When the debate on Section 15 was adjourned last night, I had said—and I want to repeat it now—that this section is the fundamental section in the Bill. It enshrines the principle which Deputy Dr. Browne and his colleagues, Deputy Cowan and Deputy Cogan, refused to accept or refused to allow to be inserted in the proposals which Deputy Dr. Browne himself had and which led to the general election and the change of Government with all the consequences which have followed from that. It is, as I say, the fundamental section in the Bill. I want to make it clear again, as we have so often in this debate made it clear, that we are not objecting to that principle. As a matter of fact, it was on that principle that the situation came about which led to the change of Government. It seems to me difficult to understand that Deputies are now prepared to accept something, if not more than, they were asked to accept on the previous occasion. Deputies who brought about the situation in which we find ourselves discussing this section to-day instead of having in operation for the last three years a better Bill, will, I am sure, let us hear their views on it and will be only glad to get an opportunity of defending their acceptance of the principle in Section 15. Would Deputies like to have a conversation?
Health Bill, 1952—Committee (Resumed)
I was asking the Minister whether he had seen the Bill you are talking about.
No, nor nobody else.
You are quite right; there was not any such Bill and we always told you that.
You said it was a better Bill.
I said proposals which would have led to a better Bill. I am glad the Deputy and the Minister have confirmed that there was not any such Bill or scheme.
We did not confirm anything, only to laugh at you. We are permitted to do that any time we like.
Certainly, even under a Fianna Fáil Government, except that we do not get occasion to laugh as often as we used to. However, that may be remedied very soon, too. I am not trying to discuss previous proposals. All I am saying is that if certain members of this House were prepared to accept three or four years ago what apparently they are prepared to accept now we would not be discussing this Bill or section at all. We would have had in operation over the last two or three years an infinitely better Bill. Let Deputies justify how their action has helped to improve the health of the people in the meantime by putting the absolute necessities of life and good health beyond the reach of the people. There will be greater demands under Section 15 because of what has taken place in the last few years. Essential nutritious foods are being put beyond the reach of certain people.
This is the third day of it.
If the Minister takes up that attitude, we will be here for the next three weeks or three months.
I do not care.
Let me remind the Minister that this is the Committee Stage of a very important and highly contentious bad Bill. On the Committee Stage of a highly contentious Bill and a Bill which purports, but only purports, to change the whole of our medical and surgical services in this country, Deputies are not merely entitled but are in duty bound to examine each section and amendment in a detailed way. If we had more detailed examination of measures on Committee Stage in this House we would have less bad legislation.
This should have been done on the Second Reading.
The Minister always interrupts——
The Deputy cannot forgive us for leading him up the garden on the Second Reading.
——at a time when something is being said that is very damaging to his Government and to those who are keeping them in office.
We can stand the shock.
I am going to repeat what I said in case the Minister's interruptions may have smothered it. The actions of the Government and those who support and keep them in office have reduced the people's resistance to disease in the last two years because essential nutritious food has been put beyond the reach of the people, particularly beyond that of the very poor. If to increase the price of butter from 2/8 to 4/2 a lb. and the price of the loaf of bread from 6½d. to 9½d. is a contribution to good health, to keep the people in the condition that they will not have to avail of the services provided under Section 15, I do not know what to say. I am fully entitled, and so is every member on this side of the House, to pin the ears of certain Deputies to the pump and pin on them the responsibility for throwing this country into the state it has been in for the last two years and putting the imposts on the people who will have to avail of the services of the Bill if and when it becomes law.
But be careful not to put up an alternative.
The only alternative is that if Deputy Dr. ffrench-O'Carroll and Deputy Dr. Browne were prepared to accept the principle now enshrined in Section 15, instead of the Minister, Dr. Ryan, piloting a Health Bill through this House, it would be Deputy Dr. Browne. It would have been a better Bill and it could hardly be much worse than this. These are the facts and Deputies cannot deny they are facts. This principle is now being accepted. I am glad it is being accepted even now. I regret, as hundreds of thousands have reason toregret, that the principle was not accepted three and a half years earlier.
As Deputy Morrissey referred to me, I want to say that as far as I am concerned I had nothing to do with the dissolution of Deputy Morrissey's Government, in connection with the Health Bill at any rate. I would like to point out that Deputy Morrissey expressly stated that his Leader dissolved the Dáil because of excessive demands made by Independent Farmer Deputies for a higher price for milk.
I am not going to allow discussion on previous proposals in respect of the principle involved in this section. We must discuss the machinery section of this Bill and that only, that is Section 15, as amended.
On a point of order. Deputy Morrissey made a specific reference to me in this connection, and I felt that I was entitled to reply to him.
I watched carefully what Deputy Morrissey said.
The only mistake I made was in mentioning the Deputy's name.
The only point I want to make is to repeat what I have already said as regards the principle of the section in reply to what Deputy Morrissey has said. The principle underlying the making of the £1 charge which I have accepted in this Bill is, as he says, the fundamental difference between us. It is the only contentious issue in the whole of our health legislation. This principle was put forward to me a few days before the break-up of the inter-Party Government by the T.U.C. It was Deputy Larkin who was largely responsible for putting it forward. I accepted the principle at that time. These facts, again, are available. I can give the Deputy the references if he wants them. This principle was referred to in the annual report of the T.U.C. for that year and, as I say, I accepted the principle of making the £1 contribution.
The procedure then was for the T.U.C. deputation to contact Deputy Norton, who was to put the proposal before the Government. I am sure that Deputy Morrissey's contention this morning was probably made in good faith. The proposal, I understand, did not reach the Government, as I am informed at this stage. The only point is that I had accepted the principle at that time. I was unable to put it into operation not because of any decision of the Government or of any decision of mine, but by virtue of the fact that Deputy MacBride had insisted on my resignation.
I find it very amusing to see Deputy Morrissey charging the Fianna Fáil Government with not bringing in the Bill which the inter-Party Government were to bring in. It is a most revealing situation. There is a fundamental difference which Deputy Morrissey cannot by-pass in this situation, and that is that the inter-Party Government pledged themselves to bring in a certain type of Bill, but in all the contests that took place they changed their minds completely. Deputy Dr. Browne stuck to his principles and resigned.
We are not going to discuss all that on Section 15, as amended.
With respect, Deputy Morrissey has made this allegation and he says that he wants to pin——
He has said that certain Deputies are accepting now what they refused to accept before. I was watching the Deputy carefully. I intended to intervene and not to allow Deputy Morrissey to proceed any further. I cannot allow any Deputy to go any further than that in discussing the previous measure.
The position, as far as the present Government is concerned, is that we have reached the Committee Stage of this Bill, and, despite a number of amendments, the Bill has not suffered any changes whatsoever in principle. As far as the present Government are concerned,they are absolutely in the clear. They proposed in a White Paper to introduce a certain type of Bill. They did introduce it, a Bill that was exactly in principle with the White Paper. The Bill has now reached the Committee Stage and the Government have indicated that they propose to stick to their guns.
That is a very different situation from what Deputy Morrissey has been speaking about, that they had an infinitely better Bill. Surely if Deputy Morrissey and Fine Gael had an infinitely better Bill, then why all these months and years of discussion on health legislation when we were not allowed to hear from them that they had an infinitely better Bill? If this Bill is as bad as they say, why could they not have taken one or two of the valuable suggestions in their infinitely better Bill and put them down to this Bill by way of amendment? We all want some form of health legislation.
What is before the House is Section 15 as amended, which sets out certain machinery provisions. We cannot have a discussion over the whole range of the question as to what is a better Bill or a worse Bill. The Deputy must keep to Section 15 as amended.
Naturally I accept the ruling of the Chair but it puts me in a very difficult position because of the fact that all the discussion that took place before I got up to speak related to this, that the underlying principle of Section 15 was the fundamental issue in the whole Bill.
I am not preventing the Deputy from discussing that. What he says must be related to the section as amended.
Since I got up to speak I have endeavoured to relate my remarks to that fundamental issue which Deputy Morrissey was speaking about. Deputy Morrissey is very amused now at the position in which I find myself.
I want to make it clear that I gave no special latitude to Deputy Morrissey.
I am not suggesting that.
I am amused at the Deputy's futile efforts to extricate, himself from a very difficult position.
I think it is a great pity that, if Deputy Morrissey and Fine Gael have any alternative to this, they should not let us know where they stand. We all want a health service of some kind. It is a great pity that we cannot all get together and put forward suggestions representing all our different views on this subject. But it is absolutely hopeless if you have a Government bringing in a Bill, with Independents and the Labour Party putting down amendments to it, while all you get from the main Opposition Party to this section and to all other sections of it is destructive criticism without any alternative being offered.
I would like to know if there is any agreement on the Fine Gael Front Bench now as regards, this particular section. I listened to Deputy Dr. Esmonde speak on the section. He made it quite clear in his intervention in the debate that he was entirely against this section, while Deputy Morrissey is entirely in favour of it.
I am not. I was not against the principle in it.
Now we know where we are. Deputy Morrissey says that Deputy Dr. Browne and Deputy Dr. ffrench-O'Carroll were against this section.
This principle.
I should have said against this principle in the discussions in the inter-Party Government with regard to the production of a Health Bill. Deputy Dr. Browne has stated here that he accepted the principle enshrined in this section when it was put to him by the T.U.C.
And never informed the Government of that.
I am not in the position to question that.
Deputy Dr. Browne admitted it.
Deputy Briscoe should be allowed to make his speech without interruption.
