Dáil Éireann debate -
Tuesday, 21 Jun 1955

Vol. 151 No. 11

Committee on Finance. - Vote 63—Health (Resumed).

Debate resumed on the following motion:—

That the Estimate be referred back for reconsideration.—(Séamus Ó Riain.)

Mr. McQuillan

There are just one or two points I wish to raise on this Estimate and I do not propose to delay the House in dealing with them. Both are connected and I think they are of very great importance to our people generally. It was only in recent months that one of these matters was brought to my attention very forcibly, due to the fact that people who were affected by the new Health Act pointed out very grave inconveniences caused to them as a result of the administration of certain sections of that Act.

The first matter that I would like to draw to the Minister's attention is the system at present in operation in our maternity hospitals of identification of babies. This is a matter that is of the utmost importance to every family. I am satisfied, from evidence at my disposal, that the present system is not working to the greatest possible satisfaction of the people. I am satisfied that, as the system works, there is room for tragic mistakes to occur and, in view of that, it is the duty of the House and, in particular, of the Minister to take whatever steps are possible to ensure that a fool-proof system of identification is put into operation throughout all our hospitals.

I do not wish to give names in the House, but it is essential, in order to bring the matter home forcibly to the Minister and to this House, that I should give proof of the statement I have already made that the system in operation in our hospitals is not working in a satisfactory manner.

Some time ago, in a particular hospital in the country, a young mother gave birth to a baby. The mother and baby were in the particular hospital for a period of eight days. When the baby was born, the mother was told that the baby was a boy. There was a tag put on the child's wrist with the surname of the parent and the sex of the baby indicated on the tag was "male". For eight days, while the mother and baby were in the hospital, the mother fed the child every day but had nothing more to do with the child because the washing and dressing and other care of babies is carried out by the nursing staff. For eight days the mother was under the impression, and was told by the hospital authorities, that the child was a boy. After eight days, the mother and child were discharged from hospital. When they arrived home, to the consternation of the mother and father, they discovered that the child was a girl.

This is a very serious matter. There is no doubt in my mind that that particular child belongs to that family but it was a terrible blow to the parents and, naturally enough, there was a doubt in their minds immediately as to whether it was their baby or not.

In the particular hospital in question there were very few births at that particular period. I would like to ask the Minister, if this could happen in, we will say, a small hospital, what is the position likely to be in one of our large maternity hospitals in Dublin?

Certain publicity was given to the particular case that I have mentioned in the daily Press in recent weeks as a result of which I have had correspondence from parts of the country in which the people mentioned that they believed that similar mistakes had taken place in other hospitals. I have no evidence to that effect. I have the evidence that it did happen in one particular hospital and I am satisfied that, if it could happen in this hospital, it is quite possible that it has been happening in other hospitals in the past.

I am not looking, in this debate, for heads to fall over this. I dislike very much having to raise the matter at all but when we get a specific case like this, where proof is available, we should take all possible steps to ensure that the system of identification is changed or tightened up to such an extent that there would be very little room left for mistakes, apart from the human element.

In the particular case that I have mentioned, the parents, naturally enough, felt very bad about it. At this point I want to dovetail into this case a second matter which I wish to bring before the Minister's attention. It is in connection with certain sections of the Health Act that deal with confidential information. The parents of this baby wrote to me and asked me, as a public representative, to make the facts known to the public, in order, in the words of the parents, to ensure that similar mistakes would not occur again. They were told and advised at the time that the less publicity the better. Their attitude has been that, in view of the tremendous amount of publicity in the locality where they live, it was better, at this stage, to have the matter properly clarified and, in so far as it lay within the power of the Minister, as a result of this information being given to him, to ensure that he would take the necessary steps to tighten up the identification system in our hospitals.

In order to have the matter brought to the public attention, the parents of the baby notified their local councillor and asked him to raise the matter at the next county council meeting. He did so and, to my amazement, the chairman of the county council, on the advice of the county manager, ruled the discussion out of order on the grounds that the matter was confidential under the health regulations. I do not blame the county manager at all. The county manager was acting according to the legal advice given to him, but it is rather extraordinary that a matter that is of such importance as this could be kept from the knowledge of the public through the use of some health regulation.

I ask the Minister to have that position clarified. The minutes of the county council meeting are available to his Department. I am sure there will be no difficulties as far as the county manager is concerned and that he will co-operate to the utmost in giving the necessary information with regard to that particular council meeting. I think it would be a very serious matter for this House if our local authorities were not allowed to air matters of importance like this. I believe it is a matter of the chairman and the manager being overcautious in their reading of the regulations. That is all I have to say on that particular point at the moment; I will, of course, on another occasion refer to it.

I want to make this suggestion to the Minister in connection with the identification system. In addition to this tag or label that is put on a child's wrist after birth, the Minister should bring into operation a system whereby both the mother and the infant are marked with a similar stamp or something in the line of a code system—a number. The same number should be put on the arm of the mother as on the infant's arm. That stamp should not be used for any other birth. The stamping arrangement would last for a fortnight or three weeks and would then be allowed to wear off. After a fortnight or three weeks the danger of a mix up would not be so grave or serious.

