Dáil Éireann debate -
Tuesday, 6 Jul 1954

Vol. 146 No. 8

Committee on Finance. - Vote 63—Health.

Minister for Health (Mr. T.F. O'Higgins):

I move:—

That a sum not exceeding £7,687,700 be granted to complete the sum necessary to defray the Charge which will come in course of payment during the year ending on the 31st day of March, 1955, for the Salaries and Expenses of the Office of the Minister for Health (including Oifig an Ard-Chláraitheora), and certain Services administered by that Office, including Grants to Local Authorities, miscellaneous Grants and Grants-in-Aid.

In common with my colleagues who have moved Estimates in the House in the last week or so, I am to-day introducing an Estimate prepared not by me but by my predecessor in office, for the sums needed by my Department for the current year. I have too recently taken up office to have had the opportunity of examining fully the services covered by the Estimate. I intend, therefore, to present the Estimate to the House as it stands, giving merely a brief comment on the working of the main health services during the past year.

I propose in the first place to review some of the main vital statistics for the previous year. The figures quoted for 1953 are provisional but figures for earlier years are final.

The birth rate per 1,000 of the population for 1953 was 21.1 as compared with 21.9 for 1952.

The marriage rate also fell slightly from 5.4 in 1952 to 5.3 in 1953.

There was a slight decrease in the death rate from 11.9 per 1,000 population in 1952 to 11.8 in 1953.

The infant mortality rate, at 39 per 1,000 live births, was the lowest yet recorded for this country. It compares with a figure of 41 for 1952 and an average of 47 for the five years to 1952. The maternal mortality rate also improved from 1.4 per 1,000 live births in 1952 to 1.2 in 1953.

It is gratifying to find that the downward trend in the mortality from T.B. has been maintained. The rate for 1953 —40 per 100,000 population—was the lowest yet recorded. It compares with a rate of 54 per 100,000 population for 1952 and is exactly half the rate for 1950. That there is still room for improvement is shown by the rates recorded for other countries; in the Netherlands for example, a rate of 16 per 100,000 population and in Denmark a rate of 14 were recorded in recent years.

The death rate from cancer was 143 per 100,000 population as compared with a similar figure for 1952. The heavy mortality from cancer emphasises the need for improving to the maximum possible extent the facilities for diagnosing and treating the disease.

There were 35 deaths from measles as compared with 52 in 1952; 59 deaths from whooping cough as against 86 in 1952; and scarlet fever deaths fell to three, from ten in the previous year. There was also a decline in the deaths from diphtheria from seven in 1952 to three in 1953. I shall have something further to say about this disease later.

Deaths from influenza increased from 238 in 1952 to 476 in 1953 and deaths from poliomyelitis from 13 to 33. Deaths from gastro-enteritis among children under two were also higher than in the previous year, this disease being responsible for 185 deaths in that age-group as compared with 160 in 1952.

We again had a clear record in regard to smallpox.

I now propose to review briefly the work done in connection with the statutory health services—using the term generally—during the past year.

Medical assistance services were further improved during the year by the provision of new buildings, to which I shall refer briefly later, and by the improvement of equipment in existing hospitals, etc. During the year the former fever hospital premises at Cork Street, Dublin, became available for other purposes and it was decided to use it to accommodate a large number of the ambulant persons in St. Kevin's Hospital. At the same time the Dublin Board of Assistance, having acquired other premises from the authorities of the Mendicity Institution, was adapting them for use by male casuals who are now housed in portion of St. Kevin's. The transfer of these persons from St. Kevin's in the near future will contribute substantially to the rehabilitation and improvement of that institution and to the improvement generally of the services which the board provides. Public assistance authorities throughout the country continued their efforts to provide special accommodation for particular classes as was done by the Dublin Board of Assistance. Side by side with the more spectacular building programme, the authorities mentioned continued the improvement of the services by providing additional staff where needed.

I have referred to the very greatly reduced death rate from T.B. Up to the present time a large part of the effort of the Department of Health and of the local authorities administering the T.B. services has been devoted to providing sufficient beds for sufferers from the pulmonary variety of the disease. An additional 350 beds became available during the past year, mainly at the Western Regional Sanatorium in Galway and in Ardkeen Chest Hospital, Waterford, and so far as can be foreseen the time is now near when a bed will be available almost immediately for every pulmonary patient in need of treatment in a hospital or sanatorium. In future, greater time and attention can be devoted towards the expansion and development of the field services, particularly the tracing of contacts of cases which come to light and the preventive measures represented by tuberculin testing, B.C.G. vaccination, and mass-radiography. The National B.C.G. Committee and local authorities which operate their own B.C.G. schemes performed over 56,000 vaccinations in the year ended 31st March last. The National Mass-Radiography Association and the Cork County Council which operates its own mass-radiography scheme between them X-rayed over 190,000 persons.

