13 October 2004
Dr. Henry: I welcome the Minister of State, Deputy Sean Power, and look forward to seeing a lot of him in the House because I have found him a good person to work with.
I find the amendment to this motion very depressing because while we all know there has been terrific economic growth in this country over the past ten years and that there has been a huge investment in the health service, the paper published by the Economic and Social Research Institute yesterday entitled Ireland’s Health Care System: Some Issues and Challenges, by Anne Nolan and Brian Nolan, made the most profoundly depressing reading. Having spent €20 of my own good money on it, I will give Senators some of the benefit of what they said in their conclusions. They looked at Ireland and the basic outcome of our health service, including the life expectancy of men and women, infant mortality rates, low birth weights and so on. The only country worse than Ireland is the United States and I hope the Government takes this into account when considering the fact that investment in financial terms is not the only thing that matters with the health service. The paper states:
Some of the difficulties in such a benchmarking exercise were seen when we [looked] at a key indicator, namely the level of health spending. This has risen very rapidly indeed in nominal terms in recent years, outpacing even the exceptional scale of economic growth. However, in purchasing power terms and as a percentage of GNP it was only at the UK level — which the British government considers too low compared with other EU countries — by 2002. Re-classification of some spending by the Department of Health by the OECD in 2003 also significantly reduced their estimate of Ireland’s health spending, a process which may not be applied uniformly across countries.
In other words, some expenditure which we put under the health heading was included by other countries under social services.
The report further states:
With primary care a central focus of official strategies we then investigated the use of general practitioner services by people at different income levels, in particular those with and without entitlement to free GP care. Having controlled for other characteristics, including health status, those with medical card cover were found to have on average about 1.6 more visits each year than those with similar characteristics but without a medical card. Even if the health status indicators available to us understate the difference in needs between those with and without medical cards, it seems likely that the different financial incentives they face also play a role in producing this very substantial gap. The current substantial charges facing Irish patients without medical cards in all probability discourage some “necessary” as well as “unnecessary” GP visits, and this would also apply to introducing charges for medical card patients, essentially because of the uncertainty about drawing this distinction — particularly for the layman in deciding whether to visit.
I can tell Senators that is the way it is. As several Senators have said, we have a situation where those who are just above the limit are put off going to see their doctor, which can be most counterproductive at a later stage when they end up in accident and emergency or are admitted to hospital.
The difference in visiting rates have been alluded to. Table 6 on page 79 of the above mentioned paper is very useful because it compares visiting rates per percentile income of people in the various OECD countries from the lowest ten percentile to the top ten percentile. We differ in one dreadful aspect, that is, in the third percentile — I am sure most people would probably reckon it is a pretty low income — we drop off from 6.6 visits to the doctor per adult to 3.6. That does not occur in respect of any other country. There is a serious problem for patients at that income level which must be addressed. I do not care what we have put into the health service — it is a huge amount of money — but there is a target group of people who are probably at the butt of the discrimination in the health service.
One finding which cheered me up, from the point of view of general practitioners, was that there was no difference in visiting rates to doctors, whether they were paid a fee per item or capitation. That was cheering. At least the medical profession is not encouraging people to go to their GPs.
We are also running into trouble where people manage to get the money together to go to their GPs but do not have the money to buy the drugs they need. There is pre-fixing in every country in Europe, and Ireland is one of the highest. The prices for drugs are fixed between the pharmaceutical industry and the Government. Is the price being fixed particularly high in this country because of the extent of employment the pharmaceutical provides? We really need to look at that issue and I have no doubt the Minister, Deputy Harney, and the Minister of State, Deputy Sean Power, will do that. A doctor telephoned me today to say that a patient of his with respiratory disease could not buy her inhaler, that she had lost her medical card and that she ended up in Beaumont Hospital. That is counterproductive.
Even in areas such as chiropody — I declare an interest because I am the president of the Diabetes Federation of Ireland — chiropodists’ payments have been index linked since 1979. They now get €18.87 per visit but the cost of dressings and so forth have gone up enormously in the interim. They reckon they need €35 per visit, so those who will take medical card patients are asking them to pay €10 towards their treatment. Many of these people cannot afford the €10, so they do not visit the chiropodist and present in the diabetic clinic when they have ulcers on their feet and are admitted on average for a month. Can anyone tell me the rationale behind that?
I read in the newspapers the other day that in Ballymun, there is considered to be an excessive use of anti-depressants and that people there are on them for far too long. Ballymun was one of the primary care pilot centres.
6 o’clock This is a very good idea. Members must have seen in newspapers the antiquated Ballymun health centre that has been closed on occasion because of a danger from electrical faults. It also had to be closed last winter because there was no heating. That is bad but what is infuriating is that there is a state-of-the-art medical centre across the road which has been idle for two years because of some kind of dispute between the Department of Health and Children and the Eastern Regional Health Authority. Nobody can identify the problem. Can anyone explain the point of that?
In addition, the centre was told it could recruit more staff, yet when it tried to do so it was told there was a ceiling on recruitment. Is that any way to run a health service with such fragmented decisions being made? We have to look at how things are on the ground, taking into account the improved economic situation and the fact that so much money is going into the health service.
I cannot understand why some people cannot get medical cards immediately. The Post Polio Support Group made a presentation to the Joint Committee on Health and Children, of which I am a member. Thank God we have not had an epidemic or any cases of polio since the early 1960s. A group of some 200 people suffer with post-polio syndrome. They have serious medical problems. Many of them have not been able to work for years and others who struggle to keep working are above the income threshold for entitlement to a medical card. They are dying off. Each year there is a decreased number of them, yet this small group of people cannot get medical cards. The over-70s got medical cards, which I welcomed but I said there were more deserving groups.
The level of investment in the health service needs to be examined. I recognise what is being invested. I read the Brennan and Hanly reports. I have read about 100 reports commissioned in the time the previous Minister was in Hawkin’s House which, incidentally, is a dreadful building. Unless we take a more targeted approach to dealing with problems in the health service we will still keep coming up with dreadful reports about the basic statistics. When I saw that our infant mortality rate was so bad I could have wept. I keep looking at infant mortality rates in reports like that of the UNFPA so I can boast about ours and I was very surprised we figured so badly in this one.
I warmly welcome the Minister to the House and to her new position. I hope she will have great success in her job. I assure her that any criticism I may make of departmental policies is only done in an attempt to be constructive.
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