I think this is about the most unsatisfactory public service of all the public services we have been dealing with. Some time ago, when a Vote was passing through this House under this heading, I raised the question of the difficulty of securing benefits for people who are ill and entitled to benefit. The Minister for Local Government, on that occasion, gave me to understand that it was merely a matter of bringing the irregularities under the notice of the National Health Insurance Commission and steps would be taken immediately to ensure that benefits would be paid to those people entitled to them. At that time when we were discussing the question I emphasised the necessity for prompt payment of sickness benefits, and I want to touch on that side of the question again. When people are ill and all sources of revenue are cut off it naturally is a tremendous handicap to them if they cannot secure sickness benefit under the National Health Insurance. That is the time when they would require to be removed from mental anxiety concerning the provision of the necessaries of life for themselves and their dependants. It is essential at that time that there should be some source of revenue in order to procure the necessary forms of nourishment to insure a speedy recovery.
Another serious aspect of this difficulty in securing payment of benefit is that people have to return to work before they are physically fit, because the people dependent on them are in want and they cannot secure benefit. The result is that these people become chronic invalids, and are a permanent drain on the societies or other institutions. Since this matter was discussed in the House before I have had complaints from various parts of the country on this question. I do not want to deal with these now, but I wish to mention a few cases in my own experience as a medical certifier. The first case I wish to bring to the notice of the Minister is number 8879, Sláinte Insurance Society. The first certificate was issued on 21st February, 1928. This person was discharged as being fit to resume work on 26th March, 1928. No payment was made until after he had been discharged as being fit to resume work. Number 22116, Sláinte Insurance Society, is another case. The first certificate was issued on 10th January, the first payment was made on 15th March, and there was no communication or acknowledgment whatever from the Society during that period. I may mention that I brought these cases to the notice of the National Health Insurance Commission after a reasonable period had elapsed, and that eventually resulted in payment. I could cite further cases but I do not suppose it is necessary. I could cite half a dozen cases in my own experience since this matter was discussed here before where the very greatest difficulty was experienced in extracting benefits out of insurance societies.
When one comes to consider the cost of administration of this particular service one would expect that it would be administered more efficiently. The total cost of administration in 1926, the latest year for which figures are available, was about £180,000, and yet in spite of that enormous figure for administering the National Health Insurance people are unable to secure benefits when they are ill. I think one of the great difficulties is the multiplicity of societies, and the different societies being in different financial circumstances there is no uniformity of benefit. Another considerable drawback—and it is a very big question that, I presume, we cannot discuss now—is that no treatment is provided, and that all these people are entitled to under the National Health Insurance is a medical certificate that they are unfit to work. Of course, they get certain benefits from their societies. The fact that no treatment is provided means the people have to go to the dispensaries in most cases, and as we know there is a certain taint of pauperism attaching to the dispensary service. To my mind, if this service were entirely taken over and administered by the Public Health Department it would be more efficiently administered than it is at present. I think it ought to be administered as a department of Public Health, and as a part of the State services. It is an extraordinary fact—and the Minister for Local Government is responsible for this particular Department—that its inspectorial staff is costing upwards of £28,000 per annum. I fail to see what return is given for that, and what all these inspectors are doing. I think if the Minister for Local Government had complete control of the administration of this Department he would find that he could put into operation some of the suggestions we made yesterday on the Local Government Vote with regard to the co-ordination of his work, and that some of the inspectors engaged in other sub-departments of the Department of Local Government could carry out inspections under this National Health Insurance.
For instance, the medical inspector goes to a certain district to carry out ordinary inspectorial work under the Department of Local Government. I do not see any reason why he should not be able to examine a patient and decide whether such person was physically fit to resume work or not. Certain classes of people are bound by law to have National Health Insurance cards stamped. It is hard to understand why it is necessary to have what for all practical purposes is a civil police force in the form of inspectors, at enormous cost, going about to see that people comply with those provisions. We have a police force in this part of the country, and I fail to see why they should not be able to secure that people comply with this law as they do in the case of other laws. I do not know that anything very much can be done, but I think the Minister has not been fully aware of the very serious difficulty insured people labour under in securing these benefits. If it is necessary to scrap this Department and take complete control to secure efficiency, then the sooner the Minister for Local Government does it the better.