Repeated tax increases on cigarettes and tobacco are forcing people to go without food in order to have money to satisfy their addiction rather than deterring smoking, the Joint Oireachtas Finance Committee has heard.

During a discussion of pre-budget submissions with a range of health interest groups, Labour TD Kevin Humphreys said the rise in the price of cigarettes in shops was forcing people to either buy smuggled or counterfeit products or go without essential items.

Excise duty on cigarettes has risen by some €1.80 since 2007.

Responding to Deputy Humphreys, Chris Macey of the Irish Heart Foundation said the tax was “regressive” but that the proportion of people smoking in Ireland had fallen from 29 per cent to 22 per cent in recent times and that higher prices were a “key driver” of the trend.

He said research involving young people had shown that they considered the cheapest cigarette to be the most attractive to them, and that while a “crude instrument” on its own, price rises were important as part of a suite or measures to combat smoking.

Representatives of the Irish Medical Organisation refused to be drawn on a suggestion from Mr Humphreys that GPs in certain areas, regardless of the quality of their offering, were all setting their prices at similar levels, which he said was "anti-competitive".

They said the organisation had no role in private practice or how its members set their prices as that would in fact be anti-competitive.

Replying to questions about the odious working hours facing junior doctors, IMO president Matthew Sadlier said it was “amazing” and a shocking indictment that people were being expected to provide intensive care to patients while working shifts of between 24 and 48 hours.

Socialist Party TD Joe Higgins said it was “quite incredible” that the “running scandal” of junior doctors hours had continued for decades and he asked the IMO if it intended to properly address the issue or come to a “shabby compromise” that left junior doctors in a similar mess.

Dr Sadlier said there was a definite drive within the junior group to find a solution to be issue but that he could not say much else on the matter.

Fine Gael TD Liam Twomey, a Wexofrd GP, said it was “disgraceful” doctors were working so hard as it was “significantly dangerous” for patient care.

Orla Barry, director of Mental Health Reform, told the committee she was concerned about the way posts in the mental health sector were being filled.

Some €35 million has been set aside in each of the last two years by the HSE to recruit some 900 professionals to fill gaps and modernise mental health services in areas such as community care and suicide prevention.

However, the committee heard concern that the money might not be ringfenced and was perhaps being used to cover shortfalls in other areas.

Ms Barry said her understanding was that the HSE was reporting 500 posts in the area had been filled but that there was difficulty in sustaining the posts and that as far as she could see only 192 extra mental health staff had been added.

She said the moratorium on staff in the health service meant short term contracts were being used to provide services and that people from inside the HSE were taking new roles but their previous positions were not being backfilled.

Labour TD Aodhan O Riordain said he found it ironic that money being raised through betting levys was kept for the horse and greyhound racing industries but the same did not apply to mental health.

On the subject of assets being used to means test grants for third level students, Irish Farmers Association president John Bryan said thousands of his members had to choose between reducing the worth of their farms by selling off land to put their children through college, or depriving them of higher education altogether.

Mr O Riordain said the issue applied to self-employed people across the board and that “nobody should ever have to make a choice between education and their livelihood.”

Mr Bryan said “a wet farm in Co Leitrim” could be worth up to €750,000 but that “if you sold it in the morning you couldn’t buy a senior civil servants pension”.

Carers’ Association chief executive John Dunne told the committee that income supports for the people he represents were hit twice as hard as the norm in last year’s budget and that it had been a step towards a tipping point where community healthcare “becomes unviable and collapses”.

Fianna Fáil TD Michael McGrath said carers were regularly coming to his office in crisis because of the lack of support they received in the community, particularly when they had an elderly relative set to be discharged from hospital.

He said people were having to make “a harrowing decision” not to take loved ones out of hospital even when it is not the most suitable environment for them.

Mr Dunne said families were in many cases not being given an option around hospital discharge. He said he had found cases where patients were bundled up with suitcase and family told to come and collect them. “There’s some pretty poor stuff going on there,” he added.

Michael Harty, chairman of Home and Community Care Ireland, said the ringfencing of money for projects such as the Fair Deal nursing home scheme was pushing people into situations they did not want or need to be in.

Quoting Department of Health figures, he said 29 per cent of those accessing the Fair Deal scheme were deemed low dependency and 16 per cent medium dependency but yet they were living in a nursing home setting.

Gerry Martin, of the Alzheimer’s Society, said a greater focus needed to be placed on the cost of dementia care as it was likely to be the biggest health issue facing the State over the next 20 years.