Mrs. A. Doyle: Prescription only.
Mr. Ryan: The problem with a prescription only system is that it would involve people getting items on prescription and the State could end up paying for them. That would concern me.
Mrs. A. Doyle: I am being sarcastic.
Mr. Ryan: Cigarettes should only be sold in off-licences in the same way as the sale of alcohol is restricted to a limited number of premises. Cigarettes should not be sold anywhere that families or children might be. I do not believe in prohibition, but ease of access should be reduced to the maximum possible extent.
The price of cigarettes should be increased. I make no apologies for saying that it should be made prohibitively expensive to smoke. A specific health tax on premises that are prepared to sell tobacco should probably be introduced. If people want to sell tobacco, a specific health tax, in addition to the normal taxation rates, should be imposed on them. I want to discourage places from selling tobacco. It should be made as difficult and inaccessible as possible. I do not believe in prohibition - it has not worked in any area - but those measures would be useful.
Any area to where the public has access should have, at a minimum, a legal requirement to make a non-smoking area available. I do not care how much the vintners whinge. The institute of technology where I work has one little area in one student canteen where people can smoke. Smoking is not allowed in any other place. I remember when people were allowed to smoke in cinemas. That is now prohibited and the quality of the atmosphere in cinemas has been transformed. I remember when people tried to get away with smoking in theatres.
Mr. Martin: And bingo halls.
Mr. Ryan: I suspect they still smoke in bingo halls.
Mrs. Jackman: Absolutely.
Mr. Ryan: Any place in which the public congregates either for leisure or commercial purposes should have a predominantly non-smoking emphasis. The biggest centre of recreation in Ireland is the pub, but that is the one place where there has been no attempt to restrict smoking. Pubs should not be allowed to sell cigarettes; they do not need to sell them. In addition, they should have to make provision for an area for non-smokers which is proportionate to the size of the population that does not smoke. Approximately 60% or 70% of the adult population does not smoke now and that is the proportion of the space which should be available in any premises. These measures need to be taken. Although I do not blame the Minister, my only argument with these provisions is that they do not go far enough.
Mr. Martin: We know that.
Mr. Ryan: That is my only complaint. I am the ultimate liberal in many ways, but the imposition of smoking on society is horrendous.
Mrs. Jackman: That is true.
Mr. Ryan: I may not be as positive about other provisions of the Bill. The health service in general is in tatters. It is lacking in vision and philosophy. It is a health service that was imagined when Ireland was poor. It has not developed the vision to deal with the idea of a health service of the quality that should exist when a country is rich. One example is the so-called improvements in the drugs scheme. I agree with Senator Doyle's point that nicotine replacement therapy is not available to medical card holders, but the State is happy to spend thousands of pounds on them once they get cancer from cigarettes.
Mrs. Jackman: That is true.
Mr. Ryan: It is ridiculous that nicotine replacement therapies are not available on the medical card scheme. Our priorities are confused at times.
As the Minister is aware, there are two problems in this area. In terms of the GMS, there is a question about what is available under it and it is a matter of continuing controversy. It is time to move on. We can afford to do better and it is time that was done. With regard to the drugs refund scheme and a single person with an income of £160 a week, a GP now charges £25 per visit.
Dr. Fitzpatrick: Where?
Mr. Ryan: On the north side of Cork. My GP has many medical card patients and he charges £25 a visit, although a plumber charges £40 just to come to one's door. Perhaps Senator Fitzpatrick should move to Cork.
Dr. Fitzpatrick: I am reviewing the situation.
Mr. Ryan: They are obviously more affluent there. The maximum amount payable under the drugs refund scheme in that case is £10 a week. On an income of £160 a week, that is one sixteenth of one's income. If one adds other sums for other items, it could amount to close to 10% of the person's income. The irony is that the State spends 5.5% of GDP on health care but we are prepared to say that someone on a low income should spend 10% of it on their health care. We in the Labour Party have endeavoured to come up with the proper figure to provide a decent public health care system but all we got from the Minister was an inadequate and under-researched response, which was not up to his standard - I am sure the Minister saw the letter in The Irish Times last week from Dale Tussing - and it deserves a good deal better and a more in-depth response. It may not be the only way but it will be a lot better than what we have at present.
