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Dáil Éireann debate -
Thursday, 6 Jun 1957

Vol. 162 No. 4

Committee on Finance. - Health and Mental Treatment Bill, 1957—Committee Stage (Resumed).

Question again proposed: "That Section 1 stand part of the Bill."

I was remarking last night that this section was a step in the wrong direction. Many of us in this House who supported the 1953 Health Act did so on the basis that it was a progressive measure. It was not everything we had hoped for but, at any rate, it was a step in the right direction. At the time, the Government, which was a Fianna Fáil Government, got credit from the people for the fact that in spite of long and relentless opposition, they brought that measure through all stages here and passed it into law. Nobody ever envisaged that within a few short years of the passage of that Act by the Fianna Fáil Government, they themselves would take the reactionary line they have now taken and repudiate the good points in that measure of 1953. That is what is attempted under Section 1.

I had no ties in this House in 1953 and I make no apology to anybody. I supported Fianna Fáil in the passage of the 1953 Act and helped by my vote to bring it successfully through the various stages. The main Opposition at that time, Fine Gael, did their utmost to prevent that measure from reaching the Statute Book. They maintained it was bad legislation, and so forth. In the intervening period, even though the Act was not everything we had hoped for, it certainly improved conditions for people in rural Ireland for whom I speak with particular knowledge.

It seems extraordinary to me that such a somersault could be taken by any political Party over five or six years. That somersault has been taken by both the Government and the major Opposition Party. In 1953 Fianna Fáil were out for progressive legislation in health matters. They have now reversed that position. In 1953, Fine Gael were against progressive legislation on health matters and now they have reversed that. They are all for improving the measure. I think the title in connection with mental treatment attached to this Bill is rather appropriate as far as this House is concerned.

This savings device in Section 1 is a mean one. It is a form of taxation, and it was appropriate that for a considerable part of the proceedings here yesterday evening, the Minister for Finance himself sat in on the debate, because the necessary warning in connection with this measure was conveyed by that Minister for Finance in the course of his Budget speech. We must accept the fact that it is a Finance measure which is to save money for the Government at the expense of the section of the community who may suffer illness. It is deplorable that one of the first acts of the Government in the savings campaign is to hit that section of the community.

Deputy Russell pointed out last night that he felt this burden that must be borne by the community in order to put the country on its feet was not equally distributed among those who should be best able to bear it, and I agree with him completely. One of the first acts of the Government, in order to improve the economic situation, is to penalise a section of our people who may be ill. It is significant that the very same Budget that contains a promise of this measure bestows a present of £140,000 on the Racing Board. I find it rather contradictory that a Government, which expresses its desire to improve the health and the lot of the people generally, should by one of its first measures, ease the burden on those who can very well afford to carry taxation, namely, the racing fraternity, and increase the burden on the sick.

When an amendment was being discussed here in connection with this section the Minister suggested that the sum of 7/6 was a mere bagatelle, that it would be no trouble to anybody to produce 7/6 at any time for an X-ray. It is extraordinary how arguments can be twisted in the House to suit the purpose. We find now that the sum of 7/6 is a mere nothing. It is extraordinary how valuable 1/- is when an increase of that amount is given to the old age pensioners and other sections of the community as a result of the hardships imposed in the Budget. I wonder what the Minister's description is of that sum of 1/- if 7/6 is a mere bagatelle. I should like to hear his rich vocabulary in action when he is describing the 1/- that has been given to the old age pensioners. I know that if the Minister were in Opposition at the moment and if such a miserly increase were given to that section, he would be one of the first to condemn it. I am opposing the section and I will vote against it if there is a division on it.

The Minister indicated last evening in reply to a question of mine that, in his opinion, if an X-ray were needed by anyone in the middle income group, it would have to be paid for before the X-ray was taken. I do not presume to quote his actual words but the sense of them was that there was very little good in looking for the 7/6 from the person when the job was done, implying that the difficulty of securing the 7/6 would be overcome by playing on the person's need for the X-ray, the urgent need that would force him to collect the 7/6 before the X-ray was taken.

That statement, in my opinion, finally disposed of all the fine talk we had on the introduction of the Health Act, 1953, when it was stated that no one who needed it would go without medical service. That was the whole tenor of the Bill and of the discussion on the Bill. That is what we in the Labour Party supported, believing that it was a very fine step forward. I still believe that it was but, if I believe that, I must believe that any attempt now to interfere with that Act and to worsen it is retrograde action.

Let us consider the people who will have to pay this 7/6. It has been said by Ministers that, following the introduction of the Health Act, 1953, no direction was given to county managers. That is not so. A direction or advice was issued by a Minister following the Health Act, 1953, which said, roughly, this: "In future you should be guided by a scheme that I now enclose"—a copy of a certain county council scheme which said that in rural areas a single man earning £4 10s. a week is eligible but if he earns any money over £4 10s. per week he is not eligible under the Health Act—"should he be married, you can add 10/- for his wife; and should he have a child or children under 16 years of age, not working, you can add 7/6 per week". The scheme indicated also the groups eligible in an urban area. A single man in an urban area was permitted to earn £5, with the same additions for a wife and child. In city areas, the limit was £5 10s. for a single man.

These directions are uniformly being carried out by all the county managers representing health authorities throughout the country with the exception that the county manager has a discretionary power.

Where did the Deputy get that information?

Is it authoritative?

I am quite satisfied that it was sent out by a Minister of this State.

Quote the reference.

I can quote it.

We asked the last Minister for information like that and could not get it.

It was cancelled by the last Minister for Health, allow me to say. That instruction was cancelled by the last Minister for Health. Let us examine the groups covered by this section. A man and his wife, if they have £5 1s. 0d. a week in a rural area, come into that group. That covers road workers, forestry workers and all sorts and types of workers under the present wage rates. They are now required to pay 10/- per day under this section if in hospital and 7/6 for an X-ray and 3/- for the first attendance by a specialist and 2/- for every other attendance. Is that a retrograde step or not? It is quite obvious what we are doing.

The Health Act of 1953 was forced out of the then Government due to the political alliance that they had with a pressure group and it was given only to keep that pressure group with them. I am glad that it was given and I want to see it continued. If I could be part of a pressure group with this or any other Government to force them to continue or to improve that Act, I would be very willing to do it. I am a complete believer in a health scheme without a means test. I cannot get that but I want to get the nearest thing I can. I feel it is my duty as a member of the Labour Party that is pledged to that belief to vote against this section, to oppose it in toto. That is what we intend to do.

The Minister for Finance intervened in the debate last night and in the course of his observations stated that, in regard to the wording of the law as it existed before the present Health Act became law, there was no change whatever in the manner in which the law was framed. He pointed out that if there were people who were entitled to free medical treatment before the present Health Act became law they were certainly entitled to it with the present Health Act in operation.

That is right.

He went on to say that, if they were not entitled to it, there must be something wrong in the administration of the present Health Act. When a statement of that nature comes from a Minister for Finance who for some time was Minister for Health and is also a medical doctor, one would imagine that the energies of the present Minister for Health would be directed to rectifying any wrong that exists in the administration of the Act.

On a point of order, may I put it to you, Sir, that the Deputy is now discussing, as Deputy Kyne did, the administration of the Health Act, 1953? My Estimate is ordered for to-day if it is reached and I submit that it is quite out of order for Deputy Flanagan to start criticising the Minister in regard to details of administration in a debate on this Bill.

The Minister for Finance last night, as pointed out by Deputy Oliver Flanagan, stated that there was no change in the law and that, if there was any difficulty, it was in administration. I submit, Sir, that on that point Deputy Flanagan is entitled to make the case that he is making.

Administration does not come under discussion on this section. There will be ample opportunity for discussing administration. The only matter that falls for discussion are the terms of this section. That is all. I would ask Deputy Flanagan to keep within those terms.

On the point of order, may Deputy Flanagan not rebut the assertion made by the Minister for Finance on that point?

I have no knowledge of what the Minister for Finance said.

I was listening.

I have no knowledge of what the Minister for Finance said. I must, therefore, keep any discussion on this section to the section.

Further arising out of that point. In view of the fact that a statement has been made by the Minister for Finance that the difficulties the existence of which we pointed out are difficulties in administration, how can we indicate the difficulties in relation to this section?

I do not know what the Minister for Finance said, but neither he nor any other person has any authority to widen the scope of the discussion in respect of this section. Only the terms of the section fall for discussion now and I would ask the Deputy to keep within them.

I hope to raise the point on another occasion.

The Deputy will have an opportunity on the Estimate.

Surely the Minister for Health must be aware that there are many citizens who are holders of medical cards and entitled to free medical treatment under this Act who are not getting the free medical treatment, because, as was clearly pointed out by Deputy Dillon last night, even though one may hold a medical card, one has to enter a long queue in order to obtain attention.

Surely that is administration also?

I was endeavouring to point out that because the increased charges which are provided for in this Bill, the road worker, the agricultural worker, the forestry worker and every worker in receipt of wages of £5 a week—certainly of five guineas a week—will be obliged to pay increased rates for hospital treatment, and, in addition, will be obliged to pay for X-ray examination at the rate of 7/6 for each examination.

That is not right.

