All quiet on the medicine front.

OK so it’s christmas eve, we all come out of the trenches and we are having a few bars of “silent night” with the good folk of the H.S.E. We swap little presents, they give us some methadone clients and we offer them our some balls on a plate. It’s real christmassy, we have icy conditions, some asses, a kcamal and three four wise men, Ritchie, John, Michael & Edward. We light a fire to keep warm but the H.S.E. stay back as they have their asses burnt too many times before.

But meanwhile back in the real world the truce still seems to hold. As for me I’m back in for the time being. The experience of a week without methadone did not leave me with any signs of withdrawal. I’ve agreed to take back my clients for now as the H.S.E. are a positive danger to methadone clients. However I will be re-assessing in January and will look at a more phased withdrawal then.

I find it hard to believe that the H.S.E. went into this without an exit strategy so I wonder what is their bigger picture. If perchance they did not have an exit strategy then boy are the health services in deep doo-doo. I then start my depressive thinking about the H.S.E. Does being a wonderful paediatrician make you a good (even adequate) administrator? You come from a situation where you are god and your word is gospel. You say “Jump!” and your minions chorus “How high?” Further down the line some administrator makes things happen. Now you are in a field where partnership (remember that?) is the name of the game. And you throw a hissy fit when everybody doesn’t do what you say. So what do you do? Of course you hire some good administrators. And boy have you hired some administrators. Except many of them aren’t good and many aren’t administrators. They are mostly other consultants who think like you and who end up with brown nose/tongue syndrome. Some are browner than others.

As for me, I’m back in my trench. I’m digging in deeper because for (and not if) the next round of bombshells start dropping.

Wrong era but I thought that I would stick this in anyway.

It’s cosy here in the trenches

I called my first post “Once more into the breach”. Things have moved on and now it’s cosy in the trenches. I got the idea from an email that was floating around. Ambrose McLoughlin was being criticised for taking the high moral ground over the withdrawal from the methadone scheme. The gist was that the high moral ground can be a very lonely place especially when the people you represent are taking cover in the trenches. He said that most pharmacists don’t support the “Methadone 140”. This brought a rush of comments from non-methadone dispensing pharmacists saying that they did support us. It occurred to me that this dispute has engendered a comradeship amongst pharmacists that hasn’t been seen in some time. So as I said “It’s cosy here in the trenches”.

I got to thinking what kind of pharmacy do the HSE want in this brave new world. When I started my own pharmacy I made a decision that I would not stock the latest “miracle” weight loss products. You can add to this the latest “wonder” hair restorers, cellulite removers etc. Most of them come straight from the back end of a bull and rely on junk science to justify themselves. I can’t look people straight in the face and sell them grossly overpriced crap that is only designed to relieve them of their money. The kind of product that gives “Quack Cures” a bad name. But I thought if I had turned my pharmacy into “Dr. Feelgoods Emporium, (we’ll sell you something that will cure whatever ails you)” then maybe I can survive the latest round of HSE cutbacks. The pharmacies with the big non-medicine front of shop business are better equipped to withstand these cuts. Not that I begrudge those with big F.O.S. business. It works in many locations, but not mine. Is this the kind of pharmacy that the HSE wants? They have already said that they want fewer pharmacies. So it looks like they want a Boots/Unicare type operation where pharmacy is just another small department at the back of the store. Patient counselling, pharmaceutical care, drug reviews? “No they cost money!” What about Mrs Murphy who is on that hard to get ULM ? “Let her suffer!” Rural Ireland better look out. Along with the local Post Office, Bank and Garda Station, your pharmacy is next.
So here we have one of the few parts of the health service that is working and Harney and Drumm want to wreck it. Maybe this is to be part of the new uniform health service. None of it works.

That’s what they want, cheap as chips, lick, stick, count and pour. I don’t think that they have any concept of what pharmacists do, what value they bring to healthcare. It’s the old story of knowing the price of everything but the value of nothing. And who benefits from all this, foreign owned chains. And what will they do with the money that they make out of Irish pharmacy? Pay it out of the country in dividends to their shareholders.

And who loses? In the short term the small independent pharmacies. Those pharmacies with a large prescription based business. In the longer term the public. Lower service levels and closure of rural pharmacies. Big picture Ireland loses as these foreign chains take profits out of Irish healthcare and send them abroad.

So where from here? As for me I’m happy in the trenches. The HSE’s bombardment explodes over my head but doesn’t touch me. It looks like that December 1st will be our day to climb out of the trenches and storm the HSE. But instead of the Battle of the Somme it will be more like Stalingrad. We will be battling street by street, house by house, room by room. It will be bloody and gruelling but defeat is not an option.

Nobody cares about me!