While I am glad the Minister is rationalising this and regulating nursing homes, an area which needs fundamental and major resourcing is the provision of nursing home care for our increasing elderly population. It is a nonsense, only capable of being thought up by the Department of Finance, that anyone can afford to pay £400 a week indefinitely in a nursing home. Some £20,000 a year is what the John Byrnes and Dermot Desmonds of this world can afford but most people cannot afford the cost of a nursing home. I have no objection to people paying a reasonable contribution out of their income but we should not turn the elderly in our society into a burden on their children.
The Minister has a problem with the ideology of the Minister for Finance. In his previous Ministry, the Minister for Finance believed in spending money on what he was doing, but he does not believe that in this Ministry. The Minister's biggest challenge is to change his mind.
Dr. Henry: I welcome the Bill in which I have a great interest. I will not indulge in a diatribe about why the hospital employers are involved in brinkmanship with both the nurses and the non-consultant hospital doctors because it would not be productive. I hope the Minister will be able to come into the House as soon as possible to address the serious staffing issue in hospitals. This debate has an impact on that issue because if nursing and convalescence homes were used as step down facilities for hospitals, it would help to unblock the beds in the acute hospital service.
I do not want to inflame the situation as regards the non-consultant hospital doctors but I am extremely worried by the lack of progress within the Labour Relations Commission and the fact the psychiatric nurses have decided to take strike action again next week. It must have been the Leader's influence and that of Senator Glynn that St. Loman's in Mullingar is not included in the first group of psychiatric hospitals to be hit by the strike. The psychiatric nurses say they will attack the flagship hospitals first, so I do not know how pleased those in Mullingar will be to hear that. It is a serious situation, as I am sure the Minister is aware, because some of the most vulnerable patients in the health service will be affected by this action.
I was disappointed with a reply to a parliamentary question last week, which the Department must have given to the Minister of State at the Department of Health and Children, Deputy Hanafin, who is a truthful person, which suggested there was no problem with staffing in hospitals. However, that is not true. There are last vain advertisements in the past few weeks' medical journals for staff throughout the country, including Portlaoise, Tullamore, Galway, Castlebar, Sligo and St. Luke's. Those jobs have been advertised for 1 July. If they do not have staff for them now, they will not have any on 1 July. There are no locums for June.
This is a useful Bill which deals with three separate topics. I hope the Department will try to seriously address the problem of patients who believe there is no cure without a pill. The medical profession needs to be educated about it but so does the public. We have a big problem with multiply resistant staphylococcus aureus in the hospital service. There is not a hospital in the country which does not have a problem with it. This has arisen from the overuse, and some would say abuse, of antibiotics.
Litigation in the medical profession is a serious problem. A doctor is more likely to be sued in this country than anywhere else in the world, including the United States of America. For reasons of defensive medicine, there is an over-prescription of antibiotics. The public must be made to realise this is not in their best interest. The Department should introduce an initiative because we are talking about preventative medicine to prevent more serious infections.
The prescription of antibiotics for upper respiratory infections, which are mainly viral, is well known. I am sure Senator Fitzpatrick read the recent interesting articles about the inadvisability of prescribing antibiotics for children with an initial middle ear infection and indicating that perhaps they would be better to wait for 24 hours to see how they are doing. If the child does not do well, the doctor is in a serious position because it will be said that it would have been better to have prescribed antibiotics for the child in the first place. However, that might not be true.
The over-prescription of antibiotics by medical practitioners as a protective mechanism has been influential in the development of multiply resistant staphylococcus aureus. We need to resist the pharmaceutical companies and to remember that some of the narrow spectrum older antibiotics may be the ones of choice. I am sometimes astonished to see patients on something I would have regarded as a hospital antibiotic which should not be given except in a hospital as a last line of defence. Just because an antibiotic is broad spectrum and will hit a lot of bacteria and is the newest does not mean it is the best thing to prescribe.
