I move that the Estimate be reduced by £100 in respect of item F (2). I think this amendment affords an opportunity of referring to some illuminating figures provided in the Estimate, which seem to me to constitute an entire refutation of the claim upon which unification was originally based. I think Deputies in this House, and people in the country who followed closely the change made in National Health Insurance some time ago, when it was proposed to amalgamate 65 National Health Insurance societies into one organisation, thought that the argument advanced was to the effect that a reduction in expenditure was urgently necessary and would take place. It was held that the system which was to be replaced was wasteful, unsatisfactory and extravagant, and that the new centrally co-ordinated system of National Health Insurance societies would do away with a lot of unnecessary expenditure without curtailing or restricting in any way the rights of the insured persons under the scheme. I submit that the change made did not do anything of the kind, and that this Estimate affords proof of that fact. The cost of the central service in the Minister's Department relating to National Health Insurance—and, incidentally, I may say I am very glad that service is maintained in an efficient way, because I think it affords protection to insured persons from any encroachment on their rights—instead of being reduced has been very substantially increased.
The Estimate before us reveals an increase from £75,200 to £82,614, the figures being for the years 1935-36 and 1936-37. There has been an increase of £7,400 since unification became effective, because the two years I have mentioned cover the period since unification became effective. Minor staff changes have taken place but the expenditure remains as I have stated. The one striking fact that emerges from an examination of the Estimate is the increase I have mentioned. There is probably a definite reason for that increase. The Minister's view as to the reason for the increase might be different from my view. I think that the increase has been necessitated by the administration of the society.
It must be evident to officials of the Minister's Department who deal with the administration of National Health Insurance that there is very serious dissatisfaction with the manner in which the Unified Society is being managed. It must be evident that a great many of the difficulties of the central staff who deal with National Health Insurance have been accentuated or increased by the attitude taken up by the society in regard to the payment of benefits. There have been frequent complaints of delay. In many cases this has arisen because of some technicality which has been resurrected. In my opinion there has been an attitude of, to some extent contempt for the claims of insured persons. I came across a case recently of a man who had been in hospital and who left hospital for two or three months, having notified the officials of the Society. Afterwards he received a letter, through the Minister's Department, to say that only a few days before did the society ascertain that the man had left hospital several weeks before. There should be some understanding of the position of a man who spent several weeks in hospital during which he could not receive benefit and who had left hospital several weeks before the Society admitted that they had information of the fact. I am aware that letters—I could substantiate this in some cases—addressed to the offices of the Society containing applications for membership and a request for the official form were not even acknowledged. In one case several weeks have elapsed since that application was made. The fact is that this society is extremely unpopular with a very large section of insured persons throughout the country, and that unpopularity seems to be gathering strength, instead of waning, in several parts of the country. I think that it is the duty of workers' representatives in this House to call attention to that, and to point to the fact that, in their opinion, as in my opinion, the increased expenditure on this whole service is due to the policy of the society, which necessitates a more close and vigorous watch over their activities than would be required if the society were administered along the lines a National Health Insurance society should be administered.
There has been a saving in other directions, and the nature of that saving is very striking. It is estimated that about 15,000 persons come into insurance each year. This year, the grants-in-aid for the various benefits provided under National Health Insurance have been reduced. The reduction is a very striking one. The State grant for 1935-6 was £188,000. The estimated expenditure in the current year is £173,000, or £15,000 less, for sickness, disablement and maternity benefits than last year. It must be remembered, at the same time, that there will be 15,000 extra persons in insurance this year. Working out the reduction in relation to the amount given by the Minister's Department in aid of benefits—two-ninths—it is found that the total reduction in benefits anticipated under this Estimate is about £67,000. There we have the secret of the inquisitions that go on on the merest pretence in regard to claims for benefit. I wish the officials of the Society would get out of their heads the idea that seems to prevail that a very large number of the people who apply for National Health Insurance benefit are just impostors— people who are malingering. That seems to be the attitude in a very large number of cases, and were it not for the machinery that is adequately, humanely and properly maintained in the Minister's Department, this story would be a much sorrier one. I am glad to admit—I think that it is right this should be said—that a great number of general applications for National Health Insurance benefit would be rejected were it not for the subsequent proceedings by arbitration. These proceedings are long and wearisome to sick people waiting for benefit. In a very large number of cases, as a result of arbitration, which involves two or three months' delay, substantial awards of benefit have been made to the insured persons in flat contradiction of the view taken by the Society. I had hoped for a change in the whole policy associated with National Health Insurance. I had hoped that some of the schemes outlined in the beginning for the development of National Health Insurance and kindred services, as well as schemes to supplement the present system of National Health Insurance would be the things to be discussed on an Estimate of this kind rather than their defects.
Deputies will remember that when unification was set up it was stated to be for the purpose of making substantial progress along the road of social reform, in which National Health Insurance and services of that kind must always occupy a central position. I hoped that we would have had an opportunity of discussing progress of that kind rather than harking back, as we have to from time to time, to this subject. I think the present position is entirely unsatisfactory, and that I have established in fact that one of the claims made for the promotion of the scheme originally, that a certain amount of expense in the central services associated with National Health Insurance could be saved, proves to be groundless. In my constituency, in Cork City and other places, I think there is a great deal of dissatisfaction with the present service on the part of the Workers' Council of Cork and various trade unions which have voiced dissatisfaction with the whole system as it prevails. There is one ray of hope in the whole position, and that is that before we come to discuss this Estimate again a new committee of management will be elected. I sincerely hope that the election of that committee will result in a very considerable change in the administration of the society, and that a more humane and progressive view-point will eliminate from the control of National Health Insurance in the Unified Society the outlook that obtains at the present time. Whatever view may be taken in regard to certain aspects of this service, we have to admit that it is unsatisfactory, and that nothing we have seen or heard recently has caused us to change that opinion. The whole position is unsatisfactory.
I want to enter a very emphatic protest against a position that reveals a possible reduction of £67,000 in benefits for insured members during the coming year. They are not in the position to have their claims substantiated in a court of law with due publicity given to the manner in which they were treated. They have to avail of the machinery laid down in the Act and to conform to requirements which, in some cases, are difficult for them, and in any case involve very considerable delay. A great many have had their points of view and their claims vindicated, because they were dealt with not by officials of the society, but by officials of the Minister's Department, who, in my opinion, constitute the only protection that a large number of insured persons have at the present time from the policy of hostility very often adopted towards their claims. I object as strongly as I can to the very substantial reduction in benefits that is contemplated. I think that can only be enforced if a wrong is done to insured persons. You cannot have a very substantial reduction of that kind carried out, while at the same time 15,000 new persons come into national health insurance, without loss in some way, and I object to a system under which the scale and cost of administration is higher while there is an endeavour to get it where insured persons are concerned, and who are in a worse position to defend themselves. I hope the Minister will be able to throw some light on a position which is an unpleasant one, and that we will have some indication that the policy of the society, as we have seen it for a considerable time past, is likely to undergo a very much wanted change in the immediate future.