If the system I suggest were brought into operation, it would mean that whatever mix up took place within a ward where there were 40 or 50 babies and no matter whether the tags on the wrist got mixed up it would make no difference because a quick check of the stamp on the child's arm would identify the mother. I think that system is one that should be adopted generally in our hospitals. I discussed the matter with a number of medical men and other people who have a knowledge of this. They agreed that such a system would be desirable and that it would give a great feeling of encouragement and confidence to the mothers who go into our hospitals to have babies.

There seems to be a feeling of worry amongst other mothers throughout the country when they go into our hospitals as to whether they will get their own babies when they are leaving the hospitals. Somebody put it to me one day when this matter was being discussed that in so far as births in some of the hospitals are concerned none of us really know who we are. I do not think the situation is as serious as all that, but I would ask the Minister to give his very sympathetic consideration to that last suggestion of mine. I have no doubt that if he consults the medical men in the various hospitals he will find many of them in agreement with that suggestion.

Mr. Gogan

I think the most welcome feature of the Minister's speech is to be found in that paragraph in which he referred to the fact that he hopes, before the end of the year, to implement the 1953 Health Act by putting into operation Sections 15, 16 and 17. Listening to the Minister's speech on the Health Bill of 1954, I must say that one would hardly have expected that he would have arrived at that decision so early. The Minister's statement has, on the whole, been a happy one and both himself and his predecessors. Deputy Dr. Ryan and Dr. Browne, are to be congratulated on the position of the health services in the country to-day. I think it would have been fitting for the Minister to have paid some tribute to the work done by those two people.

I should like to congratulate the Minister on his statement earlier in his speech that he proposes to carry on with vigour the scheme of hospital building so ably carried out during the past ten years. I should like to congratulate him on his decision to improve the position in the mental hospitals. As far as Grangegorman is concerned, I would advocate that quite a number of the buildings that are in existence for over 50 years should be pulled down and completely rebuilt. Speaking of Grangegorman, I should like to congratulate the staff on having got an improvement in their salary position during the past year. I would appeal to the Minister to bring into operation for the staff a scheme in relation to the cost-of-living bonus.

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

That is already there.

Mr. Gogan

It is already there. In dealing with medical cards the Minister said he would ask the various local bodies for an explanation of the very low percentage of applications for medical register. In my opinion it is the means test adopted in connection with the medical register which is largely responsible for the lack of applications. I would ask the Minister to appeal to the local authorities to treat those applications in a more generous fashion. The same thing applies in regard to applications for maternity cash grants. I think that a much more generous scale should be put into operation. At the present time I think it is impossible for a man earning £5 or £6 a week to get that grant unless he has three or four children.

I should like to devote a certain amount of my time to the question of the disablement allowance. The most recent figures I have got in connection with the City of Dublin show that Dublin Corporation received a total of 2,081 applications under these maintenance allowance regulations. Out of that 400 were refused on medical grounds and 650 were refused on the grounds of means, means being divided into three categories—personal income, income of the family or State grants. During the year the Minister was kind enough, following on questions I raised in the House, to make representations to the Dublin Corporation with consequent improvement in the investigation of these cases. The fact still remains that large arrears of payments are still due to these disabled persons.

I have during the course of my employment come to know a large number of those people who have been in receipt of home assistance for a long number of years, who have been certified as disabled by the local dispensary doctor and who on application to the Dublin Corporation have been turned down as medically fit. Quite rightly, the Minister pointed out that it was necessary for the deciding officer employed by the Dublin Corporation to take every care in the investigation of these disablement allowances because these allowances were tantamount to a pension for life. At the same time, by no stretch of the imagination could some of the cases that have been disallowed be described as otherwise than disabled.

There was one case of this kind which came to my notice only last week, of a woman aged 24 who was certified as suffering from epilepsy. She had been a patient in a mental hospital on three occasions and was in receipt of home assistance on the ground of her disablement. Her means are nil; she resides with her mother who has a widow's pension and is in receipt of supplementary home assistance. Another case which has come to my notice just yesterday is of a woman, aged 66, suffering from total deafness. She has been accepted by the Dublin Corporation as totally disabled but she receives only 15/- per week due to the fact that she has a railway pensioner residing with her who gives her 10/- towards a rent of 13/4.

I could enumerate hundreds of such cases. I know another case of a woman, aged 40, suffering from meningitis. The only means in the family are the old age pension of her widowed mother and the earnings of a sister, about £4 a week, in Jacobs. That person is in receipt of 15/- by reason of her disability and she has been refused the allowance "in view of your family's present income". There is another person suffering from deafness but I do not think that is the cause of her total disability. She was refused on the grounds of her family's present income. Her only means of existence is 15/- home assistance; she is staying with a brother-in-law.

A further case which came to my personal notice is that of a man, aged 32, suffering from epilepsy since the age of 14. He is in receipt of 17/6 home assistance and resides with a widowed mother with 24/- pension, a stepbrother in receipt of 18/- unemployment assistance and a brother earning £6 a week as a cleaner in C.I.E. This man applied last October and when no trace of his application could be found he reapplied on the 29th March and was refused on the grounds of family income. Another case is that of a woman, aged 55 years, suffering from nervous debility. She resides with her mother who has an old age pension and the only other means is that she lives in a room belonging to her married sister whose husband is employed but who has three or four children to keep out of his own income. I do know the Minister in his speech made an appeal that a more generous attitude be adopted towards those people and I would ask the Minister to press for early payment of the arrears due to such disabled persons.

