I move:—
That a sum not exceeding £6,737,940 be granted to complete the sum necessary to defray the Charge which will come in course of payment during the year ending the 31st day of March, 1957, for the salaries and expenses of the office of the Minister for Health (including Oifig an Árd Chláraitheóra) and certain services administered by that office, including grants to local authorities, miscellaneous grants and Grants-in-Aid.
The Estimate now before the House shows a net decrease of £17,110 on the amount voted for the year 1955-56. Most of the sub-heads show only slight variation from the previous year, but sub-head H—Grants to Health Authorities—is increased by £971,000, while sub-head K—Grant-in-Aid of the Hospitals' Trust Fund—shows a reduction of £1,000,000. Before making the customary review of the services in the current year, I would like to deal with the two last mentioned sub-heads.
The Estimate of £1,250,000 for Grant-in-Aid of the Hospitals' Trust Fund is a realistic assessment of the amount that will be needed to supplement the fund in 1956-57. As I mentioned last year, the subvention from the Exchequer in aid of the Hospitals' Trust Fund has been overestimated since 1953-54, when it was first decided that the Exchequer should contribute specially to the fund so that hospital building works would not be held up for lack of money. In 1953-54 the Estimate of £4,500,000 proved to be £1,600,000 more than the amount needed. In 1954-55, the amount estimated was £3,500,000 but only £2,000,000 was required. For the year just ended, the amount provided for this Grant-in-Aid was £2,250,000 but the amount which it was necessary to transfer from the Exchequer was £1,000,000 less than that figure. One and a quarter million pounds will again be sufficient this year to supplement the Hospitals' Trust Fund and, with this subvention, it is expected that the resources of the fund will be adequate to meet all the calls on it.
One of the reasons for the decreasing demands made on the Exchequer to aid the Hospitals' Trust Fund is the continuing and welcome increase in the income from the Hospital Sweepstakes. In 1950, the amount accruing to the fund from the sweepstakes was £946,000; in 1951, £1,160,000; in 1952, £1,256,000; in 1953, £1,584,000; in 1954, £1,774,000, and in 1955, £1,899,000. In estimating the Grant-in-Aid of the Hospitals' Trust Fund required for next year the income from sweepstakes has been taken to be the same as in 1955. In other words, with the addition of £1,250,000 from the Exchequer, the amount available for grants from the fund will be over £3,000,000 next year, of which over £2,000,000 will be spent on building works and about £800,000 on other grants, including payments to meet the deficits of voluntary hospitals. I would like to make it quite clear that in making these calculations I have not in any way cut the scope or speed of the hospital building programme.
The programme which was drawn up in 1948 is going forward without any diminution and with the least possible delay. It was originally hoped that it would be completed about now but this hope was not realised in circumstances already explained to the House. About two-thirds of the programme has, in fact, been completed and paid for, involving grants from the Hospitals' Trust Fund of about £20,000,000 in the last seven years, but it is now clear that the programme will not be finally completed until the early 1960's. Four major schemes, costing about £6,000,000, represent a large part of the programme still to be carried out. These are the new St. Laurence's, St. Vincent's and Coombe Hospitals in Dublin, and the new Regional Hospital in Cork. The planning of these projects has taken a much longer time than was anticipated but building work on them should be in progress during the current year. Certain urgent works not provided for in the original programme are also being proceeded with.
I now turn to the other main sub-head of the Estimate, i.e., the amount required for the grants payable to local health authorities which, at £7,946,000, represent an increase of £971,000 over the previous year. These grants meet half of the cost of the local health services and any increase in the sub-head reflects a corresponding increase in the amount met from local authority funds. In fact, the total cost of the services in the coming year is expected to be £15,580,000, an increase of about £2,000,000 on what they cost last year. This increase is due to a number of factors, the more important being the improvement of the services for the groups covered at present, the recent increases in salaries, wages and other costs, and the extension of the services to further groups.