I want to say categorically that the Fine Gael people do not know at this moment what they agree on or what they disagree on. Deputy Morrissey talked about proposals which might ultimately have seen the light of day as a Bill, and said that it would have been a better Bill than this. He pretends to have great concern for the poor people who, as a result of the loss of two years in the passing of a Health Bill of this kind, have seriously deteriorated in health. I say that he pretends to have that concern. Deputy Morrissey has now left the House when I wanted to answer him straight from the shoulder. I say that this particular Health Bill and the section that we are discussing are the natural consequence of the 1947 Health Act. Deputy Dr. Browne, when he became Minister for Health in the inter-Party Government, was accepted not only by this House but by the whole country as a Minister who was concerned with improving the situation in regard to our health services. Everybody had testified, even when we were in opposition, that he had done tremendous work. It is now quite clear that that work was that of Deputy Dr. Browne himself and not of the inter-Party Government.
I do not understand the attitude of the Opposition. Deputy Dr. Esmonde, I say, is against this section. I heard him speak several times on it. He adduced as evidence of the frame of mind he was in the hospital board treatment that was going to be given if this section was passed with the Bill as it is now more or less agreed. He knows very well that is not the case. I have some little experience, not as a medical man but as a layman on the board of a very important maternity hospital in Dublin, the Rotunda Hospital. I have some idea as to the need for this section and the advantages this section will bring to the vast multitude of our people who will benefit under it. I cannot understand at allwhat is in the minds of Fine Gael on this matter. I know that the Labour Deputies are in support of the Bill and in support of this section as it is now going to be put through and as explained by the Minister yesterday. Labour are in favour of it.
We would like it better if the £1 were left as the contribution.
It is going to be left. The Minister said yesterday that whatever the charge would be he is prepared to bring in an amendment to make that maximum charge £2, of which the contributor pays 50 per cent.
No. £2.
However, we will see the amendment when it comes in.
The Minister has corrected the Deputy's statement.
Yes, he has. I understood that the £1 remained and that at the end of a period of years——
The Minister says "no."
It has not been established yet what the cost will be. That will only be ascertained after a number of years' operation. Is that not so?
That is not what the Minister says.
That is what I understand.
Let Deputy Briscoe make his statement, whether it is right or wrong.
According to my particular interpretation of the section, the amendment which the Minister proposed to introduce would have had the effect of stating now that whatever the charge would be after it was ascertained, the contributor would pay 50 per cent. of that charge. Nobody knew what the charge was going to be. The Minister himself said that from the examination he has given it and from the statistics available, he believed his estimate was a correct oneand because he believed that he was prepared to withdraw the previous amendment and enshrine in another amendment a provision fixing a maximum of £2. When we come to the stage of deciding the charge, it can be discussed here.
The fact is, however, that a mother and child scheme will be made available for the people who need it, both under the £600 level and over it. It will be made available in the sense that was intended when Deputy Dr. Browne came to his Government with his health scheme proposals for the purpose of framing a Health Bill.
I do not know yet and I would like to know if there is any agreement among those in the Fine Gael Benches in regard to this Health Bill. Are they in favour of it or are they against it? Are they divided on it? Who is the power behind the throne that is directing the policy at the moment, if there is some strong opinion held by some leading member of Fine Gael? Notwithstanding what Deputy Morrissey says about the willingness of the inter-Party Government to bring in a better Health Bill than this, with a better Section 15, the conclusion everybody has come to, in listening to Fine Gael interventions and in reading what they have said, is that they are only trying to delay the passage of this Bill in the hope that it will never become a completed measure as far as the country is concerned.
Hear, hear!
Now we have it from Deputy Mulcahy that that is the correct assumption. We know that Deputy Esmonde and Deputy Mulcahy are against it and Deputy Morrissey said a few minutes ago he was in favour of it. Where are we?
In favour of the principle in that section.
This is the vital section of the Bill. This section is really the Bill itself.
No.
Deputy Morrissey is in favour of it and other Deputies areagainst it. If Fine Gael were really concerned about the welfare and health of the people and about making the means available by legislation to help further in that direction, surely it was their business to come in here and produce an amendment to this section to make it a better section. In all my experience in this House, I felt always when we were in opposition or in the Government that if we wanted to improve a Bill we could improve it by way of amendment, but all I can gather is being done in this regard is delay and delay. Maybe they hope that something would happen and that a situation would arise where this Government could not fulfil its intention with regard to this Bill.
In conclusion, I want to say there is a big difference between the method in which this Bill is being handled and that in which the health proposals of Deputy Dr. Browne were handled. At least the Minister here has the complete co-operation of his own Government and he has the backing of his whole Party. That is something Deputy Dr. Browne did not have in his Government.
I must sympathise with the Minister for Health on Deputy Briscoe's contribution to the discussion. I do not think it was just what the Minister wanted. Deputy Morrissey has stressed the point that the principle of the payment for what is regarded as a contributory scheme is very important and that he is glad that the Minister has taken that line. We get this situation that one Deputy says he always accepted that and another Deputy, who immediately supports him, says that that was not so. Be that as it may, the fact that it is inserted now shows that the Minister is prepared to accept the advice of people who are in a position to give it to him or are qualified to give it to him.
We are told by Deputy Briscoe that this amendment and section are the natural consequence of the 1947 Act. I would like to hear from the Minister some explanation as to what Deputy Briscoe means by that because Deputy Briscoe has said that the Minister hasthe support of every member of his Party. Therefore, I assume that he has discussed these sections with the Party and that the Party are au faitwith every principle involved. Neither the Bill, when introduced, nor the White Paper contained the contributory scheme or the £1 contribution. It has been amended to that extent. The big point in this section that I want to get after is not that. I am opposed to this section because it establishes the State official, the State doctor. No matter what anybody may say to the contrary, if a doctor in an area does not enter into a contract or agreement with the Minister to operate the section, a patient who may want that doctor will not be able to get him. The Minister was quite positive last night that unless the doctor had a contract or agreement with the local authority, that doctor could not be paid and that any doctor operating the service in a maternity case would not be paid, unless he had a contract. Therefore you are forcing the patient to accept the State officer. That is what the doctor will be under this new regulation.
That State officialism is condemned generally. I do not want to be sneered at when I try to prevent it. I would remind the House that, no later than yesterday, in Cork, it was asserted that it was important that those in public life should be able to study the implications of Catholic principles and their relevance to the controversies of the hour. Therefore, there is an obligation upon everybody to see exactly where the Minister is going or where we ourselves are going and that we should know.
Therefore, I think the Minister at the earliest opportunity should say that the Bill as he now proposes to amend it does meet the requirements. If he said that, it would be a helpful contribution to the whole question, but he goes on ahead as if 1947 was to be ignored as never having happened, as if 1950 and 1951 never happened. We must remember what occurred. These things remain facts. The obligation is on the Minister to do his part.
Deputy Briscoe said that we did not know whether we were in favour of the£1 or not, and that the Minister had asserted that it was to be £1. That is not so. It is quite obvious that Deputy Briscoe did not know what the Minister said last night, that the best he would go and the farthest he would go was that the contribution would not be above £2, that he put a ceiling of £2 on it but that it may be £2. If more than that is required, I presume the Exchequer will bear it. In the past it was undertaken that the Exchequer would bear practically all the expenditure. I do not know how the Minister is able to convince Deputy Dr. Browne and others that that is the same as they wanted. They bell everybody in this country for not accepting it.
The Deputy said he was glad that I, now—he used the word —am prepared to accept arguments from those who have a right to advise me, in other words, the Catholic Hierarchy.
Yes.
Can anybody rival Deputy MacEoin as a smug Catholic in this House, a Catholic who is glad to see that there are good Catholics on the other side too? Did anybody ever hear of the man who, when he kneels down to say his prayers, says: "Thank God, I am not like the rest of men. I am not like the rest of the men sitting opposite me in the Dáil?" It must be a great consolation to the Deputy to feel that he is not like the rest of men and it must be a great trouble to him that he is facing heretics and others in the Dáil every day. I suppose we must have respect for Deputy MacEoin if we thought he was sincere in that and that he would like to convert us, but he is doing it all for the sake of a few votes in the country.
No.
No? He is not thinking of that at all. He is trying to convert us. He gets up here day after day trying to make out that the good Catholics are sitting beside him and the bad Catholics are sitting opposite him and calling on the country to throw us out and put them in because theyare good Catholics. It is the lowest motive for which anybody could talk religion in this House, the lowest of motives. As the statesman said once, "religion is the last refuge of the scoundrel". That is very true, indeed. It is the last refuge of the scoundrel and when anybody in politics has to turn to religion and accuse his opponents of not being as good Catholics as he is in order to get a few votes I do not know how to describe it. I think it is disgusting, that is all, just disgusting, that any man should go on with that talk and go on with it day after day. Of course, he is joined by his colleagues on the other side. I have been for seven or eight days here listening to this sort of thing, listening to them day after day trying to get some little handle so that they could show that we are not as good Catholics as they are.
I do not think the Deputy is a very good theologian, as a matter of fact. He says that State officialdom is condemned. I believe it is. It should be avoided as far as possible. In this particular section we are making the thing very much more acceptable from the religious point of view than it has been before, very much more acceptable, by giving a choice of doctor. Deputy MacEoin twists that around; he twists the choice of doctor to officialdom. It is obvious that somebody must find out who is prepared to work this scheme and, as I have explained, the regulations will lay down that the doctor who undertakes this scheme will be obliged to give certain service, certain visits before. certain visits after, the birth. He will be paid so much. That, of course, if the Irish Medical Association are willing to do so, will result from negotiations with the Irish Medical Association and then the regulation will lay down what the agreement is and all that is necessary then for a doctor to do is to send his name to the local authority and to say: "I am prepared to work this scheme". That is officialdom. That is condemned by the Church according to Deputy MacEoin —condemned by the Church, that the local authority would like to know who is going to work this scheme.
