I move that the Bill be now read a Second Time. When the Health Bill was under discussion in the Dáil earlier during the year Deputies were anxious about the cost of that Bill. I was not, at the time, in a position to discuss that item because the White Paper had not proceeded far enough to give me authority to make a definite statement. By the time the Bill had reached the Seanad I was in a position to do so. I told the Seanad on that occasion that, as far as the health services were concerned, there would be no extra cost on the local authority for some years to come. The idea I had in mind at that time was that we would stabilise the cost of health services for each local authority and that the extra cost would be paid by the State until we had reached a stage where the local authority and the State would be paying half and half and, after that, they would continue to go fifty-fifty in the cost of the health services. I also made clear, and I want to repeat now, that that arrangement does not include capital costs such as building hospitals and so forth. As Deputies will realise, the capital cost of building a hospital or institution is met to a very substantial extent by moneys from the Hospitals Trust Fund. In fact, they are getting better terms on the capital expenditure than they would actually be getting on the health services. This Bill is brought forward to implement what was mentioned during the debate in the Seanad. A memorandum was circulated with this Bill. It explains some rather intricate details into which I need not go very fully now except to give a very broad outline of what the Bill means.
The Bill is designed to ensure that the rating authorities will not be required to meet, in the year 1948-49 and subsequent years, any expenditure on health services greater than the amount met from local rates in the present year. This is to be done by fixing a standard expenditure, which will be the expenditure borne by all local authorities in the appropriate county or county borough in the present financial year. Some health services are still administered by urban authorities, port sanitary authorities, and so forth. We also have the case that mental hospital costs are sometimes administered by a joint committee. The total costs of health services for the county or the county borough will be taken. Then the receipts will be deducted — say, payments by patients or may be from land attached to the mental hospital, and so forth. We will then get what is called a standard expenditure for the year. It will be impossible, of course, to fix that for some months to come until the accounts for the year 1947-1948 are audited.
Section 4 goes on to lay down the obligation on the State of paying the health expenditure over and above that paid by the local authority until the State is paying as much as the local authority. After that they pay an equal share. Sections 5 to 8 deal with grants of various kinds that are paid at the moment. These grants are being abolished just for the sake of simplicity. There are various grants such as the local taxation grants — the estate duty grant and the licence duty grant— and so forth. It is as well that they should be taken away and that a lump sum be given to each county or county borough. These various grants arose haphazardly. I think the first was in 1888. There was another in 1898. In recent times we have had quite a number of them, such as the free milk grant, maternity and child welfare grant, tuberculosis grant, venereal disease grant, and a grant for school medical services. These will all be removed under this Bill and a lump sum paid over, whatever it may be, as laid down in this Bill. In itself that will save a good deal of clerical work in working out the various amounts. These amounts were based on certain items of expenditure. For instance, from the licence duty grant, which was established in 1898, certain payments were made in respect of salaries of sanitary authorities and towards the maintenance of mental hospital patients.
The next grant, the estate duty grant, was given in respect of public assistance services. It is evident from the title of the others what their purposes were — the free milk grant, etc. There had to be a certain calculation on each of these. The simplest thing is to give whatever is due in one lump sum.
Section 7 provides that the estate duty grant will not be payable in future to the Guarantee Fund. Up to this it was part of the Guarantee Fund. It has not now the original meaning. Hitherto, in case the annuities were not paid a deduction could be made from the grant for the county. The Guarantee Fund is quite sound without this because part of the agricultural grant goes into the Guarantee Fund amounting this year, I think, to something like £1,870,000. The taking away of this small estate grant of something like £150,000 is not going to lead the Guarantee Fund to bankruptcy or anything like that. The Bill, if enacted, will not add to the cost of the health services of a county for some time to come. At the present time 16 per cent. of the total cost of the health services is paid by the State and 84 per cent. by the local authorities. That percentage will vary gradually from year to year until the two percentages come to be equal, that is, 50 per cent. each. This Bill is not implementing any part of the White Paper except the financial provisions which were dealt with in that Paper. Even if the other provisions of the White Paper are not proceeded with for some time to come — I have no reason for saying they will not, but suppose they are not — this Bill is necessary to save the local authorities from increased expenditure under the various provisions of the Health Act which was passed some time ago. That is the only part of the White Paper implemented so far, namely, the part dealing with finance. Now, there are members here who are also members of local authorities. They know that about this time of the year local authorities have to prepare their estimates for the coming year and it is important that they should know where and how they stand. The new expenditure on health is a fairly big item for local authorities and that is why I was anxious to get this Bill brought to the Dáil so that the principle of it could be decided in order to enable the local authorities to proceed with their estimates in the knowledge that they need not budget for more in the coming year for health services than they have spent in 1947-48.
I ask the Dáil, therefore, to give this Bill a Second Reading, in the belief that it should be acceptable to everybody in the House and on the plea of urgency, in order to enable the local authorities to proceed with their estimates. If the Bill is accepted in principle I do not think it will need much detailed discussion in regard to amendments or anything of that kind.