As regards the Minister's scheme for the employment of disabled persons, I would like to extend a hearty welcome to that scheme, for which provision was made under the 1953 Act. I am glad to see the Minister has adopted it and is arranging that a semi-State organisation, a limited company, should be set up. This is one scheme that deserves the support of everyone in the country. I had a very happy experience some seven or eight years ago of providing employment for a man of 36 years of age who was a hunchback. He told me he never knew what it was to get a week's wages, to get a new suit of clothes or to get other than a secondhand pair of boots.

Seeing that the State is the largest employer of labour, I think the Minister should see to it that preference is given to those disabled persons in such capacity as that of porter or messenger. On one occasion I made representations for a man who had been rehabilitated following treatment in a sanatorium but he was unsuccessful due to his health.

I would like to draw the Minister's attention also to the question of medical cards which should be made available to people who have occasion to go to welfare clinics. I think that re-examination and reconsideration should be given to the cases of a large number of those people who have been refused attention at the welfare clinics by reason of the fact that they have not had these medical cards. In conclusion, I would like to repeat that I congratulate the Minister on his decision to implement the 1953 Act as he has indicated and I sincerely hope he will be in a position to keep his promise that the date of that implementation will be 1955.

Mr. MacCarthy

As far as the Cork County health area is concerned, I think the greatest need at the moment is the co-ordination and assessment of requirements in conjunction with the building and reconstruction programme which is now nearing completion there. That applies not only to the sanatorium at Sarsfield's Court, which will release the chest hospital in Mallow to the health authorities in North Cork as a general hospital, but the completion of the orthopaedic hospital may in great measure relieve the overcrowding suffered by children in St. Finbarr's Hospital.

There is also the question of the voluntary hospitals and the fact that it has been very difficult over a period to get beds in these institutions. I think it is very necessary also that the regional hospitals, for which we have been waiting for so many years, would be started now that the other buildings, apart altogether from some reconstruction in St. Finbarr's and in "Erinville", are nearing completion. When these units are in operation the Minister and his Department will have a better idea of the further requirements for hospitalisation in the Cork County area.

I am inclined to think that the regional hospital as now envisaged will meet the demands of that area as far as general hospital treatment is concerned. The mental hospitals are, of course, completely overcrowded. I am not blaming the Minister in any way whatever because I feel that matters of health and other questions of that kind should be discussed here from the point of view of the general needs of the people rather than on any other basis. But when Deputy Dr. Ryan introduced his Health Act way back in 1945 or 1947—whenever the year was— he made provision not only for patients in mental hospitals in so far as buildings and services were concerned, but he indicated at that time—and I think he was well ahead of modern progress in that idea—that about one-third of patients who went into mental hospitals recovered within a period of from three to six months.

It was felt then that very often when people were put into these institutions neither the relatives nor anybody else wanted to take responsibility for getting them home again because they imagined that they might become troublesome or something of that kind. When Deputy Dr. Ryan's Parliamentary Secretary, Dr. Ward, was discussing that measure in the House he stated that the idea was to have observation reception units to which patients, who would ordinarily be sent into mental hospitals, would be taken to see whether or not they were just people who had got temporary breakdowns and who could go out again and be restored to their families without ever entering the portals of a mental hospital as such!

I think that in the building schemes now envisaged—and people are crying out for them everywhere because of overcrowding—this idea should be put into effect. I should like to add the suggestion that these observation units would not necessarily be on the grounds of the mental hospitals at all —that they would be in an appropriate place where patients who get nervous breakdowns or something of that nature would get treatment in the way I have outlined. Another building problem in regard to hospitals is that of accommodation for mentally defective children. I do not know how far the Government or the Department of Health are supporting that idea but I should like to say that no praise can be too high for what the Brothers of Charity are doing at Lota for these deficient youths and children. The care they are giving them is of the highest grade.

There are still very many of these cases who cannot be taken into hospitals or similar institutions for the type of instruction and treatment that would be helpful and that would give them the change they need. That is because there are not sufficient hospitals to cater for them. A lot of work is being done in this respect at Lota but there are 41 patients of this type in the Cork County health district awaiting admission. These are patients who are on the list but there are many others who have made no application because they feel there is no chance of their getting in. Very often it takes all the care of the mother to look after mentally defective children or youths, with the result that perhaps the mother cannot attend to her other household duties. From that point of view alone it will be seen how necessary it is that institutions for the care of these children should be provided.

Another great need is the provision of homes for the aged. Perhaps when we have the sanatorium going some house like the one at Lota might be found for use as a chest hospital. It might, on the other hand, make a very good cancer hospital, which we lack at the moment; we need at least an institution for the treatment of superficial cancer even if all the serious cases still have to come to Dublin for operation and advanced treatment. In the South we need a hospital for cancer diagnosis where also cases of superficial cancer could be treated.

I hope the Minister will push ahead the matter of the orthopaedic hospital as soon as possible so that the children now suffering from overcrowded conditions can be treated in a proper atmosphere. At the moment there are 300 or so on the waiting lists. They need very prompt attention because, of course, it is in their youth that the manipulation necessary can more easily be carried out.