As the House will be aware, I have recently made regulations, operative from the 31st March, the effect of which is to make persons in the middle income group eligible for hospital and specialist services. Mothers in the middle income group will also be entitled to a maternity service and to an infant welfare service for their infants up to six weeks of age. I will have more to say later about this extension of the services.
I think it important here to draw a distinction between the increases in local expenditure which can fairly be attributed to this extension alone and those which would have occurred whether or not the services were made available to the new classes. A large part of the increase of £2,000,000 is, in fact, attributable to improvements in existing facilities. The many new beds which have become available in local authority and voluntary hospitals, improvements in dental services, ambulance services and nursing services, increases in capitation rates to voluntary hospitals—and increases in salaries, wages and prices, account for over £1,200,000 of the increase. These factors would call for an increase of this order whether or not the new groups were admitted to some of the services. The estimated cost to the rates and the Exchequer of extending the services to the new groups is, in fact, £780,000.
At this stage, perhaps, I should refer to a matter which has occasioned some comment in recent weeks—that is, the effect of the health services on local rates. Some of the criticism on this score gives the impression that the total cost of these services is being borne on the rates. This, of course, is not the case. Next year, the Exchequer will pay almost £8,000,000 towards the cost of local health services, that is, half the total cost. It may not be realised that as late as the year 1947-48, the Exchequer contributed only about 16 per cent. of the amount spent on health services in that year. Nowadays each health authority receives annual grants from the Exchequer equal to the total paid from local funds. In other words, the State now contributes 50 per cent., as against 16 per cent., of the cost of the health services and the local authorities' proportion has gone down from 84 per cent. to 50 per cent. In terms of money, the State paid £900,000 in 1947-48 and the local authorities £4,700,000; each will pay about £7,800,000 in respect of the year 1956-57.
The State's contribution has gone up by £6,900,000 and the local authorities' by only £3,100,000. This latter figure represents an average increase of about 4/8 in the £ on the local rates since 1947-48. If we assume that the new State grant had not been introduced in 1947-48 and that no extensions or improvement of services took place since then, the local authorities' contribution of £4,700,000 to the costs would, in any event, have increased by up to one-third, or £1,500,000, to make allowance for cost of living and price increases since then. We may thus deduct this from the £3,100,000 and say that for about £1,600,000—i.e. for about 2/5 in the £ on average on the rates —the local authorities will have developed the major part of the new services under the Health Acts of 1947 and 1953. The increase of £2,000,000 in the gross cost of the services in the coming year will call for an average rate increase of about 1/6 of which only about 7d. will be due to extension of the services to new groups. I feel it necessary to draw attention to these points in view of some misleading criticism outside the House.
While I am on this point, I would like to make certain other facts clear. The services which are now being extended to the middle income group are based entirely upon the Health Act, 1953, which was drawn up and passed by the previous Government. I have made it known on a number of occasions that I opposed the passage of that legislation through this House, that I do not regard it as the best, or the ultimate in the matter of health legislation for our people and in our circumstances but that, in order to remove health services as far as possible from the realm of Party politics, I undertook to implement the Act virtually in full, and to try to make it workable and acceptable to all who are concerned.
We are now at the stage when the two most important groups of services have been extended to the middle income group—that is, the hospital and specialist, and the maternity and infant services. These improved and extended health services cost money, of course, and half of that cost falls on local funds. That position is not of my making; it arises directly from the Acts passed before the present Government took office. From the very outset it was made clear by my predecessor that the new services under the 1953 Act would be provided by local health authorities and that half the cost would have to be found by those authorities.
It is, therefore, rather surprising to find certain Opposition Deputies now lamenting the effect of the Act on local rates, and trying to place the blame for it on the present Government. I do not think that is a very fair approach to a difficult problem and I hope that, during the debate on this Estimate, these basic facts will not be in dispute.