I beginning to feel left out. I haven’t received my competition letter yet. I notified the HSE of my withdrawal from the methadone scheme several weeks ago. Nobody has written to me saying that my action is in breach of the Competition Act. If I was a more sensitive soul I would say that they don’t care about me. Maybe they even forgot that I exist. Or maybe they think that I am insignificant in the greater scheme of things. That might well be the HSE’s problem. “We’re bigger than anybody else and we don’t care”. So much for a partnership approach to healthcare. Yes you can talk to your fellow consultants and that is not supposed to be in breach of the Competition Act. One law for your mates and one for everybody else.

And what’s the story with our beloved Min for Health? Did her local pharmacist not give her lollipops when she was a little girl? Who ever was her local pharmacist when she was small has a lot to answer. If it will make you feel better you can come to my pharmacy and I will give you all the lollipops that you want. And unlike the rest of our two tier health service I will treat you equally like every body who comes in my door. Just like I used to when you were Min for Industry and you used to come into the pharmacy that I managed then.

So Mary with a flourish of your pen you can exempt the health services from sections of the Competition Act. Just like nearly every other EU country. Or maybe you prefer the dictatorship model of health governance. Or maybe you prefer the Boston model, slash and burn your way through pharmacies. Old and infirm will have long distance to travel for a pharmacy, especially in rural areas. Only about half the number of pharmacies, less competition there! How does that hold with your aim of better service for the public. Oh wait you lord it over a health service that lets fine people like Suzie Long die so that you can keep the two tier system going. Maybe if we started a two tier system of pharmacy, one level of service for Medical card patients and a better service for Private patients you would like us better.

“Medical card patients can wait outside in the rain, Private, come in and have a seat. Would you like a back rub while we do your prescription first? Everybody is equal, but some are more equal than others!”

As for me I couldn’t look people straight in the face doing something like that. But then I probably would never vote PD either.

Pharmacy and the media

I know that it shouldn’t but I never seem to be amazed at some of the crap that comes out in the media. They seem willing to rehash a PR statement and then call it journalism. Do nobody ever do any research any more. They will accept statements from ministers as if they were gospel. A little bit of basic background and they could tear these people apart.

Pat Kenny was interviewing Mary Harney yesterday. Two things she said had me wanting to throw something at the radio. Firstly she said that the proposed cuts would affect the smaller pharmacies least. What planet is she living on? Do she really believe that crap or is she happy to spout lies for PR purposes? The bigger pharmacies have more room to manoeuvre with staff and overheads. Most will have more reserves to back them up. The smaller guys like myself have less staff and no reserves. We’re too busy paying back our loans and mortgages. And Mary in case you don’t realise we are the ones who opened all the pharmacies that you wanted. Now you want to screw us! Why don’t you come out and say what you have been wanting all along, that you want half the pharmacies in the country to close. Guess which half will be closing, not the chains, both foreign and native. No it will be the small guys (& gals) who are most vulnerable and will soon be rendered un-viable.

Don’t even get me started on the €18 fee on the GMS. Pat didn’t even challenge this. In my 28 years in pharmacy I’ve NEVER seen an Emergency/Urgent fee paid on the GMS.

In the Irish Times this morning there was a piece on the the HSE’s plans for methadone next week. They were talking about having security guards in the clinics and having the Guards escort the methadone deliveries. They never sought this for community pharmacy when we dispense methadone. One law for them and another for us.

And what about their service for the “emergency dispensing of methadone”. Monday to Friday 7pm to 9.30pm and Saturday 1pm to 3pm. Fourteen and a half hours per week. 1000 patients with an average of 2.2 visits per week. That’s 2200 visits in 14.5 hours. Or one visit every 24 seconds. Do they really think thta this will work.

I think that’s enough spleen vented for today, stand by for the next thrilling instalment.

Once more into the breach

After 28 years working in the pharmacy field, 23 of them as a pharmacist I get a feeling of Deja Vue. There has always been a dispute about something with the Health Boards then, the H.S.E. now. It varied in scale but it was always settled at the last minute. It’s as if the H.S.E. don’t know how to enter reasoned discussions about anything. It always has to be done their way.

And it is not as if they are the experts and everything works well for them. They have screwed things up so many times and never seem to have to have the ability to admit that maybe they might be wrong.

Now they seem intent on destroying independent pharmacy. Make life easier for Unicare & Boots and the other big chains. Maybe they want to see a level of pharmacies similar to the U.K. where there is only one third the number of pharmacies per capita. They are saying to the public “We don’t care what type of level of pharmacy service you get as long as it is cheap for us.”

Mary Harney wanted pharmacy de-regulated and it was. She wanted more pharmacies opened. Those of us who re-mortgaged and borrowed to open these pharmacies are now the very ones being kicked in the teeth. I think that she was listening to he own propaganda too much. Does she have any conscience? She’s a politician so I doubt it.

And the public, they don’t seem to care much. It is a case of “You don’t know what you’ve got until it’s gone”. As I type on the radio is Van Morrisson with “Real, real, gone”. A bit apt really.

The next few days and weeks will tell if we should worry or panic!