If a man comes in here as an authority on theology and tries to get that theology to fall in with his own crooked, distorted, political views, that is dragging religion in the mud, if ever it was dragged in the mud, but Deputy MacEoin is prepared to do it in order, as I say, to get a few votes down the country.
If the Deputies opposite would try to drop this silly obstruction and to make this a better Bill and if they have any suggestions to make we will listen to them, but the only suggestion so far from their side is that this is such a rotten Bill that we cannot do anything about it and that they will go on opposing it. What proposal would they make on this section? Deputy Morrissey says that it is right in principle. What he means is that it is right in principle that there should be a contribution from the better off people. I think that that is the principle he agrees with. What is the suggestion made to improve matters? No suggestion has come from Fine Gael—none whatever. They have talked on this for four days now. This is our third day on this section and they have made no suggestion whatever to improve matters—just obstruction, that is all. I am sure that they have no suggestion to make but they go on with this obstruction. Is it not time that they told us what would be a better suggestion than what is in the Bill?
Deputy McGilligan made a suggestion here last night that a doctor need not enter into an agreement with the local authority. Well the first case he takes up he must tell the local authority he is taking it, otherwise he cannot be paid. Surely if he does not notify the local authority he has taken on a case the local authority cannot pay him. The only difference between us is this that Deputy McGilligan has suggested that we should wait until he sends in his bill and says: "I have agreed to your terms," and I say let him agree to the terms before he sends in his bill. That is the great Fine Gael suggestion. We have spent the third day on this section and that is the only suggestion that has come from FineGael, the only suggestion on this Bill that has crossed the floor of the House in three or four months.
As I have said here already, it is fairly obvious what the Fine Gael opposition is due to. They are watching like hawks all the time seeking to see can they catch us saying something or doing something that is not exactly in line with Catholic principles. I suppose they will catch us out. It is easy to catch people out on that sort of thing, but what will they achieve if they do catch us out is what I cannot understand. I do not know. I suppose they hope to gain something out of it, otherwise they would not go on with this talk.
Deputy Morrissey, speaking here, talked about how in the last two years we had injured the health of the people by increasing the price of food. Where is the proof that we have injured the health of the people? It is not true just because Deputy Morrissey says it or because Fine Gael says it, and the only guide we have in these matters are returns published from time to time. These returns have shown that in 1952 the health of the people was higher than ever. I do not know what 1953 is going to show, but there is no evidence to suggest that the position is changing in any way. The health of the people is improving all the time and has improved. It improved under the Coalition Government and has improved since, and why Deputy Morrissey will get up and make a statement like that for which there is no foundation I cannot understand. The fact that there is no foundation for it does not stop Fine Gael making these statements. But I do not see what is gained by that.
One of the big objections that I think Fine Gael have to this section is that we are only providing accommodation or services for women in public wards. When we come to another amendment, amendment No. 45, we may discuss that matter, whether it is true or not. But suppose it is true, why this shoneen attitude of Fine Gael about public wards? Would Fine Gael, I wonder, produce any reputable doctor in this city who will say that the service givenin the public wards of maternity hospitals is not better than in the private hospitals or at least as good? Why this criticism of the public wards? Is it not only a sort of class distinction in the Fine Gael mind? They are appealing to a certain type of person who would not like to have it said that she would go into a public ward. They are appealing to the prejudices of a particular type of that kind. But, as I said, so far as this section is concerned, that question is not dealt with. When we come to amendment No. 45 we can discuss the question of what service is available at the patient's choice or what service is available to patients in the public wards. I think that particular objection made by Fine Gael can be left until that stage is reached.
I think it is desirable that our Party should place on record their general attitude to this particular section. Let me put it like this. In a general health scheme or a comprehensive health scheme our Party believes that a contributory scheme of some sort should be worked out because the fundamental fact is that we wish to accept our benefits not as a charity but as a right, a right to which we have contributed and paid in some measure. In this particular section of the health scheme we have envisaged and in this particular scheme we would wish to see no means test but accepting that benefit as an overall right to which we had contributed. That has been our view and is our view—a free for all mother and child scheme within a general health service to which you contribute. When the difficulties arose in the previous health scheme and Deputy Dr. Browne was Minister for Health—I do not want to mention how they arose—but when they arose we faced up to the fact that it did not then appear possible to get a free for all mother and child scheme. The T.U.C. made certain proposals to Deputy Dr. Browne which we understood he was willing to accept and which he gave certain assurances on. He would not take certain action until they had been either examined further or cut out. What arose then is a matter of history.It is clear that this Government are being forced back to the very same position as the inter-Party Government were. There is no possibility of going on with a mother and child scheme free for all, because of certain objections. The Labour Party are keeping consistent in this. We in the past were prepared to accept either a free for all scheme or, if we had to, a certain scheme in which we paid a certain amount. We were prepared to do that. Certain Deputies in this House have in the past day or two been suggesting that the Labour Party did not carry out its functions and were afraid to do things.
That is ridiculous, in face of the fact that these same Deputies have now been forced to swallow the very thing that we faced up to. I only make the point to show that the Labour Party has been consistent in its attitude. Our view of a health scheme has been to move a step closer to every approach to the ideal scheme, where health services will be as required on a contributory basis within the means of every person and given without distinction of class, creed or social position.
Deputies from the Minister's benches have complained that they find a different approach from different people on the Fine Gael Benches with regard to this Bill. They talk of the different types of criticism that various Deputies from this side of the House have made. They seem at one particular time to sum up the Fine Gael attitude to the Bill by saying we are completely against it and are just indulging in obstructive and delaying tactics here. Deputy Kyne has very clearly and simply explained the attitude of his Party in relation to Section 15. I would like to put simply the attitude of our Party to the whole Bill.
It is Section 15 we are on.
Yes, but Section 15 is part of the whole Bill.
You should explain your position on the Bill on the Second Reading and not now.
I will explain my position, then, on Section 15.
A Leas-Cheann Comhairle, is this obstruction for the third day?
We are on Section 15.
Yes, and I am going to explain my attitude concisely and precisely to Section 15 and the Minister can take it and refer it to every other section in the Bill.
The Deputy is entitled to refer to Section 15.
We are charged here with delaying and we are also charged with criticising. Our attitude to Section 15 is that the Minister has not given us sufficient information to enable us to criticise.
For goodness' sake, such hypocrisy? More information—and I have been giving it for three days!
Our approach to the Bill is not one of criticism: it is one of inquiry. From the very beginning until the last question, it is one of inquiry. We asked and pleaded that the Minister would put us in the position of having a proper inquiry, by the kind of committee we asked should be set up. The Minister does not do that, so we are inquiring.
What do you want to know now?
I will tell the Minister what we want to know. We want to know the services that are being provided, the principles upon which those services are being provided, who is going to get them, who is going to pay for them, and what they will cost. The Minister has made no attempt to answer that. We are told he has the whole of his Party behind him and the whole of the Government behind him. They are so convinced the thing is right that they want it put through. Although no doubt they have the Department behind them, with the whole machinery of statistics and the machinery of the State, they will not go to the trouble of putting their proposals down in a systematic and clear way. We want them to tell usexactly what these services are going to be, and who is going to benefit from them. We want them to give us information that will show us how these services are going to be put there, what they are going to cost to put there, what they are going to cost to maintain and who will have to pay for them.
In these circumstances, I say that we have not got the material for criticism. We have got the opportunity for inquiry. Everything in the Bill and the whole of the Minister's approach to it confirms, day after day, as we go along, that this Bill is a fraud of a Bill and that it will not work.
We are on Section 15.
Section 15, Sir. I require to be told, on Section 15, what it is all about and I say that I am inquiring, inquiring, inquiring. The result of our inquiries here will be, we are convinced from our experience of our inquiries on the 1945 Bill, that this Bill will vanish. When the Government come to the end of the inquiries that we are forcing them to make and when they try to answer the questions that we are trying to get them to answer, this Bill will go the way the 1945 Bill went.
This Bill is based on the 1947 Bill. The proposals here are to substitute a part of the 1947 Bill, which is completely withdrawn. The Minister complains of the time we are spending on this. We spent 15 days in Committee on the 1945 Bill, although we went only two-thirds through the Bill at that time.
And then you walked out.
Then we walked out.
Why not walk out now?
We are not yet 15 days on this measure and we are not yet convinced——
Could we not add three days to make it the 15?
——that our inquiries have got sufficiently home to the Government, particularly in view of the Minister's attitude this morning. Although we walked out sooner than sit through Holy Week on a Bill which was supposed to be——
Religion again. Sitting in Holy Week? There is no doubt you will have a halo before long. More religion—they would not sit in Holy Week!
We refused to sit during Holy Week, 1946, to discuss the Health Bill, 1945. In spite of the fact that we walked out, 15 days in Committee brought the Government to their senses and the Bill broke in their hands.
We sat in Holy Week all right.
I am on Section 15. The 1947 Bill followed that. It was kept in whatever kind of a limbo Governments have for Bills that are completely exposed. We opposed the 1947 Bill.
You used a good deal of it when you were in office.
Yes, but we used it in the spirit in which it is possible to use it without disturbing the principles on which we opposed these health measures. The fact that we used it shows how interested we are in doing what it is possible to do in an effective way to improve health services. There were certain aspects of the 1947 Bill which we opposed constitutionally and otherwise. When the 1947 Bill was passed I made for myself a note on my papers—and what did I say? That we had struck a blow against the development of the police State, that we were not quite sure whether it had been completely effective or not.