Before going on to give some information on the operation of the various services in the past year, I propose, as is customary, to give the House some information on the vital statistics for 1955, which have recently become available. These figures are provisional at this stage. The number of births in 1955 was 61,575, giving a rate of 21.2 per 1,000 of the population, which was very slightly below the previous year's figure. Deaths were up a little at 36,525, giving a rate of 12.6 per 1,000 of the population. Marriages were also up slightly on the 1954 total, at 16,137, a rate of 5.5 per 1,000 of the population.
There has been a gratifying decrease, once again, in the figures for infant mortality and maternal mortality. Deaths of infants under one year of age totalled 2,249 as compared with 2,364 in 1954, making the 1955 rate 37 deaths per 1,000 births, which is the lowest on our records. There were 65 maternal deaths due to childbirth and pregnancy, four less than in the previous year and the lowest figure ever recorded in this country.
The number of deaths from all forms of T.B. has again fallen—from 1,005 in 1954 to 860 in 1955. This latter figure gives a rate of 30 per 100,000 population, which is much less than half the death rate recorded from this disease as recently as 1951. The same satisfactory trend is not, unfortunately, followed by cancer which continues to be one of the major health problems of our time. Deaths from this disease totalled 4,559 in 1955 giving a rate of 157 per 100,000 population, the same as in the previous year. Cancer deaths have shown a slight but continuing increase in recent years: this phenomenon is apparent in many other countries, too. We now have, however, in addition to the older established specialist cancer hospitals, one of the best-equipped cancer hospitals in Europe—St. Luke's Hospital, Rathgar—which is run by the Cancer Association of Ireland, and this association is in process of extending its services to provincial centres.
Deaths from many of the infectious diseases, other than T.B., have declined remarkably in recent years and, in some cases, it is possible to record further improvements in 1955 Measles accounted for 15 deaths, compared with 33 in 1954. Scarlet fever caused two deaths, one less than the previous year; and poliomyelitis caused five deaths, compared with 14 in the previous year. Another welcome improvement was in the deaths from diarrhoea-and-enteritis in children under two years of age, which reached a new low level of 152 deaths. On the other hand, there were increases in the number of deaths due to typhoid fever, whooping cough and diphtheria. Typhoid fever accounted for four deaths in 1955 as compared with one in the previous year; whooping cough caused 39 deaths, six above the 1954 figure; and diphtheria caused 14 deaths compared with five in 1954.
I would like to say a special word about poliomyelitis and diphtheria. My Department is keeping in touch with developments in other countries regarding the use of anti-polio vaccines and the matter is being considered at the moment by the Medical Research Council. With the help of a grant from the Hospitals' Trust Fund, the council is at present conducting a survey to determine the concentrations of poliomyelitis anti-bodies in children in this country. The results of the survey should be useful in deciding the age groups of the child population in which the use of an anti-polio vaccine would be most beneficial.
With regard to diphtheria, a disturbing feature was the increased incidence of this highly infectious disease last year. In 1955, there were 77 cases throughout the country, mainly in Dublin, involving 14 deaths. A few years ago, it might have been pardonable to think that victory over this disease had been almost achieved. In 1953, the number of cases had fallen to 29 and only three deaths were caused. This vast improvement on the epidemics prevalent up to about ten years ago was due mainly to the widespread immunisation of young children but, unfortunately, the very improvement in the position seems to have led many persons to believe that the disease had become almost extinct. The increased number of cases and of deaths last year has proved, if indeed proof were needed, that the danger of diphtheria is still present and that the more children who are left without the protection of immunisation the greater the risk of outbreaks and of deaths. I therefore take this occasion again to appeal to parents to make sure that all their children are immunised, if possible soon after reaching the age of six months. A combined immunisation against diphtheria and whooping cough can also be given if necessary.
While deaths due to infectious diseases in general have become fewer since pre-war years, the same cannot be said about fatal accidents. Last year accidental deaths of all kinds, including those due to transport accidents, falls, burns and scalds, drownings, etc., totalled 1,020. This is a staggering figure when compared, for instance, with the total of 860 deaths due to T.B. Apart from the deaths due to accidents, there are, of course, innumerable unrecorded injuries caused by accidents of various kinds, many of which leave people permanently injured. A great number of these deaths and injuries due to accidental causes, especially in the case of young children and old people, could be avoided with reasonable care and caution.
