imploring the Minister and the Minister of State here to address this. What has also increased in the past 14 or 15 years is the number of items and medications no longer covered by the medical card scheme. Every TD will have heard this over the past 14 or 15 years. People come to us saying that such and such a thing they used to get on a medical card is no longer there as it was withdrawn. A third thing that has come into play in the past 14 years is GPs charging for blood tests. I raised this with James Reilly, Leo Varadkar and every Minister for Health since. That used to be free for people with medical cards but what happened was that the GPs started charging for it. They say they do not have to do it, according to their contracts. However, the Fine Gael Government, which the Minister was not part of at the time, negotiated a new contract with the GPs and this was not addressed in it, despite the fact it was pointed out on the floor of the Dáil to Leo Varadkar, James Reilly and others. I remember standing here in this same spot pointing it out to them, as did others at the time. I had pensioners coming to me about it at the time. That needs to be sorted out. There is all of that. There is the low income threshold, increasing medical card costs, the number of substances not covered and then GPs charging medical card patients for blood tests. When the Government negotiated the agreement with the pharmacies this year, this was not included. The State always paid for the phased dispensing and that was used as a safer way for different people. Some pharmacies were using it to cover the costs, and that is fair enough. There are two ways to resolve this. One is to allow the pharmacies to cover the costs under the existing scheme, what is called a phased dispensing scheme. The other is to pay the pharmacies a modest fee to dispense this using the monitored dosage system and the blister packs. There has been a giveaway budget for the big hotels, McDonald's and Costa. They got nearly €1 billion. The tiny amount of money that would fix this was not thought of. This needs to be fixed. We are nearly on the eve of Christmas. I ask the Minister to do one good thing for Christmas. I ask her to sort this out, cover the cost of the blister packs and keep our patients, elderly and vulnerable people, safe.

The custom and practice is the reality and the fact that there is no charge for blister packs. Whatever the ins and outs of this issue, the Minister and her Government are now placing the individual patients as pawns between the Department, the Government and the pharmacies. The buck stops with the Minister. I am asking that the Minister does the right thing, the compassionate thing and stops any question of charging for blister packs either now or into the future. This issue reminds me of the blood test charge debacle. First, GPs started charging medical cardholders for the taking of bloods. After being told it was illegal, we were then told it was not so illegal and would be covered under the contract. Political football was played with the issue for years and the outcome was that every medical cardholder now pays for blood tests. In my home town of Clonmel, patients pay anything from €10 to €30 for a blood test, regardless of whether they have a medical card. That should not happen in this case but I am very much afraid that the attitude of the Department and the Minister means it might well happen. I am putting them on notice tonight that the blister pack issue must be dealt with now and any charge to patients in this regard should be ruled out completely. Anything short of that will show again that the Government is out of touch with the public. The whole question of the cost of living arises with this issue. The very people it is proposed to charge for the blister packs, namely, the elderly, the vulnerable, the sick and the disabled, are already being hammered by increased costs. Unfortunately, the Government made a choice in that regard in the budget when it supported developers, burger barons and landlords and failed to support the vulnerable people in society who needed energy credits and supports and who have already been hit by huge energy cost increases. Almost all the major energy companies, all of which are making obscene profits, have increased their charges in recent months. Department officials recommended to the Government that there be energy credits in the budget, noting that, without them, the average family will pay an additional €321 per year. The Government took no notice of that. Vulnerable people were not the choice. The Government chose the developers, landlords and burger barons. The budget was framed on the basis of a 2% inflation rate but a recent survey shows the rate is at 3.2%. The former Minister based his budget on a rate of 2% before taking off to the World Bank. We now have a situation where people who were already under pressure are being hit with an inflation rate 50% higher than was budgeted for in a context where not a single energy credit was put in place. Food costs are also hammering all the people who may be subject to a blister pack charge. The same survey recently showed that food prices are up by 6%. Over the past few years, the average family paid an additional €3,000 per year in food costs. People who are vulnerable, including the disabled, the ill and the elderly, are now facing the prospect of an additional charge. I ask the Minister of State to rule this charge out for once and for all. I am asking that it not be deferred for two months, six months or whatever but ruled out now and for good. If that is not done, I would be very much afraid the Government will go down the same road as its predecessor in regard to blood test charges and we will end up with blister pack charges of €10, €20, €30, €40 or €50 per month. I ask the Minister of State to do the right and compassionate thing by ruling out these charges, full stop.

