Gay Mitchell (Dublin South Central, Fine Gael)

According to research done for the ESRI on Irish men aged 55 to 64, higher professionals have a death rate of 13 per 1,000. This rate rose to 22 per 1,000 for semi-skilled employees and to 32 per 1,000 for unskilled manual groups. The latter have a death rate per 1,000 almost three times higher than that for professionals aged 55 to 64, yet these are the people to whom we deny the medical card. They need it most and are dying in greater numbers because they cannot afford to go to the doctor. Neither can they afford to be joining health clubs or to holiday, and therefore they are more likely to have a drink too many or smoke cigarettes.

If we are serious about reforming the health services, we should ensure that they are opened to those who need them. It should not be the case that because one does not have the money, one's child cannot see a doctor. People should be able to see a doctor when they need to, irrespective of their bank balance. It was an absolute outrage to give doctors three times the going rate to treat medical card holders over the age of 70. That is the deal they sought and got. Prior to this deal, they said they would not agree to it because poor people were being left without a medical card, yet they forgot about the poor, accepted the deal and gave the medical card to the over-70s. I have no problem with that. However, I am concerned that poor people were omitted by the Government and doctors, and this must end.

I want to refer to the point made by Deputy Durkan. I would like the Minister to consider on Committee Stage that Members of this House cannot ask questions of agencies set up and funded by this House. It is time to create an office of surgeon general, and that person would not necessarily need to be a doctor. A qualified person, similar to the Comptroller and Auditor General, could report directly to Dáil Éireann. The report could then go to the health committee where the surgeon general would sit as a permanent witness, as does the Comptroller and Auditor General at the Committee of Public Accounts. He or she could be the powerful advocate of patients working with the Dáil to make the system accountable. There is a yawning gap in accountability between these agencies funded by Dáil Éireann and accountable to the House.

Much more could be done to keep people at home. For the equivalent of approximately IR£10 million or €15 million — I did the calculation before we entered the euro — we could allow elderly people to spend up to IR£3,000 to convert their homes by fitting stair rails, bath fittings and so on. These people could then remain at home and not end up in step-down facilities. In some health board areas there is a three year waiting list to get an occupational therapist to assess whether an 80 year old needs a rail to get up the stairs. If that elderly person falls down the stairs, he or she is hospitalised and put into a step-down facility. I advocate that GPs should make these decisions until the waiting list is cleared.

I have two further points to make, one of which relates to pharmacies. Pharmacists who are well qualified and available to the community should be given a better opportunity to advise people. However, one would not like to stand in a shop while somebody else is buying photographic equipment or make-up and ask the advice of a pharmacist behind a cash register. Pharmacists should be given an incentive to set aside part of their premises where people can consult them quietly, and that would take significant pressure off doctors.

It is clear there is a serious problem with paedophiles, which in the past was swept under the carpet. It is not just an Irish problem, it is an international problem. This appears to be a psycho-sexual condition, with which we are not coming to terms. When we come to terms with it, it is usually at the criminal justice end of the cycle. Vincent Browne wrote a controversial article on the issue some time ago. During his commentary later he said that he would do terrible violence to anyone who attacked one of his children in that way. I am sure many of us would share that emotion. However, some paedophiles do not give in to their tendencies. I am aware of one such person who visited a Deputy to find out where he could get treatment, and he received treatment.

There should be some strategy to encourage people who have these tendencies to receive treatment. Treatment should be made available to them before a crime occurs. This might entail psychological and psychiatric advice, and psycho-sexual advice if necessary, particularly on avoiding places where there may be children and so on. People who have this condition but have not committed a crime should be treated. There should be a specific plan to make treatment available to people who have committed a crime before they are readmitted to society. I ask that some strategy be put in place in this regard. I am raising the issue because it is never debated and the issue arises usually after someone is sentenced by the courts. There is need for a much more proactive approach in this area.

Any reforms to improve the health system must be welcome. However, there must be transparency and accountability. Even though we are low in the OECD expenditure league on health compared to other European countries, particularly before the Union was enlarged, our health expenditure has grown and is still growing. This expenditure must give value for money, result in productivity, serve patients' interests and put patients first. I ask the Minister to ensure that there is full accountability to this House for that expenditure.

See this speech in context