I now turn to the hospital building programme. Over the past year, from Donegal to Kerry, I have seen ample evidence of the progress made in providing first class hospital and clinic facilities throughout the country. Among the major projects completed were the regional sanatoria at Dublin and Cork, which between them supply 946 additional beds and the Regional General Hospitals at Galway and Limerick of 525 and 286 beds respectively. The new 133-bed Orthopaedic Hospital at Gurranebraher, Cork, and the new District Hospital at Cahirciveen came into commission some months ago. Another important addition to our hospital facilities was the new 80-bed genito-urinary unit at the Meath Hospital, Dublin. A newly reconstructed and extended wing at St. Kevin's Hospital, Dublin, has made 228 beds available for medical patients. The completion of the extensions at St. Mary's, Drumcar, and St. Raphael's, Celbridge, has made available extra accommodation in these homes for 530 mentally defective boys. A new establishment for 240 mentally defective girls was opened at Sligo and an extension for 180 boys at Our Lady of Good Counsel Home, Glanmire, County Cork, will be completed within a few months. Two new county clinics were opened at Wexford and Portlaoise, and 70 dispensaries were completed in various parts of the country.
As I mentioned earlier, work on four further major projects—the new St. Vincent's, St. Laurence's and Coombe Hospitals in Dublin and the new Regional Hospital in Cork—will be under way during the year.
The high operating cost of our extensive hospital system is already a matter of some concern, and the indications are that costs will be higher in the future, not only by the addition of new facilities but also because of the high running expenses when compared with the simpler but, of course, less suitable and less effective older buildings. In relation to our population we already have very extensive hospital facilities by comparison with other European countries and, before embarking on further building programmes, we will have to be satisfied that we are making the best use possible of existing hospitals. My Department has this question constantly in mind and with the solution of some of our health problems it will be possible, by a reallocation of buildings, to ease the pressure on certain types of hospital beds.
An example of this reallocation is the reversion to the Ballinasloe Mental Hospital Authority in December last of the premises at Castlerea, which had been in temporary use for several years as a sanatorium. These premises will accommodate about 450 mental patients and already nearly 300 have been transferred there from Castlebar, Sligo and Ballinasloe. The full range of modern treatment for mental illness will be provided at Castlerea, and direct reception of patients from a suitably defined area is being arranged. It is also intended that a unit of about 100 beds there will be allotted to mental patients in the western region who are suffering from T.B.
Other progress has also been made in improving accommodation for mental patients. New units have been completed at Portrane Mental Hospital, with 268 beds, including a special 20-bed unit for children. A new 80-bed unit at Grangegorman has been completed and occupied while preliminary work has commenced on another similar unit at the same hospital. Planning of an infirmary unit for Cork Mental Hospital is in the final stages. A similar unit for Ardee and admission units at Ardee, Carlow, Castlebar, Cork, Grangegorman and Waterford Mental Hospitals are being planned. Additional staff accommodation at Limerick Mental Hospital is nearing completion; the building of a nurses' home at Monaghan and a staff home at Mullingar has started, and work is about to commence on the nurses' home at Kilkenny; nurses' homes at Carlow, Cork and Ardee Mental Hospitals are being planned.
All of these projects will provide additional and improved accommodation for mental patients, but far more extensive improvements would be needed before the amenities at our mental hospitals could be said to be satisfactory all round. The small expert committee which I appointed last year to consider and make recommendations as to the practical steps which could be taken to relieve overcrowding in mental hospitals has submitted an interim report which deals with certain important aspects of this problem, namely, the extent to which the present overcrowding is attributable to the increased receptions and to the retention of senile patients, and the possibilities of reducing or controlling such receptions without detriment to the persons involved and of accommodating these old people elsewhere.
