I move amendment No. 1:—
In pages 3 and 4, Section 6 (1), to delete paragraph (e), and substitute two new paragraphs as follows:—
(e) three members (in this Act referred to as insured persons' members) appointed by the Minister from a panel of ten persons to be submitted to him by the General Council of County Councils of whom one shall be from Munster, one from Leinster and one from Connacht or the Ulster counties of the Saorstát, and
(f) two members (in this Act referred to as insured persons' members) appointed by the Minister from a panel of ten persons to be submitted to him by the Council of Municipal Councils.
I should like to say at the outset that I was rather sorry I could not have been here for the Committee Stage of the Bill. I have had an opportunity, however, of reading the debate on the amendments moved, particularly two amendments which stood in my name. I should say that, with one exception, these amendments of mine form a scheme, and I think I can best make my case on amendment No. 1. The Minister, apparently, misunderstood the purpose of the amendments which were before the House the last day, one of which I think he offered to give further consideration to, namely, the amendment with regard to a medical member of the committee. One of the reasons why I proposed my original amendment, that the chairman of the society should also be a trustee, was to enable me to get in the medical member without altering the number of three trustees or enlarging the committee as set out in the Bill. That was one of the reasons. Of course, there were many others which I shall not go into now.
It seems to me that the Minister did not make any case for the rejection of the amendment dealing with the medical member. I have read very carefully what he said and I must say that I was very disappointed. I was of the opinion that the Minister would welcome the suggestion to have a medical member on the committee and I can only come to the conclusion that the Minister's further consideration of that matter has not been favourable, as he has not put down an amendment for this stage dealing with the matter.
To anybody who has any knowledge of the working of national health insurance the necessity for at least one medical member of the committee will be apparent. Deputy Rowlette, I think, made a very good case, perhaps a much better case than I could make. I want to approach this matter from two points of view: one is the point of view of recognising, even in that way, that this is a national health service and that it ought not to be the beginning and end of this service merely to pay certain moneys when persons are sick. It would be of very great advantage to any committee, charged with the management of a society such as this, to have at their disposal the advice and experience of a registered medical practitioner. There is another reason that is, perhaps, the most important reason of all, and I should like the Minister to consider it. One of the great difficulties in dealing with national health insurance in this country has been the question of medical certification. I do not know whether the Minister is aware of that, but probably he is. The Minister ought to be aware that it is one of the big questions that have not been solved. It is one of the questions which committees of management under the old system were unable to deal with, and I suggest to the Minister that it will not be dealt with by the committee of the Unified Society unless they have at their disposal a person who can give them advice from practical experience.
The Minister will probably have some idea of what this question of certification means to the expenditure of the society. I have some experience as a member of a committee of management under the old system. I know it was one of the big problems we had to deal with and which we had to watch very carefully. I do hope, for the sake of the proper and efficient working of the Unified Society, apart altogether from what is perhaps even more important, the question of having proposals dealing with the health of the members continually brought before the committee of management and suggestions made which can be passed on to the Minister, that the Minister will very favourably consider the inclusion of a medical member. There is nothing whatever to be said against including a medical member on the committee. I do not think the Minister was wise in suggesting to the House that there was no difference between suggesting that a lawyer should be put on the committee and that a medical member should be put on it.
To come to this amendment, which is my alternative to the Minister's scheme outlined in the Bill for electing insured members' representatives on the committee of management, I wish to say that it is not a perfect scheme by any means, but it is the best I can think out. I suggest to the House, and I hope to be able to show, that it is infinitely better from every point of view than the scheme in the Bill, to which the Minister appears to be wedded. Many Deputies, I am afraid, and certainly the greater part of the public, do not seem to appreciate what a huge service this national health insurance is. It is perhaps the biggest service we have in the State. It embraces 500,000 members. There is approximately a reserve fund invested amounting to £3,500,000. The yearly income of the society is approximately £1,000,000. The committee of management of this huge society, dealing with millions of pounds and with 500,000 persons, is presumably being set up for the purpose of managing this society, and the committee that is to manage such a huge organisation as this is going to be selected in the haphazard and absurd way set out in the Bill.
It is, perhaps, no harm briefly to outline what the Minister's scheme is. The Minister's scheme is that local authorities shall, having regard to 5,000 and 2,500 insured members in their functional area, nominate so many insured persons to form what is called the electorate. This electorate, formed in this haphazard, loose way by county councils and corporations all over the Free State, will number anything from 100 to 120 persons. There is to be no question as to their knowledge of national health insurance, whether they are completely ignorant of it or not; no qualifications whatever will be required beyond the fact that the person selected by the country council or the corporation must be an insured member.
Eventually, if the scheme works, we will be presented with an electorate of anything from 100 to 120 members. This body is to hold office for three years. The main, the only function of this particular body that is to be brought together in some part of the Free State once a year, is to select from amongst themselves five members to act on the committee of management. Again, there is going to be no question as to whether those persons will be useful members, whether they will have any knowledge of the National Health Insurance Acts or the working of them. We are going to appoint those persons, without any regard to their qualifications, to a committee of management which will be charged with the control of a society dealing with a reserve of £3,500,000, an income of £1,000,000 a year, and with the claims of, roughly, 500,000 people. I think it is the most absurd proposal I have ever heard. I cannot for a moment believe that the Minister has any regard for the scheme outlined in the Bill. I expect he has given considerable thought to this matter, but surely some more feasible scheme might have been devised. I agree it is not easy to get a scheme which will give you direct nomination from the membership.