Your notes must be very interesting.
How does this arise on the section?
It arises in thissense, that I want to explain to the Minister why it is that we are pursuing a policy of inquiry with regard to this section. We still find in the Minister what we found then, that the Government were incapable of an educational approach. They were intent upon compulsion. They think that by dipping their hands into the public purse and setting up control over health services to which people will have to go, they will cure all the ills of the people. The spirit we find there is the same and the lack of information makes us convinced that the objections we had to the 1945 and 1947 Bills are not uprooted in the minds of the Government.
Therefore, I want to ask the Minister to tell us something about this section. For instance, the proposals here are conceived in an insurance frame of mind, or they are conceived in the frame of mind that the people are unable to pay for the services the Government think they should have, or they are conceived in the frame of mind that the Government think that more efficient services should be arranged and that they will not be arranged unless the State has its hand in it.
On the insurance question, are the proposals here based upon a health insurance principle? It is very difficult to conceive that they are in view of the discussion we had yesterday on the amendment in relation to the appropriate sum, and the result of that amendment, and in view of the joint contributions this morning from Deputy Briscoe and the Minister.
Deputy Briscoe tells us that the £1 is going to remain. The Minister says it is not. The Irish Pressof this morning suggests that the sum will be £2. In any event, will the Minister please tell us if there is an insurance principle behind this proposal and, if that is so, will the Minister do something to convince us that there is some kind of a normal approach to an insurance proposition?
It seems to me impossible to think that any kind of an insurance approach has been systematically worked out, in the light of the discussion we had yesterday, the way in which the amendment has been withdrawn andthe kind of discussion we have been able to have this morning about it from the Government Benches.
Is it on the question of ability to pay? The Minister has indicated that 88 per cent. of the farming community of this country will come in under the completely free mother and child service. Imagine, 88 per cent. of the farming community of this country! We boast that the whole economic fabric of this country is based upon our agriculture. The Government have had 16 years of office beforehand and now they have had a further couple of years in which to deal with the problem of building up our agriculture. After all that the Minister can hardly say that it is as a result of inability to pay that these proposals are being put forward for a free maternity service for 88 per cent. of our farming community. Is it a question of inefficiency? If it is, then will the Minister say to what extent the domiciliary work of the State medical service at the present time in dispensary areas is of a higher class than the domicilary work of any other section of the medical fraternity, and will he say on what exactly he bases his claim for efficiency on the part of the public administration of maternity work in institutions?
I quoted the Minister yesterday with regard to the figures for beds and also the figures that are available as a result of parliamentary questions which were put to the Minister. These are the things that come perfectly readily to our minds when we want to examine these services to enable us to come to our own judgment as to the cost and the types of services that are available and estimate their effect from the financial, medical, social and even moral points of view. At the present moment it is very difficult to have any kind of an idea as to the background or proposal of this section. As far as the free service is concerned, we deal with three classes—(a), (b) and (c) in Section 14, sub-section (2). Has the Minister made any estimate of the number of people in the insured class in the under £600 class or in the farming class that will have to be attendedto? Does the incidence of maternity differ in these three classes and what is the average number of cases that would require to be dealt with under each of these classes as a domiciliary case and as an institutional case and what are the costs of these likely to be?
The Minister refers to snobocracy in connection with the mention of public wards. Our concern about the public ward is that the Minister bases his financial estimate for the running of this thing on the public ward of the institutions up to the present and the dispensary system. The Minister has indicated that the average cost of providing medical, surgical, midwifery, hospital and specialist services for a birth, and everything connected with the birth, without taking into consideration the administrative overheads, is £8. I think the Minister should give us some information that would carry a little more conviction to our minds than we are able to get for his belief that £8 is the average cost of all the services—of medical surgical, midwifery, hospital and specialist treatment—that go with a maternity case at the present time. These are the considerations that make us press here now.
We believe that if the Minister were true to his responsibilities and if he himself examined the background of these matters to the extent which I have outlined, then, without any necessity on our part to continue to pursue the inquiry that we are pursuing here, he would withdraw this Bill and sit down again with the various classes of people—local authorities, doctors and others—who have a concern in this matter and have a contribution to make and make a decent Bill out of it. We do not believe that the present Bill will work or that it would stand the scrutiny and examination of any body that got a chance of examining it. The Minister is not giving this House a chance of examining it but we will continue to examine it as long as the Bill is before us in this House.
I wonder if Deputy Mulcahy expects this House to believe the sort of dishonest statement which he has made to the effect that hisParty are merely making inquiries? Will the Deputy read the speech made here last night by Deputy McGilligan on this section—a speech which lasted for over an hour—and see if he can find a single inquiry in it? We have put up with a lot but it is very hard to put up with that sort of thing from the supposed Leader of a Party who says, after three days' discussion, that they are not obstructing but merely making inquiries. The discussion on this section started this day last week. Why were the inquiries not made then? Why have they waited until now?
We have been inquiring every day.
Deputy Mulcahy asks if this £1 is an insurance scheme. I think I mentioned about four times since the discussion on this section started that it is a type of insurance scheme. It does not fulfil all the conditions of an insurance scheme but it is run on the basis of an insurance scheme. What more can I add to that? After three days' discussion, the Deputy comes along and wants to know something further: he wants to know if it is an insurance scheme. Is it not ridiculous to ask us to understand that sort of dishonest nonsense?—and it is nothing else.
Again, Deputy Mulcahy comes back to the question of beds. The relevant figures were very fully given on a previous occasion. Does he want the subject of beds to be brought up again and discussed? I really do not know what Deputy Mulcahy expects to gain out of this. If I had some idea of the political advantage he might get out of it, then maybe I could sympathise with him in trying to build up a derelict Party on some rolling stone. I cannot see what political advantage he would get from this obstruction and therefore I feel that the whole business is futile.
Section 15 deals with the maternity service in which there is considerable interest in the country. It covers a very wide field. The difficulty of those on this side of the House, as has been stated by Deputy Mulcahy,Deputy Morrissey and others, is that we have not the requisite information. I will endeavour to show the Minister by running over the section briefly our difficulty in that respect.
This is a good joke after three days.
It is all right for the Minister to say that we are looking for political advantage. The fact is that for three days we have been looking for information.
What do you want to know? Ask the question.
I am speaking on the section and no doubt the Chair would like me to deal with it. As I go on there will be certain questions to ask.
How long have you been asked to speak for?
This section divides the nation into three different classes. We have the lower income group, the middle income group and the upper income group. It has been stated to-day that Deputy Dr. Browne is accepting certain principles that he was not prepared to accept before. I hope I will be in order in quoting from a speech by Deputy Dr. Browne made in Dublin, as reported in the Irish Timesof 23rd May, 1951, when he said:—
"I will not under any circumstances vote for any amendment of the Health Act which would authorise any Minister to bring into life what should be dead 50 or 100 years ago, this means test, the pauper law, the red ticket, and all the rest of it."
Is not that a definite statement by Deputy Dr. Browne that he will not stand for a means test in any shape or form, for the red ticket or anything pertaining to pauper law?
Section 15 is dealing with three sections of the community. One of them is the lower income or dispensary class, if you like. This section makes no real difference for the lower income group except in so far as it is purported to offer them a choice of doctor. Thatwas fully discussed yesterday and I think it was shown that in many cases there would not be a choice of doctor. As far as that goes, it is acceptable to us, if it is at all possible. The benefits proposed for these people are benefits which they already have under the existing medical services. They have the right to be treated by a doctor, the right to go into a hospital if they are emergency cases. The only change is this, and this is where we join issue with the Government, that the benefits which they now enjoy they will be sharing with the rest of the community, and the hospital accommodation and the maternity resources in this country are already grossly overtaxed.
As far as the lower income group are concerned, what they get then is permission to choose a doctor. Whether that will be practicable or not it is not necessary to go into now. But the strained resources of the State will be thrown open to another large section of the community and, when you have people queueing up for something, it is always the poorest section who suffer because they will probably be at the end of the queue. That is one of the things to which we object. We have stated that this is an impracticable scheme. In spite of all the taunts thrown against us, the Fine Gael Party want to give to the public the best maternity services possible in keeping with the power of the Irish people to pay. All through this discussion there has been no indication as to what the scheme will cost and who is to pay for it.
We now come to the middle income group, which includes farmers under £50 valuation and people with an income of up to £600 a year. One point which strikes me in regard to that income of up to £600 a year is that it will be the county manager or city manager, as the case may be, who will be the deciding factor with regard to anything relating to a means test. Of course in this maternity section there is no charge imposed on those with an income up to £600 a year. But the point is that they will have to prove that their income is under £600a year. How is that to be done? If a person says that he is entitled to this treatment free because his income is under £600, how is the Minister or his representative, the county manager, to decide whether he has more or less than £600? That seems to me to make for a lot of administrative work and that is another reason why we object to it. We object to any increase in administrative charges. I stated very categorically the point of view of this Party with regard to the voluntary hospitals. We felt that these hospitals are being run with the minimum of administrative costs. A State medical service means more civil servants and if you have more civil servants you have fewer medical benefits. That is our objection. The Minister has not clarified that position or indicated to us how much will be absorbed in administrative costs and how much will go to the benefit of the people. He has not given us anything like a proper bill of costs. If he has introduced a bill of costs, he has not broken it down.
Then we come to the higher income group. Deputy Dr. Browne and others who support this Bill along with him have accepted the principle of a means test. That is a fair statement. I do not blame them for accepting it. Probably they could not get anything else. Deputy Dr. Browne has been systematic throughtout in saying that what he wants is a free-for-all medical service. He makes no secret of that. I think I am right in saying that Dr. ffrench-O'Carroll wants the same thing. Who is to pay for it?
