Phil Prendergast (Labour)

The Minister mentioned that half the people who are on hypertensive medication should not be on it. I agree with her. What was very common during my time in active nursing was what was called "white coat syndrome", whereby if one went to the doctor and one's blood pressure was taken immediately, the blood pressure was bound to be high as the nature of the visit to the doctor caused it to happen. If people who are on medication had frequent check-ups in the primary care setting by utilising the public health nurse system more effectively, it would give rise to a review of people's medication. A series of estimations of blood pressure taken over a series of days would allow that. If there is a track that shows blood pressure within relatively normal limits, is that down to the fact that the patient is being visited by a public health nurse specialist or to the fact that they are on medication? If the blood pressure is down, should they try to only have the medication every second day? There is scope, therefore, for examining best practice with regard to how people are monitored.

It is also widely acknowledged that if people make lifestyle changes, their need for medication reduces. In the case of somebody who is overweight and suffering from hypertension, for example, reducing the weight could reduce the blood pressure as well. There is also diet, exercise, reducing salt intake and so forth, all of which is well known. The issue is trying to tailor the medication needs of individuals. If there is a primary care team operating effectively and people on medication are regularly checked by public health nurses, it would be a far better system because, in fact, people's need for medication would reduce. The fact that people would be able to make changes and perhaps stop taking medication is a positive thing, rather than a visit to the doctor resulting in somebody having to continue or increase their medication. That is a far more depressing scenario than somebody telling them there is no need for it because they have made a number of changes in their lives.

The moratorium in the recruitment of public health nurses and the fact that 120 posts are not filled are having a major impact on how people are treated. There is scope within the system to make the savings other than through imposing a charge on prescriptions.