My proposal, in a nutshell, is that instead of every corporation and every county council—there are 27 county councils in the Free State—functioning in the way set out in the Bill, the General Council of County Councils, one body representative of all the county councils, from amongst the names of insured members submitted to them by the members of each county council, will submit a panel of ten names to the Minister. That will ensure that there will be some selection, some filter if you like, before the panel reaches the Minister. He thus gets a panel of ten names from which he can select three. This will again enable the Minister to use his discretion and knowledge and whatever advice may be given to him so as to ensure that from the ten he will get three men likely to give the best service on the committee of management. That is not a perfect scheme, but I suggest it is infinitely superior to the Minister's. It is less cumbersome and less costly.
The second part of my amendment suggests that a further panel of ten shall be submitted to the Minister by the Council of Municipal Councils and from amongst the ten the Minister can select two names. Again, it is left to the Minister to get from the ten the men he considers will be able to give him the best service. My reason for dividing up the five in that way is this, that it is essential to see that you have as fair representation as possible, and it is desirable that we ought to try, as far as we can, to bring about some local contact between the insured members and the representatives on the Committee of Management. That is also my main reason for setting out in my amendment the provincial representation. One of the drawbacks of the unified scheme is that it removes all local or personal contact between the insured member and his representative on the Committee of Management. Then there is the further point that you have 27 county councils and the active and closely organised insured members in rural areas are mainly road workers. When I say closely organised, I mean those who can be organised and who can use their votes and strength in a particular way much more easily than a scattered and diffused membership.
The Minister suggests that under his scheme, whilst his electorate is going to hold office for three years, the five members appointed by that electorate to the Committee of Management are to hold office only for one year, being, of course, eligible for re-election. On the Second Reading the Minister intimated that he had a very sound reason for making it one year as against three years, but he did not give us the reason, and I shall be very glad to hear it. I will be surprised if the Minister will give a reason that will satisfy the House. You are going to bring 120 persons together from all over the Free State and they will hold office for three years. They will appoint five to act on the Committee of Management for one year. These five men may be completely ignorant of the working of national health insurance. They are to be put on the committee of management, and at the end of 12 months, just when they are getting some knowledge of how the Insurance Acts work and of their responsibilities in regard to membership and the funds, they are thrown out and you get five fresh men who, perhaps, may be men with a fair general knowledge of the Insurance Acts, but it is quite conceivable, on the other hand, that they may be persons who have no knowledge whatever of the working of the Acts.
The Minister knows quite well how these things are worked when it comes to selections by county councils and corporations. The Minister knows it does not always follow that the person who would be best qualified to act will be selected by the county councils. It might conceivably be a person who knows nothing at all about national health insurance, but who is perhaps a sound, a strong and a vocal supporter of Fine Gael or Fianna Fáil and who would be selected for that and for no other reason. I can claim to have some practical knowledge of the working of national health insurance under the old system, and yet to-morrow, if I were an insured person, I have not the slightest doubt that, as it is at present constituted, I would be the last person in North Tipperary who would be selected by the North Tipperary County Council.
I want the Minister to keep these things in mind, and I will ask the House to realise that we are appointing a committee of management, not of a club or anything else of that sort, but of one of the biggest organisations in the country, a committee that will presumably have responsibility with regard to the investment of surpluses and the handling of £1,000,000 a year. Of course, there are certain statutory regulations with regard to the investment of surpluses, etc., but I need not go into that now. Whether the Minister's scheme is to be retained or whether my scheme is to go into the Bill, I have heard no reason advanced why the committee of management, the insured members' representatives, should not hold office for three years instead of one year.
I think there is everything to be said for their holding office for three years. The only reason I think which could conceivably be advanced against that is that the Minister is afraid that the persons he will get in the first election will be so hopelessly incompetent and so hopelessly ignorant of the work they are being called upon to do that he wants to be in a position to remove them and have another gamble as quickly as he can. I think my scheme gives the Minister an opportunity, to say the least of it, of ensuring that he will get a better type of men—a better type in the sense that they will probably know more about the working of the Act or that those of them who do not will probably acquire the knowledge much more quickly than those he will get in the haphazard fashion set out in the scheme contained in the Bill.
As I say, in this speech of mine I am covering all my amendments, with the exception of No. 2, which is rather a separate matter, but is to a certain extent bound up; it is the question of the one or three years. Whether my amendment is carried or not, that will remain, and in my opinion it will be more necessary, perhaps under the Minister's scheme than under my scheme. I shall be very interested to hear the Minister on my scheme as against his own, and I shall be very glad indeed to hear from the Minister that he is prepared to adopt the suggestion of having a medical member on the Committee. I think whatever scheme of selection or nomination is to be adopted finally, it is desirable and essential for the proper working of the society that you should have a medical member. I sincerely trust that the Minister will meet us on that. It is a most important point. I hope that for the sake of the smooth and good working of the society he will adopt my scheme instead of his own. If he does not, I can assure the Minister that it is my honest opinion that the Unified Society will not and cannot work, and that the Minister or his successor will be forced to make this service a State service. That, I think, will happen eventually in any case, whether it is my scheme or the Minister's scheme that is adopted, but I think the Minister's scheme will bring the necessity for it much nearer.