Then we have this extra provision with regard to the £1 a year in this section under which the higher income group are to pay £1 a year; the approprivate sum went by the board yesterday. The Minister has given us one item of financial information relating to that. He told us that he estimates that each birth will cost £8. We have asked him to break that down. He has not given us any information at all. He simply said statistically each child would cost £8. Therefore he proposes to balance it by collecting such charges as would cover the cost. Let us look at what benefits the people who pay this £1 a year are going to get. I think it is quite fair to say they are goingto get, if they require it, a bed in the public ward. This is the upper income group earning anything over £600 a year. People living in Dublin and in the country to-day are all suffering from excess taxation and these people find it hard to live. People earning say between £700 and £800 are not fabulously wealthy. By the time they pay income-tax, pay for everything for which prices have multiplied within the last couple of years they have not a great deal left to spend. We would like to see on this side of the House a maternity service that would be of benefit to these people but what we are asked to support here—and the Minister gets quite cross when we oppose it—is this £1 a year scheme on the assumption that everybody in the country is going to race in and offer to pay the Minister £1 and he is going to collect enormous sums of money which is going to make the thing pay for itself straight away. That is nonsense. If he was offering something of benefit they might come forward. But what is he offering? A bed in a public ward.
The people I am talking about at the moment in normal circumstances probably go to a nursing home and there is nothing snobbish in saying that. It is to the advantage of the rest of the community that they should do so because if not they are competing for the free beds in public wards with people who are already occupying those wards. There is a considerable shortage of those beds yet the Minister is offering simply the right to a bed in a public ward. As I understand it, I think they are entitled to a bed for a fortnight in a public ward and in certain circumstances that can be extended. We agree with the principle of people paying who are able to pay because we accept the fact that in the final analysis every 1/- collected by the Minister, or being collected, comes out of the people's pockets in the end. We also accept the principle that we believe that people should have freedom and the right to spend their own money. We think that is the right way to have it. Under the £1 a year system you pay £1 a year and you have the right to a bed in a public ward. I say, why not let the Minister face facts? Hehas accepted the principle—those who support him have accepted the principle—of a contributory basis of some sort. Therefore, he cannot be under pressure by them. Why cannot the Minister face facts and scrap this Section 15 altogether? It is an unworkable section as far as we have heard from the Minister. But why cannot he introduce contributory insurance? I do not ask him to introduce the Irish Medical Association insurance scheme but he could introduce a contributory insurance, which is simply an insurance. You pay so much and for that you are entitled to so much money. It can be worked. You get a certain rate of remuneration in return for that contribution if you are sick. You are reaping the benefits of that insurance and you would be entitled to go to any doctor or institution you wanted. That is free choice of institution and free choice of doctor. That is what we stand for. That is a simple means to the end. If a person knows what he is going to get he will come in any pay contributory insurance. It has worked in other countries. In Canada they have a contributory insurance for civil servants and it has worked admirably for a number of years. Of course it covers wider services. There is no reason why the Minister should not embody it in the whole scheme and the people would know what benefits they were going to get.
Is the Deputy advocating a State contributory scheme?
It would be based on a contributory scheme.
Deputy General MacEoin would not agree with a State scheme. It would be against his Catholic principles.
It could be a State scheme. At present it is not possible for any private company to introduce a scheme such as that because you are going to have a scheme enforced compulsorily by the State—this State medicinal service that nobody wants. That is the position.
What is theDeputy advocating? That is a fair question.
I am advocating the principle that those who are able to pay for medical services should pay a certain amount towards those services. The Minister agrees with that. Deputy Dr. Browne agrees with that, and I am sure the Deputy agrees with it.
Everybody does. Everybody agrees that somebody must pay, but the point is how they will pay for it.
If the Deputy will allow me, that is just what I am trying to tell the Deputy. The £1 a year scheme at the present moment gives nothing but the right to a bed in a public ward.
And the £4 maternity benefit.
Yes, and is the Deputy satisfied that is going to cover the whole thing?
No, but it does go some distance.
I am suggesting that people if they pay something must get some return for it, and if the Minister introduces a State subsidised scheme there is no compulsion about it. Under such a contributory scheme you could have a free choice of doctor and hospital or nursing home; in other words you could be free, and not a slave. In the system advocated here you will have forced on you a State medical service and that is all it boils down to. The words are used "there is no compulsion" and "nobody is forced to engage in the scheme" but they are forced to pay for it. An already overburdened nation is being asked to shoulder this new impost the extent of which the Minister has not told us. That is the fundamental principle we object to.
On this maternity section as a whole I do not think the Minister has given us any information on the domiciliary side. He made several statements but I have not heard him explaining the domiciliary side—or has he anydomiciliary scheme whatever? I do not see how he can unless he has consultations with the people concerned. The first thing you want for a domiciliary scheme is the doctors and nurses. The Minister has made no agreement and had no consultations on the financial arrangements with any of those people at all. How can you introduce a domiciliary scheme unless you have some discussion beforehand with those who are going to work it? We are interested in a domiciliary scheme. Everybody is interested in it. When I travel about my constituency many people, particularly farmers, ask me about this health scheme, what exactly they are going to get from it, what it means to them and what it is going to cost. I do not know what it is going to cost. The Minister does not know what it is going to cost and, apparently, his officials who have drafted the scheme do not know what it is going to cost. Are we unreasonable when we say that we are opposed to such an unworkable scheme? We are told to put down an amendment to it. Deputy Costello said at the outset that he believed this Bill was so bad that it was unworkable.
The Deputy is getting away from the section.
If it is so bad that it is unworkable and cannot be amended why does the Deputy not sit down? Why does the Deputy spend such a long time discussing it if it is so bad?
To return to the section, we are asked why we do not put down amendments to it. I think myself that the only course open to the Minister now is to withdraw the section. It is quite obvious that the further he goes the deeper he is getting into the morass. We have been here for three days. We, as the major Opposition Party, have, of course, a right to state our case; that is what the people sent us here for. I do not know, therefore, why the Minister is getting so worked up. We have a right to ask the Minister to explain the provisions of the Bill, to give us some idea of what it is going tocost and how it is proposed to implement it. There are one or two other things about which I should like to get some information from the Minister.
Your time is up now, I think.
Mention was made by Deputy Dr. ffrench-O'Carroll of the emergency squad. I mentioned that matter myself in a speech I made on the Health Estimate about a year ago. Emergency squads do exist—at least they exist in all the big towns in England. There are life-saving squads. They provide domiciliary treatment and bring to the home of the patients the most up-to-date modern methods of life-saving and treatment. They have with them a doctor who is a maternity specialist and a nurse. They have a blood transfusion apparatus and equipment for dealing with any emergencies which may occur. Several instances occur in which the use of such apparatus may be called for. There is no need to recapitulate them here, as every Deputy who is a doctor will appreciate what they are. They are mostly cases that would be fatal because of haemorrhage. These squads exist everywhere in all the big towns in England. It is quite a usual thing for doctors there to ring up in order to have the emergency squad brought out.
Deputy Dr. ffrench-O'Carroll suggested that the Minister might consider the introduction of such a system here. I agree with him but I do not think it would be very feasible to introduce it all over the country. It would be very difficult, as medical Deputies will appreciate, to get to the spot in time to save life if you had to go to the extremes of Donegal or Connemara. The scattered population here may not make it possible to have such a service in different centres but I think the Minister would be well advised to consider its introduction in the Dublin area. There must be many instances in Dublin where it is necessary to transport patients to hospital and it may be that lives are lost through the shock of transport and so forth. If an emergency squad were establishedhere on the lines suggested, I think it would be of very considerable benefit.
I have asked the Minister a good many questions. In particular, I have asked him to clarify the financial position and to say whether he would consider scrapping this section or to amend it by introducing a contributory insurance scheme, the principle of which he has already accepted, a scheme which would give more benefits to the people, benefits which they could visualise and which would be better than those which exist at the moment. I think that the contributions which the Minister would get from the £1 scheme would be absolutely negligible. I do not think that they will pay even the administrative costs. I should like the Minister when he is replying, to give us some idea particularly of what he estimates the administrative costs will be in relation to this section alone and in relation to the medical benefits that accrue from it. I think that it is very important that we should know this before we proceed any further.
In view of Deputy Mulcahy's statement that this was an inquiry debate, it is rather startling to find that it took Deputy Dr. Esmonde 27 minutes to ask two questions.
Is he going to get any answer?
They have been answered already four or five times and I do not propose to answer them again. It just shows the dishonest obstruction which is being carried on and the dishonesty of statements about an inquiry debate.
I merely wish to answer a point made by Deputy Dr. Esmonde in regard to a statement which I made in 1951 about the means test. I most certainly made that statement and I certainly stand over the views which I expressed then, that I have the strongest possible objection to a means test in regard to social services or medical health services. I take that stand not from a political doctrinaire point of view but from the ordinary medical point of view—that a means test leads to discriminatory types of medicine, indifference to thepeople and a poor quality of health service for the poorer or lower income groups. I think Deputy Dr. Esmonde supported that view in his remark that when you have a number of people looking for service, the poor tend to suffer. I do not intend to delay this debate any longer than is absolutely necessary. I think there can be only a first-class health service where the doctor does not know who is paying for it, where the doctor-patient relationship is purely a medical relationship and not a financial relationship. I do not think that there should be any financial relationship. It should be a purely personal or medical relationship which should have nothing to do with money. That is why I accept this particular scheme. I had already accepted that principle, once it was made clear to me that it was necessary to accept it, in order to bring it into line with certain moral objections that were made. I think that no Deputy would expect me to continue to resist the objections which were put forward and which apparently would be met, and are being met, by the £2 contribution which the Minister says he has now accepted to meet the objections that were raised.
