Health Service Executive/Alcohol and Antibiotics: Presentation
Deputy Gormley: I welcome the delegation. As I see it, Professor Drumm’s approach is to go back to the root causes of poor health. I agree that is what primary care ought to be about. Would he agree that one of the main problems in society is alcohol? We only have to look at the number of intoxicated people attending accident and emergency units to see this. The professor spoke about a disconnection. Does he agree that a blind eye is turned to the problem? Task forces have advised the Government on the best way to approach the problem and consultants were hired and paid well for their advice. They all advised that we should proceed with the alcohol products Bill but the Government has dropped it. The executive is not directly involved in policy making but is it possible for Professor Drumm to have a word in the ear of the Tánaiste and talk a bit of sense to her on the issue? We must return to the root causes.
Senator Henry hit the nail on the head with regard to the introduction of more private hospitals. Dr. Risteard Mulcahy spoke about his concerns to my party and possibly other parties. He said that if we look at the American model, we see that the private patient is sometimes over-treated because of the money involved. Last week I raised a question about general practitioners and antibiotic prescription. I was told that if general practitioners do not prescribe antibiotics, people will vote with their feet and go elsewhere. Therefore, general practitioners look at retaining their customers. This is a serious problem. The professor referred to measuring performance. How are general practitioners regulated in this regard? It is an issue we must consider seriously.
Will Professor Drumm gaze into the crystal ball and tell us about the future? We have a problem in all health services because we have an aging population. We have better technology and medication and, as a result, people are living longer and using up more resources. We will, therefore, be obliged to pay more for our health services and health insurance premia will rise. How does Professor Drumm see this panning out? Will there be a huge drain on the resources of the State? If, for example, we improve primary care and people remain healthier for longer, they will eventually become ill. We know more money is spent on people in the last years of their lives than at any other stage. Many people will live longer but this issue has not been debated. It is one of the most crucial challenges we face.
Professor Drumm: I will respond to Deputy Gormley’s questions. Alcohol abuse, a societal issue, exerts great pressure on parts of the health system such as accident and emergency departments. It is a challenge in the widest sense. If the HSE is to deal with it, it needs to decide whether accident and emergency doctors should be responsible for dealing with inebriation as a social problem. Should their dealings with people who are inebriated be strictly medical in nature until they are no longer inebriated? Fortunately, a medico-legal approach has been taken, that doctors are responsible for inebriated persons who arrive in accident and emergency units until it is shown that they are sober and capable of operating independently. This medico-legal and societal issue creates tremendous problems in the health service, not only because it leads to a direct increase in the workload of accident and emergency departments but also because the arrival of inebriated persons in such departments can have catastrophic effects on their ability to provide services for other patients. An improvement in the syndrome of acute alcohol intoxication would take a great deal of pressure from the health service. The problems caused by chronic alcoholism do not have such immediate effects on the service. I am not sure what the HSE can do to alleviate the problem of late-night and weekend inebriation.
The representatives of the HSE have given their views on the issue of publicly owned sites being used for private hospitals. The question of antibiotic control is central. Everyone is aware of MRSA which is by no means a uniquely Irish problem. It is having a huge impact in the United Kingdom and central and southern Europe. Most countries in northern Europe had managed to keep MRSA levels quite low but it looks like such levels are starting to increase significantly from a small base. I agree education is central to this issue. Those involved in the health provision system cannot legislate for how doctors prescribe. It is helpful for everyone — general practitioners, consultants and everyone who prescribes — that the MRSA issue has become part of the public agenda. It is the first time in my professional career that I have felt a certain level of awareness of the effect of prescriptions of antibiotics on MRSA. I was not aware of the problem to the extent I should have been. We all knew there was a problem but none of us was accepting responsibility for it. It is almost as if we are lobbying on behalf of the public in order that the message is transmitted. As medical practitioners, we feel we should be responsible for dealing with the matter. The concerns in this regard have to be taken on board, in conjunction with a major education programme. The HSE is heavily involved in trying to increase the level of education on the use of antibiotics.
I was asked whether future demographics would lead to increased costs in the health sector. Perhaps what was being described is not clear to everyone. This country has enjoyed the most advantageous demographics in the developed world in recent years. Our youthful population has enjoyed tremendously high standards of education. We have done many things well, for example, by keeping down taxes. We will have to face some challenges such as providing for more long-term stay facilities as the system has to deal with increased costs. We will have to take what this means on board. I accept that health costs will rise. I am challenging many of our present calculations on the basis of our advantageous demographics. We will face a tremendous shock if we do not face the challenge. If we are unable to meet the current challenges in an efficient manner, how will we cope when we face a real challenge in 20 or 30 years when there will have been an increase in the percentage of the population that is older?