Billy Kelleher (Cork North Central, Fianna Fail)

-----it is an issue we should examine.

On the broader issues of primary care and home care, as we move towards the idea of more home care supports we must not lose the traditional relationship between a GP and a patient. If a person wishes to remain at home, there must be some encouragement beyond the dedication of the doctor and their commitment to their patients. There should be an some incentive that they would buy into the whole idea of supporting home care packages and assisting people to remain at home for as long as possible. If we want to get people out of the acute sections of hospitals after procedures into step-down facilities and back to their homes as quickly as possible, the GP will have to play a role in supporting them in convalescence and equally if they are at home.

While we have health promotion in Ireland to reduce tobacco and alcohol consumption, obesity is becoming an issue that is of concern in view of the pressures it puts on individuals in the context of heart disease, diabetes and many other complications. As a society we must become more embracive of healthy living across all sections. This is not just about promoting sport but the concept of health should form part of normal life in primary and secondary schools, in dietary, in nutritional education and in home economics. The PE curriculum should be extended and the GP should be at the centre of health promotion not only in the context of encouraging people to give up cigarettes, but that it becomes part and parcel of health provision. There should be a consciousness that a healthy lifestyle, activity and diet are all part and parcel of a package. Everybody would accept that if we continue as we are, even though efforts are being made in the context of the health services promotion unit and the control of tobacco, it is still haphazard or disparate at the very least. There is a need for a strong and co-ordinated effort through schools, sport facilities, local authorities, the health services and across the whole gamut of agencies, departments, civil society and the community and voluntary sector.

When travelling around the country one becomes aware of nice amenities and walking areas and the promotion of that type of activity. The GP and primary care centres must play a central role in the development of this concept. I visited Australia a few times on trade missions. It was evident there that all of society had bought into the idea of healthy living. I appreciate it has a nice climate and it is more conducive to outdoor activities, but I could sense the healthy lifestyle, the abhorrence of tobacco in the context of it being socially unacceptable and the promotion of healthy foods in all its aspects. That is a critical issue. I may be straying from the Health (Provision of General Practitioner Services) Bill 2011 but if we develop this theme in our minds and in society it will benefit us in the years ahead.

The issue of obesity must be challenged head on given that the statistics for same are quite alarming. We have only to look at the country that now sets a precedent for western world living in the context of changes in attitude and behaviour and how we live. The US is experiencing enormous difficulties and challenges in that context. In the coming years I hope that calorie count legislation, or the use of some mechanism and changes in attitude and behaviour will enable us address this issue before we allow a generation to be robbed because of our inactivity in addressing this challenge. These are key areas that build into primary care being at the centre of where health services are delivered and where healthy lifestyles and options are encouraged and promoted.

In most GPs offices, the health promotion unit has stickers on the wall, perhaps showing people running up the road or another sticker showing somebody else trying to give up cigarettes. This has to be at the heart of health promotion. As a GP, the Minister sees that at first hand. Wherever he can, I ask him to develop a policy and a theme around the whole idea of healthy living.

Obviously GPs are the front line service providers along with nurses. Once primary care units are established, lines of demarcation and barriers in the context of professionals having certain trenchant views on certain issues will become a challenge in itself. Nurses, because of their training and qualifications, are moving into areas which traditionally would have been the GPs remit. While I welcome this, it is an issue that creates friction. I suggest we look at that issue in the context of setting up a single primary care unit with many different professionals, eminently qualified, all providing health services and working, hopefully, in harmony and unison. However, that is not always the case as has been identified even in some hospitals where there are differing views and people who may not have the best people and management skills.

I welcome the Bill. The lifting of restrictions will allow more GPs to establish and provide good quality front line health care to patients. My only concern, which I ask the Minister to look at in the context of the Committee Stage debate, is that if there is a complete opening up there must be a mechanism to ensure that out-of-hours service is provided and that a certain number of hours of GP service is available. A former Member and party colleague, Mr. Charlie O'Connor, sent me a note today, not being aware this matter was being discussed, on the shortage of GPs in Tallaght. I do not know why that is the case. Is it because of the socio-economic make-up or that it is a new evolving growing town and that the restrictions heretofore of doctors accessing the General Medical Services scheme have allowed this to happen? We should be concerned if there are not enough GPs delivering front line services in areas such as Tallaght, which has many young people, young mothers and children, because that could create its own difficulties. It is possible that impacts on the pressures at Tallaght hospital. If people cannot access GPs in a reasonable time, they present at accident and emergency departments which, in itself, can create further difficulties and pressure points in those departments and a follow on of the difficulties Tallaght has experienced recently. I hope we can have a more clinical debate on Committee Stage.

I do not wish to appear like a puritan or a persecutor of people who like to enjoy themselves. In encouraging a reduction in the use of tobacco there is one view in the Health Service Executive about raising excise duties and tax on cigarettes in order to reduce consumption, and on the other side of the argument those in Revenue and the Department of Finance highlight the fact that the more one increases taxes the greater are the diminishing returns to the Exchequer because of smuggling. I am not sure which argument wins but reports have been carried out by the Irish Heart Foundation and the Revenue Commissioners.

I am not in favour of hiking up the price of cigarettes for the sake of it. If prices are to be increased as part of a health promotion policy, then the revenue generated should be used to encourage people to give up cigarettes. Consideration could be given to the provision of supports and assistance such as nicotine substitutes. I say that as a person who has battled with the weed on and off since I was 14 years of age. It is easy to give up cigarettes. I give them up regularly. Many people require more than just a direction or encouragement by a doctor to give up cigarettes. Supports other than a helpline are required such as nicotine substitution. Supports such as nicotine substitution are provided by the National Health Service in the United Kingdom. We should examine that possibility. If we decide to go for a hike in taxation to discourage the use of cigarettes, the revenue should be used to encourage people to give up cigarettes. I wish the Bill a speedy passage. I hope that its intention will be brought to fruition and that what the Minister outlined will come to pass also.

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