It was stated here last night, and it is no harm to direct the serious attention of the Minister to the matter again, that this is a very mean way of squeezing money out of the pockets of unfortunate people, a means of extracting money from people because of ill-health. Surely if the sum of £90,000 is to be obtained by the Government, other means of obtaining it are open to them, instead of attacking, as they do in this Bill, the unfortunate poor people who cannot provide adequately for themselves. The person who is in receipt of £5 a week and who has no medical card and is obliged to go to hospital will now have to pay at the rate of 10/- a day.

I would ask the Minister to consider seriously the fact that a number of these people will be obliged to have hospital treatment and on discharge from hospital, will be unable to pay even the 10/- per day. I think the Minister is not giving this matter the consideration it rightly deserves. If memories of Deputies on all sides of the House can go back to the statements made by the Minister for Health when this Health Bill was becoming law, it was clearly stated that in no circumstances would any citizen be denied health services because of his financial position. Now we find that that statement was all boloney and here we see what is happening to health services which we were told would be available free. We were told that no person would be refused admission to hospital or denied a doctor or medicine or treatment because of his financial circumstances, but this tune is being changed now. That cock is not crowing as favourably as it previously crowed, and we find that people will be denied services to which they were led to believe they would be entitled.

This is a very serious matter: it is something that should be put back for further examination. Speaking as one who has been for 15 years a member of a local authority, I say there are people who are denied the benefits of the Health Act, people who always had free hospital treatment before the present Act became law. I say that the charges now being imposed are unjust and unfair and I would certainly recommend the Minister to find other means of obtaining the money which the Exchequer requires, instead of resorting to this low, mean trick, because that is what it is. In addition, this Bill hits an unfortunate section of the community and it is for that reason that I have been so emphatic in expressing my views on it this morning and last night. It is unfair and unjust, and it is certainly not what the people expected.

If a member of the inter-Party Government, a Fine Gael Minister, came into the House with this proposal, and if he was sitting on that side of the House and if Fianna Fáil were on this side what would they say?

You have three guesses.

The first thing they would tell us is that since Fine Gael took the 1/- off the old age pensioners, there was never anything to equal this, or that this was even worse. I am asserting that. We heard a statement from the Minister for Finance in which he outlined his budgetary proposals to get sufficient funds to carry on the services for the year. He then asserted that the £240,000 to be paid to the master bakers was an essential, that there was a commitment for that amount, but he forgets that there is a commitment in respect of this amount to the people who are already entitled to this treatment and this service. If an inter-Party Minister for Health made this proposal, the House would ring with protests and it would be almost impossible for one of us to get a hearing for the proposition.

We have this Government, a strong Government, coming in with this proposal and the Deputies behind them will march through the lobbies to vote for this proposal and I know that there is not a single man among them who, in his heart, approves of it. I say that deliberately: they could not approve of it, having said so much in favour of the 1953 Bill when it was going through. Either they meant what they said then or they did not and if they meant what they said then, they cannot support these proposals now.

What astonished me last night was that the Government was doing this for the sake of £90,000—a mere bagatelle. Of course, what they wanted was £90,000 from the ratepayers and £90,000 for the Exchequer. That is the total sum they are taking from these people who are entitled to this service at the moment.

It is proposed in this Bill to take £180,000 in benefits from these people. To the Government, that is a mere bagatelle. Of course, we know that to Fianna Fáil sums like £180,000 or £140,000 are mere bagatelles. They are big fellows. It is no mere bagatelle to the people who have not got medical cards and who will be excluded from benefits in future. No matter what Fianna Fáil may say, an order has been sent out to county managers telling them who should get red cards and who should not. I have seen cases in Longford, cases of people who always had free medical treatment and who are now excluded. A man might have a son in England who sends home £2 a week and the head of the family might be innocent enough to say he was in receipt of that £2. Such a man must now pay 7/6 to have an X-ray. It will not be sufficient for him to have 7/-. The regulation is that he must have 7/6 on the tip of his finger.

There should be discretionary powers allowed to the local authorities in this matter. The "shall" should be changed to "may". I think the Minister for Health does not believe in this himself. For some reason or another, he is being made to advocate it by his Government. He should have the courage to come in here and either say it is his intention to squeeze everybody, to take every halfpenny he can from every person who has it, or to say that the 1953 Health Act was a mistake and that he was letting all fend for themselves. I think the Minister would be well advised to withdraw the section.

I think the discussion on this matter has gone completely outside the bounds of realism. I propose to approach it from the point of view of a remark made last night by Deputy Corry. He said everybody whom this section affects would be very happy, if they knew, when in hospital, that all they would have to pay for their treatment was 10/- per day. This thorny question goes back really to the fact that the relevant section of the Health Act has been in operation for only a very short time.

Secondly, during the short time it has been in operation, chaos and confusion were created by the Minister's predecessor, because during that short term last year the then Minister adopted an attitude that left health authorities in the position that they did not know what they should do. I refer to the fact that, in July and August last year, the then Minister intimated, at least to the health authority of which I am a member, that the 50 per cent. recoupment from his Department would not be forthcoming in respect of any expenditure over what the health authority had estimated at their estimates meeting.

In other words, if the Cork County Council introduced a Supplementary Estimate for health services, the Government would refuse to recoup the usual 50 per cent. of that expenditure. Quite naturally, that put county managers, who are the health authorities, in the position that they had to be very careful and more than careful. It brought the application of the health services to a full stop, in many instances. When health authorities became afraid that the Government might refuse to give a 50 per cent. grant, they naturally had to look at their expenditure and consider what effect expenditure on health services would have on the forthcoming rate. I submit that, because of that action, there came about the position referred to here last night in which managers in all cases were inclined to charge the full 6/- per day.

I do not like to interrupt the Deputy, but I suggest he is widening the scope of the discussion considerably.

I am trying to show that if the thing were approached sensibly and given a chance, the charges would be considered fairly by the managers and that in very few cases would the full charge be applied at all. I feel sure the managers would give every consideration to people who would find it difficult to pay and I do not think that poor people would be victimised. In those circumstances, I think much of the case made against this section falls to the ground.

There is one difficulty which we cannot get over. The Minister tells us that this affects only the middle income group. Our problem is to find who are within that group. The person I am concerned with is the type of person who may be affected by the increase in hospital charges from 6/- to 10/-, by the imposition of a charge for X-ray examination and for other specialist treatment. Deputy Moloney has been fair in relation to what he thinks is the case, but I think the argument he has made has not a true bearing on the measure before the House. Our point is that people in the lower income group may be victimised by this section. How will they get over that? Do Deputies on the opposite side not agree that since managers saw fit generally to impose the 6/- per day charge previously, they will now seek the new charge of 10/- per day? Are they satisfied with that?

No later than this morning I had a case of an unfortunate man suffering for the last eight or nine years from acute arthritis. He was refused a medical card. It is true that two sons were earning but, unfortunately, like other cases I mentioned last night, it is not always true that sons and daughters who are earning will hand over their wages to their parents. This man and his wife have been depending on the 30/- which he receives per week but, because his two sons were working and receiving a certain amount, that brought this man within the ambit of the middle income group and he was refused a medical card. Are we satisfied to say that this unfortunate man can be charged, that he should be charged more than the 6/- per day up to now, and that he should be charged 10/- per day, if it suits the county manager in that particular case?

We know there are many other cases in the same category. It strikes me as rather strange fundamentally that many Deputies who are members of local authorities were very vocal in drawing attention to the number of cases which we considered were in that group. We believed ourselves the change was unfair to them. Surely it must be much more unfair now to suggest that these people, on whose behalf these members were so vociferous for years, can now be charged so much at the whim of a county manager, not at the rate of 6/- per day but at the rate of 10/- per day. Furthermore, if they have to get an X-ray examination they can be charged 7/6. I believe we must be realistic. We are in the unique position of being able to say to the Minister that all the way through in relation to the Health Act the Labour Party stood by the Health Act. We are still standing by it and, if it has its faults, they lie in the opposite direction to the step which the Minister is now taking. We believe it is necessary we should go forward with the improvement of the Health Act but in no circumstances can we be a party to going back with it.

I am anxious to say a few words on this point. I am not as fortunate as some of the previous speakers were as I have not the long experience most of them have of being members of health authorities. However, my membership covered most of the period since the Health Act became law and I gained a good deal of experience in that short time with regard to the operation of the Act in so far as it concerns the middle income group. I rather feel that the debate in this instance has become very confused because most speakers have travelled very far afield. I propose to keep within the very narrow path covered by this part of the Act.

Speaking after very careful consideration, I am of the opinion that the Minister's proposal is a very reasonable one. With regard to the category of people who are generally to be affected by the proposed increased charges I submit that these charges, which the Minister indicates will operate from a certain date, will not in 99 per cent. of the cases cause any hardship. The general scale of charges with regard to the middle income group is, in my opinion, reasonably satisfactory under present conditions. Undoubtedly you will have an instance where a card is refused and where some hardship will be created. I have generally found from my experience in those cases that if appropriate representations are made to the local health authorities, the case is reexamined and, if it has any meritorious circumstances attached to it, it will get the benefit of the doubt and the health card will be issued. That disposes of the suggestion that a large number of people will be subject to extreme hardship because the present scale for the issuing of health cards may be too conservative.

