Today in Question No. 1 on the Order Paper I asked the Minister for Health if he intends to remove further drugs from reimbursement under the General Medical Services Scheme and, if so, why. The Minister replied as follows:
The position will be kept under review but there are no plans at present to remove further items.
That question had been down for some time. Consequently, by way of supplementary, I asked the Minister of State if such items as dilopech which is a cough mixture or a stomach mixture such as aludrox had been removed from the prescribing list from 1 May. The Minister replied that his information would not indicate that. I have before me a letter from the General Medical Services (Payments) Board to pharmacists throughout the country. This letter is dated 28 April 1983 and the first paragraphs reads:
The following information should be noted in connection with GMS claims dispensed from 1st May 1983.
The letter goes on to list eight different items, a number of which are either adding on drugs or replacing drugs but paragraph 7 outlines that such drugs as dilopect, dimotanes, pertussin, tussionex, vallergan, and vallex are not allowed, while paragraph 8 indicates that aludrox SA, gaviscon and pyrogastrone are not allowed.
These items had been on the GMS prescribing list up to that point in time. When the Minister's predecessor had some items removed from the GMS list in October last the three white stomach mixtures to which I have referred, for example, were left on the list. I do not have to tell the House the importance of having some sort of stomach mixtures available for those people who are in possession of GMS cards, people who are unable from their own means to provide for their medical care and attention. The system was working quite well but now we have a situation in which there is no stomach mixture available so far as the holders of GMS cards are concerned. This puts these people in the position of having to buy their own medicines although that is an expense they cannot afford. In addition this puts the doctors in a difficult position because they, knowing very often that the patients are not in a position to buy the medicine, are tempted to prescribe a more expensive drug for the stomach ailment, drugs such as tagomet that can cost from £15 to £20 per hundred. This means also in effect that the patients are not getting the service as laid down under the GMS scheme. The same applies to cough bottles. The previous Minister did leave on the list such cough bottles as dilopech which were readily available to patients under the GMS scheme. This type of cough bottle was the simpler type but I am aware that the highly sophisticated preparations for specific conditions are still readily available.
The Trident Report recommended that items which could be bought over the counter should be removed from the GMS prescribing list. I understand it was intended to bring about a saving of £8 million. I understand also that that is the level of saving which will be effected this year by way of the removal from the GMS list of the overcounter sales. In the first month since these items were removed there was a saving of £1,250,000. With that kind of saving it is difficult to understand the Minister's decision to remove further items from the GMS list.
In addition, whereas previously only items that could be bought over the counter — and many of them could be bought in supermarkets — were removed from the list, the Minister has created a precedent in removing items that can be purchased only on prescription. I should like to hear him explain this departure. It will mean that the patient who needs any of these items will have to pay for them but will also have to pay a prescription charge. It is difficult to understand this change when the Minister is on target regarding his savings for this year. Indeed, it is difficult to understand why this Government should remove any item from the list in view of the various promises they made during the election campaign. I am thinking particularly of the Labour Party who during that campaign complained about items having been removed from the list. I should like to quote what the Taoiseach had to say as reported at columns 113 and 114 of the Official Report for 27 October 1982. He said:
We have seen this again in cuts in the health services, including discriminatory withdrawal of hundreds of drugs from the least well off, those on medical cards, while the full cost of the same drugs, subject to small monthly deductions, is available to all of us who are better off.
Again, during the debate on a confidence-in-the-Government motion of 3 November 1982 the Taoiseach said, as reported at column 661 of the Official Report:
By what possible standards of equity could any Government stand over that?
He was referring to the removal of the 900 items from the list. He continued:
If there have to be cuts one could reasonably say let us start with the better off and spare those on medical cards. To start with those on medical cards and spare the better off is a policy which no one on this side of the House, in any group on this side of the House whoever they may be, can possibly stand over.
That was the Leader of the then Opposition expressing his attitude to the removal of some drugs from the GMS prescribing list but this Government have not only removed further items that were for sale over the counter but also items that were available only on prescription. On 3 November 1982, as reported at column 794 of the Official Report, the Minister of State at the Department of Industry and Energy, Deputy Eddie Collins, said of the then Government:
They have blatantly brought in some cuts in a haphazard fashion. The health cuts are designed to hit the poorest worst. I came across a couple of cases in my advice centres where medical card holders and elderly people with chronic illnesses have not been allowed to get freely the basic medicines they require. I would suggest that if there were to be changes in the health service to effect savings it would be only fair to ensure that the better-off would be hit more harshly than the less well-off.
The previous Minister for Health did leave on the list simple cough bottles and three white stomach mixtures which this Government have now decided to remove from the list. I should like to quote what Deputy O'Keeffe said on 27 October 1982 in the course of a debate on the nomination of members of the Government. At column 134 of the Official Report of that date he said:
What requires an explanation even more is the saving of a similar sum of £8 million by cutting the benefits to those in possession of medical cards, by taking 900 items off the list and by ensuring that many people will suffer hardship as a result.
A former Minister for Health and a member of the Labour Party, Deputy Eileen Desmond, on 2 November 1982, as reported in column 596 of the Official Report, said:
The Labour Party cannot accept that arbitrary cuts in basic health care available to the poorest and the weakest in our community is the answer to our current economic difficulties. We cannot accept that chronically ill, pensioners and others on like income should have to pay dearly for essential medicines while public moneys are being frittered away on projects such as Knock Airport. We cannot accept that the lowest income families in the country should suffer while modest tax proposals for taxing wealthy investors in discretionary trusts are abandoned by the Government. This is the context in which we are putting forward our motion this evening. If one were to pay heed to what one hears it would seem that the principle is accepted by all that those who can most afford to pay should carry the burden of coping with the difficult financial situation but we find that this is not the case. It is the weakest and the poorest that are hit hardest. This applies under the present system to every crisis that arises.
Those quotations made by Members on the Government side show their inconsistency. I should like to know why the information was not available at Question Time today when I asked what further items have been removed from the GMS prescribing list as stated in a letter dated 23 April 1983 from the General Medical Services (Payments) Board to pharmacists.
