Tá fearg mhór ann go mbeidh ar dhaoine leochaileacha íoc as pacáistí táibléad blister mar gheall ar chinneadh an Rialtais. Beidh tionchar ar leith aige seo ar dhaoine atá ag dul siar i mblianta agus ar dhaoine atá ag maireachtáil le néaltrú agus galar Alzheimer a bhraitheann ar na pacáistí seo. Tá a fhios againn nach bhfuil sé seo ceart. Caithfidh an Rialtas gníomhú chun a chinntiú go leanfaidh na daoine seo a bheith ábalta a gcuid pacáistí táibléad blister a fháil saor in aisce.

The Taoiseach's Government's decision to restrict medications covered under the phased dispensing scheme operated by pharmacies is a disaster. The Government's decision means some of the most vulnerable people will no longer receive tablet blister packs free of charge. We are talking of tens of thousands of older people living with conditions such as dementia and Alzheimer's. They rely on tablet blister packs to help manage their medication. We are also talking about people with disabilities who are under real pressure with the cost of living. The packs help them make sure they take the right dosage at the right time of day. The Government's decision means the cost of dispensing the blister packs - paid for by the State for decades - will now be passed on to these vulnerable customers. They will be hit by fee charges of up to €50 a month in some cases for these packs.

This is a bad decision for the Government at any time but it made this cruel choice during a cost-of-living crisis when every euro is precious to people. It is like it cannot stop itself from making life harder for people. It hiked up student fees, the local property tax and the cost of petrol and diesel. It stands back and allows big energy companies to jack up electricity and gas bills and now it hits the most vulnerable elderly people. It is putting huge stress on people during the Christmas period as they know they are going to have to face these charges come 1 January.

My phone, and I am sure those of others as well, has been hopping with people very worried and very angry over this. I spoke to one elderly man this morning. He is in his late 70s and told me his lovely wife suffers from dementia. He said without the blister pack he would find it very hard to manage her medication but he does not know where they are going to find the extra money to pay for them. He says they are literally down to the last euro every couple of weeks as it is.

The explanation the Taoiseach and his Government have offered is the State never agreed to pay for the dispensing of these blister packs in the first place. Does he really think that matters to people who rely on them? The fact is the government has been paying for these for decades. If there was a mistake in how the packs were being paid for and a correction had to be made, it should have been made to ensure those folks could continue receiving their tablet blister packs as they have been but, no, the Government decided to punish vulnerable people, to ratchet up their costs instead of making sure they are looked after. The truth is the Government had a chance to sort this out. Back in October when it was finalising the new community pharmacy agreement we in Sinn Féin warned it was a big mistake to exclude the blister packs, but the Government chose to ignore that warning, chose to push on and now elderly people and others are paying the price. It is not right, it is not fair and it needs to be stopped.

I have simple questions. On behalf of the man I was talking to, and I am sure many others right across this State, I ask the Taoiseach whether he thinks it is right that people with dementia, Alzheimer's and other conditions who received their blister packs free of charge up until now will have to pay for them on 1 January. Will the Government reverse this terrible decision and ensure vulnerable people can continue getting their blister packs free of charge?

First of all, tá an-chuid déanta i gcoitinne ag an Rialtas chun costais a bhaineann le cúrsaí leighis a ísliú. Tá sé sin déanta againn, go háirithe ó thaobh an drugs payment scheme. Tá an tairseach i bhfad níos fearr anois ná mar a bhí sé cúpla bliain ó shin. More generally on the cost of medicine, and particularly charges and so on, this Government has, over the last number of years, significantly reduced the cost of accessing medicine. The DPS threshold in particular has come significantly down, exceeding even commitments made in various manifestoes and so forth. That needs to be acknowledged, as does the abolition of charges in hospitals and so on, so without question right across the board we have reduced costs in the healthcare area. It is without question and the Deputy just cannot get away with saying we are wilfully increasing costs all over the place as he just did. We are not. If you look over the last number of years, costs have come down in terms of State charges in respect of hospitals - acute hospitals, emergency departments - and in respect of medicine and the cost of medicine, particularly the DPS threshold and other bespoke interventions also.

More generally on cost-of-living measures, in the budget we took measures to support families who are on low incomes in particular. The ESRI's evaluation of the budget bears that out in that the two lowest deciles gained the most in respect of the budgetary allocation. Also, if you look at real wages and incomes, they are growing at approximately 3% per annum this year and we have targeted measures effectively on the cost-of-living side to support those most in need.

