29th May, 2001
Dr. Henry: I welcome the Minister to the House. As he knows, there has been a considerable amount of excitement in my profession over the extension of eligibility for medical cards to those aged over 70. There is a good deal of merit in that because a considerable number of people are on small private pensions not much over the limits on which other old age pensioners get medical cards, and it will be a major gain to them. It was unfortunate, however, that the Minister did not discuss the matter with the medical profession before he went ahead with it but perhaps the man who runs the health service - he who lives in the Department of Finance - would not let him do that. It would have been a help if they had felt they were forewarned before they found it included in the Finance Bill.
The over 70s are major users of the medical service and, from what the Minister said, he does not appear to have made an agreement with family doctors on how this service will be supplied. It is a difficult issue because patients are much more demanding now and they expect a better service from their family doctor. The establishment and operation of a practice costs a great deal more and the remuneration for taking care of medical card patients is not that high. I hope the Minister can come to an amicable solution with them in the near future because there is a considerable number of people over 70 who are just over the eligibility level and it is much better to have them treated at primary care level rather than have them end up in accident and emergency departments. I have frequently seen people in, say, cardiac failure which they might have avoided if they had been regularly attending their doctor.
I hope this issue is amicably settled between the Minister and family doctors because primary care is an area which we have neglected in our discussions about the problems in the health service. What is happening in accident and emergency is very dramatic so it is much easier to forget what may be going on in primary care. I hope the Minister manages to come to an amicable conclusion of his discussions with the Irish Medical Organisation, the College of General Practitioners and so forth.
Any efforts the Minister makes in rationalising the position with pharmacies is most welcome. The possibility of deregulation must be the next item so that there is a wider number of pharmacies in society. It is an exclusive business currently, as the Minister is well aware. It is easy to say that once the price of drugs is decided in town, that is the price it shall be.
I am also interested in the position regarding the use of pharmaceutical products on the Internet. As the Minister knows, the Irish Medicines Board spoke about this matter recently and I hope its funding will always be sufficient to investigate these areas because they are important. I heard Dr. Gilvarry speak about the importation of Botox from sites on the Internet for the treatment of wrinkles and other cosmetic surgery. Some international sites sell Viagra, U486 and all sorts of antibiotics, but I do not know how we can regulate the importation of these drugs. If we cannot stop large quantities of heroin coming in, how are we going to stop small packets of pharmaceutical products? We must ensure the Irish Medicines Board has sufficient resources to continue to investigate these areas.
Some of the Internet sites do not even require a doctor's prescription, or only require the most rudimentary prescription. In many cases they will know little of the patient's history. It was reported some time ago that 86 sites in America were selling Viagra without prescriptions, without carrying out any investigation of the patient's condition or inquiring about other drugs which the patient may be taking. We need to be vigilant about this area.
The reduction in the suicide rate is excellent news and makes one feel that the work of people such as Deputy Neville and others has been worthwhile. We are constantly addressing the number of suicides among young people. However, there have been depressing articles about suicides among older people, particularly among men over 65 years of age. These articles have highlighted issues of loneliness, depression, feelings of isolation and failure which need to be addressed. This is primarily an issue for social services rather than a medical issue. I would not wish to see loneliness being "medicalised", but we should pay more attention to the issue.
I am delighted by the increase in the fine for selling tobacco to children. The last occasion on which I objected to a child being sold cigarettes in a shop in Donnybrook, the owner said, "But I know his mother." I said, "I don't care if you know the whole family. This is against the law." Why is the fine not given in euros? Everyone else is converting to euros.
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