We must also look at the problem of the availability of antibiotics without a doctor's prescription and on Internet sites. We heard this morning about the deaths from Viagra of two Irishmen who had heart conditions and 14 others had adverse effects. The last time I sought information on the prescription of Viagra I found 83 sites in the United States where it could be obtained without a prescription. It is as easy for someone here to look for it as it is for someone in the United States. We have a serious problem regarding the supervision of patients on antibiotics or any potent drugs who may be getting them without seeing a medical practitioner. The Department should make a major effort to address the problem of the overuse, if not abuse, of antibiotics for the medical profession and with a view to informing the public of the risks involved.
The direct advertising of drugs is useful because patients may bring to one's attention the availability of a particular drug. However, a drug may appear to be a cure-all for certain conditions but the downside of its use may not be made sufficiently clear. Pharmaceutical companies need to be extremely careful in the way they promote products which are aimed at the general public.
I am glad that renewed efforts are being made to restrict the sale of cigarettes to people over the age of 18. The only difficulty is that existing legislation governing this area is not being enforced. I do not know how the new provisions will be enforced because it will be extremely difficult to ascertain whether a person is over 18 years of age. It will also be easier for shopkeepers to plead that they did not know a person's age. This restriction on the sale of cigarettes is welcome but I do not know how we will encourage environmental health officers and others to police the legislation.
I was in a shop recently when a child of approximately eight or nine years of age purchased cigarettes. When I objected to the shopkeeper, I was informed that the child's mother was known to them. I stated that I did not care whether the shopkeeper knew the child's entire family and pointed out that it was illegal to sell cigarettes to the child.
A useful survey, one among hundreds of its kind, was recently published by the Southern Health Board. It shows that children as young as eight or nine years of age, particularly boys, drink alcohol at least once a month and smoke on quite a regular basis. It is clear that our attempts to reduce the consumption of cigarettes and stop young people from taking up smoking must focus on providing information to children in primary school. We must adopt a multi-faceted approach to trying to prevent children taking up smoking because, unfortunately, those who smoke or drink at a very early age are much more likely to become involved in the abuse of illegal drugs. It is vital that we address this problem.
A number of representatives from the tobacco industry in Ireland recently complained that restrictions on tobacco advertising are becoming even tougher. I have no sympathy for these people because approximately 90% of those who smoke want to stop but it appears to be extraordinarily difficult for them to do so. Regardless of what one might say about alcohol, no evidence can be provided to show that there are benefits to be gained from smoking cigarettes or any other form of tobacco.
When advising people not to smoke, emphasis is placed on the dangers of contracting chest conditions, lung cancer and emphysema. However, it is important to note that people who smoke can develop terrible cardiovascular problems. Evidence which shows an earlier onset of heart disease among women who smoke and of their deaths from heart attacks is remarkable. I do not believe adequate emphasis is placed on informing women, particularly those who smoke, about the dangers of heart disease.
I have never known a non-smoker, unless he or she was a severe diabetic, who lost a limb. However, I aware that numerous smokers have had limbs amputated. Such people have lost limbs at quite an early age, perhaps when they were only 50 or 60 years of age. We must continue to stress the problems which may result from smoking.
I am familiar with a number of surveys which indicate that 40% of teenage girls smoke. I am inclined to believe this because I recently chaired a meeting in Trinity College and, despite the presence of huge "No smoking" signs, I was nearly asphyxiated and I thought I would have to be carried out on a stretcher. Those present at the meeting obviously possess some form of high intelligence because they had managed to gain entry to third level education. However, regardless of the emphasis that has been placed on warning people about the dangers of smoking and despite my strong objections, many of those at the meeting were puffing away on cigarettes.
We must adopt a different approach to warning young women about the dangers of smoking. New surveys have shown the effects of tobacco consumption, particularly in terms of the thinning and ageing of skin. At 17, 18 or 19 years of age one does not think that one will be covered in wrinkles by the age of 40. However, it might be an idea to use "before and after" photographs to illustrate the position. In that context, I recall that, in the past, the "Toni Twins" television advertisements used to employ such photographs and inquire whether people could identify which model had dyed her hair. Perhaps we could try to make young women aware of the effect smoking will have on their physical appearance.