It should not be necessary for me to stress that all diagnostic and treatment facilities for T.B. are freely available to every citizen and that I, my Department and the health authorities are only too anxious to see them availed of to the fullest extent to ensure that treatment is commenced at the earliest possible stage in the development of the disease.

The scheme of cash allowances for persons suffering from infectious diseases continued during the year. The primary purpose of the scheme is to encourage people with certain infectious diseases, especially T.B., to undergo the treatment needed for their conditions by relieving them of anxiety as to their own maintenance or the maintenance of their families while they are getting treatment.

I find that some noteworthy improvements were made in the mental hospital services during the past year. In several mental hospitals, schemes of reconstruction are in progress, while in other cases planning is actively proceeding. Work started on the provision of 328 extra beds by the Grangegorman Mental Hospital authority. Overcrowding in mental hospitals is acute in a number of places and it is hoped that the additional patient and staff accommodation which will be available when these works are completed will relieve the problem very substantially.

The various modern forms of psychiatric treatment are now in general use in district mental hospitals. The extension in the use of these treatments has been helped by the fact that medical and nursing staffs in the hospitals have been increased considerably in recent years. The better facilities for the reception of voluntary and temporary patients, and the development of active treatments have given a great impetus to the treatment of mental illness in the early stages, when, of course, the prospects of quick recovery are most favourable. This is reflected in the increased receptions of voluntary and temporary patients, the numbers of whom have risen roughly three-fold between 1947 and 1953. The numbers of discharges of such patients are also very satisfactory. A gradual advance is also being made in the provision of facilities for occupational and recreational therapy in mental hospitals. In most of the district mental hospitals, at least 50 per cent. of the patients are provided with suitable employment. Upwards of 70 per cent. take part in the indoor and outdoor recreations available. Both forms of therapy are found to help considerably towards recovery in many cases.

Approximately £3,650,000 was paid out by way of grants from the Hospitals' Trust Fund for the building of hospitals during 1953-54. Among the major hospital works completed during the year were the new fever hospital at Dublin with 280 beds, and the new county hospital at Manorhamilton. Work commenced during the year on a large number of projects. The most important of these were a new unit at the Meath Hospital to provide 80 beds, a new nurses' home at Mercer's Hospital, Dublin; a new orthopadic hospital at Kilcreen, County Kilkenny; and the provision of 328 extra beds at Grangegorman and Portrane Mental Hospitals. The work of converting premises at Celbridge to a mental defective institution was also started.

A number of large hospitals and hospital buildings were at a very advanced stage of construction by the end of March and the majority of them should come into operation during the current financial year. These include the regional sanatoria at Galway, Cork and Dublin; Our Lady's Hospital for Sick Children at Crumlin, Dublin; the new orthopaedic hospital at Gurranebraher, County Cork; St. Luke's Hospital, Dublin; the Limerick Regional Hospital; the new nurses' home at the Mater Hospital, Dublin; the main block of Galway Regional Hospital and the major extensions to the mental defective institutions at Drumcor, County Louth and Lota, County Cork.

Out of a total of just over 1,000 dispensaries and dispensary depots in the country, local authorities have indicated that they propose to replace approximately 400. From May, 1952, when grants for the erection of new dispensaries were first promised, up to the 31st March last, 65 new premises had been provided, and it is hoped that a further 100 will become available during the current financial year. This rate of progress should see the finish of the dispensary replacement programme within a few years. Seven county clinics in all have been completed and seven others now in process of building should be finished before the end of the current year. In three other cases the stage of inviting tenders has been reached, and the planning of the remainder included in the county clinic construction programme is proceeding.

Expenditure on local authority health services rose from £5,650,000 in 1947-48 to over £11,500,000 in 1953-54. The Exchequer is now bearing 50 per cent. of the cost of these services.

The fact that health services are costing the ratepayer and the taxpayer such large sums prompts me to offer some advice at the risk of incurring the displeasure of those who hold that it is wrong that a Minister for Health, a politician and a layman, should usurp such functions.