The best way to describe this situation is that we are now right at the bottom of the barrel in society. In the UK, the Labour Party Government brought in cuts in funeral cost supports and there was an absolute outcry. Elderly people in the UK are absolutely disgusted their Government did that. What the Government here is doing with blister pack charges is shocking. It is attacking the most vulnerable in society, namely, the elderly, the disabled and the sick. The Government knows that is whom it is attacking. It is why it is slipping in a kind of underhanded charge. I thank Sinn Féin for bringing forward this motion. In fairness, it calls a spade a spade. The blister packs we are talking about cost anything from €20 to €50 and even more for complex medications. The charges will affect people with dementia and their carers and people with Parkinson's disease. Taking their medication on time every time is very important for those patients. This really is an attack on the elderly. People are facing a range of little charges, including prescription charges and GP blood test charges. Elderly people are telling me they cannot get to see a chiropodist. A gentleman who came to my clinic in Clonakilty the other day said he is finding it very difficult to get a chiropodist appointment. All these hidden withdrawals of services and hidden charges are attacks on people. The most annoying thing is that we have a pharmacy union that is putting up with this nonsense from the Government. The Minister announced free HRT medication for women and then threw it to the pharmacies to clean up the dirty mess. She had to clean it up herself in the end but that situation should never have arisen. In this case, once again, the pharmacy union should be not in that situation. Pharmacists are being dragged here and there having to explain to the people to whom they have been so good and caring down through the years that this is a cost outside their control. Blister packs are not a luxury but the Government seems to think people only want them because they are a cool thing to have. In fact, they might be the difference as to whether a patient with dementia or a very serious illness can control their medication every day without missing it and then collapsing and having to go into hospital, which ends up being a terrible cost to the State and their family. I do not understand where this is coming from. By saying it is deferring the charges and kicking the can down the road to March or April, does that mean the Government will bring forward this proposed charge again? It has been resoundingly rejected by the public and the majority of the political system in this House. The Government needs to be very clear on what will happen. Every TD I have heard speaking has said that. The Government must make up its mind. Is it going ahead with this? It must tell the truth and stop codding people. This is an outrageous attack on elderly people. I know of a lady who cares for her 82-year-old mother who has Alzheimer's disease. A blister pack charge means she is facing extra costs of up to €40 a month that she cannot afford. Where will this money come from? There are extra costs across the board and nothing for people in the budget other than €10 for pensioners and people on disabilities. A lot of people have lost €1,400 in disability supports this year, which is an astonishing attack on them. There is time for the Government to wake up and act.

I have been here for the entire debate. I have heard from the Minister and from all sides of the House. I accept the Minister's explanation that there was a private service, that some pharmacists were giving out a free service and that others were charging to the Government with an incorrect charging rate. I accept all of that. However, what she has told the House is an indictment of the Government. It knew this was happening back in September, when it went into negotiations with the pharmacy union. The Government knew the issues with blister pack charges. We are all TDs and we are all dealing with constituents day in and day out. I defy anyone in this House to say it was not known how blister packs were being distributed. The Government decided to go back into negotiations, get this done and save itself a couple of bob. My God, it could find €125 million for Ukraine the other day, just like that and no problem whatsoever, but it cannot find the money to support people with medications. Blister packs are vital for anybody who is elderly. If we ask people in the ambulance service, they will say that when they go into somebody's house and that person is unconscious, they will check the blister packs to see what medication the person is taking. They can make the right decisions on that basis. Blister packs are essential for those who want to live independently in their home. They are essential for the carers who look after people. The Minister wants to take the blister packs off them. She also says she is going to have an investigation. By God, the Government is brilliant at investigations. It is brilliant at drawing them out forever and ever. The Taoiseach wrings his hands every now and again and he will stand in this House and say we must learn from our mistakes. The Minister is making another mistake by getting rid of this. It is an absolute disgrace. The excuse coming from the senior Minister was cold and harsh and did not give a damn. She does not give a tuppenny curse for what is going on with the people of this State. They do not give a damn about it. The proof of that is the empty Fianna Fáil and Fine Gael benches today.