I might say in passing that I find it difficult to understand why a completely non-contributory scheme is acceptable in the Six Counties and in Great Britain for our fellow co-religionists and is not acceptable here. I do not propose to pursue that further. I merely say that I accept the proposition that is now put forward here and I think I have shown why it was possible for me to make that statement in 1951 and to accept the scheme now put forward. The only force that could make the present scheme acceptable to me was the force of the moral objection put forward by particular authorities.
As to the other point raised by Fine Gael, that is to this levelling down, Father Coyne put the case for that extremely accurately in a contribution to Studiesin March, 1953. He stated:—
"There is a type of service that women in this middle income group,and still more those in higher income groups, desire and have been accustomed to. Is a woman to pay a £1 contribution per year to enjoy the same services as she has already paid for in taxes for less well-off women to enjoy free? Private rooms, a special nurse, a different type of cooking, general amenities —presumably these will not be supplied free to mothers in the middle income groups and to those paying the £1."
I cannot see any difference at all between one mother and another, whether she is in the middle, upper or lower income group. So far as I am concerned, she must receive one standard of service. If there is any disgrace, any shame or any odium attached to the public bed, our job is to get rid of it and not to say that that condition must persist. It is a fantastic attitude to adopt in what is described as a democratic republic to say that the public bed is good enough for the lower income group and not good enough for the upper income group. I cannot see any difference, as I say, between one and another. Each must be treated equally in relation to the medical service she gets.
That is my ambition and that is why I support the amendment, because I believe that, in time, we will be able, by dint of infinite patience and slowly, to educate those who do not see that point of view, who differ from us conscientiously, into an acceptance of the view that there should not be a difference between any of the services, medical, nursing, accommodation or amenities of any other kind. I do not agree with Deputy Dr. Esmonde or the Fine Gael Party in this regard, nor do I agree with Father Coyne's discrimination—this class distinction or snobbery which is completely out of place in what we claim to be a democratic republic, a republic founded on a democratic programme, the Proclamation of 1916, and James Connolly's conception of the Ireland he would like to see.
Deputy Dr. Esmonde asked if this would or could work. I point to many other countries in which this has been tried, countries where there are equalopportunities in respect of all aspects of social life, education, health, old age pensions and so on. In New Zealand, to a large extent, in the Scandinavian countries and also in Great Britain, there is tremendous equality of opportunity and there has not been a drop in the standard of the service. Here at home, we have equality of opportunity in respect of our infectious disease services, in our T.B. and fever hospitals and we are now coming to the stage at which there is no need for private beds in relation to these services. There is the single room referred to by Father Coyne, but that single room is reserved for the sick person, irrespective of whether that person has money or not. The sick person gets these amenities because he or she requires them, because he or she is a human being in need of them, not because of being one of the soft well-cushioned members of society who can pay for them. I cannot understand the mentality that would divide our people into those who should be treated in a particular way and those who should not be so treated. They must all get the best, rich and poor. I simply do not understand the attitude of Fine Gael Deputies or of these contributors to periodicals, who, however, are not here to defend themselves.
The question of emergency squads has been referred to and we have in Dublin one of the best emergency squads, I suppose, in Europe for a neo-natal health service operated by the three maternity hospitals. It is a free, no means test, neo-natal service under which any mother in any income group can get the finest neo-natal health treatment, with magnificent modern equipment of every kind— superb equipment, hospital beds and incubators thermostatically controlled, as good as there is in Europe. It is a most interesting and most excellent service operated by the three maternity hospitals for the Dublin Corporation who pay for it. The whole principle we are fighting here has already been exploded and it is simply a myth to suggest that it brings medicine back or that it can be objectionable. It is already in existence in relation to thousands of beds in our hospitals andit is doing marvellous work in our Dublin hospitals.
The hospitals have made agreements with the local authority in regard to it and I do not think they have found any onerous conditions insisted on. The local authority says: "You run the service and send us the bill." and it is being run extremely well and has been instrumental in saving many lives. I agree that such a service would be very difficult in Connemara, but these difficulties could be overcome, and I hope the service will be extended throughout the country when further experience of its working in the City of Dublin has been obtained. All the medical men operating that service operate it on a salary basis. The service is already there and all the principles being opposed here, because of the fear of doctors being imposed upon by the State, are in existence already and are doing great work, and I cannot see why the principle cannot be further accepted without all the bitter quarrelling that is going on.
As to Deputy Mulcahy's contribution, he said he is asking questions to get information, but he also said to Deputy Briscoe that he intended to obstruct the Bill. That was his function. I would exclude Deputy Esmonde in this regard, because he has made some interesting points and helped us a little in telling us what is Fine Gael policy, but I do not think Deputy Mulcahy has done anything, as Leader of Fine Gael, but obstruct, so that that must be their policy. I do not think he could honestly say he has made any conscientious inquiries. We have to have patience in order to carry on and make progress in face of the very stiff opposition put up by Fine Gael.
The Deputy, echoing the Minister, has said that the sole function of this Party is to obstruct the Bill and not to make any contribution to it. I think it is quite useful that this section has been so fully discussed. I understood the Deputy to say at the beginning of his speech that he now accepts the principle enshrined in the Bill, although at a later stage ofhis statement, he spoke of the principle which "we are endeavouring here to explode". I will leave it to the Deputy to reconcile these two statements. This talk about the snobbery of Fine Gael in relation to differentiation between classes is, of course, absolute nonsense. What we are exposing here is the pretence to people who will be charged fees under this in addition to what is paid for these services through the rates that they will get different treatment and different institutional segregation from those who are already entitled to free services. That is the pretence of this Bill. We are exposing that. I think we are entitled to expose it. May I remind Deputy Dr. Browne that his description yesterday of this section of this Bill was that it is merely an extension of the poor law system? That was his own description of this particular Bill, a Bill about which he appears at times to be rather enthusiastic.
As briefly as I can may I say—unless I am needlessly provoked now I do not intend to speak again on this particular section—that the discussion on this has been extremely useful? The Minister has changed his stand on this section at least twice, if not three, times in response to representations made to him from both outside and inside this House. I think I am correct in saying in relation to this section that the Minister had not even the £1 in his head originally. That was the first change made in the Minister's scheme to meet representations or compromise on certain representations made to him. Subsequently in reply to still further representations, both inside and outside the House, the Minister put down an amendment to delete the £1 from the section and to substitute "an appropriate amount". As a result of the debate on this section and on that particular amendment, which is, of course, a fundamental amendment, and as a result of representations made not merely from this side of the House but by the Minister's own Party, by Deputy Dr. Browne and others, the Minister has again changed his step and we arenow in the position that we do not know whether, when this section is finally passed, if it is ever finally passed, it will contain £1, 30/- or £2. The Minister tells us in one breath that after careful examination he is satisfied that all the services set out in sub-section (1) of Section 15 will not cost more than £8. The average cost, he says, will not be greater than £8, and on more than one occasion he said that he was satisfied it would be less than £8.
Now we can agree to differ on that but, if that is so, what does the Minister mean now by talking about £2 if he is still going to retain the 50 per cent. liability on the patient because he can only justify his £2 for the making available of these services if the services are to cost £16 and not £8? Surely we are entitled to ask for information on that. May I remind the Minister again that he has not been able to give, or if he has been able, he certainly has not given to the House, what the cost of this will be to the State? In so far as the Minister has given any information on that point he has again changed his step. A fortnight ago we were told that the estimated cost to be borne by the local authorities would be £900,000 and the estimated cost to be borne by taxation would be £900,000. Subsequent to that he told us that it would cost £1,000,000 from taxation and the estimated cost on the local rates would be another £1,000,000. That represents an increase of £200,000 already. The Minister has not been able to tell the House, nor was he able to tell the representatives of local authorities whom he met, whether it would be 2/- in the £, 2/6 or 3/- or even more. We do not know what the particular class concerned will have to pay for whatever maternity services are provided.
The Minister does not know and we do not know and we are criticised now for trying to get for the people some idea of what this will cost. That does not mean for a moment that we are measuring the lives of either mothers and infants or adults against the cost. No one is trying to do that. As I said earlier, if certain Deputies were prepared to insert, or agreed to the insertionin a health scheme three or four years ago, what the Minister is now inserting and what they are now agreed on we would never have had all this trouble.
I will answer the questions once more but I guarantee that I have answered the questions at least ten or 12 times already. I will answer them once more, just to see what will happen. I have been accused by Deputy Morrissey of changing step. I said in the beginning in the White Paper that the estimated cost was £1,200,000 on the central Exchequer and £1,200,000 on the local authorities. There were certain amendments made then as a result of discussions with local authorities. Does the Deputy blame me for changing my step when I met these representatives?
No.
Why does he accuse me then of changing my step so often? Was I not right in changing it?
Quite right, but we do not yet know what this will cost.
The purpose of a White Paper is to get suggestions and make certain modifications. As a result of certain modifications the cost will now be £900,000 on the central Exchequer and £900,000 on local authorities because we introduced certain things like the £1 for the higher income groups and also a certain charge for hospital treatment. As a result of further amendments subsequently in relation to choice of hospital, etc., the cost went up again. It will now be roughly £1,000,000 on the central Exchequer and £1,000,000 on local authorities.
There is not a choice of hospital.
That is why the costs have changed. They have changed with the changes in the Bill.
There is no choice of hospital.
The choice of hospital has entered into it in amendment No. 45and that will make a big difference in the cost.
That is a choice of hospital for a certain class only.