I have said earlier that there was no case of smallpox in this country in the last year. In fact, we have had no native case of it for many years. I have also given the number of deaths from diphtheria in the last year. The number of cases of this disease and the number of deaths from it have declined enormously in recent years. This happy position, competent and widely accepted medical opinion assures us, is attributable to the widespread vaccination against smallpox and immunisation against diphtheria. The same opinion warns us, however, that we cannot hope that the present freedom from the one disease and relative freedom from the other can continue unless parents continue to see that their children are protected by vaccination and immunisation. The trouble involved in bringing a child to a doctor to have these procedures carried out is a very small price to pay for the immunities they confer. The family doctor will be glad to do what is necessary or the health authority will provide the service free for anybody who wants it. I would therefore appeal to all parents of young children to make a special point of seeing that all their children get this protection.

There is probably no adult in this country who has not witnessed the misfortune which can descend on a family through T.B. It is not a hereditary disease—anybody in an unprotected state can contact it from close contact with an infected person and we do not always know who is infected and who is not. Every one of us who has the least suspicion that he may have been unfortunate enough to contact it has the duty of going for a check-up in his own interest and lest he should be the cause of passing it on to his relatives, his colleagues at work, or his friends. The facilities for such check-up are available to everybody. In addition, medical science has discovered a means of providing a considerable measure of protection against it—by B.C.G. vaccination. If all children and young adults were given such protection, the saving in suffering, in economic distress and in the expenditure of public moneys on the hospital services would, in the course of a relatively few years, be enormous. I would appeal, therefore, to all Deputies to co-operate fully with health authorities and the voluntary agencies set up to deal with particular aspects of the tuberculosis services in encouraging the public and particularly the parents of children and young adults to avail of the services made available for their protection.

I indicated at the beginning of my speech that I had not yet had an opportunity of examining the health services fully. I do not intend, therefore, to make any statement about future policy on numerous important details of those services. I will, however, say that it is my intention, and the Government's to obtain and maintain in the health services of this country a standard as high as that which applies in other comparable countries. Everybody in the House will be with me in declaring this intention; the means which should be taken towards securing this end are receiving my active consideration at the moment and I hope to be able to deal more fully with the matter in the course of the discussion which will take place on the Health Bill in this House in the immediate future.

Mr. Briscoe:

I do not think anybody can find fault with the manner in which the Minister has presented his report on the general health services that concern his Department. I think we can generally compliment ourselves on the fact that for the past number of years efforts have been made to improve the health of our people, to make services available to them and to make our people understand the need for medical attention for the cure and prevention of disease.

The figures which have been given to us show a drop in the incidence of various types of illnesses and diseases. It is, however, clear that we are far from perfection. There is still a great deal of uphill work before us in order to bring the present figures, which by comparison with previous years, are satisfactory, near to the figures that have been obtained in other countries.

The Minister has given a great deal of detail with regard to T.B., its treatment, prevention and early diagnosis and the provision that has been made to assist people financially so that their cure can be hastened and their minds can be at ease during the period of treatment and convalescence. He also mentioned that even in the last year a substantial number of additional beds has been provided for T.B. cases. We will all agree that money spent by the State and by local authorities in the cure and prevention of T.B. is money well spent and that when we get to the stage where the incidence of T.B. may be regarded as negligible there will be consequent saving and the money now being spent on T.B. patients can be made available for other types of health work and even, if necessary, research.

Cancer is a problem. Certain developments have been made recently in connection with this particular disease. One of the problems is the difficulty people have in recognising the disease. Persons suffering from cancer recognise that they are suffering from it only when it is almost too late. I happen to be a governor of a cancer hospital in the City of Dublin which is doing extremely good work. I would suggest to the Minister that his Department should issue a constant reminder, by way of a radio talk, warning the people about this disease and telling them that it would be a good thing for persons to have a check-up once in a while specifically for the purpose of discovering if there is any likelihood of their developing this disease. One of the great problems is to get people to go for a check.

The Minister should try to get his Department to educate people through whatever services are at his disposal, the local authorities' medical officers, and so forth, not to be so afraid of cancer being found in them. Unfortunately, in the past, this country suffered from the fact that persons hid that they were suffering from T.B. or cancer, as if it were some crime that they had committed and they did not wish it to be known that it had happened to them. A great deal of education is necessary if people are to understand that our human beings are frail and that we are prone, through infection or otherwise, to illness or disease, and that the best thing to do is to have immediate medical attention so that, if cure is possible, treatment will be easier and less dangerous to the person concerned.