Blister packs are essential for people who live with dementia. They are an essential part of the lives of people on medication who live at home. It is even essential for first aid responders who come to houses looking for people, as they know what they have taken. The main point in the debate is that the blister packs are for the same people who have blisters on their hands from working all their lives to support the Government. These are the people who are now retiring. They are the same people to whom the Government gave €10 extra in the budget for their pension. Now, it is taking €20 back. Let us flip to the other side. These are the same people throughout the country from whom the Government has taken €3 billion in carbon tax this year. Let us look at the amount of income tax this Government has taken in the past 12 months. What did it do but lower the USC? It never changed the tax base. It gave a minimum wage increase and taxed people more on the minimum wage increase. It said it was doing something good but it was taking it all back off people again. My God, has it come to this for the people in this country that the Government is giving them this and then taking it back? It is not taking it back singly; it is taking it back on the double and treble. These are the same people that come looking to the Government for help with their electricity bills. These are the same people who are saying they are doing without food themselves to provide food for their children. These are the same people that come to the Government to say they want to bring their elderly parents home with them. They want the Government to allow them to put up a modular unit on a small piece of ground at the back of their house so they can take care of them. These are the same people that are taking care of their own family because the Government did not. The Government cannot look after a simple blister pack.

I thank the Deputy.

I am sorry. I have another half a minute.

I am just keeping the Deputy on track.

Fair play to the Leas-Cheann Comhairle. It is a Limerick thing. These are the same people that are looking at a children's hospital that has gone €1.2 billion over budget, yet the Government cannot look after the vulnerable in regard to blister packs.

Blister packs are fundamentally important. They are not a luxury; they are vital. I spoke to a pharmacist yesterday who explained what happens to dementia patients and patients with a cognitive impairment who are not on a blister pack. Many often end up going back into hospital because they cannot manage their medication. Their home help cannot assist them with it. They present back to the pharmacy, the GP and go into hospital when the medication is not provided to them in a blister pack. Blister packs reduce errors and prevent readmission to hospital. The cost to the pharmacy is enormous. On average, it takes about one hour to prepare a blister pack. They have to be clinically checked first, over and back with the GP, and an assembly process then takes place, usually by a technician, and finally then it is verified by a pharmacist. It costs in the region of €70 per hour. This is a loss-making exercise for pharmacists. That is what is happening. They are doing it for the benefit of their patients because they have an obligation to them. The Minister is disregarding dementia patients. She has money for the Ukrainian situation and for the 32,000 NGOs in the country, but the most vulnerable people in the State, the people who have built this society - the roads and infrastructure in this country - are being disregarded. I take issue with some of the comments made by the Minister. She stated that if patients are getting their blister pack free at the moment, this will probably continue. That is not the reality. I have been speaking to pharmacists across Mayo who are telling me this cannot continue. They cannot continue this loss-making exercise, particularly with regard to the changes that are set to be introduced. I want that to go back to the Minister. Many patients with dementia will be put in significant jeopardy if these changes go ahead. The Minister stated that patients should report their pharmacists to the regulator. What planet are we on? What planet is she on? Pharmacists in Mayo and across the country are trying to do their best for patients. They are trying to use the available schemes to get their patients a blister pack. They are doing that for the safety of their patients. Pharmacists are still operating at a loss in this regard. The Minister is asking patients to report their pharmacists to the regulator. Goodwill should be recognised here. It should be recognised that pharmacists are doing their best for patients while operating at a loss. This is the respect the Government has for them in relation to this service. I question the Minister's statement that this has always been a private service and therefore that should always be the case. HRT was only available privately up to a few months ago and the State saw fit to pay for that and to bring it into the public scheme.

Deputy Lawless should conclude.

The blister pack is fundamentally important for the most vulnerable. I have spoken to pharmacists across Mayo who say they will have to cap the number of patients who get blister packs. It is crucially important that the Minister, the Minister of State, Deputy Murnane O'Connor, and the Government prioritise the most vulnerable in society.

