The government us setting up a specialised agency to buy various medicines through a number of systems, Health Minister Joseph Cassar said in parliament. He was answering opposition supplementary questions on medicines falling out of stock, trying to explain the pitfalls of the system.
Labour MP Leo Brincat’s original question asked the minister to investigate why Temazepam (10mg) which was again unavailable at public pharmacies. Dr Cassar said that the medicine was ordered from the present contractor – a UK wholesale dealer – who could not provide it because of production problems. Various attempts were made to procure this medicine, which should have arrived two days ago, from other sources but with no result. Maltese suppliers did not tender for this particular medicine.
Labour MP Noel Farrugia said the problems of medicines running out seemed to be escalating, and asked how could it be that there was no immediate solution.
Dr Cassar said not all medicinal purchases could be treated the same way. The specific medicine that Mr Brincat had asked about could not be bought because the mother company had encountered manufacturing problems. To date, when an awarded contract was appealed, the Department of Health went out to buy medicines directly while the appeals process was under way, but only within financial terms that did not allow for buying in bulk.
Mr Farrugia asked why the contractor who failed to deliver was not fined. The department should buy from other sources and pass the costs on to the contractor.
Dr Cassar said that sometimes not even alternatives could be found for the out-of-stock medicine. The new agency was only being set up with the help of the Finance Ministry, and would operate on new systems in an effort to procure medicines with urgency and transparency.
It was not unheard-of for the department to buy medicines for just one person, with next-day delivery. But it was obvious that not even fining the contractor would procure the medicine. Some specialised medicines also needed the approval of a foreign ministry before export.
The best might not be good enough, he said, but the truth was that there were limits to what could be done, both in Malta and overseas.
Mr Farrugia asked how long present government stocks would last. He said the country could not keep getting caught with long lists of outof-stock medicines.
Dr Cassar said this depended on the medicine and the levels of consumption thereof. Tenders were normally awarded for one year. When a tender could not be immediately adjudicated, direct buying depended on the cost of the medicine. Even if supplies were ordered for a year, but something happened to increase consumption, re-ordering would take time.
It was important not to generalise, and unfair to discredit department employees who were working flat out to avoid shortages of medicines. The process could be very complicated.
Anthony Zammit (PL) asked how the government could arrive at projected needs if doctors were being asked not to determine usage on Schedule V cards. Dr Cassar replied that the cards were just a permit, not a prescription. A doctor could write how many times a day a medicine should be taken, but not quantities in milligrams because this could lead to abuses of patients continuing to receive supplies of medicines without ever being seen by a doctor.
Last week, Mr Farrugia asked for a list of medicines out of stock and reasons why patients cannot avail themselves from such medicines which they are entitled to.
Dr Cassar put on the Table of the House a list of more than 100 medicines, including ones taken by heart and high blood pressure patients. He said that in 46 per cent of the cases medicines were out of stock on the international market or the tender had taken more time to be issued.
In 46 per cent of the cases, the importer delivered late and in another six per cent there was no more demand for them.
CHAMBER OF COMMERCE VIEWPOINT
The Chamber of Commerce in a reaction last week to comments by the Health Minister on reasons for shortages of medicines said the Government Health Procurement Services (GHPS) still lacked a dynamic forecasting system in its purchasing procedures. This despite repeated calls for the adoption of such forecasting by the Chamber.
"To make matters worse, GHPS insist on imposing delivery periods which fall short of international manufacturing lead times, and refuses to communicate any form of order planning or rolling forecast to its suppliers," the Chamber said.
"All medicinal supplies to the Health Department are procured via tender contracts with stringent conditions which among others include that government will purchase supplies from the open market in case of late deliveries, and this at the expense of the defaulter’s account.
"The fact that this condition has not been invoked in most of the quoted 48% of cases of shotages allegedly due to late deliveries by contracted parties ( as otherwise availability would have been resolved ), suggests that the actual cause may have well been some other, all be it late ordering."
Shortages due to problems in adjudication
The Chamber said that in the second half of 2009 and a good part of 2010, an endless list of tenders had been cancelled by the department of contracts, practically all because of minor technicalities arising from conflicting, contradictory and unworkable conditions on the tender document. The Chamber's Health Care Business Section has on various occasions alerted the the government procurement arm, namely GHPS, of the consequences these conditions could lead to, but GHPS would not take any advice.
"The majority of tenders stuck at adjudication phase were simply self inflicted problems resulting from a unilateral attitude of GHPS and it’s lack of consultation with stakeholders."