The scale of charges differs as between health authorities. I understand there are some plans for that here in the Department of Health and it is not for me to go into that at this date. I believe the part of the Health Act which gives treatment to the middle income group is, to say the least of it, a very generous provision. I can very well see how the Minister, in his endeavour to bring about this adjustment, should draw attention to that section of the Act. The general category of people within that section are those within the middle income group by way of wages, or if they happen to be holders of property, of land, up to £50 valuation. I believe the proposed increased charges to those people will not in present circumstances be any hardship at all, although we are told it will be by speakers on the Opposition Benches.

I know, from my own experience over the past couple of years, that people who have benefited from this provision in the Act are in many cases surprised that it is so generous. I was rather surprised to hear certain speakers advocate that instead of adding a surcharge, if you like to put it that way, to the original amount that was specified, we should actually reduce it. What is generally forgotten is that during the past two or three years the cost of maintaining a patient in hospital, and the cost of running a hospital, has in general increased very substantially. Surely it must be expected that when an increase of that kind takes place, those who have to use the hospital must try and make some sacrifice to meet that increased cost? I think the Minister for Health has taken a very wise and practical step. I have listened during the past couple of days to the arguments put forward from the other side of the House and I must say they have failed to convince me in any way at all.

I want to oppose this section because it maintains the means test, because of the increase in the charge of 6/- per day to 10/- per day and also because of the charge for an X-ray picture. The point I want to make is that the Minister in his statement put forward the point of view that the charges were necessary and that the person in the middle income group would readily pay up rather than submit to an inquisition of his affairs. He has said this person would sooner pay up than have that inquisition. I think that argument should have been used at the time when Fianna Fáil were passing the 1947 Health Act in which they made the point, I am quite sure, that a means test was not desirable for these services.

First of all, from a medical point of view, a means test involves two standards in medical treatment, one a good one for those who can pay and a less good one for those who cannot afford to pay. That is a valid argument which I think has been shown up in the administration of our poor law health services over the years. Since the British left, the services have been maintained as they were. There is a general differentiation between the poor law services and services for those who can pay. In other words, there is a good standard for one and a lower standard for those who cannot pay. That is the most important argument that can be adduced to show that not only should these charges not be increased but removed and that the whole question of the means test should be removed. That is the medical argument and it has been proved by experience.

The second point that would have been made in 1947 by Fianna Fáil in connection with having no means test health services is the argument used by the Minister in trying to sell this contrary idea to the Opposition which is an extraordinary reversal. The position is that the blackmailing pressure effect of a means test is now being used to extract money from sick persons. The Minister has more or less told us that a means test is such an objectionable and obnoxious thing to the average family that he would do anything possible to try to avoid being pushed by a health authority into an inquisition into its private affairs.

That is an admission by the Minister of a very important point which those who believe in a free no means test health service have always put forward. It is a recrudescence, in spite of himself, of the grand radical spirit of the Fianna Fáil Party in the great days when it put forward progressive legislation. It is the reappearance of the attitude the Minister once showed when he accepted the spirit of a free no means test and his sympathy with the under-privileged and the poorer sections of our people.

The general idea in the Fianna Fáil Act of 1947 was, first of all, to provide first-class medical health services and try to get rid of the old British system, the old poor law system, the red ticket system which everyone in the 1919 Dáil said they would get rid of. That was the second incentive behind the Fianna Fáil Party in 1947 when they introduced their magnificent Health Act. They would in respect of the people who could not pay get rid of the fear, the shame, the humiliation and degradation of the inquisition into their private affairs which must go on for persons in the lower income groups in trying to claim the right to have health services not only under this means test Act but under any means test Act. From his statement, I suggest the Minister has conceded that this means test is a form of blackmail——

——and an insistence that the unfortunate lower income group shall be——

The Deputy is still widening the scope of the discussion.

I want to make my point.

The Deputy should take the opportunity of making it on another occasion.

This section must certainly be opposed by myself. It is a very radical, serious and sad departure from the past attitude of the Fianna Fáil Party to health legislation in this country.

It comes as a surprise to me to find that the Party which has always advocated the needs of the poor man are now throwing the burden of hospital expenses completely on to the poorer sections of our people. We know, whether or not we agree with the previous Health Act, that to-day in our towns in rural Ireland, people are paying for health services for which they never had to pay before. We were told that the Health Act was brought in to help the road worker, the forestry worker and the small farmer in poor circumstances. When the Act was in operation, those of us who are members of local authorities discovered that the very people we were told the Health Act was brought in to help are those who are bearing the brunt of the cost when they go to hospitals and need medical attention.

We have the cases of people who have been paying national health insurance down through the years. They have discovered that when they need medical attention on going into hospital, they have now to pay 6/- per day for a hospital bed. When this section is passed, as I suppose it will be, they will have to pay 10/- per day for a bed in a hospital. I believe that this whole Health Act has gone haywire. It was brought into the House to help the poor, but when the Government gets into difficulties and want to make a saving, it is at the expense of the poorer sections the saving is made, just as happened in the case of the Budget. We in the Labour Party have advocated that the poorer sections of our community should be helped.

We now find that the State will save £90,000 at least and the total saving will be £180,000. That is to be made at the expense of the people for whose benefit the Health Act was supposed to be brought in. I listened very carefully to the Minister yesterday and he said that there was going to be no saving in regard to this section. If that is so, is it possible that he will give another group of the people some other free hospital services and if he is not, surely he cannot deny that he is taking £90,000 from the poorer sections of our people.

I am concerned with another aspect of this matter altogether. I do not know, as I am quite a recent arrival in this House, whether I will be allowed to discuss it or not. Not all the people who are in the middle income group are people who can afford to pay even the 6/- or the 10/- per day. In my experience of local authorities, there is a vast number of people who have been forced, due to reasons stated by other speakers, to come into the middle income group. I heard speakers on the far side make a good case in reference to holders of land up to a P.L.V. of £50. Where does "a farmer" start and where does "a farmer" stop?

Even if a man has only 11, 12 or 14 acres of land, he is classified in many parts of the country as a farmer. Such people are compelled to pay 6/- per day. Since the Health Act came into operation, we have not been getting the same service as we got before it.

That is a matter of administration.

Due to increased demands for beds and increased attendances at clinics, the health authorities have not been able to provide a service adequate for the people in general. It is not unusual to bring people 15, 20 and even 30 miles——

The Deputy must take advantage of some other opportunity to raise that matter, as it is not relevant now.

I understand that the people whom it was intended, in the first instance, to benefit under the Health Act will suffer as a result of this increase. The Minister would be very wise to withdraw the section. For the past three or four years, I have known members of the Fianna Fáil Party—they had my support in this matter—to make representations to county managers and to various county council officials on behalf of persons who were not able to pay—and I really believe they were not able to pay.

The previous Minister provided that any person who was turned down for a medical card had no appeal, not even to the Minister himself. I had a case of a blind pensioner drawing 24/- a week who was refused a medical card. I brought it to the Minister's notice and he informed me he was powerless to interfere with the decision of the county manager.

The Deputy is still pursuing the same road.

That is a hard case.

It may be. However, we cannot discuss every hard case on the section.

Is the Minister really being honest when he says he is not making a saving of £90,000 at the expense of the poor? Can he give this House a guarantee that he will instruct county managers not to press for the increase from 6/- to 10/- from any insured worker? Can he give a guarantee to this House that the small farmer will not suffer? If he can do these things, the Minister will save many members of his Party from embarrassment down the country.

I fear the Minister is not being honest with the House or with his own Party. He should be honest and open and say: "We want £180,000. We will take it from people who are more likely to forget it and give it to people who will invest their money."

The proposals in this section occupied the time of the Dáil for over six hours yesterday. As a result of that discussion, the Opposition amendments were defeated by overwhelming majorities—by majorities of over two to one—indicating the poor opinion which the House as a whole had of the arguments by which the amendments were supported. It is unusual for the Government, in relation to proposals of this sort, to secure such sweeping support in this House.

Mostly from the members of the Minister's own Party.

It constitutes, I think, the most demoralising defeat the Opposition has had since the Dáil was established. Yet, notwithstanding the manner in which they were repudiated here, Deputy O. Flanagan, Deputy McQuillan and the rest of them got up again and repeated ad nauseam the same stale arguments and misrepresentations and occupied the time of the House for one and a quarter hours. That type of behaviour is an abuse of parliamentary procedure.

The Chair, unfortunately, is in the position that it has to listen with patience to a great number of arguments which are repeated ad nauseam. They were repeated so frequently that he had to call the attention of Deputy O. Flanagan to the fact that it was the seventh time he had used an argument and a phrase——

That is not so.

——on two occasions yesterday evening. Notwithstanding that fact, the Deputy gets up and indulges in the same sort of vain repetitious and empty argument this morning.

On a point of order, is it necessary that the Chair should be lectured by the Minister for Health?

It is not. I am merely drawing public attention to the shocking and scandalous waste of parliamentary time in which the Opposition have engaged on this Bill.