Ní bheidh an Teachta Ó Nualláin anseo anocht. The Minister has had to leave. I missed the opening part of the debate but I hope to clarify some pieces of misinformation that in the media that have been bandied about in the Chamber this evening. The role of a pharmacist and their team, including pharmacy technicians, is a very professional one of safeguarding and ensuring that the right patient gets the right medicine at the right time. Over the years, the delivery of complex medicines has increased, as has the complexity of ensuring that the right patient gets the right medicine. Initially, pharmacists offered an opt-in for an optional blister packing service. Then it became slightly more formal with the recognition of phased dispensing. That could be requested by a GP. In 2017, the HSE PRCS decided to take a more in-depth look because the fees for the phased dispensing service were increasing. They were up around €68 million per annum at that stage. They dropped back to between €53 million and €54 million, on average, in 2022-23 and €58 million per annum in 2024. There are effectively three systems in place. The first is phasing without a blister pack, which is requested by a GP or a consultant. If a pharmacist recognises that a patient is having difficulty with his or her medicines, they can advise the family, the carer or the public health nurse to have word with the GP or to request a consultation. There may or may not be blister packing. Then there is a blister packing service that has been provided for nothing by many of my colleagues. There is a charge of around €12, on average, by others. Then we jump to €50 and the fearmongering around that. I do not know where that figure came from. I am searching and I have not found it but I will put it in context as to where that may have arisen. A review of the scheme has been announced and that review has come about from the HSE primary care reimbursement service. That review was not announced by the Department and it was not announced by the Minister. There has been a reference to "age friendly" and Age Friendly Ireland. I was a member of the committee in Meath for a number of years and two recommendations came from Age Friendly Ireland about three years ago. They were to the IPU and the then Minister, Stephen Donnelly. That was the dump scheme to dispose of unwanted medicines properly because a lot of older people tend to stockpile, or medicines accumulate. Sometimes there is a fear there where people are afraid to say to the receptionist in the GP clinic or to the GP that they do not need X, Y or Z medicine. They are afraid they might not get it again so it appears on the prescription and it is dispensed continuously. The other situation is where the blister packing was and is very highly regarded by Age Friendly Ireland and the older persons' councils, as it is primarily intended to be a safeguarding mechanism to make sure the patient gets the correct medicine at the correct time. However, the rules for phasing are currently set down by the HSE and relate to medicines that are high-risk medication or medication with a potential for misuse. The reality of the situation is that my colleagues going back 20 years have, in the main, been providing the service free of charge. Some 22 or 23 years ago, a customer - a family friend, very dear to me - was on 16 medicines. The only way I could actually cope to make sure he got the correct medicines in the correct blister at the time was to go in at 7.30 a.m. or 8.30 a.m. when there was no one around, to do it in complete peace and quiet. That, effectively, is what is being done by pharmacy teams up and down the country. To be putting the fear of God into the general public about a phased scheme that is going to be reviewed is actually, in itself, shameful scaremongering and does not do anything for older people and anybody who is vulnerable or who may even suffer with anxiety as part of a mental health condition. The system needs to be reviewed and the recommendations of Age Friendly Ireland and the carers' organisations have to be taken on board but the record also has to be set straight that the service, in the main, has been provided free of charge or for a modest enough fee that is well below the cost - the cost of the time and the materials involved. I have absolute faith that proper consultation will take place, given that part of the new pharmacy agreement for 2025 is a section on medicines optimisation. This is exactly where that sits - in the discussion on medicines optimisation and enhancing the role of the community pharmacist and the teams within to make sure that if anything, the service is improved. I am not throwing down the gauntlet to my colleagues; I can speak for the two pharmacies I worked in over the past couple of years. One charges nothing and will continue to do so. The other charges a fraction of the rumoured €50 and will continue to do so. That is not accounting for the time that is taken in consultation on phone calls to GPs, consultants, carers and public health nurses.