I wish to comment on the sale of smuggled cigarettes. I work in a part of the inner city where I frequently see people selling cigarettes on the street at prices well below those charged in the shops. I accept that customs and excise officers and the Criminal Assets Bureau have enjoyed a degree of success in tackling this problem but there is a need to deal with it in an even more enthusiastic manner. I understand that it is more profitable to deal in smuggled cigarettes than in illegal drugs because people do not have to pay as much for them, the turnover is excellent and those involved in their sale are not as enthusiastically pursued as those who deal in hard drugs.
There is a need for a full debate on nursing homes, an area where major growth has been experienced. Convalescent homes and step-down facilities could be used more extensively and provide great assistance to the acute hospital service. However, like the hospital service, such institutions are encountering difficulties in attracting staff. Perhaps the Minister will address this matter on another occasion.
Mrs. Taylor-Quinn: This important Bill is an attempt to update the legislation relating to smoking and convalescent and nursing homes. However, on Second Stage one is entitled to speak on wider health issues.
I concur with Senator Jackman's comments on the provision and distribution of drugs through the various drug refund schemes which have provided relief to a considerable number of people. However, there is a need to expand the existing system. Statistics have increasingly shown that the number of people suffering from respiratory and lung diseases has increased dramatically. This may be due to changes in the environment which have been caused either by the release of various gases into the atmosphere or by global warming. However, the incidence of such diseases among young people cannot be denied. I am sure Senator Fitzpatrick encounters such people at his medical practice on a daily basis.
People have been campaigning for a number of years to ensure that those suffering from asthma are included under the drug refund scheme. However, the Department, for whatever reason, has refused to accept proposals in that regard. This is most unfortunate because a large number of young children are affected by asthma. Many families come under huge financial pressure and incur major costs as a result of their children contracting asthma. The Department and the Minister have a responsibility to give serious consideration to this matter.
Public representatives are aware of the financial hardship incurred by families in this regard, particularly by young couples with mortgages and other major financial responsibilities who perhaps have two or three young children suffering from asthma. Such people find it extremely difficult to meet the financial cost of drugs and other support services. At a time of economic boom, I urge the Minister to consider the needs of these people, allow them into the drugs refund scheme and provide them with the financial support they require. That would be a huge relief to the families of severe asthma sufferers. The Minister is progressive in a difficult Department but people have confidence that he will respond to these issues and show his ability to deal with them in a forward-thinking manner.
On the Tobacco (Health Promotion and Protection) Act, 1988, I welcome the introduction of legislation in regard to revised policy in this area. However, I am very disappointed that in view of the amount of work undertaken by the Joint Oireachtas Committee on Health and Children in this area, in which Members of the Oireachtas from all parties researched the national and international situation and published a conclusive report, this legislation has not taken any of the report's recommendations on board. I am particularly disappointed that the legislation does not encompass the report's recommendations on fines. It is imperative that fines would become so frightening and prohibitive that they would prevent people from selling cigarettes to underage people. The increase from £500 to £1,500 is not adequate; the fine should be increased to £2,500, as recommended in the committee's report. That would be far more prohibitive and effective. I urge the Minister to introduce an amendment on Committee Stage or to accept Members' amendments to address this matter.
The report also includes recommendations in regard to advertising, promotion and monitoring. There is a huge onus on the Department, together with the health boards, to ensure that the sale of tobacco in health board areas is monitored closely. The Department must provide the health boards with the funding required to employ people to ensure that regulations are being complied with by manufacturers, traders and distributors. Such monitoring cannot be carried out effectively unless the Government provides the necessary funding to the health boards.
Although I will not refer to any specific campaigns conducted by the Department of Health and Children, we have seen very successful advertising campaigns in the past. The Minister has an opportunity to promote an attractive, anti-smoking advertising campaign in the national broadcast and print media to encourage young people not to smoke. Some tobacco manufacturers sponsor major sporting events in which young people have a particular interest and, in doing so, subtly encourage young people to smoke. The Minister must counteract that influence.
There has been a dramatic increase in the number of nursing homes throughout the country over the past ten to 15 years. There has been a further increase since the Minister for Finance introduced the special tax incentive scheme in the 1999 Finance Act due to the attractiveness of investment in this area. I commend and support the thinking behind the scheme. However, those seeking tax relief through investment in the scheme will approach projects from a business point of view and it is very important that the Minister and the Department ensure that the standards in nursing homes built under the scheme are up to scratch. I recognise that this legislation will ensure that nursing homes built under the tax incentive scheme will be registered and I commend the Minister for that. I urge him to ensure that additional personnel are provided in the health boards to monitor these homes to ensure that they are properly managed and that a proper standard of care is provided.