The administration of the Department will arise on the Vote for the Estimate for my Department. It is ordered for this afternoon. I want to make quite clear now, at the outset, that I am not responsible for the administrative chaos which Deputy Donegan told the House was created by the circulars issued by my predecessor. The people on the other side of the House must carry the responsibility for that. All the alleged hard cases which they recited here this morning were dragged out by them in order to defeat the proposals in this Bill. I want to emphasise that all these cases arose because of the manner in which the public services were mishandled by the Coalition which they were then supporting.

Let us put this matter in its proper perspective. The Bill proposes to relieve the taxpayers and the ratepayers to the extent of £180,000. Opposition Deputies have sneered at that. Instead of saving £180,000, they would like to increase the burden. To judge by the speeches of some Opposition Deputies in this debate, it would seem they would like to pretend they would wish the burden on the taxpayer and the ratepayer to be increased by, shall we say, ten times that sum. The policy they pursued when in office brought the State to the verge of bankruptcy.

Now they want to push it over the verge so that they will be able to say: "That is what the Fianna Fáil Government have done." Let us get this thing in its right perspective. The health services of this country are costing almost £16,500,000. Of this sum, over £8,000,000 is provided by the local authorities. Most people feel that, however much we would like to do for certain elements in the community, the health services are costing too much. That is the argument which the members of the Opposition used to use in relation to the Health Bill when it was before the House——

And we were right.

Perhaps the Deputy was right, but that was not what the Deputy was saying this morning. The difficulty about Deputy MacEoin is that he is a sort of Vicar of Bray. He would be prepared to serve in any cause or espouse any plan that he thinks will suit his Party programme at the moment. When the Health Bill was before the House and before the country, he was condemning it on the grounds that it was contrary to Catholic social teaching. Now, when we come along and try at least to remedy one of the deficiencies, if you like, in the health programme, the Deputy takes up the other attitude. He throws off the guise of a moral teacher and comes out here in true character as a parliamentary demagogue.

Any other adjective?

That fairly represents Deputy MacEoin's attitude to this Bill——

Senile decay.

If you like to apply that phrase to the Deputy, you may.

I am applying it to the Minister.

The Health Act is costing the country £16,500,000. Many people believe that that service and other public services represent a greater burden than the production of the country and the community can bear. Even the recent elections have shown that 75 per cent. of the people believe that. Having regard to the present burden of taxation and the cost of public services and having regard to what we had to do in the Budget to defray that cost, we think that wherever we can save the people money—and when I talk about the people I do not mean individuals; I mean the community as a whole—it is our duty to do it.

Like the Turf Board.

That is what is involved in this Bill. We are not asking the poor people to pay——

What else are you doing?

The Deputy knows as well as I do that the people who are excluded completely from this Bill are the poor people. The lower income group are not affected by any amendment of Section 15. What we say is this. Inside the categories covered by Section 15 there are undoubtedly people who could afford—not to pay the whole cost of the service, not to pay the whole cost of their upkeep and maintenance in public institutions, but who could afford to contribute something. We say that, in fairness to those who are not able to contribute anything but who would be taxed the same as the others, in fairness to the community as a whole and particularly to the majority of the people, those who can afford to contribute should be asked to contribute. That is the principle which is involved here——

They are being compelled.

It is not a new principle. It is a principle which has been accepted by the Labour Party and the Fine Gael Party when they put Section 15 into operation. There is no divergence of principle between us, just the one simple question as to whether in existing circumstances the present maximum should be enlarged, whether, in present circumstances, the permissible maximum should be raised from 6/- to 10/- I showed conclusively yesterday, on the figures available to me, that in fact in only about 14 per cent.—one in seven, you might say—of the cases coming within Section 15 was any charge at all made. Only in 45 per cent. of the cases in which a charge was made was the 6/- a week asked. Out of every 14 Section 15 cases undergoing hospital treatment, in only one case was the maximum asked for. Yet you want me to believe, you want the people to believe and you are trying to make the people believe that the maximum charge is exacted in every case.

Deputy Flanagan gave the reason why in some instances the local authorities were compelled, by administrative order, virtually to charge the maximum. That was due, as I have said, to the financial chaos which was created by my predecessor. It is a matter which can be discussed later. It is not due to the fact that county managers or others approach this question in an inhumane or in an unduly rigid way. I am perfectly certain that those who administer the Health Acts, or any other of our social services, have always concern for the fact that these services would not be there at all, that the State would not provide them, unless it was assumed that they would be operated and administered in the spirit in which the Oireachtas has established them—that is to say, to relieve hardship wherever real hardship exists, but certainly not to permit any person, who is not entitled to their enjoyment, to secure, at the expense of his follows, benefits and advantages which the Dáil never intended them to have.

Outside that, I am perfectly certain that the county managers and those who are engaged in the administration of our social code give the benefit of the doubt, where any reasonable doubt exists, always in favour of the applicant. Therefore, I think there is no real substance in the arguments which have been advanced here against the proposals in this section. On the other hand, we are up against the fact that the health services, as I have said, will cost almost £16,500,000 this year. The saving we are making is not a very large saving but is a significant saving. At any rate, it goes to make the burden on the general community lighter. It is a saving which the Minister for Finance requires in order to avoid increasing taxation or depriving the public of some other service, the deprivation of which might impose greater hardship in another quarter. That is what it is for. It is not done wantonly; it is not done arbitrarily; it is done just because of the fact that we have taken over a situation in which, as I have said, the State was on the verge of bankruptcy, in which we found the Budget unbalanced to the tune of over £6,000,000, in which we found that to provide for the increasing cost of the services in this year, we should have to increase taxation and do the other unpleasant things which we had to do, so as to put the public finances of the State in order, and to lay the solid foundation, the only foundation, on which real progress can be made in the future.

The £140,000 for the Racing Board—where did the Minister get that?

Question put.
The Committee divided: Tá, 68; Níl, 33.

  • Aiken, Frank.
  • Bartley, Gerald.
  • Beegan, Patrick.
  • Boland, Gerald.
  • Boland, Kevin.
  • Booth, Lionel.
  • Brady, Philip A.
  • Brady, Seán.
  • Breen, Dan.
  • Brennan, Joseph.
  • Brennan, Paudge.
  • Breslin, Cormac.
  • Briscoe, Robert.
  • Burke, Patrick.
  • Calleary, Phelim A.
  • Carty, Michael.
  • Childers, Erskine.
  • Clohessy, Patrick.
  • Collins, James J.
  • Corry, Martin J.
  • Cotter, Edward.
  • Crowley, Honor M.
  • Cunningham, Liam.
  • Davern, Mick.
  • de Valera, Eamon.
  • de Valera, Vivion.
  • Doherty, Seán.
  • Donegan, Batt.
  • Dooley, Patrick.
  • Egan, Kieran P.
  • Egan, Nicholas.
  • Fanning, John.
  • Faulkner, Padraig.
  • Flynn, Stephen.
  • Gallagher, Colm.
  • Galvin, John.
  • Geoghegan, John.
  • Gibbons, James.
  • Gilbride, Eugene.
  • Griffin, James.
  • Haughey, Charles.
  • Hillery, Patrick J.
  • Hilliard, Michael.
  • Kenneally, William.
  • Kennedy, Michael J.
  • Killilea, Mark.
  • Kitt, Michael F.
  • Lemass, Noel T.
  • Lemass, Seán.
  • Loughman, Frank.
  • Lynch, Celia.
  • Lynch, Jack.
  • MacCarthy, Seán.
  • McEllistrim, Thomas.
  • MacEntee, Seán.
  • Maher, Peadar.
  • Medlar, Martin.
  • Moher, John W.
  • Moloney, Daniel J.
  • Ó Briain, Donnchadh.
  • O'Malley, Donogh.
  • Ormonde, John.
  • O'Toole, James.
  • Ryan, James.
  • Ryan, Mary B.
  • Sheridan, Micheal.
  • Smith, Patrick.
  • Traynor, Oscar.

Níl

  • Belton, Jack.
  • Browne, Noel C.
  • Burke, James.
  • Byrne, Tom.
  • Carew, John.
  • Coburn, George.
  • Coogan, Fintan.
  • Cosgrave, Liam.
  • Crotty, Patrick J.
  • Desmond, Daniel.
  • McQuillan, John.
  • Mulcahy, Richard.
  • Murphy, John.
  • Murphy, William.
  • O'Donnell, Patrick.
  • O'Higgins, Michael J.
  • O'Higgins, Thomas F.
  • Dillon, James M.
  • Esmonde, Anthony C.
  • Flanagan, Oliver J.
  • Giles, Patrick.
  • Hogan, Bridget.
  • Hughes, Joseph.
  • Jones, Denis F.
  • Kyne, Thomas A.
  • MacEoin, Seán.
  • McMenamin, Daniel.
  • O'Reilly, Patrick.
  • O'Sullivan, Denis J.
  • Reynolds, Mary.
  • Rooney, eamonn.
  • Tierney, Patrick.
  • Tully, John.
Tellers:—Tá: Deputies Ó Briain an d Hilliard; Níl: Deputies O'Sullivan and Kyne
Question declared carried.
SECTION 2.
Question proposed: "That Section 2 stand part of the Bill".