Fáiltím roimh an deis labhartha anseo anocht ar an motion seo. Since this issue arose, I have been contacted by numerous constituents of mine, many of whom are elderly, vulnerable and on limited incomes, who fear there will be a cost of €50. I bow to Deputy Toole's superior knowledge in this particular area. They are worried about the impact such charges will have on their monthly outgoings and their ability to provide for themselves with fixed incomes, such as old-age pensions. Without access to monitored dosage systems or blister packs, there is a real risk of medication errors, missed or excessive doses, loss of independence and avoidable deterioration in health. In fact, it would not take a lot of imagination to envisage somebody ending up in a nursing home, and the State having to fund the nursing home fair deal scheme for that individual, on foot of a mistake that had a catastrophic effect on such a person. I welcome the Minister for Health's decision to pause the charges until quarter 1 of 2026, as the IPU and its members now have time to engage over the next three months. I encourage the Minister, the HSE and the pharmacies to prioritise a targeted patient-centred solution that ensures those with the greatest clinical need continue to receive support, no vulnerable patient is left worse off, and safeguards are in place to ensure appropriate use of such medication. This is about supporting safe medication use, dignity and independent living for those who need it most, and there is scope for a balanced solution that protects vulnerable patients while remaining consistent with the objectives of the community pharmacy agreement. At the heart of any outcome should be safety, dignity and fairness for vulnerable patients.

I thank all the Deputies for their contributions today, particularly Deputy Toole for her knowledge. What she spoke of was very informative for me. I know some pharmacists in my own area of Carlow and I can only say their work and commitment to the people in the area is brilliant. First, I thank Deputies again. I know that the Minister, Deputy Carroll MacNeill, has outlined that the proposed changes to phased dispensing have been paused until the end of quarter 1 of 2026. This pause was agreed to allow the IPU and its members to have more time to engage with patients in a structured way over the next three months. Charges for blister packing are currently a matter for individual pharmacies providing that service as a private business. It has always been a private service and we have heard the range of prices, if any, that pharmacists charge their patients. The State has never agreed to fund this monitored dosage system or blister packing. The HSE has consistently taken steps to inform the community pharmacists of this important distinction. The IPU is also aware of this issue and in March 2025, it published an article making it clear to its members that blister packing is not the same as phased dispensing and is not reimbursed by the State. While monitored dosage systems may have a role for some patients, there is significant uncertainty around the robustness of the evidence supporting this. It was for this reason that, during the negotiations for the 2025 community pharmacy agreement, when monitored dosage systems were discussed it was agreed not to change their status. Inappropriate claims for monitored dosage systems as phased dispensing represents a significant opportunity cost for other patient safety and clinical services. Under the landmark community pharmacy agreement, a new strategic collaboration group will be established in early 2026. This will provide a structured forum for joint consideration of a strategic issue shaping the future of community pharmacy in Ireland. That is what Deputy Toole spoke about. This will be really important. A new strategic collaboration group will be established in early 2026 to provide a structured forum and I think that is the way forward. A key pillar of this is that a dedicated fund has been allocated to progress opportunities to improve or expand community pharmacy services in relation to medicines. The aim is to examine and test new value-added services in the community pharmacies to support patients with management and safe use of their medicines. This new, structured, collaborative process will help to design and deliver evidence-informed, high-impact medicines optimisation services to patients and support future opportunities for services investment. The strategic collaboration group will be tasked with exploring the best way to utilise this fund. The Government is keen that the public is not misled in regard to the way that changes are going to happen. Deputies have spoken about phased dispensing and how it is reported. The one thing we have learned from today is that we need to make sure that the proper information is out there and that we deliver it. We do not want to frighten people either. We are all very mindful of people who are very vulnerable and that will definitely be considered. I have no doubt about that. Concerned members of the public and their families and carers should realise that their local community pharmacist is the expert in their medication. They have the expertise and they are so approachable when someone wants information or advice. In line with the pharmacy contract, the regulatory framework and the service provided by pharmacists and pharmacies can assist patients through counselling, reminder charts, the Know Check Ask system with the HSE and tools like pictures or large-print labels and alarms so there are ways to help. All of these are aimed at improving understanding of the medication. There are lots of ways that pharmacists can help patients. It does not always come down to the blister packs. International evidence will show that blister packaging to maintain compliance is always supported so we need to look at the evidence as well. That is something we will be addressing, along with how we all work together. All of us here want to help the most vulnerable in our community - the people who need these supports - and that is what we are here to do. There is very good evidence relating to true community pharmacy intervention, including patient counselling when a new medicine is prescribed or for high-risk medicines or when prescriptions are changed or just discharged from hospital medicines, so that the pharmacist can really support people to understand and use their medicines appropriately. We understand the role of the pharmacist and the pharmacies and the work they do. It is important to highlight that tonight. Phased dispensing is not being withdrawn by the community pharmacy agreement but there will be improvement controls around phased dispensing in order to put patient safety first and to allow the State to look at the funding to be used to implement new patient-centric services. Phased dispensing and the supply of medicines in monitored dosage systems are separate and distinct with one being State supported and the latter being a private service. In her statement on 12 December, the Minister noted that community pharmacies are under pressure at the moment with an earlier than expected start of the flu season. At the moment, we see all these incidences of flu. They are also delivering vaccinations and preparing to establish the new common conditions service. I know the Minister has been working extremely hard on this. The Minister agrees that the IPU needed to engage further with its membership to clarify what the community pharmacists had to do on further work with their patients, especially the most vulnerable, to clarify these supports. It is all about getting information out there. It is important that when a pharmacy charges a fee for any professional service, it provides updated information to patients in line with the new pricing transparency guideline, which came into effect on 1 December. I want to reassure the House that the Department, the HSE and the IPU will continue to engage, including on two new collaborative structures to support any clarifications required, and, importantly, to ensure the success of the new pharmacy agreement. Older persons counselling, Age Friendly Ireland and carers were mentioned. It is important that everybody works together and no misinformation is given. I thank the Deputies. It is a really important issue and it is important that we have these few months and that the proper information is given.

