Was the fee cut reversal made with one eye on the General Election, wonders Fintan Moore

At the tail end of 2019, we collectively dodged a bullet in the shape of a proposed batch of FEMPI cuts. If they had been implemented, the loss in fees to the average pharmacy would have been over €25,000, so it’s certain that these cuts would have put the kibosh on some struggling pharmacies. It took a concerted lobbying effort by the IPU and individual pharmacists to get the message through to government TDs that these proposals were unfair and unreasonable, especially at a time when FEMPI was being reversed for other groups. It would be nice to think that the various supportive TDs were all converted to our point of view, but it is equally likely that they just wanted to avoid adding one more pissed-off lobby group to an ever-growing list.

The timing of the issue probably worked in our favour because Fine Gael had just lost four by-elections, which I reckon had the party rattled. They were obviously going to be calculating that if that kind of under-performance continues, then the impending General Election could be a massacre. At the time, the date of the Election had not been announced, but they were aware that it was possible at any time. So it suited them not too badly to kick the pharmacy can down the road pending contract negotiations, etc.

The sad reality also is that many of the families relying on Deliveroo or Dominos for their dinner are in deprived areas

Now that we do have an election in progress, with the real possibility that Fianna Fáil may be forgiven enough by the electorate to end up in power, then we will almost certainly have a new Minister for Health. Whatever happens, Simon Harris will want to shuffle to a safer portfolio anyway. Whether it makes much difference as to who is in power is a moot point, in my view. I think the deferral of the recent proposed cuts was a temporary stay of execution, rather than a full pardon. If we end up with a stable new Government with a working majority and no prospect of an election for a few years, then we could be faced with similar cuts again, and this time the politicians we lobby might be doing the sympathetic shrug of the shoulders as they trot out the well-rehearsed ‘love to help you, but… ’ line. Time will tell.

Appetite for Success

It can interesting to hear what people regard as a sign that the country is doing well economically. A recent caller to the Newstalk breakfast show, who was by his own admission a Fine Gael member, wanted to challenge the narrative that large numbers of people were in financial difficulty. He claimed, probably using accurate data, that if you look at various metrics and indices to compare Ireland with other countries, then we are performing well. He stated that we have higher levels of home ownership and better health indices than most other countries, but the statistic that stood out for me was that we have the highest level of spending on food in restaurants and takeaways. He was presenting this as evidence that we are generally earning enough money to have high levels of discretionary income enabling us to eat out or ‘order in’ more. However, this level of ‘success’ is actually evidence of a much larger failure.

The clear narrative behind the idea that eating out is a positive sign of financial wellbeing makes sense up to a point — it’s nice that people can go out for a meal every so often. What should be setting alarm bells ringing is the level of takeaway food that people are eating, and the implications that has for health generally and obesity in particular. Rather than being a sign of progress, this is a sign that a whole swathe of the population has lost the ability to select, prepare and cook basic meals for themselves. The reasons for this vary but the end result is clear to see when you look at the statistics for obesity and diabetes.

The sad reality also is that many of the families relying on Deliveroo or Dominos for their dinner are in deprived areas. They are spending money on junk food because they don’t know how to do better. There is a myth propagated in the media that ‘healthy food is too expensive’, which never gets challenged, despite being so blatantly false. I’m not much of a cook but with minimal effort, I can feed my family for two days with a decent stew from fresh ingredients made for about €20. On the occasional nights we get a ‘chippy’, it costs about €30 for one meal. Healthy eating is not decided by money, but there needs to be a significant investment in teaching people how to cook in schools and in communities, or else the negative health consequences will have negative economic ones also.

Sign of the Future

As our pharmacy days have got more time-pressured, I find it is harder to keep the levels of patient service that I used to. In general, I will do whatever I can to fill any prescription that comes in to me, but recently, I had to think again. A lady who was new to my pharmacy handed in a hospital prescription from a consultant with two items. As I took the prescription, I knew I had neither, so I told her I would check availability. She said that she normally goes to the ‘pharmacy beside the doctor’ and maybe he would have them, but I asked her to give me a moment to check, and I went to the dispensary to look at the wholesaler website.

The first item was one of the various unavailable steroid creams, so I would have had to ring the consultant for an alternative. The second item had no GMS code, but the patient had a medical card, so I know from past dealings with this consultant that I would have been told ‘tell her she can get it through the Hardship Scheme’. As I was thinking about my options, the penny dropped with me that no matter what I said to this patient, she would doubtless think that her usual pharmacist would do it better, so I gave her back the prescription and told her to bring it to him. Some fish you just have to throw back.