When nursing homes were built here initially, some of them left a lot to be desired and were closed down. It should be compulsory for any nursing or convalescent home to be registered in order that they or their patients could receive assistance. I note that the legislation distinguishes between convalescent and nursing homes.
I suggest that the Minister should consult with his colleague, the Minister for Social, Community and Family Affairs, as carers and nursing and convalescent homes are closely inter-related. If carers were given more serious consideration and if better provision were made for the carer's allowance, fewer people would have to go into nursing or convalescent homes. There are some cases, particularly with very elderly people, where it is impossible for people to remain at home because of inadequate finances. There is room for manoeuvre in this area between the Departments of Health and Children and Social, Community and Family Affairs.
The Minister recently visited County Clare and we were delighted to welcome him to the county at such an early stage in his term of office, although we were somewhat disappointed that he was only there to put an initiative announced three years' ago by the then Minister for Health and Children, Deputy Noonan, on a solid footing. Nevertheless, we welcomed his visit. However, the Minister did not manage to visit the mammography unit in Ennis General Hospital. That unit was established in 1984 as a result of voluntary fundraising carried out by a group of people drawn from throughout the county. A private fund was set up at that time and people continue to raise funds on a voluntary basis. I understand that a report was commissioned and is possibly on the Minister's desk-----
Mr. Martin: The report was prepared by the Cancer Forum, which was established by the Senator's colleague, Deputy Noonan, when he was Minister for Health.
Mrs. Taylor-Quinn: Although the report has not yet been published, I understand that it contains a recommendation that such units should be centralised. There would be a huge degree of dissatisfaction with that. People from Dublin and other large urban centres may automatically think that major hospitals should be centralised but people living in counties Cork or Clare know how far away west Cork and west Clare are. If these units were to be centralised, the number of people who would avail of these facilities would be reduced. Middle class, mobile people would be in a position to travel to the centralised units to avail of the services but less privileged people who do not have cars would find it impossible to do so.
Regarding the centre in Clare, a number of the specialists in Limerick are not happy with the recommendations in that report regarding centralising in Limerick. The people of Clare who have been using this service, and particularly those on the periphery of the county, are most dissatisfied at the idea of its being transferred, particularly given that it continues to be funded from voluntary sources with a little subvention in recent years from the Mid-Western Health Board.
I ask the Minister undertake a close examination of this matter when the report becomes public. I am sure he has had it examined in detail already, but he will recognise that there is a social dimension to all of this and it is essential that services be provided near those who require them. Services 60, 70 or 80 miles away are not adequate for a high percentage of the population and I urge the Minister to look at this with a view to retaining the mammography unit in Ennis General Hospital.
Minister for Health and Children (Mr. Martin): I thank the Senators for their constructive contributions to the debate. I am greatly encouraged by the convergence and the unanimity of views on adopting the strongest and most stringent anti-tobacco measures possible.
Senators Fitzpatrick, Doyle, Glynn and Jackman and all the Senators spoke strongly on the tobacco issue. The Bill raises the age at which tobacco products can be sold to young persons to 18 years and increases the fines. I have been advised that that is as far as I can go on the fines issue and I must accept the advice available to me.
Mrs. Jackman: The Minister should check again.
Mr. Martin: There is legislation of a much more substantial nature on the way. I am currently preparing a tobacco Bill. The Office of Tobacco Control has been established and a chief executive and board have been appointed. The next step is to appoint a tobacco-free council. The Office of Tobacco Control, in conjunction with my Department, is currently preparing the heads of the Bill. I look forward to bringing that Bill before the Oireachtas in the autumn session - that is the timeframe towards which I am aiming. Many of the issues raised here will be covered in that Bill. For example, we are looking at providing that 60% of the cigarette packet will show the effects of tobacco on the person. We are looking at the availability of cigarettes in retail units and the degree to which they are advertised in retail units. We know, for example, that when children go into shops to buy sweets they see packets of cigarettes adjacent to the sweets. I agree with Senator Ryan that we must change the climate to one of intolerance of cigarettes in society.