Gastro-enteritis is a problem which faces us in Dublin. I suppose it occurs in other places but in Dublin in particular it is a problem. Gastro-enteritis is one of the most contagious illnesses that can affect infants and one of the most important things in the treatment of gastro-enteritis is immediate detection and absolute care to prevent the disease spreading. I do not know what the cause of gastro-enteritis is. Some people say that it is caused by dirt in food. We have legislation which more or less compels under penalties cleanliness and hygiene of certain minimum standards in the sale of foodstuffs. I would like to know that the Minister is following this up. I know that some time ago there was an outbreak of gastro-enteritis in a city in another country. For a long while it was gathering force and affecting more and more people. It was discovered that a laundry attached to an institution was not doing its work properly in the disinfection of garments.

The figures given by the Minister, showing a fall in the incidence of certain illnesses and diseases, are proof positive that we cannot rest at the present stage. We cannot just say that we have reached a certain expenditure and consequently we will not make further improvements or give further assistance. We have got to wage war with the only implement we have—money—in order to make the necessary attack effective.

The Minister talked about new buildings and new equipment. He also talked about the developments in connection with St. Kevin's Hospital, Dublin. Most of us can see the development which has taken place in recent years. We remember when St. Kevin's was regarded as a workhouse and a union to which hopeless cases were sent to spend their last days there. To-day, we see St. Kevin's rapidly becoming one of the most modern, up-to-date hospitals where everybody can go and get treatment equal to that which they would get in any hospital anywhere else. I think that the administrations responsible for this development deserve great credit for having converted a building associated with the workhouse and a union into what it is to-day, a hospital gradually becoming something we can be proud of. The walls around it are being demolished and extensions are being built. This is the kind of work which will continue and, if continued, we will reach a stage where we can say that, as a result of Government attention in the provision of health services, the health of the people has been brought to the stage where it will be easier to do other things.

I hope the Minister will confirm—I have not concluded this from anything he said—that there will be no economies to bring about what might be called a marking of time or a retarding of the development which has taken place. Mental hospital improvements are also very important. I should like the Minister to say, if not at this stage then at a later stage. whether any rapid progress has been made to deal with the treatment of young mental defectives and young people who are housed with adults afflicted with this unfortunate illness.

The Minister referred to the Hospitals' Trust Fund and the manner in which it has helped to contribute towards the building of new hospitals. The Parliamentary Secretary to the Minister for Local Government is aware of a particular case which I am now going to quote. We have hospitals in the City of Dublin with large overdrafts and on these overdrafts they have to pay substantial sums by way of interest. This interest payment is a recognised charge when the deficiency account is being checked up. I think the Minister might be able to find some way of relieving that situation and reduce the deficiency to the extent of these charges. I find it difficult to understand why hospitals should have to pay a large sum of money every year by way of interest whilst, at the same time, every care is taken as regards everything else that there should not be waste or unnecessary charges. I do not know whether we have yet reached the stage where the Minister might be able to get a rough estimate of the total amount of money due by these hospitals, particularly voluntary hospitals, and see whether some method can be adopted by the State to wipe out the overdrafts and so reduce that particular charge.

There is need for further improvement in our dispensaries. Improvements have been made and are being made. There is need for additional clinics. All these things are bound up with the general health service. The extent to which our people avail themselves of treatment, examination and care will be a measure of the extent to which such treatment brings a charge upon themselves.

The Minister referred to the maternal mortality rate and also to the infant mortality rate per 1,000 live births. I can only speak of the authority of which I am a member. I wonder to what extent people have been educated in matters concerning the birth of children, the treatment and attention both before and after birth, the problem of mothers going to hospitals for confinement, the numbers that can be taken in and the numbers that should be taken in that are not taken in. It has been suggested to me—I have heard the matter discussed—that every mother who is having her first baby should go to hospital. Judging by the manner in which the baby is born and the general situation, it can be decided whether that mother, when having her second baby, should go to hospital or whether she can have the baby born at home. Again, the home itself has to be taken into consideration. It has to be considered whether the woman has the necessary facilities and assistance at home to have a baby born at home. All these things are of vital importance. I hope, when the Bill is being discussed to-morrow, that we shall have some opportunity of dealing with that particular aspect of the matter.

I know from my own small experience as a layman on the board of a maternity hospital that these are problems which have confronted our people for a great number of years, and it is only in recent years that any improvement has been made. One begins to realise that the facilities the masses of our people should have in connection with bringing children into the world are not there to the extent they should. Every mother having a baby cannot be taken into a maternity home. We on the Dublin Corporation, in association with the maternity hospitals, have toyed with the idea of providing a certain type of nursing home so that a woman who left hospital early could go to one of these nursing homes for a period before she went home. Attention to the baby at birth and for a few weeks afterwards is of vital importance in the subsequent bringing up of that child. These are matters upon which we will probably be able to touch on another occasion.