That is as far as the cost goes now. I have never changed from that, whatever the Deputy may say. Let Deputies be clear on it now so that they will not have to spend another day asking the same questions. In the White Paper it was £1,200,000 on the local authorities and £1,200,000 on the central Exchequer. As a result of changes made between the issue of the White Paper and the introduction of the Bill that figure became £900,000 on the central Exchequer and £900,000 on the local authorities. After the Bill was issued it changed again and the cost went up to £1,000,000 roughly on local authorities and £1,000,000 on the central Exchequer. I admit these are all rough figures because no one can accurately estimate the cost. That deals with that point.
If Deputies go back over the progress of the Bill they will find that all these figures were given before. Deputy Morrissey accuses me of changing my step once more in relation to the £1. The White Paper was not acceptable. It was opposed very, very strongly by the local authorities as being too costly. It was opposed by the ecclesiastical authorities as giving a free service to people who could well afford to pay for it. The £1 was put in for the higher income group then as an insurance or contributory scheme. Then, as Deputy Morrissey says, as a result of objections to that £1 being a subterfuge, I offered an amendment. I have all the time believed that the £1 was a fair contribution if we were going to pay 50 per cent. I have always believed that and I still believe it. I admit that I may be wrong sometimes in my estimate but neither Deputy Mulcahy nor Deputy Morrissey will ever admit they might be wrong. I am not afraid of my estimate. I am prepared to put in a clause to say that if it is more than that I will collect it. When that amendment was put in certain people had a fear that the amendment might be used by asubsequent Minister who had not the same ideas as we have about these schemes and might pile up all sorts of administrative costs and make the contribution £5 or £6. That would be ridiculous. It could never be made that amount. In order to ensure that no future Minister would do that I withdrew the amendment and put in £2. That is what happened.
That is fair enough. It confirms what I said.
The Minister reiterated the figure of £1,200,000 reduced in a particular way to £1,000,000 but he has not given us any information in relation to the breaking down of that figure. Neither has he given us any information as to what the broad costs of the proposals in Section 15 are. He has not in any way gone into the situation as to the principle behind the scheme. He says there is an element of insurance. He has not indicated in any way that there is an element of inability in regard to a scheme which brings in 88 per cent. of the farming population under a free mother and child scheme. He certainly did not cover the point that I raised as to what extent a scheme like this is based on efficiency.
I outlined very fully on a previous occasion why I thought it was necessary to help the people in the higher income group. I guarantee that if you go back you will find mention of it at least once in the debate. Take the case of a young married couple in the City of Dublin. Perhaps, they have to buy their house. They may have to buy their furniture on the hire purchase system. If the young married man happens to be a commercial traveller or in some other business he may require a motor car. He may have an income of £600 per year and it is not easy for him to meet his expenses. That is why I said that the higher income group will have to be assisted. Is not that sufficient? That was what induced me to do something for the higher income group. I mentioned that before.
Deputy Esmonde put a question to me in relation to maternity costs. Deputy Esmonde is a member of the Irish Medical Association and he may be on a group negotiating with me in regard to what the doctors will be paid. Am I going to be in the position where Deputy Esmonde will say: "Surely, you said in the Dáil you were going to pay the doctors so much?" It should be obvious that I cannot mention these matters until they are fixed up with the doctors. I would have liked to have negotiated this thing with the doctors before this Bill was brought in but they adopted the same attitude as Fine Gael, that is, they would not have it. If you have a small dwindling Party like Fine Gael adopting that attitude——
Dwindling?
I say it is dwindling.
You are a brave man.
If you have Fine Gael adopting that attitude in the Dáil and the Irish Medical Association adopting that attitude outside, all we can do is to go on with the business. The country wants this and we are putting it through.
Could the Minister give an indication as to the percentage that would go in administrative costs? Could he give us a brief outline?
Does the Deputy mean the collection of the £1? Let us take the position in Wexford which the Deputy represents. I estimate that there will be hundreds, not thousands, of women who will adopt this scheme in the County Wexford. The clerk dealing with the matter will buy a book costing 4/- or 5/-. He will have to enter three or four hundred names per year. That should in all probability take over half a day in the year. Therefore, the administrative costs will be negligible so far as that is concerned. When a doctor sends in a bill in respect of a patient the clerk has to look up the book and will say: "She is all right. She is eligible," and the bill is paid. I cannot see the administrative costs being more than those few pounds ayear. Paying out the money is a different matter. It may happen that a woman may join this scheme in preference to disclosing her income.
I really meant those under £600.
And who do not join?
Yes.
That will come up for more detailed discussion on Section 25 and, perhaps, it would be better not to deal with it at this stage.
And the great principle is accepted.
SECTION 16
I move amendment No. 27:—
To add to the section the following sub-section:—
(2) Regulations shall provide that medical services under this section shall be made available for a child by such registered medical practitioner who has entered into an agreement with the health authority for the provision of those services and who is willing to accept the child as a patient as the parent of the child may choose.
This is the same thing.
The principle involved in this amendment is the same as that involved in amendments Nos. 22 and 23.
I thought Deputy Dr. ffrench-O'Carroll was going to oppose the section?
There is still time to do it.
It is on the paper with the amendments.
That is right.
I put a number of amendments down earlier with some other Deputies suggesting certain changes in the section and they were ruled out of order. I wanted to ask the Minister whether he really felt that in the mother and child scheme it was sufficient to leave the limit for children at six weeks. I think that it would make for a better scheme if it could be extended. Originally, the scheme of the inter-Party Government covered up to 16 years of age. I think we would have a far better scheme and far better co-ordination of the services available if it were brought up to 16 years. I appreciate the Minister's difficulties and the fact that there has been so much delay in discussing the Bill. At this stage, I am quite happy to see any progress being made at all.
I feel, particularly in view of the fact that the Minister has included the school medical service under this Bill, that the various investigations which will have to be carried out under it will, in fact, be part of the extension of this mother and child section to 6 years instead of six weeks as envisaged in the Bill. I believe that when the scheme is in operation whoever is administrating it at the time will find it very much easier to extend it. The Minister knows that the neo-natal side of the scheme has been in operation in Dublin City for some time. That is a point that Deputy Dr. Esmonde did not seem to realise yesterday when he said that the Minister had not made arrangements to negotiate with any doctors except the dispensary doctors. That is not so. When Deputy Dr. Browne was Minister for Health he negotiated arrangements for the neo-natal side of this scheme which the present Minister is going to co-ordinate in the Bill under the mother and child scheme. In the Dublin maternity hospitals special arrangements were made available to provide neo-natal facilities. The scheme is in operation at present. I wonder would the Minister consider it possible to extendthis scheme beyond the period of six weeks as envisaged at present.
I would like to support the plea that has been made by Deputy Dr. ffrench-O'Carroll. The Labour Party had an amendment down, their view being that the period should be brought to six years. We felt that when a child had passed that age, it would continue to receive attention in school right up to the age of 16 as Deputy Dr. Browne had thought of doing in his earlier scheme. I think there is need for to do what Deputy Dr. ffrench-O'Carroll has suggested, so as to close the gap between the age of six weeks and six years.
In this section we are dealing with infant welfare, that is with children under six weeks of age. In the next section we will be dealing with those from six weeks to six years, and after that with children attending school.
I should be glad if the Minister would clarify this matter a little bit for me. I appreciate that no arrangements have been made so far, with regard to the implementation of Section 15. Section 16, more or less, continues treatment for the infant after birth. I wonder could the Minister tell me if it is envisaged that the doctors will be paid a capitation fee for attendance during the period of childbirth and whether that will cover the six weeks' period after birth? Will the two run concurrently in any contract that may be entered into between the Minister and doctors who may accept service under this scheme? With regard to what Deputy Dr. ffrench-O'Carroll has said about the neo-natal service, I would remind him that it is run by the voluntary hospitals and is not a State concern. That makes a considerable difference.
It is paid for by the State.
It may be, but the principle is there, and that is the difference that is between us. I say that it is a voluntary service. To put it in another way, there is a Stategrant. What we utterly object to is State control. We do not mind the State providing help or assistance in the way of ex gratiapayments, but we do not like the State to be put in complete control.
Are we to take it that whatever treatment is required for the child up to the age of six weeks is also to come under the £8?
Yes. The doctor who takes on maternity cases will have the child up to six weeks, but he is not going to get the whole of the £8.
Can the Minister tell me what is the position going to be in regard to the provision of medicines? Has any particular arrangement been made in regard to that? Will the parent be charged for the medicines, or what will be the position?
The medicines are provided for those in the lower income group, but not for those in the groups above it.
So that the £8 is to cover the cost of the medicines also?
We are to take it then that it is only those in the lower income group who will get medicines— not the others.
That is so.
Will the Minister say on what basis the six weeks was accepted? What are the particular weaknesses or defects in children that are expected to pass inside of six weeks?
That scheme has been in operation in Dublin for some time, and that is why the six weeks' period was accepted.
Then it is based on Dublin experience only?
I would ask the Minister to give special consideration to this question of medicines. As most Deputy-doctors know, medicines, in recent years, have become a terribly big part of treatment in relation to disease.Fortunately, that does not trouble me personally, but I do know of general practitioners who, on occassion, have found it necessary to order an old-fashioned drug which is not so effective as one of the more modern drugs, simply because they knew that their patients could not afford to pay for the more expensive drug. Really good new drugs when they come on the market, are terribly expensive.