There have been references to the disability allowances, but I will not stress the case further than to say there has been a great deal of dissatisfaction throughout. No Act is perfect, especially Acts which perhaps overlap other services and which, when the local authorities get hold of them and try to co-ordinate them with the regulations dealing with similar services, develop snags which were not anticipated and which could not have been anticipated in the matter of allowances and payments. I think the tendency of the Minister is to treat these snags sympathetically and I hope he will continue to do that.

Before departing from the question of treatment of children, I think it is correct to say that formerly children were treated in homes and so forth. There was no proper accommodation or specialised treatment in hospitals for them but the tendency now is to provide for children the same treatment as for adults and it is regrettable that the school medical services have been held up so long. I think, however, that we are nearing the end of that dispute. I am hopeful that in Cork County it is coming to an end and I hope the Minister will be able to let these services operate now without the additional appointments that he had in mind.

There is no need to make further appointments and put additional burdens on either the rates or the State finances, if these services can be operated through the, county and voluntary hospitals in the normal way by the specialised staff available. Even though we have gone to the first stage of appointing medical men for these services, I think we ought to try if the present medical men in the various areas and hospitals concerned are prepared to operate these services.

We are all very pleased to see the new tendency since the conditions of nurses were improved. Formerly, when these nurses qualified, and even before they qualified, the tendency was to go abroad for employment. Now the tendency is the other way, and, when vacancies arise here, many of our Irish girls return to our hospitals to give service in them, a service at which they are so competent, so kind and so painstaking, instead of being lost to another country. The improved conditions, payment and so on which they now get here at home are an inducement to them to return to their own country.

It is a matter of congratulation for all that so much progress has been made in recent years in relation to the disease of diphtheria which was a plague and which took away many children before they were a year old. This is now almost a thing of the past. The treatment of T.B. is making remarkable progress and, with the goodwill of all concerned, the health programme and policy of our country will bring remarkable results to the people and will give confidence to those who are ill or who may in their declining years lose their means of support. These health services, without taking away entirely the responsibility of a family for their parents and relatives, will operate as far as it is possible to give the people a really up-to-date health service and give them a feeling of confidence that their needs are being attended to, and consequently hope for the future.

Mr. O'Leary

I have some questions to put to the Minister, the first of which relates to the mental hospital in Enniscorthy. It is overcrowded and the doctors have been asking the committee there for some time to get an admission unit. I understand that we cannot get any money from the Hospitals' Trust for such a purpose and I think the Minister told us at one time that the Hospitals' Trust programme was filled for the next ten years, so far as this money is concerned. It is very regrettable that we should have people in corridors in a mental hospital where there is no central heating and where, in winter-time, the water runs down the walls. The prospect of getting no money from the Hospitals' Trust for the next ten years is not very hopeful for the ratepayers, if they have to foot the full bill.

The Minister's predecessor, shortly before the general election, gave over to home assistance officers the duty of collecting cottage rents. To my mind, that should not be so, because when a man who is a home assistance officer and who has to collect the rents of cottages goes into a house to ask for rent, he must take it from the home assistance.

Mr. T.F. O'Higgins

This would be more proper on social welfare.

Mr. O'Leary

Deputy MacCarthy has spoken about the disability allowances and I can say that, since these allowances were brought into operation in my county, I have never got as many letters expressing dissatisfaction. The county council are sending out from their offices a typed letter to nearly every applicant saying that he or she is not entitled to the allowance and people have been refused the allowance in areas in which a person who is probably not half as bad is drawing it. There is something wrong there. I understand that the home assistance officer has a lot to do with the granting of the allowance, because I was told by the county manager in Wexford that he makes a report on each applicant when the claim comes in, and the Deputy who spoke from the opposite benches who is a home assistance officer should be aware of that.

Mr. Gogan

That is not the position in Dublin.

Mr. O'Leary

It is the position in our county. I have a cutting here with me of a discussion we had on the matter in Wexford, which sets out that so many people were granted the allowance and so many people disallowed. It is only right that we should put this before the Minister and give him an opportunity of having it investigated. At the time, the county secretary told me, there were 472 applications, of which 203 were granted and 179 were to be examined. Since then more applications have been received by the county council and the only excuse put forward in relation to them is that the medical officer is busy and cannot reach these things.

The Deputy opposite argued that payment should be made retrospective. I put the matter to the Wexford County Manager and he told me that it is operated from the date the manager makes the order. I would like to see people getting this back-money, if at all possible, but I believe it is a matter for the manager, who makes the order, and not the Minister.

Reference was made here to the Health Act, 1953. To my knowledge, there is very little provision in that Act for making beds available. People are waiting for beds and people are being sent home from hospital so that another person can get in. That is a well-known fact all over the country. Although there have been improvements in the matter of hospital accommodation, and though new hospitals have been built for the treatment of T.B. cases, very little has been done for the ordinary person who falls sick and who now has to wait until such time as he can get a bed. It is nearly impossible to get a bed in Dublin, unless a man is well able to pay for it.

With regard to maternity grants administered through the county council, no provision was made by the Minister's predecessor in this regard and the onus was thrown entirely on the county council. In the case of our county, the county manager did not know how many would be applying for these grants during the year, but we had to give him a figure of £4,000 to cover the year. It is very easy for the Department to put a scheme into force by pushing it on to the local authority, as is done by the 1953 Act. The scheme is thrown completely on the shoulders of the ratepayers and no provision is made for a contribution from the Central Fund.