I wonder would the Minister indicate the effect of the section on the classes to whom it will apply, and generally, the effect of the amendment.

The effect of the section—there is not an amendment— is virtually the same as——

The section itself is an amendment; what I mean is the effect of the amendment proposed in the section.

It will merely give permissive authority to charge up to a maximum of 10/- per day for any person who is receiving treatment in a mental hospital.

Is there any time limit on the charge?

I assume there is no time limit on the charge, nor is there anything to prevent the position being reviewed on application. The charge is not fixed for all time.

I understand the effect of this section is that henceforth any patient in a district mental hospital, or other mental hospital with which the health authority has an arrangement, who is not entitled to, or has not got a medical card, may be charged 10/- per day in respect of his treatment, or his stay, in a mental hospital. If that is the effect of the section, I should like to draw the attention of the House to what is proposed here.

I think we all know that in relation to mental illness, there may frequently arise the necessity for a long stay in hospital. Indeed, the condition may be chronic. Any Deputy who has a knowledge of rural Ireland must certainly have experience of cases where a farmer, the father of a family, has to go into a district mental hospital. He remains there and if he is to be charged for maintenance at the rate of 10/- per day, which is over £150 a year, one can well appreciate that when that unfortunate man dies there will be in the administration of his estate a claim by the health authority in respect of his maintenance, which will necessitate the sale of the farm and, in many cases that I know of certainly, the complete impoverishment of the widow and children.

I am aware that, under the Health Act, 1953, a charge of 6/- per day was permitted. I also felt that that charge in relation to mental illness was one that certainly should be invoked only in very exceptional circumstances. Unfortunately it passed through in the Health Act without very much deliberation in this House. I want, therefore, to remind Deputies what the effects of this proposed amendment may be. It means that, henceforth, if a person is not going to get a medical card in relation to this fearful mental ailment, generally involving long periods in hospital, the health authority will now have the right to charge at the rate of 10/- per day.

I regret to say it has been my experience in the practice of my profession in the Circuit Court that the question of the administration of estates of deceased persons often arises because of a claim for a very large amount by a mental hospital authority in relation to maintenance. I urge the Minister not to insist on this section. The 6/- per day provided in the Health Act originally was a sufficiently high maximum charge, so far as mental illness is concerned. To increase that charge to 10/- per day is making quite an unnecessary change and it is obviously being done just for the sake of uniformity. While there may be some ground for uniformity in the case of persons treated in ordinary general hospitals—I think the average stay in a general hospital is 12 days—there is no ground for uniformity where mental hospitals are concerned, since, in mental hospitals, the stay is very much longer. It is only where, as a result of the excellent provision in the Mental Treatment Act of 1945, whereby voluntary admission is encouraged, that shorter stays are a normal feature. Many of the patients in our ordinary district mental hospitals are there for life. Many of them are in for periods in excess of one year. One of the reasons for the overcrowding in mental hospitals is the fact that there are so many chronic patients.

If it is the intention now to charge these people at the rate of 10/- per day just because they happen to have a farm, or some other property, and are therefore not entitled to free service, Deputies must realise what they are doing here. Deputies in the Government Party should be fully aware that they are imposing a very serious hardship, a hardship which may bear very severely on certain sections of the community not in a position to defend themselves.

I have indicated to the House that so far as my Party are concerned this section is opposed, and opposed very strongly. Whatever may be said in relation to charges in respect of persons who are unfortunate enough to suffer injury or contract illness and are compelled to go into a general hospital, the fact is that they can look forward, generally speaking, to a speedy recovery. The people we are dealing with in this section often have to face a life sentence in a mental hospital. Certainly their stay is invariably a very long stay. From that point of view, this imposition is absolutely unjustifiable.

I support Deputy O'Higgins's plea to the Minister to reconsider this section upon much the same grounds, though I can extend them a little further. Treatment of an ordinary illness of short duration is one thing; treatment of mental illness is another thing. A case could be made, though I would not support it, for charging people for treatment in mental hospitals when the illness is of short duration. It is a very serious thing to increase the burden on the dependents of a mental patient to the extent proposed here. Mental illness may continue for five, ten, 15 or 20 years. It may last right through a person's lifetime. To impose on the dependents an increased charge of 3/10, or whatever it is, will cast a very considerable burden on any family. Few families should be asked to shoulder this burden.

I appeal to the Minister, in support of Deputy O'Higgins's plea, to reconsider this matter. Mental disease is something completely different. It is somewhat like tuberculosis in so far as it necessitates a much longer stay in hospital; but, as compared with tuberculosis, the stay is unfortunately very much longer and the drain on the family resources, therefore, is so much the more prolonged.

One of the best features of the 1945 Mental Treatment Act was the effort made to get patients to submit themselves voluntarily for treatment in the early stages. That was a big step forward. The same idea was incorporated in relation to tuberculosis treatment where a free X-ray service was made available. With a free X-ray, objection to treatment subsequently was not so strong. Equally, the Mental Treatment Act of 1945 encouraged people to look for treatment voluntarily in the different clinics. It is most important that those suffering from progressive mental disease should not be dissuaded in any way from seeking early treatment.

The Deputy seems to be widening the scope of the debate. The section deals with the charges.

If the charges are now increased, the likelihood is that persons will not seek early diagnosis so readily, with concomitant early treatment, if necessary. I think the proposed increase from 6/- per day to 10/- is a retrograde step. The charge of 6/- was bad enough. This increase is an increase of over 50 per cent. and it may have the effect of undoing a lot of the good work envisaged in the 1945 Act. First, there is the long term chronic case with all the subsequent hardship imposed on the dependents; secondly, because of the increased charges, those requiring early treatment will be deterred from doing so. As in most other diseases, a tremendous amount can be done for mental patients if they come sufficiently early. Because the patients may hesitate to seek early treatment, I regard this increased charge as a retrograde step and I would ask the Minister to reconsider it.

The hardships which the change in the hospital charges will cause have already been debated under other legislation. On this occasion, we are debating it under the present Bill. This new legislation will have the effect of confiscating any small savings that the unfortunate patient may have, any small property that came to him or any small business which he held when he was afflicted by this mental illness which very frequently is of a prolonged nature.

The clearest way to point out the injustice of this Bill would be to give some examples. Take, for example, the small holding on which a mental patient is barely getting an existence along with his spinster sister, and perhaps a couple of unmarried brothers. Even supposing the unmarried brothers fend for themselves by being obliged to get away from trying to make a living on this small holding, what is the aged sister to do? She has no means of support apart from that holding. When this person becomes a mental patient that spinster sister, who has no other means of support, cannot expect to get any kind of a living from the small holding. It means that the day the man goes into hospital the hospital becomes the owner of that small farm, small business or the small savings of the patient concerned. It means that this small amount of property which came to the family over generations immediately becomes the property of the hospital, assuming that there is a prolonged period of mental illness.

The former Minister for Health, Deputy O'Higgins, pointed out at the very outset the hardship that this Bill will cause when there is no time limit. Even if there was a time limit it would mean there would be a specified charge imposed against that small estate. If representations are made to the board of assistance to relieve the position they will point out that the legislation in relation to mental patients is so peculiar that they cannot interfere, that they must allow the law to take its course and allow the property which was held by that mental patient to be used up first before they can come to the rescue in the matter of contributing towards the maintenance of the patient in a mental hospital.

In cases where there are poor patients representations are made asking the local authority, through the board of assistance, to contribute towards their maintenance but it is pointed out that, by statute, the property of the mental patient must first be used up before the local authority or the board of assistance can come to the rescue of the patient in the matter of a contribution. This will affect to a considerable extent the small farmers down the country and persons who are not engaged in insurable employment. Those who are engaged in insurable employment will have a measure of assistance from those sources, but people who have not the advantage of insurance cards, not having been engaged in insurable employment, are exposed to the hardship of having their property confiscated.

It has often been argued that mental treatment should be a national charge. This is an example in favour of this argument where we have legislation now being put through which will confiscate far more rapidly the savings and the property of those people who are in poor circumstances and who are afflicted by mental illness. In fairness the Minister should, if possible, bring into the legislation a time limit. That would mean that, in the event of prolonged illness where the patient will not react within a reasonable time to enable him to go back to the management of his farm or business, there would be a maximum charge on the mental patient who was obliged to seek treatment in one of those mental hospitals.

The Bill as it stands will have the effect of frightening a number of people who have very limited means, and who see what a catastrophe a mental illness can mean to a family which has scraped together a small estate by hard work over generations. That is why I should like the Minister to bring in amendments designed to meet these hardships which are peculiar to mental illness where there are prolonged periods of treatment.

Could the Minister tell us how much of his £180,000 he expects to get from the charge in this section?

There are 20,000 patients.

That is what my estimate was, that there were 20,000 patients in our mental hospitals.

But the 10/- a day does not arise at all. It is just a figment of the Deputy's imagination.

Why does the Minister say that?

Just work it out— 20,000 patients, a saving of about one-fifth of £180,000.

That is what I would just like to know from the Minister. If the Minister says it is not proposed to make a charge in respect of maintenance in district mental hospitals that is an end of the matter. I understood the effect of this section to be that, in respect of persons not entitled to free medical service as defined in Section 14, a charge of 10/- a day henceforth——

Might be made, not "will" be made.

