Maurice Hayes (Independent)

That might be like asking the Minister to climb the north face of the Eiger in the current political climate. Primary health care contains the core of the answer to the problems. Without going the whole hog of a totally free system, Senator McDowell made some other suggestions. I believe the new generation of doctors, particularly female doctors, would welcome a different form of contract or organisation. Strong arguments exist for extending the co-operative system, particularly the after-hours system, which is very successful where I live in Northern Ireland and is staffed by young doctors. Equally much is to be said for ensuring that children have care in the same way and a great deal of weight could be taken off accident and emergency departments by having minor injuries units staffed by nurse practitioners as well as by such doctors. Changes are taking place in the boundaries between professions and roles and we should be prepared to take advantage of these changes.

Since the cost of drugs is so penal, not only on the health service but also on those who have to buy their drugs when they lose eligibility, a case may be made for more insistence on generic prescribing. It is worth looking at the organisation of the health service to determine why it costs so much in terms of input to produce a relatively small output. The machine has an enormous capacity for consuming resources and just keeping itself going. We used to argue that for every £5 of input, we were lucky to get £1 of improved output.

I refer to a matter to which Senators Henry and Feeney adverted, namely, the case of a small number of survivors of the polio epidemic in the 1950s. They are now aged and some are frail. They have very heavy medical costs and generally do not have medical card eligibility. I was present at the Oireachtas joint committee on the day they appeared before it. The Secretary General of the Department was questioned and was to come back to explain why they could not get these cards. I would like the Tánaiste to make that a matter of personal interest, as it could do an enormous amount of good for a very small expenditure.