The result is that the poor people are suffering more than ever. In my county, where people had home assistance—in some cases amounting to 10/-, 14/- and 15/—the home assistance was cut off when the £1 was granted, so that in some cases the people concerned were worse off because they then lost the fuel vouchers and things like them. I know that the Minister has said that it is not Government policy that such a thing as that should happen and that it is a matter for the local authorities. I should like, however, if the Minister, when concluding, would make some reference to that matter, because it is not right that people who are to get £1—some of them 15/—and a fuel voucher in the winter-time should be worse off with the £1 than they were before.

I think we should have some assurance from the Minister that he will not allow, in certain cases, home assistance payments to be reduced, especially in a family where there are invalid boys and girls over 16 years of age who are unable to do anything for themselves. I do not think it is right that the cost of their maintenance should have to be borne by their brothers and sisters. I know of cases in my own locality where that has happened. The father, say, is working with the county council and there may be an invalid son or daughter in the family getting the £1 disability. I think the Minister should step in, in a case of that kind, and see that the full amount is granted. Surely, a man working with a farmer or with the county council who has an invalid boy or girl who is over 16 years of age, should not be deprived of this payment by any county medical officer or any county manager. I would ask the Minister to give me some information on this matter when he is replying.

Mr. T.F. O'Higgins

I should like, first of all, to express my appreciation to the House, and particularly to the Deputies who have taken a part in the discussion on this Estimate, for the very generous manner in which they have received the matters that I dealt with in my opening statement. We have had our fill of controversy with regard to health matters, both inside and outside this House over the past 12 years or so. I think, however, that in the controversy that took place there was agreement as to the objects but perhaps divisions as to the means of achieving these objects and aims. I do not think that since we got our freedom in 1921, freedom which was followed by the very rapid strides that were made in public health in this country and with the initiation of a very fine local public health administration, any political Party here has been concerned other than to see the establishment of better and improved health services. Accordingly, the differences that may have arisen have only been differences as to the means of achieving what is the common object of all.

I would like to make some few general observations before I go on to deal with some of the points which were raised by Deputies. It appears to me that a proper and adequate health service in any country, and in this country, needs a number of necessary facilities. Hospitals must be provided and properly equipped; and there must be the necessary arrangements made with the bodies and professions who are trained to provide these necessary health services. I mention that because, when I became Minister for Health 12 months ago, I found the scheme contained in the Health Act, so far as the legal formalities were concerned, committed to go into operation. But I found a shortage of hospital beds; I found a state of cold war between the medical profession and my Department and I found a state of complete bewilderment amongst other affected bodies as to the place they would have to play in the new health scheme.

Accordingly, in order to avoid complete chaos in this country, and particularly in order to avoid unnecessary hardship being imposed on persons and classes who up to 12 months ago were being provided with services, I found it necessary to move in this House a Bill entitling me as Minister to build a scheme out of the Health Act bit by bit, according as the necessary facilities would become available. In doing that, I did not express any approval of the methods contained in the Health Act for the achievement of better health services in this country. In fact, I still regard the Health Act as not being the best course for achieving even the limited aim that it sets out to achieve, but I did say 12 months ago that, as a contribution to ending dissension, strife and controversy on health matters in this country, I was prepared to implement the Health Act as soon as I could do it.

I think it is just as well, in view of some statements made recently outside of this House by Deputies of the House, that I should recall what I said here in the debate on the Health Bill of 1954, I have here the Official Report for the 7th July, 1954, Volume 146, No. 11. Speaking at column 1342 in reference to the Health Act, I said:—

"I voted against that measure— the Health Act, 1953—when it was before the Dáil. I do not think that it incorporates the best that could be obtained in this country. I was against it and spoke against it, but I do feel that a contribution can be made in this whole turbulent controversial subject of health by accepting what has been done by those who went before me. I propose to accept the Health Act, 1953, in so far as the services are concerned, in full. I do not intend to change them. I do not intend to alter them, to minimise them, to counteract them in the slightest. I do intend to see that they are made available. I do intend to see that the Health Act works and that is the purpose of this Bill."

In another part of the debate, I mentioned my concern to see that the measure would be made workable and implemented as quickly as possible. During the course of the debate on that Bill, some Deputies moved amendments with the object of trying to specify a particular date on which the full Health Act would come into operation. I resisted those amendments because I felt it was wiser to be free to act myself in accordance with my own discretion and with the information that was available to me.

I mention that matter because, in the course of this debate, Deputy Dr. Ryan and, I think, some other Deputies, suggested that my announcement, that I hoped to implement the Health Act, 1953, in the latter end of this year —I should like to make a slight correction there, because what I intended to say was the latter end of this financial year, although I think I said the latter end of this calendar year when speaking—was some new announcement. In fact, it was not. I made it quite clear 12 months ago that, as soon as I could, I would implement the Health Act. It is because I think we are nearer to providing the necessary facilities that I have expressed the hope that we would be able to do it at the end of this financial year.

Deputies will recollect that, in the past 12 months, a number of new hospitals have been opened. I cannot just remember all of them but certainly it was possible to open the regional hospital in Limerick and other large hospital units have become available which were not available 12 months ago. It was just on that precise point that I differed so considerably from my predecessor in the debates on the Health Bill of 1954. To my mind, it was useless to say: "We are going to provide a health service now because in three, four or five years' time there will be beds available for the people who, under our law, should benefit now."

