There are a few small points arising out of the debate. In regard to the remark of the Minister on the question of the shopkeeper with all the resources of his shop—I know I am not quoting the Minister verbatim—that it would not be right that he should not be charged, that it would be contrary to natural justice if he were not, I wonder would the Minister expand that thesis a little for us and tell us, if that is so, why is it that the magnificent provisions of the 1947 Health Act which the Minister helped to frame, I have no doubt, and which his colleagues helped to introduce, contained a number of clauses, all of which, according to him now, must have contravened the law of natural justice in so far as in relation to the fever hospital treatment regulations, the infectious diseases treatment regulations, the tuberculosis treatment section of that Act and, of course, the famous mother and child provisions, the Act contained a free no means test provision which lays down that a person gets treatment in hospital irrespective of income, family income or personal income? The result is that there are throughout the country at the moment in all our tuberculosis hospitals and sanatoria and fever hospitals and to a certain extent in our maternity hospitals, shopkeepers, wealthy persons, who are being treated under the provisions of the 1947 Health Act of the Fianna Fáil Party, a magnificent Act which, as I have said before, any Government would be proud to have introduced.
Are these people who are in hospital in any way contravening the law of natural justice, whatever that may be? I am very vague about it. The Minister may know about it. He may know more about it now than he did in 1947 when he allowed these things to go through. Does he intend now, in order to remedy the offence to the law of natural justice, to remedy it in respect of these other services and introduce charges of some kind or other in relation to tuberculosis services and fever hospital services generally?
Does the Minister now want to backtrack on the magnificent provisions of the 1947 Act as he is backtracking on the relatively conservative provisions of the 1953 Health Act and does he want now to introduce charges in order to catch the wealthy shopkeeper or other wealthy person who is at present benefiting from the provision of these services?
It would appear to me to be a logical conclusion to the argument he used a moment ago that he should now try to seek out all those people and try to remedy the position in relation to the law of natural justice which he says is offended if a person who can pay does not pay. If a person who falls ill, goes to hospital and gets treated and does not pay if he has money, then this in some way contravenes this curious law of natural justice which applies in health services and which does not seem to me to apply in so many other of our services, whether the service is free fertilisers, lime and so on for farmers or the hundred and one amenities that people get to help them— children's allowances, Small Dwellings Acquisition Act loans and all these other amenities which people get without means test. Are all these people contravening the law of natural justice if they get these amenities from the State without being subjected to a means test and if they have money and, superficially, do not appear to need the grants or concessions from the State?
This, of course, is a very important point because it was one of the main arguments used by the present Opposition against Fianna Fáil when they were trying to introduce the 1953 Act and when at one time I was trying to introduce the mother and child provisions of the Fianna Fáil 1947 Health Act. Has the Minister gone over to the Opposition? Does the Minister now share in this point of view that free health services are contrary to the law of natural justice or that the principle is in any way vitiated or offended by giving a person a health service which he can pay for himself? Does he now in any way wish to repudiate on behalf of Fianna Fáil or do Fianna Fáil wish to repudiate, the free, no means test principle of their 1947 Act? Is that the point he is trying to make now in his suggestion that the wealthy person who can pay for health services should pay for them in order that we may keep intact this curious, amorphous, confused thing, the law of natural justice?
The Minister has made a point in reply to Deputy O'Higgins that there is only a negligible number of people paying the full 6/- at present. I will accept his very small number. A small series of cases were investigated to find out whether they were paying the full 6/- at present and whether the local authorities were using their discretionary powers to reduce that charge in certain cases.
In the first place, I do not know whether this argument merits the vehemence with which the Minister used it to refute Deputy O'Higgins's suggestion that the charges are nearly invariably 6/-. I have no figures at all to go on, but from what one hears, while the 6/- may be a discretionary charge it appears to me to be the standard in use at the moment. The Minister has produced this series of cases to show that only in a negligible number of cases is the full 6/- charged. I am giving only my impression and I do not wish to appear to be in any way dogmatic about it, but I get the general impression that Deputy O'Higgins is nearer the truth when he says that, on the whole, 6/- is the usual charge made by local authorities.