Receptions of persons over 65 years of age have increased from 345 in 1934 to 1,066 in 1954. The average resident population of mental hospitals aged 65 years and over increased from 2,566 to 4,717 over the same period. The committee's recommendations are being dealt with as a matter of urgency. It is hoped that as a result of other suitable residential accommodation becoming available, some relief of the present overcrowding in mental hospitals can be arranged.
I might mention that the numbers of voluntary and temporary patients received into mental hospitals during the past year again showed an increase on the previous year's figures, thus maintaining the upward trend which these figures have shown since the coming into operation of the Mental Treatment Act, 1945. In 1947, when the Act first came into operation, 376 voluntary patients and 772 temporary patients were received. The corresponding figures for 1955 were 2,033 and 2,449, respectively.
As regards mental hospital out-patient clinics, 1,704 sessions were held during last year, at which there were 4,823 attendances. The increases in the numbers of voluntary and temporary in-patients, and the large numbers of attendances at out-patient clinics, indicate a welcome willingness on the part of persons with mental disorders to seek the skilled treatment and advice which can substantially improve their condition. The percentage of recoveries amongst both voluntary and temporary patients continues to be very satisfactory.
I mentioned earlier the fact that deaths from T.B. have continued to decline and dropped to 860 in 1955. Though it is gratifying to be able to record this, there is no room for complacency. The T.B. death rates in England and Wales, Scotland and the Six Counties are still a good deal below ours. Moreover, we must take account of the number of new cases of T.B. coming under notice which, although showing a small but steady decline in recent years, still totals more than 6,000 a year. In other words, while the death rate from T.B. is decreasing noticeably from year to year, the number of new cases of the disease is still large enough to require prolonged and extensive effort if the disease is to be eradicated.
As all new cases of T.B. arise from contact with infectious cases, the large numbers of new ones found each year indicate that there are as yet many infectious cases not yet diagnosed. In tracing these undiscovered cases, improved field services—mass-radiography, tuberculin testing, etc.—play a most important rôle, but in addition to the intensive efforts of health authorities and their medical staffs, the maximum co-operation of medical practitioners and of the public at large is needed. An excellent free service is available throughout the country to help in diagnosis at the early stage, when treatment is most effective. Close co-operation with the local authority's medical staff will prove advantageous to the medical practitioner in the treatment of his private patients, and will help the chief medical officer of the area in tracing cases of the disease. The general medical practitioner, with his knowledge of his own patients, is in the best position to secure their co-operation in availing themselves of the facilities provided by the T.B. service and in inducing their families and other contacts to take the necessary precautions of having X-ray examination and, if necessary, B.C.G. vaccination. I arranged recently a meeting of chief medical officers and medical superintendents of sanatoria to discuss the T.B. problem and, as a result of their discussions, an intensification of the campaign against T.B. may be expected in all areas.
We now have sufficient beds for T.B. patients throughout the country, and health authorities are able to provide hospital accommodation virtually immediately it is required. In fact, the demand for beds has fallen in recent years, as the following figures will indicate. The number of beds required for adults suffering from respiratory T.B. was 5,143 on the 31st March, 1951. This figure increased each year to a total bed requirement of 6,052 on the 31st March, 1954. On 31st March, 1955, the number of beds required had fallen to 5,607 and, whilst I have not final figures for the end of last month, provisional figures indicate that the bed requirement fell to about 5,000 at that date.