That, I am afraid, was Deputy Dr. Ryan's approach and indeed he repeated it here in the debate on this Estimate. I feel that that is putting the cart very much before the horse. In my view, you should not encourage people by telling them they are entitled to services if, in fact, the machinery is not there to give the services to them. It is because, amongst other things, so many new beds have become available in the course of the past 12 months, and will become available in the course of the next eight or nine months, that I have been able to implement the Act. I do not think there is any inconsistency about it. In fact, I think I correctly said 12 months ago what I would do and if I am to be charged with anything it is that I am being very uninterestingly consistent.

With regard to the implementation of the Health Act, I personally—and I think there is a great body of opinion in this House that would agree with me—am against providing any form of health services free or partially free to people who can afford to pay for them. I think that is wrong. I think it is soul-destroying and an insult to individual integrity and independence. In so far as, under the net of the Health Act, there may be individuals—and, indeed, perhaps there are—who are getting services for which they can afford to pay, it may be that some weeding may have to be done; I do not know; that is a point that will have to be examined later. However, I am prepared to accept the case that the Health Act is intended to deal with the needy—those who need the services. I do not think there can be any question that every individual, particularly married men, whose income does not exceed £600 a year cannot possibly provide these services for himself. There can be no question about that. In fact, the real pity is that it was not possible to provide these services a long time ago for persons within that income limit.

Questions may arise with regard to the position of farmers. The £50 valuation limit for farmers in this country is a very problematic approach to ascertain who need the services. The £50 farmer in the South might make the case, with justice, that he is in fact a farmer in the middle income group—and one could concede that point of view. However, a £50 farmer in Mayo or Galway or Leitrim or Donegal might be a man in the upper income bracket—and there is that difficulty about it. I hope, in examining that matter, to see if it is possible— it may be completely impossible—to devise a method of getting where we want to go, namely, to provide a service for the farmer in the middle income group because, in fact, he needs some help in providing services for himself. As I say, it may not be possible to devise an alternative method but I hope to have the matter examined, in any event.

There is one other point which I should like to deal with before I come to some of the points of detail mentioned by Deputies—and I say this without any hope of having what I say regarded with any seriousness by certain Deputies in this House. I did not devise the Health Act of 1953. I did not introduce it. I did not work out the details. As it goes into operation, it must be remembered that I am bringing it into operation in accordance with legislation passed in a House in which I was not the Minister for Health.

It is one of the cornerstones of the Health Act of 1953 that the financial provisions for the payment of services should be a wedding, if you like, between the Central Fund and local authorities. That runs right through the whole scheme of the Health Act—that, for every £1 the health service costs the local authority, £1 will be added to it from Central Funds. The idea behind the scheme contained in the Health Act was that local authorities should provide the facilities aimed at in the Act and should pay for them and then, at the end of the year, get a refund as to 50 per cent. of their costs.

That financial proposal goes to the very root of the scheme contained in the Health Act. That has had its effect on insured workers. Prior to the Health Act of 1952, I think, under the additional benefits scheme which was introduced some years ago by the Minister for Social Welfare, insured workers were given something that was not covered by their stamps—a benefit that was not engaged for when the unemployment insurance stamp was paid— and that was free hospital services for themselves for six weeks provided they were in benefit. I forget the terms of the benefit but they had to have a certain number of contributions paid. They were to get free hospital services. That provision was carried out by the Department of Social Welfare entering into an agreement with every local authority in the country and with all voluntary hospitals. The agreement was that the Department of Social Welfare would pay every county council a sum of £5 12s. per week to cover the maintenance of any insured worker being maintained in the hospital and the same terms applied in the voluntary hospitals.

When the health scheme was introduced, the previous Government, on the proposition of my predecessor, decided to terminate the additional benefit scheme. That scheme cost £500,000 per year. They decided to terminate it and to throw on to local authorities the cost of providing hospital services previously borne by the Department of Social Welfare. That decision was taken by the Government in July 1952 and became effective in the year 1954. Accordingly, in the Estimates prepared by the previous Administration and in the Budget of 1954 no provision was made for the operation of the additional benefit scheme by the Department of Social Welfare after August 1st, 1954. Deputies will recollect that August 1st, 1954 was the date of the operation of the Health Act, 1953. Accordingly, on and after that date, there was transferred from the Central Fund to local rates the sum of £500,000 which represented the cost of providing hospital services for insured workers.

That was done before I became Minister for Health. The facts I have mentioned are easily ascertainable and cannot be disputed. I must say that I recent very much the suggestion made, even by my predecessor—I could understand other Deputies making it without full knowledge of the facts, but it was made even by Deputy Dr. Ryan—that it was a decision of mine that transferred to local rates the cost of providing hospitalisation for insured workers. It was not my decision and I would just like to add this footnote that, if it was my decision, I would stand by it even if it suited my political purpose to suggest that it was somebody else's. It was not mine. It was the decision of Deputy Dr. Ryan and the Fianna Fáil Government. Why are they ashamed of it? If it was a good decision, why are they afraid to stand by it?

Mr. S. Flanagan

Was not it a good one?