As a newcomer to the Department of Health and Children, I am somewhat taken aback by the statistics and the research. People complain rightly about waiting lists and about the accident and emergency service. The reality is that health is a simple equation and the health status of the Irish people is poor relative to that of our European partners. Ireland has the highest instance of coronary disease in Europe and is highly placed on the cancer table. Accidents and injuries apart, these are the three main causes of illness and death in Ireland. One of the single greatest determinants of death and illness is cigarette smoking. If we focused our efforts on cigarette smoking, we would do the health status of the Irish people now and in the future an enormous amount of good.
There is a moral imperative on me, the Minister for Health and Children, to attack this issue with everything at my disposal. Some people have accused me of becoming a fundamentalist overnight. I am not. I never smoked, although I tried it once. There is a downside to that in the sense that one can be overly intolerant of smokers because one has never been addicted. We must understand that it is an addiction and smokers need help to quit the habit. It is estimated that about eight out of ten smokers want to give up smoking and have tried time and again.
Mrs. A. Doyle: Why do we make it so difficult?
Mr. Martin: The issue of nicotine replacement therapy was raised by Senator Doyle. The policy decision has been taken to introduce nicotine replacement therapy for medical card holders. The issue is how we will do it. The report of the tobacco-free policy group, which I launched in March, recommended the introduction of NRT for medical card patients in the context of cessation programmes. In other words, it did not want smokers simply going in and grabbing the NRT without anybody talking to them or without proper programmes. There is a dilemma in that obviously there is a lead in time before one can establish a cessation programmes in all locations.
The tobacco-free policy group's report was significant in that for the first time the Government stated that it accepted it had to do more than just campaign against cigarettes and state that people should not smoke, and that it must help people to get off cigarettes. The NRT is a factor in that process.
The cardiovascular forum, which is advising on the cardiovascular strategy, was asked some time ago to tease out this issue with a view to advising Government on how best to introduce NRT in the context of the GMS scheme. That is happening at present. I am awaiting the recommendations of the cancer forum regarding the mechanics of doing it and the context in which it should be done. Obviously that will lead into the Estimates process also, but the bottom line is not so much the decision to do it, which has been taken already, but how we will do it. That is an issue because there could be a considerable amount of wastage. There is a necessity at some stage in the process to link it with a proper cessation programme. We are working on a number of different settings to develop that. Only yesterday we launched the minimum standards for public hospitals in terms of smoking and cessation programmes. Interestingly, Beaumont Hospital has a cessation programmes facilitator, whose function is to co-ordinate the smoking policy within the hospital but also to develop cessation programmes for staff, patients and families. There is a great deal of work to be done on that, but we recognise the importance of NRT.
Senator Doyle raised the apparent absurdity where a person has no difficulty buying 80 or 120 cigarettes but cannot buy NRT over the counter because it is a licensed drug. We need to tease out that matter a little further. If one takes NRT off the list of licensed drugs, then there remains the issue of dosage.
There are other issues coming down the tracks. One ought not to be surprised if in five years the tobacco industry states that it will not sell cigarettes anymore. Some of the pharmaceutical firms have pointed this out. There is no regulatory framework, for example, to distinguish between NRT and whatever else may emerge. The tobacco industry is one of the most resourceful industries in the world. We are facing a very tough opponent here.
Senators Jackman and Fitzpatrick made interesting points about young smokers. We actually succeeded in making good progress from the mid-1970s to 1993, when we reduced the number of tobacco consumers from about 50% to 28% on average. Unfortunately in recent years it has risen to 31%. It seems that a significant proportion of those are young women and young people generally. That suggests to me that the tobacco industry has regrouped, refocused and redirected its marketing strategies to get people hooked again.