Let us leave that aside for the moment. A charge of 10/- a day may be imposed. Am I right in saying that is the effect of the section? I assume I am. If that is so, we have always been told that generally a third of the population is entitled to free medical services.

We know, in fact, that the proportion receiving medical cards is now around 25 per cent. of the entire population but, even if it were one-third, we know there are 20,000 people at present in district mental hospitals and I assume these rules of thumb apply to them the same as to everybody else. I should like to be certain from the Minister that he does not propose to get considerably more than one-fifth of his £180,000 from the operation of this charge. Certainly, it appears that it may be imposed on something around 14,000 patients in district mental hospitals. Certainly, if the averages that apply elsewhere throughout the country, apply in this case, some 14,000 people at the moment in district mental hospitals would not be entitled to free medical service and, not being so entitled, could be charged this sum of 10/- per day.

I do not claim to be an expert in mathematics but, if they were so charged, the amount to be raised would be considerably more than one-fifth of the total saving. I have a sort of belief, in any event, that the purpose or the effect of this entire Bill will be to save considerably more than the sums mentioned by the Minister.

May I just put this to the Minister? I do hope the Minister will give us his views in defence of this section because, certainly, so far as I am concerned and, I am certain, so far as other Deputies are concerned, this is a section which quite genuinely does arouse opposition. It is a section imposing a charge on persons with a particular and unfortunate malady. I would ask the Minister to test this matter by examples that I am sure he can call to mind from recollection.

Take the example of a shopkeeper with a small business sufficient to provide himself and his family with frugal comfort. That small shopkeeper gets some mental illness and has to go into a district mental hospital. There is then a double tragedy. The person running the shop, the person upon whom whatever goodwill was there depended, has gone. The business is affected. The wife is left with the problem of trying to carry on. Under this section, such a man or his wife may be charged 10/- per day. I think that in a case of that kind it is carrying a sense of individual responsibility to extremes to suggest that a charge in any way approaching this sum should be levied. We are now asked to charge £182 a year in respect of treatment in district mental hospitals of those who have not medical cards. That is, for two out of three patients in district mental hospitals such a charge may be imposed. I think it is wrong. I can see no justification for it.

If the Minister says: "While it might apply to two-thirds of the patients in mental hospitals, in fact, of course, it will not apply because we estimate that we will get only one-fifth of the £180,000 from these people," well then, of course, if it will not be imposed, it will not be imposed because of the very case that Deputy Dr. Browne, Deputy Rooney and myself have made in this debate—that the facts of individual hardship are so strong that county managers or managers of health authorities will find, in fact, that they could not impose a charge which, in its cumulative effect, could be a sentence of insolvency to many people. In those circumstances, it would seem to me to be quite wrong by legislation here to give authority to district mental hospital boards throughout the country to impose charges which, in fact, we believe cannot be paid in the majority of cases.

I would urge the Minister again to reconsider this matter. It can be considered quite separately from other portions of the Bill. It deals with a peculiar problem but a problem that we have had with us in a very singular way in this country. I particularly ask the Minister to remember that a great number of the patients in our mental hospitals are persons with small holdings of land whose departure from the farm, alone, means a complication and inability to run the farm as it should be run because the woman left behind cannot do it and frequently there are young children. They may be persons with small businesses of their own.

All of these people, by reason of the illness itself, by reason of the necessity to go into hospital, have suffered quite a serious financial loss and if, as it appears probable, the charge proposed here cannot be levied, then it appears unreasonable that we should give the power to, perhaps, some county manager in some part of the country who, obsessed with a sense of regulation and a sense of his own authority, may proceed to impose a charge which the law entitles him to charge, despite the fact that its effect may mean, on the death of a patient in hospital or whenever the charge comes to be collected, complete insolvency to others in the family.

I want to ask Deputies, particularly those from rural Ireland, do they seriously suggest that if a family in rural Ireland is afflicted by the disaster of one of its members becoming mentally ill and experience all the distress and misery of reconciling themselves to the inevitable removal of that member of the family to the mental hospital, that we in this House want to legislate that over and above and in addition to that affliction they are to have levied upon them at the discretion of a county manager, £182 a year for so long as it may be necessary to leave that member of the family in the mental hospital?

Prior to the passage of the Health Act, during all my life in rural Ireland, if a family met with that disaster, so far as the neighbours were concerned, their sympathy was for the family, and I never heard it even suggested anywhere in all the time I have lived in rural Ireland, that a family, one of whose members had to go to a mental hospital, was confronted with a weekly bill while he was there. It must be common knowledge to all of us that the thing is out of the question and absurd. How could they pay? Surely we are all familiar with the fact that well-to-do people normally elect to send a mentally-afflicted member of the family to a private mental home, if they are in a position to meet the charges, but that they allowed that member of the family to go to the public mental hospital only because the disaster so crippled the family finances as to leave them no alternative.

We need not portray the county manager as a person divorced from reality or bereft of any human sympathy, if he levies these charges, because a public officer has a duty to levy charges which, by statute, he is entitled to levy. He has a duty to protect the finances of the public authority which he is an officer and he is not entitled to exercise sympathetic consideration for a citizen, if he believes that it is possible to recover for the local authority what this Bill entitles him to recover. Is there any Deputy who thinks that if a neighbour's family has a person mentally afflicted, at the end of that afflicted person's life, when they go to collect the remains at the hospital, we want them to receive on the day of the burial a bill from the local authority for anything up to £800, being the last six years' liability for that patient's maintenance in the mental hospital, with the knowledge that they may have a decree issued against the deceased person's estate or the family, which they will be required to pay, possibly by instalments of, possibly, have a mortgage clapped on the property as security for it?

I think I know my neighbours as well as most people in the House and I do not believe the neighbours would want it. I do not believe that anybody in rural Ireland, knowing these circumstances in a neighbour's family, wants to legislate to the effect that, consequent on the death in the mental hospital of one of their own, they may also be faced with the obligation of selling the farm in order to pay what the county manager is in duty bound to levy, if he has authority to charge 10/- per day for the care of the patient.

I would be strongly in favour—and I want ot say quite clearly that I invite any Deputy on the Fianna Fáil benches who disagrees with me to tell me why he disagrees—of repealing the provision which entitles the county manager to make a charge for a mental patient. Is there a Deputy here who disagrees with me? Personally I believe that every member of Fianna Fáil agrees with me, certainly those who know rural Ireland, that it is wrong to levy on the family of a person who is either committed as a person who sound mind or who is induced to go into a mental hospital as a voluntary patient and whose condition requires protracted detention there.

I do not believe there is a member of the Fianna Fáil Party, knowing the conditions in rural Ireland, who thinks it is right that the funeral expenses of such a person should be inflated by a bill of from £700 to £800 in respect of the last six years of that person's life in a mental hospital, with the possibility that throughout the whole period of that person's detention, his family may be harassed by continual applications for ad interin payments. The sum of money here involved for the Exchequer must be relatively insignificant, but the sum of money involved for each of these individually afflicted families must be absolutely staggering.

I suggest to the Minister—a great many of his colleagues are talking about revolutionary approaches and completely new viewpoints—that on this occasion, instead of presenting us with a section incresing the charge from 6/- to 10/- per day, he should consider the possibility of dropping this whole business of charges in respect of persons in public mental hospitals. I ask him now if this matter were left to a free vote of the House in which every Deputy did what he thought was right, having full regard to his obligation not to bestow benevolence on his neighbour at the expense of the Exchequer and fully realising he has a duty to consider the claims of the Exchequer pari passu with the claims of individual families, how many of us would vote for levying this charge? I think 90 per cent. of us would vote against it and say quite deliberately: “We do not think this charge should be made.” I would urge strongly on the Minister in this connection that in respect of mental patients there should not be nay charge where they are under treatment in a public hospital and I think that is the right approach to this matter.

I want to direct the attention of the House to the fact that, prior to the passing of the Health Act, 1953, I believe that was the practice. I never heard of anybody being levied in rural Ireland in respect of a relative who had to go to a mental hospital. There may have been some cases, but all I would say is that in the 30 years of my recollection I do not remember a case of a persons being charged in respect of the treatment of a person who was in a mental hospital, but I must admit that during the period of which I am speaking, those who were in mental hospitals were persons who had been committed. I am not talking of the situation that may have arisen under the new dispensation, under the Mental Treatment Act, where people could apply to be admitted as voluntary patients.

I can see the case put forward regarding the value of that new procedure of which I am not such a convinced advocate as Deputy Dr. Browne would appear to be, but whatever value it has is somewhat mitigated by the charges. That is arguable. What I am primarily concerned about is that the class of patient who for the last 30 years has been received and on whom nobody thought of levying charges should now be made liable to a charge of 10/- per day. I would urge on all Deputies to tell the Minister now what they think of his proposal. I think it is wrong. I do not believe the saving to the Exchequer can material from the Minister's viewpoint, but I think the charge may be disaster for many respectable families in rural Ireland, a disaster which this House is imposing on them.