In effect, therefore, the demand for beds for T.B. cases having reached a peak early in 1954 is now falling and, with the virtual completion of th regional sanatoria, is satisfied and it has been possible to close a number of hospitals formerly used for treating T.B. patients. I have already mentioned the Castlerea institution. The next largest which has been closed is Rialto Hospital, Dublin, with 279 beds. This is being converted for use as a general hospital connected with St. Kevin's Hospital, Dublin. The T.B. hospital at Mallow, with 149 beds, was closed in July last, when the patients were transferred to the new Regional Sanatorium at Sarsfieldscourt, and the premises will be used as a general hospital for the North Cork area. The 50 patients in the Pigeon House Sanatorium have been transferred to the Dublin Regional Sanatorium. The Auxiliary Sanatorium, Kilkenny, which accommodated 37 patients, was closed in October last and is now available for other purposes. The small T.B. hospital, St. Carthage's, Lismore, was also closed a few months ago, but for the present is being held in reserve. In addition to the places which have already been made available for other purposes, it is intended that Heatherside Sanatorium, County Cork (172 beds), Monaghan T.B. Hospital (144 beds), St. Kevin's T.B. Hospital, Rathdrum (38 beds) and Naas Sanatorium (44 beds) will also be closed as sanatoria and diverted to other uses. Heatherside Sanatorium will be transferred to the Cork Mental Hospital authority for the relief of overcrowding in the mental hospital. Monaghan T.B. Hospital will also be occupied by mental patients as an admission unit and to relieve overcrowding in Monaghan Mental Hospital. St. Kevin's, Rathdrum, will be used as an extension to the County Home and Naas Sanatorium will become a maternity hospital.
It is inevitable that a reorganisation like this should cause a certain amount of inconvenience to patients who may have to be transferred from one hospital to another, and to the staffs. Nevertheless, it is essential that the available hospital accommodation should be put to the best possible use in the interests of all patients for whom local health authorities are responsible.
The number of persons receiving maintenance allowances under the infectious diseases service on 31st March, 1955, was 8,529 and the amount paid during the 12 months ending on that date was £576,638. Most of those drawing these allowances are persons undergoing treatment for, or recovering from, T.B.
One important aspect of the T.B. problem is the rehabilitation of recovered patients to enable them to take up suitable employment when they have been discharged from hospital. The Rehabilitaton Institution, Limited, has centres for ex-T.B. patients in Dublin, Cork and Limerick for training women in garment making. There is also a centre in Dublin for training men in woodwork, and some furniture for the regional sanatoria was produced at this centre. Woodwork training for men is also provided at a residential centre in Toghermore, County Galway, which is under the control of a separate local committee.
This brings me to the wider problem of rehabilitating disabled persons generally. As the House will be aware, some months ago I invited a number of prominent people to become members of a special body which will investigate the extent of the various types of disablement in this country, and the facilities available for rehabilitation and which is charged with the duty of making recommendations regarding the best means of enabling disabled persons to secure suitable employment. This body, known as the National Organisation for Rehabilitation, will also examine the problem of finding employment for rehabilitated persons. The organisation has already appointed a full-time medical director. I understand that they have made a start on their activities and I hope that when introducing next year's Estimate I may be able to give the House more information regarding the progress made in this field.
I would not like to leave this matter without referring to the trojan work carried out on behalf of particular types of disabled persons by a number of voluntary bodies. The fact that it has been decided to set up a State-sponsored body to deal with this problem on a wider basis detracts in no way from the good work already done. A central body, designed specially to look into the national problem of all kinds of disablement and to make recommendations to local authorities and to the Minister for Health on how the problem should be tackled, is necessary but the voluntary bodies already in existence can help in no small measure by making available their expert knowledge on the subject. The new organisation includes representatives of a number of such voluntary bodies among its members. A grant is being made from the Hospitals' Trust Fund to enable the organisation to get on its feet.
Under the Health Act, 1953, health authorities are responsible for rehabilitating disabled persons in their area and they have power to provide equipment, training facilities, etc. When, as a result of the investigations of the National Organisation for Rehabilitation, we will have gained a clear appreciation of the problems of rehabilitating and training the disabled, we will be better equipped to see how these difficulties should be tackled, and the health authorities will be enabled to go ahead with their functions in this matter. In the meantime, since 1st October, 1954, they have been paying maintenance allowances to certain chronically disabled persons. Up to the 30th September, 1955, over 13,000 such allowances have been granted and nearly 3,000 were under consideration on that date.
