Dáil Éireann - Volume 399 - 06 June, 1990

Written Answers. - Primary Health Care.

41. Mr. Garland asked the Minister for Health if, in view of Ireland's signing in 1978 of the WHO Alma Aba Declaration which stated that primary health care was the key to attaining health for all by the year 2000, and called on all Governments to formulate national strategies, policies and plans for action to launch and sustain primary health care as part of a comprehensive health service, he is satisfied with the Government's commitment to primary health care; if he considers that the financial provision for community and primary care is adequate to reach the target as set out in this WHO declaration; if he will outline the Government's commitment to primary health care; and if he will make a statement on the matter.

Minister for Health (Dr. O'Hanlon): I place considerable importance on the concept of primary health care, which is [1327] central to the World Health Organisation programme, “Health for All by the Year 2000”. Primary health care is not confined to medical care and curing but also encompasses prevention, health promotion, rehabilitation and personal social services. I am continuing my efforts to develop primary and community care and to make the services more responsive to real needs. While accepting the reality of a continuing role for other levels of care. At the same time, effective planning and management arrangements are being reviewed to provide an integrated network of complementary services to meet measured health needs in the population.

I consider general practice to be a key element in meeting the Government's commitment to the reorientation of the health services towards a more efficient delivery of care at the primary care level in the community, with a consequential lessening of the demand upon acute hospital services. I have taken steps to strengthen the capacity of the general practitioner service and to forge better links with the other community based services and the hospital system.

A number of important initiatives have also taken place in the context of health promotion. Much of the premature illness and death in our society e.g. from cardiovascular disease, cancer, accidents, is linked to unhealthy behaviour and lifestyle — to such factors as smoking, alcohol abuse, unhealthy diet, stress, lack of exercise. At the beginning of 1988 the Government put in place a new Health Promotion Structure. A wide variety of health promotion projects are in train to reduce the toll of avoidable deaths and illness from accidents, alcohol, smoking, and diet, including the Kilkenny Health Project, the measles, mumps and rubella campaign, the anti-smoking campaign, the issue of an updated information booklet on AIDS and the development of a Drink Awareness for Youth Programme in co-operation with the National Youth Council.

A range of community based facilities [1328] such as day hospitals, day centres, supported hostels and community residences have been developed and put in place.

Another area of the health services which has undergone fundamental change is the psychiatric service where the delivery of the service has changed from an institutional base to a community setting. A greater number of people with psychiatric problems are now living more meaningful lives in the community.

These specific developments will build on the framework of a rationalised and integrated health care service which has been developing over the last few years. It will enable us to carry forward the strategy already marked out in such areas as mental health, mental handicap and services for the elderly.

Community care has increased to 26 per cent of total health expenditure in 1990 from 20 per cent in 1980. The average annual increase in community care expenditure in the period 1980 - 1990 has been 11 per cent. Tangible evidence of the commitment to orderly development was given in the budget when the Government made additional resources available for priority needs in mental handicap, services for the elderly and in the dental services. For example, half of the £5 million additional allocation to services for the elderly is being used to help strengthen home care, including home nursing and home help support. The remainder of the allocation will be used for such matters as the provision of more facilities for increased day care and additional nursing home — places for heavily dependent elderly people, thus bringing well earned relief to many caring individuals and families. A new carer's allowance worth £45 per week, will be introduced later in the year. This progress in the development of community and primary health care will be maintained in future years.