As I indicated in the earlier part of my contribution on the health services, this Government's policy has been and will remain consistent with the broad strategy set down in the national plan, Building on Reality. The emphasis in policy now and for the foreseeable future is a shift towards prevention of disease and an emphasis on community care, ensuring that scarce resources are directed more specifically and selectively towards those in greatest need. The measures being taken in 1986 in the light of the allocation for health services should be judged in this way.
Naturally, at a time when resources are scarce it becomes more difficult to shift the emphasis within total spending, since development in one area must be compensated for by scaling down of activity elsewhere. This amounts to no more than a recognition that the cash resource we are dividing up is of limited size and that desirable policy changes must be achieved within those limits. However, it also imposes an obligation to ensure that the nature of the changes introduced are such as to improve the way in which resources are used. Policy changes must necessarily be directed to bringing about a more effective, equitable and efficient health care system and this Government can certainly point to a range of activities which satisfy these criteria.
First, there is no longer any argument about the need for a greater emphasis on the whole area of prevention and health promotion. This country is a party to the World Health Organisation strategy for Health for All by the year 2,000. There is a concentration in this strategy on the development in each member country of an active health promotion policy. While we can point to a number of services already provided in the preventive area, the strategy put foward by the WHO envisages a much more aggressive and comprehensive approach in which all decision making in an economy is informed to some extent by a health perspective. I contend that I have followed that approach and have introduced a number of immediate measures. For example, last year as a matter of budget policy we introduced a measles vaccination programme which came into effect on 1 October last. That scheme has achieved a 75 per cent vaccination of the target population in the short period since its introduction. This is almost three times the success rate achieved in the United Kingdom over a period of two years. The Government have provided an extra £250,000 to extend the measles scheme to the end of March, bringing total spending to date on the scheme to £900,000. The investment in this scheme will yield a very substantial return by eliminating much unnecessary and costly illness from the child population.
Developments in preventive services have not been confined to the child population, of course. Among adults, smoking is considered by the World Health Organisation to be the single most preventable cause of ill health in developed countries. Since about 5,000 deaths each year in this country are directly associated with tobacco smoking and the health of many more is impaired by smoking there is an urgent need for Ireland to adopt the type of measures advocated by the World Health Organisation.
As part of my programme to reduce the damage to health caused by smoking I recently introduced new Tobacco Products Regulations. The main effects of the new regulations are to introduce a new system of rotational health warnings and increase the space requirements for such warnings on tobacco advertisements and packages. The aim behind the new measures is to ensure that smokers are more aware of the risks smoking poses to their health.
Existing provisions relating to control of sponsorship are currently being examined and I will shortly be making recommendations to Government on any changes I think appropriate. It is also my intention to introduce shortly a Bill to prohibit smoking in certain designated public places and this Bill will include the collection of a levy on moneys used to promote sales of tobacco products, the proceeds of which will be used for additional health education on smoking and health.
At a broader level my Department are continuing to support the Kilkenny Health Project, which was inaugurated in March 1985. This project, which embodies a unique combination of research, education and primary intervention is supported by the Irish Heart Foundation and involves participation by the Medico-Social Research Board and South Eastern Health Board. Its aim is to bring about a reduction in morbidity and mortality from coronary disease in this country.
These initiatives represent concrete steps in the development of our preventive services. They demonstrate positively that it is possible to make progress, even when resources are under severe pressure, and they mark the direction in which the health services, in collaboration with other sectors, will have to devote an increasing share of their energies and resources.
The sensible strategy adopted in regard to community services is to switch the emphasis to community care when it is a viable option, recognising the need to maintain an efficient and orderly hospital system.
The Government's commitment to the development of community care is documented in a number of major service reviews completed over the past number of years. These include the report of the Working Party on the General Medical Service, which marked a serious commitment to the development of primary health care in this country and the review of psychiatric services which advocated a radical reorientation of psychiatric services to the community. The follow up to both of these reviews is currently proceeding and further reviews are planned for services for the elderly and on the whole question of community care organisation.