The Minister pointed out that in 1947 the cost of the health services of the State on local authorities was £5,650,000. That figure rose in the intervening years until in 1953 it reached £11,500,000 and, as the Minister has pointed out, 50 per cent. of that charge falls upon the Exchequer. That is money that has been very well spent. Nobody can measure in pounds, shillings and pence the value to a nation of the health of its people. We have gone a very long way towards, improving the health of our people. Those of us who remember the services that existed some 30 years ago know that we have travelled a long road, but we have not yet reached perfection. The Minister, when mentioning that figure, indicated that we had reached what might be regarded as the maximum expenditure possible; I hope that it will not be taken that we intend to stop this good work because it might be suggested that the cost of making our people a healthy people is too dear.

Mr. P.J. Burke:

I have spoken on numerous occasions on this Estimate for the Department of Health. There is one matter with which I am primarily concerned, and that is the provision of homes for our old people who are unable to look after themselves. While we have a number of homes in Dublin City and County, chiefly run by religious orders both well and efficiently, there is still a big gap to be filled. I agree with the last speaker that vast improvements have been made in St. Kevin's and I compliment the executive committee, the previous Minister for Health and his predecessor for the co-operation they gave in carrying out improvements there. As I said, there still remains a gap to be filled. The religious orders are not able to meet the demands. I would like to see proper provision made for caring for our aged people and I would like the Minister to note that point for special consideration.

The Minister referred to the increase in this Estimate from 1947 to 1953. One of the most important factors contributing to the health of our people was the introduction of the T.B. allowance under the 1947 Act. Deaths from T.B. have been considerably reduced. That allowance has proved to be a national investment and the advantages accruing therefrom to posterity will be one hundredfold. It is obvious that individual enterprise will never be sufficient to solve the health problems of our people and it is equally obvious that those problems can only be solved by State intervention.

There are numbers of our people to-day in institutions and homes because of neglect at birth. These people are a continual drain on the resources of local authorities and the State. Until the State intervenes, no matter what the advice of other people may be and no matter what they may say about it, and tries to remedy that long standing defect in our health services we will never eradicate the present drain on our resources. We must have proper health measures implemented here. No matter what one does someone is bound to be hurt, but we should bend all our energies here in the Oireachtas to helping the majority of our people. By advancing along that road we will ultimately reach the ideal Christian State in which all sections of our people will be looked after in a reasonably Christian way.

I want to deal with the overcrowding in certain hospitals, particularly in mental hospitals. I happen to know something about them. I do not think it is right that young children should be sent to these hospitals where they have to mix with adults. The previous Minister for Health tried to do his best for them by assisting the Order of St. John of God to build additions to its institutions. Despite the fact that many young children afflicted in this way are sent to these latter institutions, we still have hundreds of children who cannot be admitted to them because of the lack of accommodation, and so they have to be sent to the ordinary mental hospitals. I think that is a most undesirable practice and gives those youngsters very little chance. I hope the Minister will be able to do something that will be of some benefit to youngsters who are mentally afflicted.

As regards dispensaries, I hope that the Minister will be able to follow up the good work of his predecessor by pressing on local authorities to continue building those of a modern type. A number of them that we have near Dublin lack water and sewerage facilities as well as any proper accommodation for a doctor or nurse to receive and examine patients. I know of one dispensary which is situate not far from the City of Dublin and it is a disgrace. That is a matter that should be remedied at the earliest date possible. Dispensaries in which examination and treatment can be carried out under civilised conditions should be provided at the earliest moment.

The provision of adequate supplies of pure water is a matter that concerns not only the Minister's Department but the Department of Local Government. I spoke on this when the Vote for the latter Department was before the House recently. The position in this respect in parts of County Dublin is very bad. Quite an amount of illness is caused amongst our people because of the fact that a supply of pure drinking water is not available for them. In many cases, they have to depend on getting a supply from streams running along the roadside and from wells which are subject to impurities of all kinds. I have been hammering at this question for a long time in the course of debate and by parliamentary question. So far it has not been dealt with in a satisfactory way. I feel that the only solution is by having a co-ordinating body composed of representatives of the local authorities and of the Departments of Health and Local Government. The problem is one that needs to be dealt with in a thorough way.