Deputy Dr. Browne must be thrilled after listening to the speech of Deputy Dillon, since Deputy Dillon has taken the first step to align the forces of Fine Gael under Deputy Dr. Browne's banner. Whether he will regard them as reliable allies or not his own experience will suggest to him. If we were to accept the principle which Deputy Dillon has now announced in relation to the treatment of mental patients, I cannot see how we could possibly, in logic or in justice, refuse to go the further step so as to have a free-for-all medical service without any menas test, such as Deputy Dr. Browne has been advocating. If this represents a change in attitude by Fine Gael towards the health services in the way they changed overnight towards the Constitution—

More power to you.

How many times have Fianna Fáil reversed themselves?

The Minister for Health on the section.

Deputy Dillon has just suggested that he is now converted, in relation to mental patients, to the principle which Deputy Dr. Browne has endeavoured to make general and universal in respect of all medical services in the country. That is what Deputy Dillon has announced. The difficulty is that it is a rather belated conversion having regard to the fact that the first legislative act for which his colleague, Deputy T.F. O'Higgins, was responsible when Minister for Health was a Bill introduced post hasten in 1954 to suspend the operation of Section 15 of the Health Act.

When the Deputy was bringing in that Bill with the assistance of his Cabinet colleagues and the support of the Parties behind the Government, he did another very significant thing. While he suspended the provisions of Sections 15 in relation to general hospital treatment, he refused to include any provision enabling him to suspend the operation of Section 71 which asked even mental patients to pay to the extent of 6/- per day. If Deputy Dillon felt that the imposition of such a charge was so unjust, if Deputy T.F. O'Higgins felt it should not be done, why did they not avail in 1954 of the big majority they had in the House to repeal the provisions of sub-section (8) of Section 71, which provides:—

"Where mental hospital assistance is given to chargeable patients in cases not covered by sub-section (2) of this section, they should be charges such charges not exceeding 6/- per day for every day during which mental hospital assistance is given."

Is it not quite clear that this attitude of the Opposition is all sham and pretence? Is it not clear that these expressions of sympathy for the dependents of mental patients which we have heard from Deputies Rooney, Dillon and T.F. O'Higgins are not genuine? They are giving lip service when in Opposition to the principles of Deputy Dr. Browne but, while they were in power and could have given effect to the principles which they have given expression to to-day, they failed to do so.

£180,000 is no joke.

Apparently 6/- per day did not mean much either. If the 4/- extra now proposed represents £180,000, the 6/- sanctioned by the former Government represented £270,000. That is what Deputies opposite were prepared to swallow. They swallowed that in 1954 without any demur. Now they say that in relation to all the provisions of this Bill they think the £180,000 is too much.

Let me get back to the potential effects of this Bill. We have heard that when a mental patient dies his dependents, relatives or executors may be presented with a bill for £800. I challenge any Deputy to give me a specific instance of that happening in the case of a person whose estate could not well afford to pay it.

It can be done under the existing law.

In the case of a person whose estate could not afford to pay? Deputy Dillon's entire speech was devoted to trying to delude the people of this country into believing that in the case of any person who died in a mental hospital and whose dependents were liable to pay, the estate might be asked, under this section, to pay a bill of £800.

They could be presented with a bill for £1,000.

I challenge any Deputy to produce a specific instance of a case where the estate might be asked to pay even £500.

I can produce it.

If the estate is well able to meet the cost there is no injustice done in the Bill that is being presented.

What about the family?

There is a Fourth Commandment as well as every other Commandment about which Deputy MacEoin used to be so eloquent. It imposes upon the individual the responsibility of providing as well as he can for his parents in their infirmities. I do not want to dwell on that. I should like to get back to the realities of this section. We had fanciful speeches from Deputies Dillon and Rooney and from the former Minister himself telling us about the 10/- per day charge. Do not forget that when Deputy O'Higgins was Minister and had power to wipe out the whole thing, with the support of his colleagues and allies in the Coalition, he did not do it.

Death bed repentance is always of doubtful sincerity, in circumstances when there is a temporal objective to be secured. The Deputy asked me how much of this £180,000 would be procured by the amendment which we are making now to the existing provisions, how much of that would accrue as a result of the operation of Section 2 of the Bill and I said about one-fifth. I think it might range from £30,000 per annum to £35,000 per annum. I am not pinning myself down but, assuming that there is £35,000 per annum to be divided between the State and the health authorities and on the Deputy's own calculation that there are 14,000 persons who might broadly be described as coming within the categories corresponding to those embraced by Section 15 of the Act, if you divide £35,000 by 14,000 people it does not give £800 a year. It does not give £182 per year as the average charge. The whole burden of the Deputy's speech was to suggest that figure as the average charge.

I said it could be charged.

Every family in rural Ireland was the suggestion by Deputy Dillon, every patient in the mental hospitals. That was the drift, the impression the Deputy wanted to give. In actual fact, the average increase in the charge will be of the order of 5/- per year, which is roughly a charge of 1/- a week. I say that is the average but, of course, many people will not pay anything like 6/- or 10/-. A limited number of people who can afford to pay the 10/- per day is all there is.

I do not see any reason why any patient, whether he be in a mental hospital or a general hospital, who can afford to contribute to wards the cost of his upkeep, should not be asked to contribute to the extent which he can be expected to. No matter what circumstances a man or his dependents may be in, if he comes within Section 15, he cannot be charged more than 10/- per day. The vast majority of cases will not be charged anything at all. There will be a charged but working it out on the average, and the only way we can make any estimate on this is to take the average figure, it will be of the order of 50/-per year per head of the 14,000 patients. That is what is involved. That is 1/- per week.

But that is the average all over.

There is no use trotting out these fanciful cases of people who will be charged £182 per year and whose relatives, executors and administrators are going to be presented with a bill for £800. It does not exist. Deputy Dillon and Deputy O'Higgins know it does not exist.

I want to ask this question. the Minister says it does not exist. If I am mistaken I want to be corrected. I am not infallible, and I do not profess to be an authority on the health code. There is a charge promised under this section of 10/- per day. That comes to 70/- per week. Is that not so? I do not want to exaggerate anything. I multiply that by 52 and that gives me a charge per annum of £182. Is that not right? The Statute of Limitations which now applies to public bodies as well as individuals will permit public bodies to recover only six years' arrears of debt. I envisage a case where there is a conflict between a county manger, who seeks to do his duty by the local authority for which he speaks, saying to a family: " I think you ought to pay," and the family on the other hand saying: "We cannot afford to pay."

I confine myself to rural Ireland because I am not familiar with conditions in urban areas. When a patient dies the family go to collect the remains and bring them home for burial. On that occasion, the local authority can claim the six years' arrears of maintenance. If I multiply £182 by size that works out according to my calculation at £1,092. I am not saying that that will be levied on every patient in every mental hospital but I am asking Dáil Eireann do we think that it is right, just and equitable that we should give the power to a county manager in any county to levy that on any family in rural Ireland?

There is no use talking about an average increase of 1/- per head. If you average that out on the whole population it does not come to one farthing per head but what comfort is that to a person who gets a bill and is unable to pay it to be told: "You need not worry. It only averages out at a farthing on the whole community." He has to pay it. Does any Deputy in the House think we ought to give the local authority power to levy that sum?

What is the difference between this and the old charge?

You could have levied £700.

Under the old Act, which I think was a mistake, there was power to the extent of £654 and I think in respect of mental patients that charge should bot be there. I think there I great force in what the Minister says that every family has an obligation to look after its own members. The local authoritiy will help to the best of its ability. It will give assistance by providing disability benefit if the patient is kept at home and outdoor assistance if that is necessary.

A family cannot keep a person of unsound mind at home. They will not be allowed, and it is right that they should not be allowed, keep him at home. None of us wants to canvass unduly in public debate all the aspects of this problem but the safety of the neighbours may require that a person of unsound mind should be kept in a mental hospital. We are dealing with a large number of cases where the family will not be allowed to keep them at home and should not be allowed to keep them at home both for the protection of the patient and for the protection of the patient's neighbours.

Do we think that by statute we should give the local authority power to claim up to £1,000 from the family in respect of the last six years of the patient's detention? I do not think we ought to. I do not believe there is a Deputy in the Fianna Fáil Party who thinks we ought to. They may salve their consciences by pointing out that the Minister say it will never be levied but what is the point of legislating in order to enable it to be levied if the only ground upon which we can reconcile our conscience is an assurance from the Minister that it will never be levied? If we do not ever intend it to be levied and if it ought never to be levied why are we legislating to make it possible to levy it? I suggest that in respect of mental patients detained in a mental hospital the Minister ought not to levy anything at all. That is the case I make.

The Minister ways he wants evidence produced of a single case in all Ireland in which £800 was levied. Was that not his request and is not that his challenge? The answer is that no case could be produced because under the law at present the maximum claim is £654. I should be greatly shocked if anybody said that such a charge was being levied but I am told that there is a growing number of cases in which heavy charges are being levied against the estates—and they are not large estates—of deceased persons; that there is a growing number of unenforceable decrees accumulating in the Circuit Courts for levies under the existing section.