Mr. T.F. O'Higgins

I say "if it was". Why, just because from a short-term point of view it happens to suit the political exigencies of the moment, suggest something contrary to the known facts and why run away from the Health Act that was talked about so much 12 months ago? However, I state that without any hope that these absurd statements will cease to be made. I think they will continue to be made but, so far as the records of the House are concerned, I have stated ascertainable facts that cannot be denied.

I shall refer now to a few of the details that were mentioned. Deputy Briscoe and Deputy Dr. Ryan mentioned the matter I have just referred to—the position of insured persons— and I have dealt with that.

A number of Deputies mentioned the need for the provision of facilities in some institution for housing aged people. That, of course, is a very definite problem but one has to be extremely careful in an approach to this matter. It is the primary duty of every child, not only to respect, but to care for his parents and much of the difficulty that arises in Ireland to-day with regard to aged people arises from a complete disregard for the Fourth Commandment. There are, unfortunately, young people in this country who get married and who are only too concerned to see the aged man and woman out of the house as quickly as possible and I do not think it would be a right thing to facilitate them in that matter.

I do not think it would be right to encourage people to throw off their natural obligations and to provide for them some large institution in which every old person would be forced to end his or her days. That is one difficulty, but there is this to be said: In many of our mental hospitals where the overcrowding problem is so acute, as has been recognised by Deputies in this debate, there are old people who are senile. They are not suffering from any curable form of mental illness. They are suffering from a mental condition which is brought about by old age and they are chronics. They are in mental hospitals mostly although there are some in county homes. I am having examined at the moment by a committee, to which I made reference in introducing the Estimate, the possibility of providing for those people a special form of institutional care, not of treatment because really there is no treatment that can be provided.

To that extent, I think something useful can be done in dealing with the problem of the aged. Also, of course, it may be possible to provide smaller homes or houses for particular cases of aged people, aged people who, perhaps, have no kith or kin and who have no one to look after them, who are not merely the victims of an unfortunate development in our society. That is being examined and perhaps something may be done about it.

Some Deputies mentioned the question of dispensary premises and the provision of dispensary facilities. In fact, as Deputies are aware, I went to each Health authority in the country over the past 12 months and discussed with them the state and condition of every single dispensary. There is not a dispensary building anywhere the condition of which I have not discussed with the members of each health authority. The drive for the replacement of faulty dispensaries is proceeding satisfactorily and I have no doubt that very shortly that drive will reach a satisfactorily conclusion.

Cork Deputies referred to the opening of the orthopaedic hospital in Cork. I am as much concerned as they are to see this hospital functioning as quickly as possible and I am glad to be able to say that after some pressure, if I may put it that way, that orthopaedic hospital will open on the 2nd July next.

A number of Deputies referred to disability allowances and to some of the difficulties which have arisen in the implementation of that scheme. Again, it must be appreciated that under the Health Act the responsibility for the provision of the services set out in that Act is that of each health authority. I have no power at all to interfere with their decisions or to question them as to their administration provided I am satisfied that they are giving what the Health Act stipulates they should give. It is for health authorities to decide who shall qualify for medical assistance under Section 14. The decision is theirs and theirs alone.

Now, Section 14 is the section which makes provision for medical assistance. It is that section which, in effect, qualifies a person for maternity cash grants, for certain hospital services and for a variety of other services under the Health Act. That section is widely drafted. It provides that free medical assistance can only be given to persons who are unable by their own industry or other lawful means to provide for themselves. Now the decision must be a decision of the health authority in relation to each particular case. I cannot tell the health authority the way in which they should decide. The obligation is on them.

Shortly after becoming Minister I learned that in administering Section 14 health authorities were adopting a rule-of-thumb approach. They were adopting a scale of weekly income and they used that scale to decide the particular issue they had to decide under Section 14. Some Deputies may be familiar with these scales. They might run from, say, the single man with £4 per week to the married man who might be in receipt of £4 10s. per week; different weekly wages of that kind were incorporated into the scale, depending on whether the person was married or single and, if married, the number of children involved and the total weekly income.

Now that, in my opinion, was not a correct or proper approach to the provisions of Section 14. Accordingly, I thought I had both the power and the duty to say to health authorities that they had no right to decide individual applications by a stated set scale. If it were intended that qualification for medical assistance should be governed by a particular scale, then either the Act or the regulations would have so provided. I, therefore, circularised local authorities and directed them to decide each case on its merits. One can well imagine a man whose income might be as high as £12 or £14 per week and who might have some personal tragedy or difficulty which would only become apparent if his case was examined on its merits; it could never become apparent if, in fact, the scale were adopted and rigidly enforced. I think that position has now been cured so far as medical assistance is concerned.

In relation to disability allowances, again I found there that certain health authorities were, in my opinion, not approaching their obligation in a proper manner. As Deputies are aware, under the regulations which I made last October each health authority was prohibited from regarding as means the amount of home assistance an applicant might receive. That was removed from the provision of means under the regulations which I made. There still remains a means test and the means test for the disablement allowance is set out in Section 50, sub-sections (6) and (7) of the Health Act.