As well as providing a pure water supply for our people in their homes, there is an urgent need to do the same for our schools, especially in rural areas. It is essential that a supply of pure drinking water should be available at all times for the children attending these schools. I have done all that I could in the matter. I have gone so far as to bring samples of water to the county medical officer of health for analysis, samples taken from old wells and streams running by the roadside. I hope that the Minister will do all that he can to remedy the present situation. I know, of course, that he has only taken over office, but I would urge on him to carry on as his predecessor did by trying to improve the health of every section of the people. The problem is a big one, and he has a long road to travel before reaching perfection in this respect. I trust that he will deal with all these things objectively. They are urgent matters.

Deputy Briscoe referred to the fact that so far a cure has not been found for cancer. I think the Minister can be assured that if, at any time, he finds that a doctor or doctors are carrying out what may be regarded as worthwhile research for the eradication of this disease, he will get ready support from all sides of the House if he comes to it looking for money for such a purpose. We are making a good deal of advance at present. At present, I think we have three hospitals for the treatment of cancer; the Central Cancer Hospital, the one at Northbrook Road, and the one in Hume Street. The latter two have been pioneers in this work. I am afraid we have yet a long way to go before we can claim to be able to cure all those who are suffering from the disease. The Minister should not allow anything to stand in his way if he finds that worthwhile research work is being carried out for the treatment of this disease and should give it every support and encouragement. Work of that kind is a most meritorious work.

Mr. James Tully:

My contribution to the discussion on the Estimate will be brief because most of the things that I had intended to speak on have been very ably dealt with by the Deputies on the opposite benches. There are one or two points, however, which seem to me to be of importance to which I should refer. I agree that money spent on improving the health of our people is money that is well spent. At the same time, I would like to point out that it is more than a coincidence that most of those who require hospital treatment and are not able to pay for themselves come from the wage-earning class. I suggest that, in order to improve the position, we should start at the bottom by improving the conditions under which those people work. Until that is done, I am afraid that the numbers of those going to hospital and requiring treatment will still be very high.

There is no use in building a hospital no matter how modernly equipped so long as the people in the country districts and in the towns and cities are working under conditions which are not conducive to good health. I think a start could be made with the Department of Health itself. Is the Minister aware that the people who are employed in the hospitals in this country have to work far longer hours than anybody who works in any other job? A few years ago, the Department of Health made an Order—and a very good one— reducing the number of hours of nurses in the hospitals to 48 per week or, as it was known, the "98-hour fortnight." I do not know whether it was accidental or not, but the other people in the hospitals were left out of that Order and the result is that we have people doing practically the same type of work as the nurses working 50 or 60 or over 60 hours. People cannot be expected to retain their good health while living and working in those conditions for very long. Even the ambulance drivers in country hospitals are, in many cases, working, or if not actually working, are required to be at what they call "stand-to" for up to 156 hours a week, but they are only paid a normal week's wages as if they were working 48 hours. The argument may be made that they do not have to work those hours, but it is true in some cases that they have to work practically all those hours and they must be constantly ready to be called out if required. I think the Department of Health would do very well if they would look into those matters and find out if conditions could be improved—I am sure in the cities they are better than in the country districts—in order to give the employees decent hours of work. If they do that, they will be removing the high incidence of illness among hospital employees.

Seósamh Ó Cinnéide:

Ní rabhas in am chun eisteacht leis an Aire ag tabhairt an Meastachán seo isteach mar bhíos amuigh fán dtuaith. Ach, mar sin féin bhíos annso chun cuid de'n díospóireacht do chlosaint agus do chuala mé mo chara, an Teachta Roibeárd Brioscú, ag labhairt agus tá mé ar aon aigne leis maidir le morán a dúirt sé. Do chuala mé leis an Teachta Pádraig de Búrca agus an Teachta atá tar éis suidhe síos anois.

I was not in time for the Minister's introduction of this Estimate but I followed part of the debate since I came in. There are a few points in connection with the Department of Health that I would like to place before the Dáil and before the Minister for consideration.

I have spoken on this before, and I have spoken to Dr. Ryan when he was Minister for Health, and I will now stress it again—that is the need for reallocating dispensary areas. In certain parts of the country there have been new housing schemes and they have gone into electoral areas which are very near a doctor's residence but because of an old area going back half-a-century or more the people have to go very long distances for a dispensary doctor. It is high time this problem was tackled because I have seen great hardships in my own county and I am sure they exist in other counties too. The same applies to midwives in the area.

