I said last evening that this important debate on the future of the general medical service scheme takes place in a totally unreal atmosphere, characteristic of the atmosphere that has prevailed in this House over the past two or three days. Since last evening the position has progressed from being unreal into being quite bizarre. Again today we have had the unedifying spectacle of Government Ministers and party spokespersons for the two parties in Government squabbling on the national airwaves. At least this disgraceful position will end tomorrow. The people will have an opportunity in about three or four weeks' time of passing judgment on this Government, on all their performances and policies.
In relation to their stewardship of the health services — the focus of our debate this evening — I have no doubt that both parties in this Government share equal responsibility and that they can expect no comfort whatsoever from the people. I dealt last evening at some length with the overall state of the health services and the indebtedness of the health boards nationwide. I put that level of indebtedness on the record for all to see. That is simply an indication of the neglect of the health services in general. The motion this evening focuses on the threat to the general medical service scheme by the possible withdrawal of a majority of general practitioners from its operation. We have a very fine general practitioner service in this country, a scheme and service that has developed over the years and enjoys the trust of the people, particularly the most vulnerable sections of our community totally dependent on the system, the elderly, the unemployed and the poor. It is a service which has performed well, giving frontline, basic and comprehensive health cover to people at home and within their local communities.
I said it is a service in which the people of Ireland trust, but that trust has now been fundamentally damaged. In the course of this debate I do not want to spread alarm or anxiety among the many thousands of people dependent on this service. I have no doubt that, even if it comes to pass that the majority of general practitioners are forced to withdraw, there will at the end of the day be very few doctors who will turn away patients in need of their help or assistance. If that were to happen it would be flying in the face of everything for which the medical profession stands. I do not believe it will happen, but what I am afraid will happen is that there are people out there — the poor, the old and the sick — who will be reluctant to call a doctor. These people are proud and independent and would be extremely reluctant to, as they would see it, throw themselves on anybody's charity. That is what will happen, as happened when one of the Minister's predecessors introduced charges for outpatient visits, when the elderly in particular simply stayed away and suffered at home. The statistics will not be visible but the hardship will be real.
We are now coming into the time of year when elderly people in particular are at their most vulnerable. Some years ago this Government took a policy decision, euphemistically described at the time — I thought it was a good line — as the shortening of the heating season, as if a Government by decree could decide that they could shorten the period of time when the weather was cold. Of course, in reality that decision simply meant that the number of weeks every year when free fuel would be available to pensioners would be dramatically reduced. Already this year we have seen the coldest start to a winter for many years. I dread to think what will happen to hundreds of people who feel they cannot call out their doctor as the winter progressively worsens.
The Minister has told the Dáil, in answers to questions I put to him on 21 October, that he will make alternative arrangements to ensure that medical card patients continue to receive general practitioner services even if the dispute goes ahead. The Minister must know that the answer he gave is simply fooling the people since the health services are already staggering under the weight of the financial debt I outlined last evening and the cutbacks imposed by himself and his predecessors. It is inconceivable that any effective alternative arrangements could be put in place on the timescale available.
When this Minister has left office it may well be that the only thing for which he will be remembered will be the glossy charter of rights for hospital patients he produced. I predict that will turn out to be seen as the public relations stunt of the year, as meaningless as any of the other Government policies simply because it was unresourced in any way. That charter is the only place one can read something about Ireland's health services, but one does not see the reality of patients on trolleys, beds in corridors or nurses and paramedical staff being laid off. That is the reality of Ireland's health service today. The crisis facing the general medical service system can only add to the sense of injustice surrounding the operation of our health services in 1992.
The Minister spoke last night about the high cost of high-tech medicine. I share his view that there is probably no developed country in the world which can afford an open-ended budget for health expenditure. It is a system that can absorb all the money that can be made available to it. It affects even the very rich countries. We have seen America fight a presidential election with the quality of health cover and health insurance as a major issue for both main presidential candidates. Therefore, it is clear that every country is faced with a challenge and a crisis in relation to proper, adequate and comprehensive medical cover for all its citizens. Surely in the light of that fact the general medical service, which is the front line service, should have priority.
The total expenditure on the GMS as a percentage of all health expenditure was outlined in detail last night. It is clear that if we properly resourced primary front line care, which is the GMS, there would not be the need for many of the more expensive hospital based procedures that are currently embarked upon. It is false economy for the Minister not to recognise that reality. It was also a false economy for his predecessor to close down geriatric hospitals, county nursing homes and other small hospitals up and down the country which cared for geriatrics and people who were convalescent. What happens now when those elderly people become sick and simply require a couple of days rest as opposed to intensive medical care? They enter acute hospitals where the cost of taking care of them is three or four times greater and force out people who need more acute care. That is a false economy, a wrong policy. I hope the Minister will recognise that and set about rectifying the situation.
The Minister spoke also last night about re-organising the GMS. He referred to multi-centred group practices, co-operative centres, shared facilities and other matters. I wish to state in relation to those suggestions that the patient must be the focus of any new arrangements and, in particular, any new arrangement that is put into place must have as its centre the right of the patient to select the doctor of his or her choice, and not the one that is convenient to any new re-organisation. The Minister also spoke last night about indicative prescribing targets. He emphasised that any such targets should be realistic but I am concerned that there would be a widening disparity, if that sort of objective was pursued, between the level and quality of service available to private as against public patients. I would ask the Minister or the Minister of State when responding to the debate tonight to explain in greater detail exactly what is meant in the script by the sentence that the Minister was seeking a greater contribution from other sources. What exactly are "other sources" in relation to the GMS?
It is clear to me that this is probably the last time I will speak on a health issue in the 26th Dáil. The current Minister is not very long in office. He came to office amid great expectations from all sides of the House and, indeed, from the broader public. Sadly, he has neither halted nor reversed the damaging health policies of his Fianna Fáil predecessors.