Dr. Matthew Sadlier:

The Irish Medical Organisation, IMO, thanks the committee for the invitation to today’s hearing. In our budget submission, we wish to highlight the negative effects of the economic downturn on the health service as well as the opportunities the recession can create to improve health and health care. Our submission covers four main areas that I will try to go through as briefly as possible.

Regarding health system reform and investment in health services, a recession offers opportunity for reform and the Government is embarking on a major reorganisation of our health services in order that the majority of an individual's health care needs are met in primary care. Since 2009, however, Government expenditure has decreased by 10% and there are 11,000 fewer people employed in the health service. While some efficiencies have been made, there have been signs in the past year or so that the health system is under significant financial strain.

In terms of hospital services, the IMO recommends that capital funding be provided to support the proposed reconfiguration. Under the principle of money following the patient, the Government must ensure adequate financial and human resources are provided. To ensure primary care patients are treated in the appropriate setting, money must follow the patient out of secondary care and into primary care. Chronic disease management and prevention must be adequately costed and resources must be forthcoming from this important programme. The Government must also ensure adequate investment in facilities and resources to support primary care teams.

The IMO is concerned about growing health inequalities and inequalities in access to care due to the recession. It is important that budgetary measures do not widen these gaps further.

The IMO welcomes the publication of "Healthy Ireland" and is calling for the development of a detailed implementation plan. We emphasise the importance of a health impact assessment. All public policy, including budgetary measures, should be subject to health impact assessments.

Regarding access to care, there should be no further increases in out-of-pocket payments for all public patients. The Government must identify and prioritise resources for universal access to primary care.

The third pillar in our submission regards suicide prevention. There is a link between recession and suicide. There is a need, therefore, to ensure adequate resources are available for a suicide prevention programme. We recommend the full implementation of the recommendations outlined in Reach Out, the national strategy for suicide prevention. We also call for the availability of suicide intervention teams in all hospitals on a 24 hour, seven day per week basis, and for the piloting of community-based, 24-hour crisis mental health care provision throughout Ireland.

Our submission's final pillar of minimum alcohol pricing is fitting, given the day that is in it. Despite an increase in excise duties last year, alcohol remains cheap to purchase relative to the societal costs of the problem. There is room to introduce a minimum alcohol pricing structure to reduce the burden of excessive alcohol consumption. There is evidence from Scotland, which is pressing ahead with minimum pricing, that difficulties arising from EU competition law do not apply to this issue. The IMO calls on the Department of Health to continue working with counterparts in Northern Ireland and Scotland on introducing a minimum price structure for alcohol, based on grams of alcohol as opposed to units. We also published a paper recently on young people and alcohol that we would be happy to distribute to the committee.