I know a case in my own area—in the Coole dispensary area—where, when a midwife is needed, they have to go 12 or 14 miles away to Ratoath. That area extends up to Finea in the north of the county, and in the village in which I live—although you can throw a stone from one end of it to the other—half of it is served by the Coole dispensary while people in the other half have to go four miles for a doctor, even though there is a doctor within 100 yards of them. I have pointed this out time and again, and it is high time that the Department would tackle this matter. Only for the charity and goodness of the local doctor when there is a case of sudden illness, these people would not be attended to.

I heard Deputy Briscoe refer to the very good work done at St. Kevin's and we are all aware of that work, and it is certainly a headline for the rest of the country. There is a fetish among certain people that new buildings must be erected even though the walls and the roof of the old one are good and the amenities are good. That is wrong. If you can reconstruct a building which is only 70 or 80 years old, why not do it? The example has been given in St. Kevin's and Loughlinstown, and it could be done in other places.

I am speaking as a layman, but it is time that we approached medicine from the preventive point of view instead of thinking that everything must be cured with the surgeon's knife. I do not think the idea behind medicine from the very beginning was the surgeon's knife. It should be the last resort. We should use the physicians and the knowledge they have to prevent a disease and prevent, if possible, major surgery. If we can get hospitals all over the country in which the physicians will use their advanced knowledge in curing disease, we will have accomplished a lot. This belief that you must have a surgery in every place where there is a hospital erected—I do not subscribe to it at all. A lot of good work has been done in many hospitals where they do no surgical work. Preventive medicine can be applied very much where we have new dispensaries, and I want to congratulate the Department on the design and lay-out of these dispensaries— those in my constituency are very good —and when we relate them to the local schools, a lot of work can be done. I hope that the function contemplated by the Department of Health—the early examination of children—will come about very quickly.

I spent a very pleasant holiday with a relation of mine—a married man— in London last summer in the end of September and early October. I saw, and I heard from this man's wife and himself the great achievements they have made in the treatment of children and preventive medicine. Every month the children in that family are visited and examined and they are fine healthy children. Some of them were born—they are fairly advanced—before the coming into operation of what is known as State medicine and their mother, who is a friend of mine, has very little trouble and always knows what to do because of the services that are there. I hope these services come very quickly here and I hope the old dispensary red tickets and white tickets, which were the badges of slavery and poverty, disappear and disappear this year and that instead we will have the family ticket giving the citizens the right to get treatment and prevent disease in their homes.

My friend, Deputy Burke, talked about new homes for aged people. Again the question of new buildings comes up but there is no need for them. If the unmarried mothers in the second and third categories were—as the Department contemplated—removed altogether from the county homes and put in regional institutions, the county homes can be converted into proper homes for the aged. I have been a long time on public boards and we took as an example the Nazareth Home in Cork where very good work was done. Some years ago we contemplated starting one in the Midlands but the good order there said they could do the work as well. They were prevented from doing that good work in relation to the various categories of people who use the county home. If we could get the segregation that is contemplated as regards unmarried mothers in the first category, and if that is done also in the second and other categories, there is nothing to prevent old people being dealt with more humanely and in a Christian fashion in the county home. The sooner that work is speeded up the better.

I think those who know rural Ireland will agree that an old man, whether he be a bachelor or a man who has reared a family and whose wife is dead and who is now living in a tumbledown shack which is ready to collapse, would be far better off if he were in an institution where he could be treated by an order of nuns and where he could get regular meals and a clean bed. There are dozens of such cases in the country. To repeat myself I think if that segregation which is contemplated were carried out in county homes generally we would have better homes. What has happened in St. Kevin's can happen in Mullingar, Athlone and other places.

Deputy Burke has dealt with the question of mental homes for children. I think the Department are doing a good day's work in that connection and that we can encourage them and say, "hear, hear" to them in their efforts. If the collaboration and co-operation of the Department of Local Government can be secured, say, in my county, in the provision of waterworks and sewerage, say, in the case of Delvin, then these mental defectives who are on the waiting list and who are probably already in the mental hospital in Mullingar, can be segregated and accommodated in the institution contemplated in Delvin.

The Minister in his statement dealt with the clinics already constructed and the number contemplated. I should like very much to see that work speeded up as these clinics are very necessary. I had not time to read the Minister's statement very closely but I should like to know when the sanatorium in Blanchardstown will be ready for occupation. It would afford great relief and would be the final achievement in dealing with the question of beds for T.B. patients. An immense amount of work has already been done in the Department in connection with T.B.

