I naturally, of course, am impressed by the argument put forward by Deputy McGilligan against this proposed system which is implicit in this part of the Bill. There are two objections which fall to the section, the insistance on the declaration of of means. Deputy McGilligan has made the case which is universally recognised against the imposition of means tests, particularly in health services. Inevitably, one must run up against these terribly complex tedious attempts by the draftsman—with the best intention in the world, I have no doubt—to cover every contingency and all the contingencies mentioned by Deputy McGilligan. Even if one did not have other objections to the means test and the attempt to cover all the likely eventualities which must flow from this very complicated legislationin relation to the means test, one would have to be moved by the appalling prospects which this opens up. This is an attempt to keep control as to the people who are within particular income groups, the people who have moved out of those groups and the people who move in, to follow the change of their financial circumstances in cities, towns or in the country. There is no doubt that in order to meet the wishes of the people who are in favour of a means test in relation to health schemes, this tremendously elaborate administrative machine must be engaged in the local authority service. It is most regrettable that this should have to arise and that it should have to be created. The ideal would have been to jump all these fences in one and have a scheme in which there was no necessity for a means declaration or means test of any kind.
If, however, one does accept the necessity for a means test—and I must confess, of course, that I accept it as a temporary measure in view of the fact that it appears to be the wishes of the majority of the House—I feel absolutely certain that there will eventually be an extension of the T.B. no means test service, the neo-natal no means test service and the infectious diseases no means test service and the maternity services included in this Bill itself. I think that is the one bright part of the Bill—that that principle has been maintained, possibly slightly vitiated but I do not think in effect vitiated. That principle will be extended over the years and eventually we shall be able to rid ourselves of this rather frightening incubus which must be created in order to help the various local authority officials who must be guided by the very rigid rules created by the Minister under this legislation. The ideal arrangement would be for us to dispense with the assessment of means and to decide that the health service shall be available to all, either because they need it due to economic circumstances or because they are paying rates or taxation, the need being decided on purely medical considerations.
The main objection to the meanstest is not any doctrinaire political objection at all. As far as I am concerned, it is an objection based on medical grounds that you can have an even type of service with a means test running through it. I think you can get different levels—two-tier, three-tier levels—and I think that the lower income group can come off least well in the contest for the health services. If one does insist on the retention of a means test in our health services, that heritage of years gone by, then I am afraid that all these sections for which you create this very involved and complicated series of regulations are simply consequent on your insistence on the retention of a means test.
Deputy McGilligan talks about the free-and-easy red ticket days, and so forth. It is no use telling a relieving officer or a public official that he can use his discretion. Unfortunately, I do not think the average official feels free to do it. He must be bound by the letter of the laws we create. Therefore, if we insist on keeping this means test we must impose this very expensive administrative machine on our local authorities.
From conversations I have had with visitors who, in their own country have valuable no means test health services, I found that one of the main arguments put forward by them for these types of services, particularly in Great Britain, was that the means test was administratively terribly complicated and very expensive to carry out and that, for that reason alone, it was thoroughly undesirable.
The Minister cannot be accused of having introduced these things particularly willingly. We know quite well that this legislation is amending the 1947 legislation for which he won the authority of the House for a free no means test scheme and which would be a much bigger bite at the whole cherry which, in reality, would be a free no means test health service.