Before Question Time, I was dealing with our aims in promoting a good health system. Perhaps I was inclined to harp back to the 1970s when this House implemented the Health Act and to dwell on the then aims of the health system. We are falling short of our targets in regard to the general medical services scheme and we are falling far short on the hospitalisation end. Any scheme dealing with health must visualise for the future a good hospital service.
Regrettably, for a long time past we have been talking of regional hospitals which we had hoped it would have been possible to establish in each health board area. Not merely that but we had hoped that such hospitals would be backed up by a proper information service and by personnel from the faculties in universities. Furthermore, we had hoped that our medical school would be updated and a better training system established. We hoped that more young doctors would remain here and elect to work in their own country. These were all targets and the shots we are firing now are falling far short of those targets.
In regard to the general medical services, it looks as if the unbridled horse of inflation is seeing to it that we will not be able to accomplish the aims which we set out to achieve in 1970. If we continue on present trends and if expenditure on the health services is going to outrun the rate of inflation, we will not be able to accomplish them within the next ten years. I mentioned these matters to try to gain some perspective of the vast amount of work yet to be done in the Department of Health. Due to the present-day trends, there is no hope of achieving the hospital programme we set out to achieve. We have to settle for a lower target in the health services. Our aim was to have at least a 300 bed surgical hospital for each health board area.
In my health board area we find ourselves being forced back to the position whereby we have to amend our targets and settle for less. We find ourselves in the position of reconstructing units which are there already and of adding extensions to them in order to try to update them and to bring them into more accord with present day medical demands. It is a pity that we should have to amend our aims. It denotes that we are not going to achieve the high level of hospitalisation or hospital services that we had hoped to achieve in the 1970s. I dwell on this part of the scheme because hospitalisation calls for about 80 per cent of the total expenditure on health and demands the largest share of the Health Estimate. If we have to settle this year for the same terms obtained last year on the general end of the scheme it indicates that we are not going to make any progress on the hospitalisation side. It is a sombre picture not calculated to enthuse one with the aims we had even six years ago. We now find that we cannot make further progress either on the GMS side of the scheme or on the hospitalisation end. Let us make up our minds to co-ordinate our plans and if we have to settle for less, we should set aside the funds at the start of the year which will ensure that at least we shall be able to build one or two hospitals in some health board areas, or if we are not able to do that, to extend and update some of the units which are already there.
If we in the House want to make a contribution and if we want to provide leadership for the community, we must be seen to be doing this unless we intend to become irrelevant. We will become irrelevant if, having made our estimates at the beginning of the year, we have to come back to the House looking for large Supplementary Estimates. Unless we can check inflation we shall continue to go down hill. It is not enough for the House to be satisfied with last year's performance. Whilst in the past we have had a relatively low growth of population, we know that we now have the highest birth rate in the Community although we are the smallest unit in it. If this continues, our population will have crossed the divide and will have started to grow rather than reduce as in the past. Hopefully the rural population will increase and there will be an end to the trend of drifting from rural parts to the urban areas. People put more emphasis now on the quality of life but this factor is taken in conjunction with the standard of living. In the past people found it necessary to emigrate and this was responsible to a large extent for the decline in the population in rural Ireland.
Each generation has its own difficulties and improved standards of living do not necessarily bring the contentment that people hope for. The greatest problems of our time relate to the absence of a sense of respect and to the trend towards violence in the community. Contentment is closely related to health so one might well ask what we are doing in the context of the health services to make our community more content. The maturity of our citizens is an important factor in all this and the degree of maturity that we attain depends on the progress we make in relation to the operations of the various Departments of State. We must ensure that we get the best returns possible for money spent but I submit that at present the results we are getting are not the best possible.
There are many ways in which we could effect savings in the Department of Health but the one area that springs to mind first in this regard is that of the prescribing of drugs. The extent to which our bill for drugs has increased is a scandal. The best doctors that I have met would not prescribe drugs unless it was absolutely imperative to have recourse to them. The general practitioner to day is over-prescribing. Since the health scheme was implemented a few years ago there would not appear to be the same control in this area as there had been previously. If we wish to be realistic in our approach to curbing the use of drugs we must take positive steps to achieve control and this is the place where those steps must be taken in the first place. We should legislate for a rigid control in the field of the dispensing of drugs and, if necessary, provide for strict disciplinary action in respect of those who are regarded as over-dispensing. In regard to effecting savings there are many other subheads I could mention but suffice it for the moment to concentrate on the area of drug prescribing.
Ours is a small country but if the present birth rate trend continues we can expect a greatly increased population and this would necessitate a rigid examination of expenditure under every subhead that comes before us. However, the experts tell us that for some time our high dependency rate will continue. It is regrettable that we have such a high rate of dependency, the highest in Europe, perhaps. In the past we ascribed this situation to a high degree of emigration which left an imbalance in population make-up because those who emigrated were the able bodied while those who stayed at home were the older age groups and the very young. However, that trend is being reversed and in about ten years' time there should be no question of any such imbalance. In arriving at these views I am applying the rule of thumb, as the late President Roosevelt would have said, but I am convinced that an examination of present trends would confirm my opinion.
As Members of this Parliament it is our responsibility to suggest ways and means of effecting savings especially when money is scarce, instead of sanctioning expenditures for some Departments to a degree where the moneys become totally irrelevant.
To return for a moment to the question of drugs, I wonder if steps could be taken here similar to those taken in England. I am not sure how the situation in England is working out in practice but it was designed rigidly to control the movement of drugs. It is not very long ago since serious consequences could have arisen as a result of the use of a drug which was being used in hospitals and which also was being prescribed by vets. The drug in question was as a specific against typhoid fever and was used only sparingly in our hospitals. It was also used by veterinary surgeons. Now it would have been all right were it only used by veterinary surgeons but it was available to farmers and, that being so, there could have been very serious consequences were it not for the fact that this freedom of use was detected and the drug was quite rightly brought under rigid control. I make the point in relation to one drug. How many other dangerous drugs are available without control?
I do not want to outstay my welcome. I have made a number of points and I have tried to summarise the position in regard to the general medical services and hospitalisation. We have on record all the information we need about hospitalisation. In view of our income and the way we spend it, in view of the fact that the Department of Health is an intensive labour unit, in view of the fact that we have an increasing birth rate and an increasing demand for better hospitalisation and so on, it would be well to have another look at our plans for health over the next decade and, if necessary, adjust those plans in line with our income. We should temper the wind to the shorn lamb. It does not make for good management here or in the Department to make Estimates at the beginning of the year and then find we are short on our targets and unable to meet our commitments. That means coming back again for more money. We should find ways and means whereby we could arrive at a more accurate estimate within which to work. I suppose that would be the ideal. For a number of years now we have been coming back regularly to discuss Supplementary Estimates. Our objective should be directed towards saving and towards attempting to curb the erosion of our money so that it will do better work and go further. If the House could give a lead in this direction we would be taking a substantial step forward in bringing about a balance and providing more up-to-date hospitalisation and better general health services.