The line Minister's statement on Friday night when she spoke about the three-month pause was tone deaf. It did not address any of the concerns of patients and their families and the issues that they raised about this ill-thought-out and cruel decision. The reason for the postponement is very clear. It is not because Sinn Féin warned the Government in October about the difficulties that this would cause patients both in terms of costs and health outcomes. In fact, the Government ignored us back then. The reason the Government has postponed this is because it has been taken aback by just how upset the public is over this move, particularly our older citizens. On the extra monthly charge, we have seen some pharmacies issuing letters, some of which our colleagues have read from, relating to someone getting an extra €30 while others got an extra €10 so it differed between pharmacies. The fact that people were getting these increases during one of the worst cost-of-living crises is cruel. It was being delivered to people in the depths of winter but that is only one part of the issue. For people who have dementia, brain injuries or mental health issues, or those who simply have to take a large amount of medication, blister packs ensure they do not overdose or miss their doses. The outcome of either of these things can be very serious for a person's health. It can also put extra strain on the health service. For carers and families, blister packs provide reassurance that their loved ones are on top of their medication while allowing them to maintain their sense of independence and manage their healthcare in their own home. If the Minister had addressed the concerns raised by Deputy Cullinane, we would not be in this mess. Why did she not take the advice given in October and prevent us from being here?

Most of us agree that blister packs are an essential and basic tool for improving medication management and safety. They can be the difference between taking medicines safely or risking missed doses, double dosing, or the all-too-familiar dangerous confusion for the recipient. We have all come across people who have been in that situation. I came across a case recently of a 94-year-old woman, where we did not know whether she had taken a double dose. The woman was distraught and upset and her family felt even worse. She ended up in hospital the next day. When one is caring for a loved one with dementia or other conditions that can cause cognitive or mobility issues, blister packs are not an optional extra but a necessity. Blister packs without subsidisation can cost an individual in the range of €20 to €40 a month. This is what people are telling us. The Minister asks where we are coming up with that number. These figures are coming to us from people. I do not know how much it is going to cost and clearly the Minister does not know, which is a problem for her and the Government. The Government's announcement that it was to withdraw blister pack supports from vulnerable people at the most expensive time of year for households and in the midst of a cost-of-living crisis reflects again how out of touch it is when it comes to real-life issues. The decision at the weekend is for a pause only. It goes back to the question of why this was not sorted out in negotiations with the IPU. That is the big question everyone is asking here tonight. The Department of Health is famous for announcing that it is going to go ahead with something and that it has the agreement of doctors. Doctors might not know about it but the Department announces it in the media. Clearly, this situation seems to be the same. This was something the Government just pushed. It did not think it was an issue and now ordinary people will be left with the problem.