Commentators who point to the slow development of community care should recognise that we must learn to walk before we can run. In effecting changes in the balance between institutional and community care we need to be particularly cautious. What many people do not appreciate is that community care has significant implications for the community and not just the community-based health services. It involves to a considerable extent shifting the burden of care to the unpaid carers in the community — the families and friends of people who would otherwise be institutionalised as well as to the formal health services at community level. This caution should not be interpreted as a lack of commitment.
In the current year I am taking particular care to ensure that spending on particular community based services is maintained at a level equivalent at least to 1985 expenditure in real terms. These include key services for the old and housebound such as community nursing services, home help services and meals on wheels; child care services, particularly day care and pre-school services for deprived and disadvantaged communities, after-care programmes for children leaving long term residential care and boarding-out payments to reflect the trend towards increased numbers in foster care. The health boards have been asked to maintain at least existing levels of expenditure on dental, ophthalmic and aural services. The effect of these measures will be to discriminate in favour of community services in the allocation of resources between care programmes in 1986.
I also expect to see significant progress in 1986 in the development of comprehensive family planning services throughout the country. Following the commencement of the Family Planning (Amendment) Act, 1985, which eased many of the restrictions on access to contraception under previous legislation, the health boards were asked to review the services in their areas and to draw up plans to develop an appropriate level of service in their respective areas. Such plans have now been drawn up and their implementation, for the first time in this country, will ensure that the community has reasonable access to a full family planning service, now considered to be a basic prerequisite in the social reality of the eighties.
Another important element in this Government's programme of social and legislative reform is the introduction of new and more enlightened legislation in relation to children. The existing legislation in this area is now badly outdated and not in keeping with current concepts in regard to the well-being of the child.
Members of the House will now be familiar with the intent and terms of the Children (Care and Protection) Bill, which has now passed Second Stage. While undoubtedly a good deal of work remains to be done on the Bill, I am determined that it should now proceed through the remaining Stages and pass into law as speedily as possible.
I intend to bring forward a Bill to amend the Adoption Act which will provide for the adoption of legitimate children who have been abandoned or deserted by their parents. These major legislative reforms mark a milestone in our society's attitude towards the care of children.
One implication of the protection of expenditure levels on a range of community services is that expenditure on institutional services, and particularly the general hospitals programme which continues to absorb about half of total non-capital resources, cannot grow in an unplanned way. We have embarked on a major development programme in our general hospital system. This has culminated in the upgrading of many existing hospitals and the building of a number of major new hospitals. However, the underlying rationale has always been that in the interests of efficiency a lesser number of larger sized hospitals was preferable to a proliferation of small hospitals. We have always envisaged that some of the older under-utilised hospitals would be phased out of the system when the new developments came on stream. Indeed, any other course could scarcely be regarded as contributing to greater efficiency. We must also continue to find the resources necessary, as we did in 1985, to fund developments like open heart surgery in the Cork Regional Hospital and renal dialysis in Limerick Regional Hospital.
In regard to psychiatric services, I recently published a report The Psychiatric Services: Planning for the Future which sets out a clear-cut plan for a community oriented psychiatric service under which the need for the large psychiatric hospitals will gradually disappear. Health boards are currently preparing their plans for the implementation of the findings of this report.
This theme was also an integral part of the strategy outlined in the national plan. In 1986 we have reached the point when it is necessary and appropriate to commence the programme of rationalising hospital facilities. The Government have decided that the first stage will involve the closure, scaling down or phasing out in 1986 of certain facilities which are demonstrably superfluous in the context of a rational, cost effective and integrated hospital system.
The hospitals due for closure in 1986 include Sir Patrick Duns; St Patrick's Infant Hospital, Blackrock; Eye, Ear and Throat Hospital, Cork; Killarney Isolation Hospital; Castlerea Mental Hospital; Roscrea District Hospital; Longford County Hospital; and St Dympna's Mental Hospital, Carlow.