From conversations which I have had with general practitioners, I know that very often they have to face the very difficult problem of deciding as to whether they will order a less expensive and less effective drug simply because they do not want to expose patients to the considerable charge of paying for the modern drugs. I know that this is a terribly difficult question. That is one side of the question. There is the other side, that if a doctor did feel that he had not given the best possible treatment because the patient could not afford it, I think that would greatly weigh with me in considering an extension of the provision of medicines. I understand some sort of safeguards have to be established. I would imagine the Minister could get a lot of information and experience from the British scheme and the New Zealand scheme as to whether it would not be possible to work out some scheme which would be equitable and at the same time not outrageously expensive. I make the point that nowadays medicines are one of the most expensive components of the treatment of the average serious case of illness.
The question of medicines is a very difficult one. I have been considering that very carefully now for some time. If a woman were to make an agreement with a doctor to look after her and if he said to her: "This is going to be a difficult case. You should go to hospital." In that case she is being sent to hospital and everything is paid. There would be a difference if a woman said to a doctor: "I would like if you could get me into some hospital or a home. I would prefer it." In that case, as far as medicines go, they would have to be on the same basis as in domiciliary treatment. Take the domiciliary treatment.When considering this scheme first, I was inclined, I must say, to the view that medicines should be included free. But it is a very difficult matter. We had a great deal of worry and trouble in coming to a decision on it and we ended up by leaving medicines out.
I do not think there is anything in the Bill that would prevent a local authority from paying for medicines eventually. Of course, in that case they would have to get the sanction of the Minister for Health because he would have to pay half. However, I do not think there is anything in the Bill to prevent it being done at a later stage when we find a practicable way of doing it. I did meet the pharmaceutical chemists to discuss the matter. They were very helpful but they were not able to get me over some of the difficulties with which I was confronted. Anyway it is a matter that can be discussed further with the pharmeceutical chemists and all concerned.
Surely if the position is going to be that if the patient accepts institutional treatment, as the Minister says——
By order.
——the medicines and everything else will be free, that will be a very strong inducement to the patient to claim institutional treatment as against domiciliary treatment.
It is only where the doctor says: "You would be better in hospital than you would be at home."
The Minister would be in a position to know that there are certain cases, in fact, quite a number of cases where family circumstances would almost compel the doctor to send the patient to the institution. There is no doubt that, as Deputy Dr. Browne says, medicines can be a tremendously costly item and it can impose a very heavy burden indeed. I think we are all agreed on what the Minister and Deputy Dr. Browne have said, that it is a difficult problem but to the extent that the Minister will try to meet it, surely this is an elastic £8. It could not conceivablyprovide for those things. I do not want to score a point on that but I do not want us to fool ourselves into believing that we are going to be able to provide the services which this Bill contemplates particularly if it includes medicines and other necessary commodities that are known to doctors. There is no use in pretending that we can do it for £8. Speaking as a lay person I feel that on the face of it it could not possibly be done.
Could the Minister state if the £4 maternity grant applies only to the lower income groups?
Yes.
I feel there is something in what Deputy Dr. Browne says. I am not often in agreement with the Deputy but certainly in this case I am. It is largely the middle income group who would be concerned in this. The costs of the products of the chemist shop have gone up considerably recently. Medicines and all the necessary appliances such as cotton wool, disinfectants, and so on, are extraordinarily expensive. Would it not be possible within the framework of the Bill to work out some scheme whereby the Minister could allocate a small amount for the middle income group? As Deputy Morrissey stated, this £8 is already strained to breaking point and I do not think it could reasonably be hoped to cover medicines at all. Perhaps in consultation with the chemists he could devise some scheme which would meet the case so as to lessen the hardship on these people.
The question of patients going to hospital has been mentioned. The Minister, being a medical man, as I am, will appreciate the fact that the difficulty in childbirth is that you never know in many cases whether it is necessarily a hospital case until the event actually occurs. I can see the occasion arising whereby the housewife would lay in for domiciliary treatment all the appurtenances necessary for childbirth and then may subsequently find herself transferred to hospital. She would then have the expense of going to hospital. Of course,there would be no charges in the hospital but there is always a certain amount of expense connected with these things and she would have laid in these items which would not be necessary. Perhaps the Minister could allocate some amount. I would not be prepared to indicate what that amount would be, but surely the Minister is in a position to meet the chemists and consult with them.
If we could meet this problem at all it would be done somewhat on that line. At least there will be a maximum fixed. As the Deputy says, I would like to get some average cost and I think it could be got fairly easily.
Has the Minister no idea, as a result of the consultations he has already had, as to the sum needed?
Unfortunately all I get is indignant letters from people telling me what it did cost. Of course, these are very outlandish cases I hear about. However, it would be easy enough to get from the chemists or private hospitals an indication as to what the average cost is.
That is the point I want to make. I am not suggesting the Minister should take his rate of cost from indignant letters he receives from patients. I suggest he could take it from experienced people. That is where the consultative council comes in. Since the Minister has chemists on that perhaps he would consider discussing the matter with them and acting on those lines.
Yes.
Would the Minister give us the background to this?
This section deals with the children between six weeks andsix years. This section provides that:—
"A health authority shall, in accordance with regulations, make available, without charge, at clinics, health centres or similar institutions, medical, surgical and nursing services for children under the age of six years."
This service applies to everybody, of course. Every woman who is prepared to take her child to the clinic will get free advice and free treatment for minor defects that may exist but it will depend on her income after that as to what service will be given. Hospital service, of course, will be given to the people in the lower income and middle income groups. Domiciliary service will be given to the lower income group. Every service will be given to the middle income group. Hospital service and specialist service will be given as laid down in Section 14. So far as the higher income group is concerned, they only get the service that the higher income group get—that is, free service in case of infectious diseases and free immunisation, and so on.
The Minister indicates here that this section deals with a child from six weeks to six years. Surely it includes the position with regard to children under six weeks, who do not come in under Section 16. On the face of Section 16, it would seem that that was the one real piece of free-for-all service enshrined in the Bill, but, apparently, the intention behind the word "regulations" would contradict that. Will the Minister say in what way these regulations will be published and in what form they will be presented to the House, considering that it proposes to make distinctions between different classes of people and that it proposes to make different charges?
Even if there was a desire to do so, the regulations could not make a charge because it says in the section "without charge". The regulations could not alter that. Regulations will be necessary to lay down the conditions with regard to the location of clinics and, perhaps, the conditions of service of doctors and nurses concerned,and so on, but they cannot interfere with the charge because it is a free service under the section.
If it cannot interfere with the charge, apparently, it can discriminate between children of different classes. Is not it rather remarkable that behind a section that speaks of giving service for children unqualified with regard to position, class or means, there would be the intention to discriminate between different classes and different means by way of regulation? Surely it is not reasonable that a section would appear like that and that regulations would make discriminations.
It seems to me that Section 17 is rather misleading:—
"A health authority shall, in accordance with regulations, make available, without charge, at clinics, health centres or similar institutions, medical, surgical and nursing services for children under the age of six years."
I take it that children between the age of six weeks and six years in the lower income group are entitled to all treatment free of charge, as at present. Is not that right?
Certainly, yes.
In the middle income group, unless it is specialist treatment, there is a charge. It is not free to the middle income group according to the provisions of this Bill. It does not provide free treatment for the middle income group other than specialist treatment. Is that right?
That is not exactly it, no.
I want to clarify the point.
It is not exactly right.
This does not make sense:—
"A health authority shall, in accordance with regulations, make available, without charge, at clinics, health centres or similar institutions, medical, surgical and nursing services for children under the age of six years."
According to that, if we read the Bill right, the only people who will get free treatment are the lower income group. They will get free treatment for everything. The section is wrong in saying "without charge".
No. Whatever is given to them at the clinic is free. I want to make that clear. They are examined at the clinic free. They get whatever service is given at the clinic free. If the dentists agree to operate this, that would be free. Treatment for tonsils would be free. Whatever would be done at the clinic would be free. If the doctor says: "What you want really is an operation for appendicitis," then it would depend on what group the patient is in. If he is in the lower group, it is free. If he is in the middle income group, what applies in the case of hospitalisation is that they get the hospital and operation, and so on, but they may be charged up to £2 a week, if their means permit it. I want to make it clear that whatever they get at the clinic is free. That is the point.
Then we have a principle here whereby anybody in this State, no matter what his income is, can go to a clinic.
That is right; that is as it is at the moment.
If he has £20,000 a year he can go to a clinic?
Yes.
Would the Minister indicate where these clinics are?
That has been the position for years. They are free to everybody.
Surely a wealthy person is not allowed to go to the dispensary.
Child welfare clinics in the city are free to anybody.
A clinic is a dispensary, is it not?
No. These child welfareclinics are different. They are not dispensaries. They are child welfare clinics.
Will the Minister indicate where these child welfare clinics are? The only one I know outside Dublin is in Arklow. I do not know of any other.
I do not think there are any outside Dublin at the moment.
There is a voluntary clinic in Arklow that has a subsidy from the county council.
I think it is not what I am describing as a child welfare clinic.
It is neo-natal. It is child welfare to a certain extent. Is it the Minister's intention to establish clinics all over Ireland?
Yes.
Will the Minister clarify the position and tell us in what places he intends to have clinics? Is it ruled by population or what has he in his mind with regard to it? It is very ambiguous, to say the least of it, to suggest that you can get free treatment.
We will never reach the stage where we will have child welfare clinics in every dispensary. It may be possible in the centres of population within reach of everybody. Take County Wexford.
Is it not a fact that clinics are being established? One has been established in Roscommon.
There is a county clinic in Roscommon. That is different. These are child welfare clinics.
Will not treatment be available at these clinics?
They will be used. I was going to say that the four cities would be the centres. That is what I have in mind. We may have to go further. I do not know.
I move to report progress.