When I worked in a pharmacy during school holidays many years ago, a different policy of dispensing tablets operated according to whether the patients were private or public. For those who were paying for the prescription themselves, we were instructed to pop out any tablets that came in a blister pack and dispense them in one of those little brown plastic medicine tubs, labelled with the name, date and directions for use. If, however, the patient had a medical card, we just stuck the label on the sheet of pills and handed them over.
Alas, no records exist of the number of our private patients who died because they forgot to take a pill, or took too many by mistake. I presume the reasoning for the practice was that we were sparing patients, especially older folk with poor eyesight and arthritic hands and only if they could afford it, the fiddly business of popping a tablet out of a blister pack, without a thought to the potential carnage that might result.
It’s one of the reasons now being cited by critics of “blistergate”, the political storm that has blown up out of nowhere over the dispensing practices of the country’s pharmacies. Our older population will be decimated, it seems, by taking the wrong pills at the wrong time or accidentally overdosing, because they’ll no longer be receiving their prescriptions in customised, Fisher-Price grade blister packs labelled with the dates and times that doses are due.
It seems that the practice of pharmacists dispensing medication in single-use packages goes back to 1996. A phased dispensing system was introduced to ensure that certain strong drugs could not be issued in dangerous quantities. Instead of getting a six-month supply at a time, patients got their drugs on a monthly basis, which obviously involved increased dispensing costs. And it was under this model that the pharmacists were also reimbursed for issuing the blister packs. But from spring 2026, only a limited number of drugs will be covered by the scheme, meaning that anyone wanting medication in blister packs for other prescriptions will face charges of up to €12.50 per week for the service.
Much like the blister packs themselves, though, there’s a lot to unpack here. As the taoiseach pointed out last week when this issue first arose, the government had never undertaken to fund this service and the state can’t be expected to pay for absolutely everything.
If pharmacists are already charging a dispensing fee, isn’t that intended to cover the safe, professional dispensing of medication in a form that is appropriate for the patient’s needs? We complain about a nanny state that takes far too many basic decisions out of our hands and yet we’re up in arms and warning of widespread fatalities if the state doesn’t help us count our daily medication doses, at an estimated cost of €40 million a year to continue the scheme.
Having worked in a chemist’s shop, I am always baffled at why you’re routinely told, when you go into an empty dispensary with a straightforward antibiotics prescription, that you can expect to wait at least 20 minutes. Apart from the age-old challenge of reading doctors’ handwriting, what exactly are they doing back there, when all they’ve got to do is take a bottle off a shelf, print a label and pop it in a bag? If some more vulnerable patients need extra care around the dispensing of their medication, that ought to come within the responsibilities of the professionals being well rewarded to dispense it.
There’s a wider question here, though, regarding what we see as our responsibilities to elderly or vulnerable family members. I accept that the blister pack system gives patients a measure of agency over their medication use, as they don’t need to seek help in determining what to take and when to take it. But is it too much to ask that a relative or a carer of a patient with dementia or Alzheimer’s, for example, might take a few minutes once a month to divide up their medication into those clearly labelled and reusable containers that are readily available in pharmacists or discount stores? Is there any element of the care of our most vulnerable citizens that we don’t expect to outsource?
Jennifer Carroll MacNeill, the minister for health, is said to be resolute on the issue, and determined not to back down on this unforeseen consequence of the new deal between the state and community pharmacies, which delayed the implementation of the free HRT scheme while they thrashed it out.
“Sensible Simon” Harris — the tanaiste and newly self-appointed minister for finance — as he has indicated that he wishes to be known, might end up riding to the rescue. The mainly older folk affected, the cohort most likely to vote after all, could be helped by a ring-fenced fund to spare them the blister pack charges.
But if vulnerable patients were able to figure out their medication doses way back in the last century, without being treated like helpless pre-schoolers, the personal and family resources are surely still there to support their ageing children. And the taoiseach is right — the same parties that whinge about out-of-control state spending are the very ones demanding that the government stump up €40 million for a convenience rather than a general necessity.
The task involved is well within the competence of any able-bodied acquaintance. Would it ever occur to those of the next generation seeking advice from the likes of SpunOut, the €3 million-a-year NGO which produced that risible video advising young people how to care for themselves if they’re forced to move back home, that their mental health might benefit from occasionally thinking about someone else — say an older relative or a lonely neighbour — for a change?
An end to roadside memorials
They’re a tragically familiar sight on Irish roadsides and pavements, but memorials to crash victims are to be banned on some roadways under new recommendations from the Department of Transport.
On motorways, dual carriageways and even regional roads with a speed limit above 60km/h, memorials are to be outlawed for safety reasons. According to the memo, these tributes increase pedestrian activity in hazardous locations, cause “stopping, parking and vehicle manoeuvres”, as well as “maintenance activity such as grass cutting and decoration placement”.
While existing memorials will not be “automatically removed”, it goes on, they will be “addressed” if they present “a clear hazard to road users or interfere with maintenance activities”. The installations, said the document, “create a distraction for other road users”. So, of course, do roadside advertising billboards, all of which are expressly designed to snag the passing motorists’ attention, but there’s no talk of banning them.
At a time of rising road deaths, and particularly after a recent spate of tragedies involving multiple fatalities, this seems like a counterintuitive move. There is no road hazard sign, whether warning of sharp bends, loose or slippery surfaces, or even “accident black spot” notifications, that has quite the same impact as a sad little monument, bedecked with wilting blooms, to advise you that someone died on the very road you are travelling. They are, alas, a form of memento mori that we cannot afford to cancel or ignore.