Finally, I endorse everything Deputy Burke said in regard to the treatment of cancer. A terrific war has been carried on against that dread disease but, unfortunately, it is a war that is not making much progress. Some progress has been made in regard to the treatment of external cancer, but it is slight. Every encouragement in the way of provision of funds should be placed at the disposal of the people engaged in that campaign to enable them to carry it on to a successful conclusion.

Mr. T.F. O'Higgins:

I should like to thank Deputies generally for the manner in which they received this Estimate and for the very helpful suggestions which have been made by a number of Deputies. I desire to deal with some of these very briefly. Deputy Briscoe referred to a number of matters and he made the point, in relation to the cancer fear, that it might be useful to consider greater publicity to urge people to seek medical attention and to take all necessary steps in the event of their having any fear at all that they have got, or are likely to get, cancer. That is a matter, I can assure the Deputy, I shall have examined, but it does occure to me that there is also a certain danger in radio talks or undue publicity of that kind: the danger is that you may cause a scare which would be ill-founded. Certainly, that did occur in England recently. When publicity in relation to cancer was indulged in rather freely by the Minister for Health, quite an uncalled-for scare was caused amongst the people. However, I can assure the Deputy that I will have that suggestion examined.

The Deputy also mentioned the disease of gastro-enteritis. There, again, the real cause of the disease has not really been discovered. There are, apparently, divided opinions as to what causes it. Undoubtedly, its incidence is reduced by a better and higher standard of hygiene. I hope that with the education of people generally and the worthwhile work that is being done in the Dublin Corporation maternity and child clinics—and which I hope to see done elsewhere throughout the country in similar clinics—there will be a reduction in the incidence of that disease amongst young children.

Deputy Briscoe and some other Deputy mentioned the question of mental defectives. I should like to assure the House that this is a problem to which I have given some study and consideration even in the short time I have been in charge of the Department. It is a matter that will require considerable examination and, of course, the provision of more facilities than exist at the moment. The whole matter is being examined at the moment and we hope to be able to embark on a programme which, while it may not completely satisfy the requirements of institutional treatment in relation to mental defectives, will at least, in some way, meet in a short time the problem which these afflicted people do represent to the State. I have not before me at the moment the exact details of our immediate proposals in that connection, but the present programme provides for some 1,400 extra beds for mental defectives, of which about 660 should be available by the end of the year. A further 1,000 or so beds are proposed in a supplementary programme which I have examined. I already approved of one scheme which will shortly commence in Sligo so that, generally speaking, I can assure the Deputy that that problem is having, and will continue to have, the attention of the Department.

Deputy Burke mentioned the provision of homes for old people. That, again, is a very real problem. The care of the aged often cannot be carried out adequately or properly in institutions. Old people, at the end of their days, do not get in institutional life the kind of comfort and the kind of ease that their age requires. There is considerable examination in the Department as to how best to deal with that problem. Local authorities are empowered to help different voluntary groups who open or start homes for old people. I hope to press ahead with provisions of a voluntary kind of that nature because I believe that only in small homes that cater for nine, ten, or perhaps 15 old people the proper kind of care will be provided.

Deputy Burke also mentioned the matter of overcrowding in hospitals. That is part of the general problem, and I think most Deputies are aware of it. He tied it up, particularly, with mental hospitals. Again, the hospital programme with regard to mental hospitals is having and will continue to have the attention of my Department. A small step forward is being taken at the moment in relation to Grangegorman, but, of course, mental hospital facilities throughout the country are not adequate and must be improved and I hope to see that improvements will take place.

Deputy Briscoe mentioned the question of voluntary hospitals having to pay interest on their deficits.

Mr. Briscoe:

On overdrafts, not on deficits.

Mr. T.F. O'Higgins:

On overdrafts. That is true. I think that, some years ago, an effort was made to meet that situation by payment of deficits half-yearly in advance and half-yearly in arrears. Apparently that proposal did not work out satisfactorily because the problem remains. I can assure the Deputy that I shall have the question further examined.

Deputy Kennedy has mentioned the need for a reallocation of dispensary areas. Again, I can say to the Deputy that the whole question of dispensary facilities is engaging, and will have, my full attention. We hope to be able to have a general review of the facilities available in dispensary areas and a re-organisation of existing areas carried out in the near future. The Deputy's remarks will be borne in mind and the worthwhile suggestions he has made will receive consideration.

Deputy Kennedy also asked when the new sanatorium at Blanchardstown is likely to become available. I can tell him that, on our information at the moment, it should be available towards the end of the year.

Generally speaking, any suggestions made by Deputies will be examined by my Department and we shall bear in mind the views they expressed here on the Estimate.

Vote put and agreed to.