Dr. John O'Brien:

The inverse care law works on the principle that poor people have greater problems with their health. The GP that I was talking to during the week told me that, last year, there were 20 people in the practice who had died. Of that group, four were over the age of 60. That gives an idea of what happens when people are poor. They get more ill, more illnesses and they get them earlier in their lives. They usually have a multiplicity of illnesses. This feeds into the financial emergency measures in the public interest, FEMPI, matter because those patients are covered by the general medical services, GMS, contract. The funding going into GMS following the financial emergency measures has resulted in them being unable to get the same amount of time and attention from their GPs because the funds are not there to employ the extra staff necessary to deliver that. If we take that a little further, the service in west Dublin for psychiatry only has two psychiatrists. It has lost one psychiatrist. It operates with locum staff. Several key staff members are missing for a variety of reasons, including maternity leave and not being replaced. The waiting lists have expanded there and now run out to five months for routine matters. It is not routine because 90% of routine matters are dealt with in general practice. If people get beyond a general practitioner, it is far from routine. If we bring it into the mental health domain, the poorest section of the community with the greatest degree of problems gets its resources delivered at the same rate as the rest of the community when it needs more than the rest. If there are twice the mental health problems in a deprived community, then twice the amount of mental health services are needed in that community. That is not what happens and as a result people get much less the poorer they are and the more they need.