Ms Vanessa Hetherington:

The Irish Medical Organisation would like to thank the committee for the opportunity to discuss the IMO budget submission. In the submission, doctors in Ireland wish to highlight the negative effect of the economic downturn as well as the opportunities the recession can create to improve health and health care. A recession offers an opportunity for reform and the Government is embarking on a major reorganisation of our health services, to include reconfiguration of our hospital services and reform of the delivery model so that the majority of an individual's health care needs are met in primary care.

Since 2009, Government expenditure on health has fallen by 10% and there are 11,000 fewer people employed in our health services. Efficiencies have been made and more people are being treated with fewer resources. However, there are signs that the health system is under financial strain. Investment in our health services is needed now if the Government is to achieve its programme of reform. Specifically, the IMO recommends that capital funding must be provided to support the reconfiguration of hospital services. Under the money follows the patient policy, the Government must ensure that adequate financial and human resources are provided to address growing waiting lists for elective care and outpatient services. In order to ensure that patients are treated in the appropriate setting, money must follow the patient also in primary care. Chronic disease management and prevention must be adequately costed and resources must be forthcoming and the Government must ensure adequate investment in resources to support the development of primary care teams.

The IMO has highlighted over a number of years the significant inequalities that exist in the health area between wealthier and poorer socioeconomic groups in Ireland. Evidence shows that poorer socioeconomic groups have relatively high mortality rates, higher levels of ill health and fewer resources to adopt healthier lifestyles. Significant inequalities also exist in accessing health care in Ireland. Those who have neither medical card nor private health insurance and who are subject to significant out-of-pocket payments are most affected. The IMO welcomes the publication of Healthy Ireland and calls for the development of a detailed implementation plan, with appropriate multiannual ring-fenced funding to support actions and initiatives. Healthy Ireland also emphasises the importance of health impact assessments and the IMO believes that all public policy, including budgetary measures, should be subject to a health impact assessment. With regard to access to care, there should be no further increase in out-of-pocket payments for all public patients. The Government must identify and prioritise funding for universal access to primary care, in agreement with all the relevant stakeholders.

The IMO submission also discusses suicide prevention. A recent study by the National Office for Suicide Prevention found some association between recession and suicide and because of this link, there is a need to ensure adequate resources for suicide prevention during this time. The IMO recommends that ring-fenced funding be provided for the full implementation of the recommendations outlined in Reach Out, the national strategy for action on suicide prevention and the recommendations detailed in the report of the Oireachtas joint committee on the high level of suicide in Irish society. The IMO also recommends funding to ensure the availability of suicide intervention teams in all hospitals and to pilot the development of community-based 24-hour crisis mental health provision throughout Ireland.

Despite an increase in excise duty last year, alcohol remains cheap to purchase relative to the societal costs of problem alcohol use. Alcohol is associated with more than 60 acute and chronic health disorders, ranging from accidents and assaults to mental health problems, cardiovascular disease, liver cirrhosis and certain cancers. The overall cost to Irish society of problem alcohol use is estimated at €3.7 billion. There is a direct link between alcohol related harm and the volume and pattern of alcohol consumed. The IMO believes there is room to introduce a minimum alcohol pricing structure in order to reduce the burden of excessive alcohol consumption, by making alcohol more expensive for younger binge drinkers and excessive harmful drinkers, without necessarily penalising moderate drinkers.