On phased dispensing, we will certainly look at any situation where there is potential hardship on any patient or any person in receipt of medicine, but we have to be clear-eyed as well. The Deputy mentioned pharmacies and so on. There is an issue between the HSE and pharmacies in respect of the whole area of phased dispensing, which was introduced as far back as 1996 for patient safety reasons. The supply of medication in instalments can support patients prescribed certain high-risk medications who would be at risk of medication misadventure if these medications were supplied monthly. Where a phased dispensing claim is submitted the current requirement is an item must be dispensed in the pharmacy across multiple supply occasions. Community pharmacies receive additional payments for phased dispensing. Monitored dosing systems, sometimes referred to as blister packs or compliance aids, are systems that enable the individual medicine doses to be organised according to the prescribed dose schedule. The HSE's contention is that monitored dosing systems and phased dispensing are two separate processes and that phased dispensing requires the patient to present to the pharmacy on multiple occasions in the month each week, as it would be unsafe for the patient to have the totality of their medication in one supply occasion. Monitored dosing systems are ordinarily provided in one visit and packaged to indicate when a medication should be taken. The State had never agreed to monitored dosing systems and that was the context-----

That is not the question.

I am sorry, this is the issue. Invariably Sinn Féin will come in another day and question Government about how the costs got out of control, value for money and so on. There has to be an engagement between the pharmacy sector and the HSE on these matters. Unfortunately in the Oireachtas from time to time, the Deputies opposite just blow all that out of the water and do not even allow interrogation of the issues. Government will interrogate this again with the HSE and others-----

Talking down the clock.

-----but there are issues here. I mean, there are agreements between-----

Three seconds.

-----the Irish Pharmacy Union-----

Two, one. Suigh síos.

-----and the Department-----

Thank you, Taoiseach. Deputy Doherty to respond.

The National Centre for Pharmacoeconomics carried out an evidence assessment.

Thank you, Taoiseach.

I am just giving the background as the question was asked. It indicated the evidence was very equivocal in terms of supporting the programme. We will go back and discuss this with the HSE.

Deputy Doherty to respond.

During discussions with the pharmacy union-----

Thank you, Taoiseach. The time is up. Deputy Doherty to respond.

-----it was agreed that improved controls would be introduced.

I asked the Taoiseach the question and he did not answer it. I asked him the question, with respect, of whether he believes people with dementia and Alzheimer's who were receiving the blister packs free of charge should be charged for them from 1 January. No matter what way the Taoiseach presents it, these packs were being funded. For right or wrong, they were being funded. Of course there are issues. The issue is that the man who was talking to me this morning and his wife who is suffering with dementia will have to pay in January for the blister pack they were getting free of charge. Do not try to pull this one - that the Government is actually reducing the cost of medication - when people out there have been getting letters from their pharmacies saying from 1 January the HSE will no longer be providing blister packs and there will be an additional charge of €20 per month for the packs.

Please do not tell people that black is white and white is black. People know what is happening out there. The question is whether the Government is going to reverse this. These are elderly people and vulnerable people who rely on blister packs to ensure they take their medication on time. Many people cannot afford to pay for them.

The time is up. The Deputy’s point is made. I call the Taoiseach to respond.

It was a Government decision that restricted the way in which pharmacies were claiming, and it has resulted in this. Will the Taoiseach please answer the question? Will he reverse the decision? Should people with dementia and Alzheimer's, who were getting it free, have to pay for it in January?

My view on monitored dosing systems is that I am not sure there should be a fee attached to them at all, but I am not so sure either-----

What does that mean?

Hold on. I am not sure either that the State should be ponying up for everything here. There is no analysis by Deputy Doherty of both sides of this engagement. That is my point. There is too much of that in the House. The easy thing to go for is that the Government must pay for everything, no matter how it is presented or manifested. Deputy Doherty, even though he is finance spokesman, just casts aside any sense of controls whatsoever – “just let it rip” is his approach.

We want to look after people with Alzheimer's and dementia, and we have done in this Government. We have done far more in the last number of years for dementia patients than was done in the previous decade or more. That is a fact.

You put up the cost.

The Minister of State, Deputy Butler, was responsible for a lot of the very proactive work in respect of dementia.

The Taoiseach has just ten seconds left. What is he going to do?

There needs to be an engagement between the Irish Pharmacy Union and the HSE on this, but it cannot be the case that every new system or modification of a system or approach is just agreed. That cannot be it either.

The Government has just agreed a deal but it left out blister packs.