Under Section 50 sub-section (6) the health authority can only make these payments to persons who are over 16 years of age, who are not able to provide for their own maintenance and whose relatives, within the meaning of this sub-section, are unable to provide for them. The applicant must be over 16 years of age, must be unable to provide maintenance for himself and must be able to show that no relative is able to provide for him. Now "relative" is defined as the spouse, son, daughter, or parent, or any brother or sister of a person normally resident with such person. Therefore, to qualify for an allowance, disablement must be proved, no means must be proved and, in addition, it must be established that no relative within the definition of sub-section (7) of Section 50 can provide for the applicant.

While I can appreciate the concern of Deputies, it is inevitable under Section 50 of the Health Act that there will be cases of unfortunate people who perhaps have some home assistance, who live with possibly a married brother or sister and who are really a cross and a burden in that household. It is unfortunate that the means going into the house must be regarded by health authorities under Section 50, but I have urged health authorities to bring to the operation of Section 50 a sense of charity and to give to the determination of the means test in that section as wide an interpretation as possible. As you know, I found some time ago that the health authorities were using that section to save money on their home assistance accounts——

Mr. S. Flanagan

I want to ask the Minister about that. At the present time in my constituency a person who gets £1 has home assistance automatically stopped.

Mr. T.F. O'Higgins

I do not think it is quite as bad as that.

Mr. S. Flanagan

Well, if a person getting home assistance, say, gets 12/6 and qualifies for the £1, the 12/6 is taken off.

Mr. T.F. O'Higgins

The position was certainly as the Deputy has mentioned up to a short time ago. I found quite a number of cases where home assistance, say, 15/- was being paid and when a disablement allowance of 15/- or £1 was given the home assistance was then terminated. It could not be done the other way round: the home assistance could not be counted as means because that was prohibited, but when health authorities granted a disablement allowance they said to the applicant: "Now, you have so much disablement allowance, therefore you are not in need of home assistance."

It was that particular problem that I dealt with on a number of occasions and I referred to it quite often. Eventually, my colleague, the Minister for Social Welfare, who is the responsible Minister in relation to home assistance matters, did come to my assistance and has made an Order now prohibiting public assistance authorities from reducing beyond 10/—in other words, if I may put it this way—when a disablement allowance is granted and if it is lower than 10/- it cannot effect any reduction or cut in home assistance; if it is more than 10/- it can, to the extent of 10/-. In other words, the effect will be that a person in those circumstances will get at least 10/- more than he had been getting.

Mr. O'Leary

That will be a great improvement.

Mr. S. Flanagan

Will it be retrospective? Can we go back over the——

Mr. T.F. O'Higgins

Yes, we have directed that all health authorities should re-examine the decisions they have already made.

Some Deputies have referred to the problem of mentally defective children. Again that is one of the great wants that we have in this country. There is a great number of children—it is impossible to be accurate as to the number—but certainly there are numbers of children in this country who suffer from some mental deficiency and for whom it is not possible at the moment to provide any institutional care or treatment. That is nobody's fault; it is just a problem that is there.

Tremendous work is being done by the institutions that we have. I have been through a number of them and certainly the work being done in Obelisk Park and by Lota in Cork by the brothers is work of real Christian charity and it needs a very high vocation for its doing. But the provision of more beds has been getting attention in recent years and we hope that by the end of the present year there should be at least another 1,300 beds for both male and female mentally defective children. In addition work should commence on another 800 or so beds this year. Accordingly, by the end of the year while the problem will still be there it will be reduced by quite a substantial degree.

The same thing arises in relation to mental hospitals. Again, if there is a supplementary building programme, as I hope there will be, the bias in that programme will be towards the mental problem, towards the provision of better facilities in mental hospitals and also for these mentally defective children. If there is a supplementary building programme, I can assure Deputy O'Leary we will not forget Enniscorthy.

Other points have been mentioned by Deputies and I can assure each Deputy that a note has been made of them and they will be communicated with in regard to the matters raised.

A number of Deputies referred to the problem of rehabilitation. I hope to be able to make an announcement with regard to that in the near future. As I indicated in my statement, we are establishing a national body and this body will be charged with the duty of examining what facilities are needed and working out a policy for rehabilitation. It will aim at providing these unfortunate incapacitated people with some form of employment and some means of earning their daily bread in the same way as everybody else. Accordingly, a scheme of that kind and work of that kind will need co-operation from employers and employees and I want to express the hope that the trade union movement will be willing to co-operate in this worthwhile work. It is not easy to find suitable work for a disabled man and it can only be found if a number of interested people are willing to help him find work. In the body I hope to establish in the near future I will ask representatives of the Irish trade unions to join and to help, with employers and other interested parties, in getting the work done.

I think a Deputy mentioned that the Government could do a lot. I entirely agree with that. I think that in the Government services there will be a possibility of absorbing many of our disabled citizens, but that will not be sufficient if the large industrial employers cannot or are not able or willing to provide employment and help in the problem of resettlement. I hope that when this body gets down to work they will get co-operation from these different people.

I want to make one slight correction. I was referring to home assistance a while ago and I think I did not put the matter quite correctly. In fact, what now happens is that the first 10/- of disablement allowance must be disregarded in fixing home assistance. The result is the same: it is just the method of doing it.

I have nothing further to say, except that I appreciate the manner in which Deputies have received this Estimate.

Motion—"That the Estimate be referred back for reconsideration"— put and declared lost.

Vote put and agreed to.