I think that whatever was the case in Deputy O'Higgins's time it is more likely in the present Minister's time that the full charge will be made, particularly when one recalls the answers to questions one hears in the House in which, by implication, the Minister appears to criticise or chide the benevolent-minded managers, the managers who know conditions particularly well and who tend to err on what I call the human justice side that seems to come into these things so very little, through consideration and ordinary human understanding of the personal problems, the financial problems, of the average unfortunate person faced with sickness or ill-health and the insecurity that follows.
I recall one remark of the Minister's in which he appeared to give the general impression that he did not want this soft-heartedness of the managers and it appeared that he wanted them to deal with such cases in a very rigid way so that if a particular charge was recommended, that was the charge he would prefer to have charged. If however, he wishes to undo the impression that I have in my mind, at any rate, through listening to him here, and to undo the impression he made in this House, I hope he will do it, and tell the managers that he would prefer them to err on the side of being thoughtful for the problems of the family in sickness, that he would treat with sympathy and consideration any decision of a county manager which appeared to err on the side of being generous rather than on the side of being stringent and harsh and that he would, as Minister, prefer that all these claims for health services were considered in a generally sympathetic way and that that would be his attitude to it.
That is of great importance to managers and health authorities generally. They are bound by the headline set by the Minister to a considerable extent and where they have a generously-minded Minister who is sympathetic to their anxiety to provide good health services it makes a great deal of difference to them. It gives them some support in coming to a decision which might not be in accordance with the absolute letter of the law but which would be in keeping with the spirit of the law as we send it out from here to give as good health services as can be provided under the circumstances.
I wonder when the Minister was thinking about this matter of increasing the charge and looking for a tax— because I insist that it is a tax, or at least one form of it; essentially, it is another form of taxation on the less wealthy and the poor who are already hit by the Budget—when he was thinking of the £90,000 he intended to get, an infinitesimal sum compared with the vast £100,000,000 Budget and because of that it seems all the more inexplicable why he should go for it at the expense of the sick—when he was considering this question, did he have in mind, or was he going on the assumption which he has used here to refute the argument of Deputy O'Higgins, that only a very tiny number of people pay the relatively small amount charged now? I think 25 per cent. was the figure he gave. When he was assessing the amount that would come from the increase from 6/- to 10/-, when he tried to assess the amount available from this increase, did he assess it on the assumption that only about 25 per cent. or so of the people trying to avail of the Health Act would be charged? Or did he assess it on the assumption that a higher number of people would be charged for health services under the present Act?
If he is basing his assumption on a contention that the apparent position is that only 25 per cent. of the persons are charged, then that seems to me to be a very dangerous, or courageous assumption, if you like, to base it on the very small series of cases from which he has derived this information, a relatively small series of cases from which he has derived his information? Is he, in assessing the amount he is getting, deciding that only a relatively small number of people are charged under the Health Act or is he basing it on Deputy O'Higgins's assumption that a very large number are charged the full sum under the Act? Will the figure be in the region of 25 per cent. as suggested by the Minister? Will the number of persons charged 10/- be in the region of 25 per cent. or so, as suggested by him, or will it be in the region of 100 per cent., as suggested by Deputy O'Higgins? To those of us who talk very much to, or have any contact with, the average person it seems the impression we have is that the permitted charge is the standard charge. Is the Minister going on the assumption that the permitted charge will be the standard charge or not?
I wonder did it mean anything to him, did it make any impression on him, the fact that such a tiny percentage of people were charged the full 6/- by health authorities? Did it not enter his mind, and did he not accept, or could he not accept, the reason why there is this small figure, or this apparent small percentage of people who paid the full 6/-? Is it not merely an indication of the fact that only a relatively small number of people can, without great hardship to themselves, pay any charge——