I have already referred in a general way to some of the effects from the financial point of view of the extension of certain services—the hospital and specialist services and the maternity and infant welfare services. I think that this might be a suitable time at which to mention what the extensions are.
On a number of occasions in this House I have explained why I could not agree, in the summer of 1954, to seek to give effect to Section 15 of the Health Act, 1953, which relates to hospital and specialist services. My experience over the last 18 months confirms me in the view that to attempt to give effect to the regulations made by my predecessor providing for the introduction of those services in August, 1954, would have given rise to chaos. In fact, had I attempted to do so, I would have had to answer a charge that I had attempted to sabotage the Act. In arriving at my decision I was fortified by the recommendation of the National Health Council established by my predecessor.
With increased facilities and following long negotiation with the persons whose goodwill was necessary for the provision of the services, I decided towards the end of the last year that it would be possible to extend the services to the additional groups last month. Section 15 is now in operation for all the persons specified in that section, including the additional groups comprising dependents of insured persons, all those in the middle income group and the "hardship" cases. The same applies to Section 25 which relates to choice of hospital.
The specialist services will be free to all the eligible groups. The hospital services under Section 15 will be free to the lower income group (including insured persons and their dependents in that group) but persons outside that group must pay such amount as the health authority may decide, within a limit of 6/- per day, except in the "hardship" cases when the charge may be higher. This is in strict accord with the terms of the Act.
By making use of the facilities in the voluntary hospitals and with the development of specialist services at local centres, the facilities are now available, generally speaking, for a good service for all the eligible groups. There will still be gaps here and there in the services, but with a little patience on the part of all concerned, it should be possible to fill these gaps relatively quickly and I hope that by the time next year's Estimates are being debated in the House it will be possible to say that all aspects of the services are working smoothly and satisfactorily.
Up to recently, insured persons who satisfied certain contribution conditions have been entitled to completely free hospital services. Under the new arrangements, insured persons who are not in the lower income group may have to pay up to 6/- per day for those services. That position is as contemplated in the 1953 Act and I think the persons concerned have no legitimate grievance, since the contribution conditions have been modified in favour of additional groups of insured persons, and dependents are now eligible as such for the first time.
The free hospital service provided for treatment of T.B. and other infectious diseases will not be affected in any way by the extension of this new hospital and specialist service to the middle income group. Persons suffering from T.B. and certain other infectious diseases will still be able to obtain all necessary hospital or other treatment completely free of charge.
Up to recently only women in the lower income group were entitled to the free medical care service in respect of motherhood and to the free medical service for infants up to six weeks of age. Under the arrangements now in operation, women in the middle income group also have the benefit of these services, including midwifery services for domiciliary confinements and hospital services where necessary.
There will be no charge for hospital services for eligible women or for their infants as in the case of general hospital services under Section 15 for the middle income group and the "hardship" group. Section 25 (choice of hospital) will apply to maternity and infant hospital services in the same way as it applies to Section 15 patients.
There is an aspect of the maternity care service I would like to emphasise. I am advised that many of the complications arising at confinements have their origin in the failure of women to seek medical supervision and advice at an early stage in the pregnancy. There is no reason why any woman in the eligible classes should be without such supervision. The doctors who will provide the maternity service under agreements entered into by them with health authorities will be only too willing to see their patients at an early stage and to give them all the attention they need in the waiting period. In addition, in most areas women will have a choice of doctor available to them. I appeal, therefore, to women to make proper and intelligent use of the service in their own interests and in the interests of the unborn child. If they fail to do so, they are failing in their duty to themselves, to their families and to the nation and the public money spent on the service will have been largely wasted.
The 1953 Act provided for the extension of the maternity and infant services to women outside the lower and middle income groups subject to the payment of annual contributions. I propose to defer bringing this part of the Act into operation for the present. The House will recall that in January, 1955, I set up an advisory body to consider and report on the feasibility of introducing a scheme of voluntary health insurance against the wide range of modern medical costs, including the costs of maternity. This body may find it possible to recommend a scheme which would, if introduced, provide cover against the expenses of confinements. Many women might wish to meet these expenses by means of private insurance arrangements rather than to obtain the services needed from the health authority in return for an annual contribution under the Health Act.
