Liam Twomey (Fine Gael)

I am sorry Senator Norris was cut short because he was making a fine contribution to the debate. It is a pity a few more people are not here to listen to what is being said.

Health promotion is linked to disease prevention. We have not exactly covered ourselves in glory with regard to implementing many of the health promotion initiatives referred to in this debate. The smoking ban has probably been the most effective of these initiatives but huge numbers of people continue to smoke and this has major implications for their general health.

We allowed the problem of alcohol consumption to spiral out of control, particularly in the context of legislation introduced by the Government and the relaxation of certain rules. People's alcohol consumption has been reined in to some degree but it is clear that health promotion was not an aspect of the Government's policy in this area in recent years.

The position in respect of obesity is strange. I do not believe the Government supports the report of the national task force on obesity. We are not doing enough in this area. Reports are being issued and small initiatives taken. When one considers, however, that this is a health crisis, it is clear that we are not at the races in terms of tackling it.

The Minister of State referred to the cardiovascular health policy group. In recent years there have been fantastic developments in cardiovascular health care — in other words, dealing with heart disease — in the context of outcomes for patients. This was achieved through health promotion, health prevention and health care. People were made aware of the dangers through health promotion, health prevention came in the form of the Heartwatch programme run by general practices and primary care facilities and the health care aspect was dealt with by means of upgrading bypass and heart surgery clinics throughout the country. The latter made a fantastic difference in the context of health care. If we did the same in respect of cancer care, there would be fantastic changes in the next couple of years.

A point missed by many Ministers is the fact that what I have stated was reflected in what occurred in recent days in respect of the budget. The Minister for Health and Children, Deputy Harney, has a pathological obsession with GPs and primary care in general. That is what caused the debacle involving medical cards for those over 70 in recent days.

The Minister received plenty of warnings regarding the nature of the issue relating to the over 70s. During the past seven years there has been a major disruption of primary and general practice care as a result of this matter. Due to the fact that the Minister set out to pay GPs capitation fees three to four times greater than they would normally receive in respect of people aged over 70, general practices in wealthier areas were able to utilise the additional resources that were becoming available. It was not just a case of there being a capitation issue in respect of those over 70 years of age, grants were also made available to general practices in respect of practice nurses, secretaries and managers. The money did not go into GPs' pockets. In order to obtain the funding, they were obliged to take on practice nurses and managers. This allowed general practices to do a great many things in the context of primary care provision.

I employ a practice nurse who is able to administer the flu vaccine to elderly people during the winter months and who also runs clinics for diabetics. The Minister of State referred to the increase in the incidence of diabetes. My practice is now in a position to screen patients for diabetes, high cholesterol and blood pressure problems. If the proper practice supports are not in place, there will be no possibility of our having practice nurses.

By dismantling, in an extremely simplistic way, the scheme that was in place, the Government has done more than just insult elderly people by removing their entitlements. Its action will result in the creation of a problem in primary care in the coming years. It is almost stupid for the Minister to refer to shifting services from the hospital sector to primary care when it is clear that she is going to withdraw supports for primary care. I will await with interest the results of the review being carried out on the Government's behalf by a senior civil servant, particularly in the context of whether he recommends that the practice supports to which I refer will be withdrawn.

The one good development in recent days is that the inequality which allowed general practices in wealthier areas to avail of these supports while those in less affluent areas could not will be a thing of the past. If one examines the position regarding health promotion and disease prevention, one will discover that it is in the poorer and more deprived areas of our cities that problems relating to alcohol abuse, people smoking too much and obesity arise. However, Government policy to date has been structured towards better-off areas. We will wait and see whether the review to which I refer tackles the inequalities to which I refer. I will monitor developments closely.

Disadvantages were built into the system for political reasons. I am surprised the Government walked into this mess last week, particularly as it would have received numerous representations from the very GPs who were in receipt of capitation payments warning that discrimination was occurring. There is no point in blaming Deputy O'Reilly for being a far better negotiator than Ministers. Perhaps the Government should avail of his services because it will be obliged to engage in negotiations with many different interest groups in the coming months.