We have seen some very bad policy decisions made time and time again by this Government but this latest stunt is the most thoughtless. Over the weekend, amid the confusion and chaos, many people got in touch with me to tell me how this was going to affect them or their loved one. Vulnerable users of the blister packs such as older people managing multiple medications, people living with early-stage dementia or Alzheimer’s disease or people with arthritis find blister packs really handy. This will directly affect their health and safety. One woman in north Kildare named Maureen told me that her daughter has cerebral palsy and lives independently with 24-hour support. Maureen used to organise her daughter's medication in the little pill boxes for many years but now the home care provider has mandated that staff can only use medication from blister packs. This leaves her daughter worried that she might have to stop her medication, give up independent living and move into a nursing home, which would be a lot more expensive with her already inadequate disability allowance. These charges are punishing those who want to live independently. It is our most vulnerable who will be affected by this. This will further push them into poverty by a Government that is really testing the limits of just how much they can squeeze out of them. Sinn Féin raised this concern back in October. We knew this was going to affect people. I listened to the contribution of the Aire. I urgently ask the Minister of State to reverse, not just pause, this decision to withdraw funding for this essential service and give our people peace of mind over Christmas. I was a community first responder. It is really handy, if you are attending somebody's house, that the first thing you can check is their blister pack. You will then have a fair idea of what medication they are on. It is a false economy to withdraw this.

The announcement by the Government to delay until later in 2026 its proposal to withdraw funding from January for medication blister packs issued by pharmacies clearly shows that the Government has bowed to the immense political and public backlash to this very unpopular proposal. However, kicking it down the road is not a solution to a problem of its own creation. It is outrageous that the Government wants to put a charge on such packs. It is also outrageous that even those holding medical cards will be liable to pay the charge. Who are the people who will be most affected by such a charge? They will be the people who will benefit most from having their medication dispensed from blister packs, such as elderly patients and those with memory-related difficulties like Alzheimer's or Parkinson's disease. It will also impact individuals who have complex medication regimes, for example, cancer patients, who realistically can have a dozen or more tablets to take for anything up to three times a day. Blister packs are especially useful for caregivers who can check whether the medication required by those they are caring for is taken in a timely manner. I have already had a number of calls to my constituency office from very distressed constituents, who are already struggling in this cost-of-living crisis. Many are on long-term medication and the thought of having to pay anything up to an extra €50 for their medication is causing them great anxiety. This stress and anxiety are not alleviated by the Government deferring the payment until later in 2026. It cannot have this hanging over the heads of some of the most vulnerable in our community. The Government should do the decent thing and reverse this proposal, which has proved itself as popular as the infamous proposal to tax children's shoes by a previous Fine Gael Government in 1982.

I will clear a number of things up for the Minister, who is not here, because she seems to think we do not understand how this works or what issues are at play here. We have never said that every patient has had blister packs paid for. That was never the case. We also understand, and I acknowledged this at the time the community pharmacy agreement was being reached, that phased dispensing was being used by some pharmacists to offset the cost of blister packs. Whatever about the rights and wrongs of that, which is what I said to the Minister in my opening remarks, what is undeniable is vulnerable patients are now being told they will have to pay. Whatever about the indirect or unorthodox way it was paid for in the past, that does not really matter to those patients right now. That is where the Government and the Minister are tone deaf. I have no problem with transparency when it comes to the Minister, the Government or pharmacists. I have no problem with what the Minister called "targeted probity processes" being put in place to examine what pharmacists were or were not doing. That is a matter for the Government, the regulator and pharmacists, but what was missing entirely from the Minister's opening speech was any empathy for people who are now left high and dry. That was what was missing - that human empathy where very vulnerable patients are now being told they are going to have to pay. What I am saying, and I do not understand why this would be in any way a mystery to the Government or seen in any way as radical, is the State should pay for those vulnerable patients. We all signed up to the spirit and logic of Sláintecare, where we want a transition to a single-tier health service that is free at the point of delivery. I hope that is where we are going. We have had a couple of examples over the past number of weeks and months, where I have had to seriously ask myself whether this Government is committed to that. It is not unreasonable to ask a Government, in circumstances where vulnerable patients are now being left high and dry, to do its job. As was said, the Government knew when it negotiated this agreement and, as it saw it, tightened up on the rules in relation to phased dispensing, that this was going to happen. I knew it was going to happen. I warned the Government, it did not listen and now we have very upset, vulnerable patients who have been left high and dry. It is simply not good enough. It is not good enough, by the way, that the Government will say it is not opposing the motion but will then not do anything about it. It has to go and negotiate with pharmacists and put in place a long-term solution for those people it has abandoned.