Tentative proposals for the reorganisation of outdoor nursing and domiciliary midwifery services have been drawn up and issued to interested parties. Discussions have been held with them and no significant objections have been raised to the proposals. In formulating these proposals I have kept in mind the desirability of encouraging voluntary effort in this field. The existing voluntary nursing associations have given excellent service to the public in the past and one effect of my proposals should be to provide them with the opportunity of continuing to do so.
It is my policy to make available the services of a nurse, employed either by a voluntary association or by the health authority, in each dispensary district as soon as it conveniently can be done and, arising out of the extended maternity services, to enable all midwives who desire to do so to participate in the service so that eligible patients will, as far as possible, in addition to a choice of doctor, have a choice of midwife for domiciliary confinements. Private midwives will be paid a fee for each such case attended.
The scheme under which a maternity cash grant of £4 was payable by health authorities in certain circumstances continued during last year. From the commencement of these maternity cash grants on the 1st January, 1954, up to the end of September last, 48,000 grants had been paid. These grants are payable only to women in the lower income group, that is, generally speaking, women who are entitled to the free general medical services for the poorer sections of the community.
A circular was issued last year to local health authorities containing recommendations as to how child welfare clinics should be organised. There is now a statutory obligation on health authorities to provide a child welfare clinic in towns with a population of 3,000 or over. They may also set up child welfare clinics in smaller towns if they wish and some authorities have availed of this discretionary power. The total number of cities and towns in which child welfare clinics are held, or proposed to be held in the near future, is over 70.
The main groups at present eligible to receive dental services are the lower income group, children attending national schools, in respect of defects discovered at school health examinations, and children attending child welfare clinics, in respect of defects discovered at the clinics. The services provided for these groups are yet far from adequate and I have pressed all health authorities to improve the services administered by them. The reaction of health authorities generally has been favourable, improvements have already been made and at the moment 20 additional whole-time posts are in process of being filled. Where services are not sufficiently developed to provide full dental care for all those entitled to such care the unanimous advice I have received is that children should be given priority in the obtaining of dental care. I have accordingly advised health authorities that they should concentrate on the making available of an adequate service for children in preference to other eligible classes. When, therefore, the additional whole-time men are available their services will be utilised mainly for children. I would like to emphasise that these additional appointments will not solve the problem of the inadequacy of health authority dental services and that the need continues for considerably improved services. Until the position is improved materially for the existing eligible groups I do not propose to seek to extend dental services to additional groups. The Department of Social Welfare is, however, continuing its scheme of dental service benefits for insured persons.
Generally, the year which has just passed has, I feel, witnessed a very considerable achievement in regard to the vexed question of health services. Relations with the professional groups on which any Government must rely for the provision of services are now, I think, better than they have been at any time in recent years and with the implementation, virtually in full, of the Health Act, 1953, the acrimonious political controversy which has been a feature of the services should be at an end. Much still remains to be done in the matter of improving facilities, but for the future in the altered atmosphere, I think it should be easier to secure these improvements. On the question of helping groups outside the present eligible groups to gain access to health services which they may need from time to time, I have already mentioned the advisory body which is considering the question of voluntary health insurance and that I expect the report of that body shortly. I want to emphasise that the purpose of this body's deliberations is to consider whether and in what manner it is possible for the State to supplement the individual's efforts to provide for himself. The Health Act has been criticised because in some cases individual effort was in danger of being supplanted by the services it sought to provide under the aegis of the State. Now that it has been found possible to implement the main features of this Act the way is, I hope, clear to consider proposals under which—apart from necessitous classes—it will be the State's main concern in relation to the provision of personal health services to help each individual to provide for himself. The obvious way of doing this is by means of a practical scheme of health insurance. When the report of the advisory body is available it should be possible to plan for such future developments in an atmosphere of goodwill and co-operation.