That said, the proposed tobacco Bill will look at the issues of passive smoking in terms of where and how, and will give strong powers to the Minister to introduce regulations in all the areas identified by the Senators. This legislation is an interim step in line with what was said in the Dáil on Ash Wednesday, which was anti-smoking week. I thought I would use the opportunity available in this Bill to make this provision because I know about the volatility of the Legislature and the difficulty in getting provisions through. Legislation can take time and therefore I decided to take the opportunity of the Health (Miscellaneous Provisions) (No. 2) Bill at least to increase the age at which a person can purchase tobacco products and to increase the fines, in accordance with the advice available, to the upper limit. I will seek clarification on the advice in accordance with Senators' wishes.
I accept the point raised by Senators about the rate of nursing home subvention. Over the years the Department of Health and Children has actually secured an additional increase in the Estimates for nursing home subvention. It started off at about £4 million in the early 1990s. This year the bill for nursing home subvention is £40 million. Last year my predecessor, Deputy Cowen, secured an increase of £3 million or £4 million. He thought that this would facilitate an increase in the rate, but what happened was that the demand grew. The increase merely pays for the increase in the number of people coming into nursing homes and reflects the demographic changes in Europe and of Ireland.
Shortly after coming into office I instructed my officials to prepare a strategic action plan for the elderly. This is currently being prepared in the Department, in consultation with the health boards. I want to move quickly on this plan because the timeframe presented by our aging population may cause difficulties and because there are significant gaps in services between acute and community care services. We have much to do.
Approximately £200 million has been earmarked in the national development plan for a range of services for the elderly in the community, including community nursing units, respite care, day care centres and so on. I suspect that the bill will be higher before the strategy has been put in place. We will then have to go to the Minister for Finance. We have increased current expenditure in the health services by 56% in the last three years and the capital programme of £2 billion is very significant. However, I suspect we will need more.
We also need reform. I note Senator Henry's point about industrial disputes. We need reform of what we are doing in hospitals. We must reform the hierarchical nature of the medical professions. Investment coupled with reform will give us a world class health service.
The question of long-term illnesses, particularly asthma, was raised by many Senators. This is an issue of concern to me. How we define certain illnesses as long term must be decided. There is also the issue of Estimates. I will explore the feasibility of defining asthma as a long-term illness over the next number of months because asthma medicine is a costly item for many people.
We are working with the Department of Social, Community and Family Affairs on the issue of carers and the continuum between nursing homes, convalescence and care in the home. The point made in this regard is a very fair one. I have already had discussions with the Minister, Deputy Dermot Ahern, on the question of taking an integrated approach to care and of giving carers greater support. Carers will be vital in assisting the elderly and others who are in receipt of community care, in ensuring that people retain independence in the community and in delaying recourse to acute services.
People may not be aware of the Walk Tall programme, a substance abuse programme which is being comprehensively introduced in all primary schools. The programme was prepared by a team of psychologists and others in the Department of Education and Science in consultation with the health promotion unit of the Department of Health and Children. It is a very good programme and in-service for teachers who will provide it is now under way. The programme was introduced in 1,500 schools last year and will be introduced in another 1,500 this year. This will give complete coverage of primary schools. Its fundamental philosophy is to give children self-esteem and self-confidence so that they can withstand peer pressure. All the recommendations are that this is the key way to give young people the means to withstand the pressure to take a drink or to smoke. It is not enough to tell children to say no. We must arm them with self-esteem and respect for their bodies and for their health and well being. If we can do this we will prepare them to make the right decisions in the future. This programme is under way in all primary schools and over time it will have an impact on the educational aspect of the debate on smoking and substance abuse.
Senator Henry raised the issue of MRSA. This is not totally relevant to the contents of the Bill but I am very conscious of the seriousness of the issue. It raises very basic questions about hygiene in hospitals and the over-use of antibiotics in society generally. We are working with the World Health Organisation, and the National Disease Surveillance Centre now has responsibility for developing a policy on MRSA in hospitals. A consultant will be appointed to spearhead that campaign.
I note Senator Taylor-Quinn's comments about the mammography unit in Ennis. I am examining the situation. When I was in Ennis I did not hear a great deal about this issue. Because I gave the grant to the control team to build the hospital and to do everything else I was asked to do, the agenda appears to have moved on very quickly. We must balance availability and accessibility with quality of care and concentration of the best service in one location.
Question put and agreed to.
Committee Stage ordered for Wednesday, 7 June 2000.
