asked the Minister for Health the number of persons in County Westmeath who have been removed from the general medical services register from January 1983 to date.

The information which the Deputy is seeking will tend to vary from day to day as the health board removes some persons from the general medical services register and adds on others. The total number of persons removed from the general medical services register in any area at any point in time is not routinely available in my Department. I suggest, therefore, that the Deputy might get in touch with the Midland Health Board in order to get the most up-to-date statistical information available on this matter.

When a question is put down demanding a simple answer it is not good enough to be told by the Minister that he cannot obtain the information, that I should go to the Midland Health Board. I understood that the machinery of putting down questions to a particular Minister was to extract a specific answer. I do not accept that a Minister can say to me he cannot readily get it or that I should go to the Midland Health Board and get it. I am entitled to receive it here in this House.

In no way do I not want to provide information to the House on any matter. But the latest information I have relates to the year 1983 which ended only six weeks ago. For the information of the Deputy, there were 1,488 medical cards covering 2,583 persons cancelled last year in County Westmeath. In the same year there were 1,997 new cards issued covering 3,397 persons, a net increase at the end of the year of 814 persons. I might stress that, in the first year of my term in office, there was a substantial increase in the cover given to the population, which increased from 38 per cent to approximately 39.5 per cent.

That is not the question I asked. Quite naturally the increase is reflected right across the country, not alone in the Midland Health Board because, sadly, the growing number of unemployed and people who must have recourse to medical cards, whose disposable income has dropped enormously has increased. The question I asked and to which the Minister, under pressure, gave a reply related to the number of medical cards withdrawn from applicants in the Midland Health Board which he said was 1,488 affecting 2,500 people. Arising out of an earlier reply of the Minister I might put it to him that surely he, as Minister for Health — as all Ministers for Health — should be advocating preventive medicine and not advocating, as he is, to students to go to hospitals, to casualty officers and partake of the hospital services when preventive medicine with one's local friendly general practitioner is by far the best type of medicine particularly for young people who would seek to establish a rapport with their doctor?

I felt the Deputy would find a way of asking that one.

Whereas I support the continuation of the general medical services scheme it is not necessarily proving to be the best in terms of preventive and community care. For example, for every £1 of a visit which a person makes to a GP at present approximately £3 of drugs is issued, that is for 40 per cent of the population. For the other 60 per cent the ratio is about one-third of that. Therefore, there is something very wrong in terms of our expenditure in that area when we are spending £85 million a year, £50 million of which is on drugs. Quite frankly, I have the gravest reservation about the extent to which that has an impact on preventive and community care. I should like a different system to be agreed between myself and the medical profession of real preventive and real community care, not based on a fee per item of service, that every time one walks into a doctor £X is paid and there is then the incentive to issue a prescription for more drugs to be consumed, for example, giving £10 million to pharmacists, £40 million to drug companies and approximately £20 million to doctors for doing what I regard as not necessary in the interests of the best preventive care or health system.

Is the Minister aware that those who hold medical cards are those at high risk, the elderly, large families and poorer families in society? Would he accept that that is the reason they demand a higher level of service than those without medical cards? Would the Minister not accept that?

I agree completely but I fail to see a differentiation of 5:1 whereby people who are holders of medical cards, 40 per cent of the population, have an incidence of visitation five times greater than the rest of the population and an incidence of consumption of drugs four or five times greater as well. There are some very serious questions to be posed about that — whether the system as it operates is an incentive, not for health care but for visitation, for the issuing of prescriptions and for drugs consumption.

I have given the last question to Deputy O'Hanlon.

Could I ask the Minister the reason why?

I am sorry, Deputy, no, I have given the last question to Deputy O'Hanlon.

Could I ask the Minister——

I am sorry, no, Deputy.

In view of his reply, he does not understand the difference with regard to patients at risk.

I said that that was the last question.

The trouble is that we understand far more than we are prepared to admit.

9.