I think that is wrong. I do not believe that any Deputy ever meant that to come to pass. Is there any Deputy in the Fianna Fáil Party familiar with conditions in rural Ireland who will get up and say now that he thinks, in respect of a patient in a mental hospital, that family ought to be made to pay and that the estate should be decreed for any sum up to £1,092 on the occasion of the patient's death? I do not think anybody thinks that is right. Why do we do something we do not think is right? for no better reason than that the Minister says it will never be done. If the Minister believes it will never be done, why legislate to make it possible?

I make a very simple request and that is that in so far as the Healthe Act of 1953 authorises a charge for the detention of mental patients— certainly, certified mental patients—in public mental hospitals that charge ought to be repealed now. Pending the repeal, I suggest that it be left at the present figure of 6/- a day instead of 10/- per day which is the Minister's proposal. There is no need for the Minister to get cross. I think that the Deputies of the Fianna Fáil Party have a duty to see what they conscientously believe in regard to this, particularly those Deputies who are present, Deputies Corry, Allen and even Deputy Burke who have a knowledge of conditions in rural Ireland. Do they believe that we should empower local autorities to levy up to £1,000 on the family of a deceased mental patient, especially those who have been committed to a mental hospital for their own good?

Anyone who had to sit here for the past two days listening to this debate would realise to what depths of hypocrisy the Opposition are prepared to sink. Deputy Dillon, who is a member of this House almost as long as I am, sat at this side of the House or on the other side during all that time. He was by no means a lazy Deputy nor did he lack mental capacity or anything else. A little over 12 months ago he sat in this House as a member of Dáil Eireann when local authorities had power and authority to levy on patients in mental hospitals whatever sums they might determine.

Up to the limit of 6/-.

No. There was no question of 6/-. There was no question of any limit.

There was a limit of 6/-.

There was no limit until the Health Act came into operation.

There was no charge at all.

Just a moment. Mental hospitals are there for quite a long time. There are all types of people in them, poor people and people who could pay. Deputy O'Higgins, as Minister for Health, made the Order bringing in Section 15 of the Health Act, 1953. Deputy O'Higgins authorised the savage county managers to charge those poor patients in mental hospitals 6/- per day. For the first time in the history of this country, less than two years ago, he made an Order to that effect. Prior to that the local authority, the county manager, the mental hospital, or the county council or whoever had authority over the mental hospitals——

They never changed than.

They did.

They had that power, is that not so?

The power was there to charge them £5 or £10 if they thought well of it.

How did they do it?

They had power to do it. The power was in the law to charge people, who were able to pay for their maintenance in mental hospitals, the full and absolute cost. The power was there. There is no doubt about that. Deputy Dillon sat as a member of this House for the past 25 years and he never even raised a question.

The Deputy is rambling.

We never heard a murmur from him about the poor mental patients in this country. Unfortunately for the country they have always been with us. Deputy Dillon had not the slightest concern for them. Less than two years ago Deputy O'Higgins made an Order under the Health Act, 1953, authorising the county manager to impose this 6/-. The present proposal is to allow the county manager at his full and basolute discretion to charge them nothing at all or charge up to 10/- per day, if in his opinion their circumstances were such that they were able to pay the 10/- oer day. Does the Health Act not provide that every person entitled to medical treatment of any kind whatever cannot be charged a halfpenny if he is unable to pay? Is it not a fact that that applies to every person in the community?

Deputy O'Higgins spent all day yesterday talking about insured persons. All the insured persons in this State are not going to be charged 10/- a day, if they or the memebrs of their families want treatment in a mental hospital. He knows well that not one-third of the insured persons in this country come within the middle income group. Nevertheless, he laid much stress on insured persons. He is well aware that two-thirds of the insured persons are getting absolutely free medical treatment for themselves and their families.

Indeed I am not, and it is not so. The Deputy is talking rubbish.

There is no doubt about it. The Deputy was fully briefed up to three or four or five months ago and had all the facts. He must be aware that a big proportion of the insured persons in this country are in the low income group and are, therefore, entitled to free medical services if akk kinds.

I suggest that the Opposition decided to go to town on this Bill. However, not alone have they gone to town, they have done the full circut. We well remember the opposition which the then Fianna Fáil Minister for Health had to face when the discussions on the Health Act took place in this House. Deputy Rooney spoke for hours and hours. Somebody described Deputy Rooney as a gramophone because of all his talk about free for all services and the dignity of our people being lowered. Now the full circuit has been covered and, instead, there is talk to the effect that the Health Act did not provide a free setvice for everybody. We may now take it that the Opposition—the Fine Gael Party—want free medical services for everyone. Is that not the objective? The difference between 6/- and 10/- is not so great.

It is four shillings, nearly twice as much.

I suppose the different between£600 and £1,000 is nothing, either?

No patient in a mental hospital will have to pay of his or her circumstances are not such that the money can be paid—and well Deputy O'Higgins knows it.

Only destitute persons.

Order!

Notice taken that 20 Members were not present; House counted, and 20 Members being present,

Deputy O'Higgins is well aware of what the records of local authorities show in respect of the amount levied on mental hospital patients for many years back. I am sure he had all those facts at his finger-tips while he was Minister for Health. He must also know the annual amount levied on mental hospital patients by local authorities, even before he made the Order empowering county managers to levy 6/- a day on them. Despite all that, Deputy O'Higgins adopted a certain attitude yesterday, and again to-day, in regard to the matter.

Nobody minds Deputy Dillon. He just blew in to kill another half an hour of time. That is all he is concerned about. Deputy O'Higgins penalised poor, mentally afflicted patients, unable to pay, to the tune of £109 a year. Why?

Deputy O'Higgins also knows there are many patients in mental hospitals —the numbers have been growing in recent years—who come from reasonably well-off families and who are suffering from senile decay. The former Minister knows the trend and was quite vocal about it when he was in office. He knew they were coming from the better-off families and that the mental hospitals were being crowded out with them. He is well aware of the demands on space in the district mental hospitals as a result of that unfortunate trend in recent years. Does he suggest that that type of patient, coming from the better-off families of this country—there are still large numbers of families still reasonably well off-should be asked to pay nothing?

They should not be in a mental hospital at all.

Acting-Chairman

That is not the question. We are discussing Section 2.

The Deputy asked me a question.

The truth is that the Deputy who is putting up all the opposition to this Bill has far more knowladge than any of his colleagues about the whole matter. I was very surprised at the bold front of the Opposition on the question of charges for mental hospital treatment. There has been a complete change over and the wheel has turned full circle. The big objection to the Health Bill, when it was going through here a few years ago, was that it would give so many people free health treatment. That was the big objection from Deputy O'Higgins, Deputy Rooney, Deputy Dr. Esmonde and all the Fine Gael Party at that time. A few years made a big difference so far as Deputy O'Higgins is concerned. He as succeeded in bringing his colleagues around to the view that nobody should pay anything for any medical service in this country—

I never said that and I do not agree at all.

That was said by the Deputy's colleague sitting beside him. The whole trend of the discussion here would appear to be in that direction.

If the Deputy were in a while longer he would know that is not so.

It looks like that. The Deputy was fully aware of the classes of people occupying mental hospitals, yet he decided to authorise the county managers to levy£109 per year on them. If he was so concerned at that time, why did he not amend the law then, when he had power to do so, and not levy anything on those mental hospital patients? A greater piece of play acting has never taken place here than that which has taken place in the last two days.

I want to make a few remarks in reply to what the Minister said moment ago. I do not want to prolong the debate and I do not want to repeat myself. I just want to put this point of view. Irrespective of what Deputy Allen may have said and irrespective of what the Minister may have suggested, I hope Deputies will realise that opposition from these benches in relation to this measure may be opposition sincerely conceived. I do not think that our deliberation here are helped by speeches such as we have heard from Deputy Allen, in which arguments are not advanced but political abuse—Deputy Allen is never guilty of personal abuse—is hurled at Fine Gael or any other Party.

Here is something which, I believe, must trouble the conscience of every Deputy. It certainly troubles mine. I shall make a present to the Minister, if he wants to use it, that in so far as I, as Minister, presided over an Administration in which a charge of 6/-a day could be imposed, it was always a matter of trouble to me. But I took the satisfaction from that particular section of the Health Act that the policy behind it, as I understood it, was to restrict the charges that could be imposed. As Deputy Dillon quite rightly pointed out, it was not in the majority of cases that the charges were imposed, but there would aries cases, particularly in the courts, particularly in the administration of the estates of deceased persons, in which mental hospital authorities, as in the past and now, would make a practice of going after the assets. That would involve the sale of a farm of and. In so far as that measure was designed to restrict the amount that could be covered, that was a good measure, but it did not mean that a claim by a mental hospital authority, which involved the administration of a small farmer's estate and the sale of the land, was a claim which could be justified under any circumstances.

I want to remind every Deputy here that, if he votes for this section, he is voting for the right of each manager of a mental hospital board to sell out a widow and family in order to ensure that the mental hospital authority may be recouped in respect of the maintenance of a patient in a hospital. That is the effect of this. The Minister seems to think that there may be nothing wrong with that. The Minister seems to think that, if the money is there and can be obtained, it should be paid.

There may be a small farmer, in my constituency or any other constituency, with 20 or 30 acres of land. That may be valued for£1,5000 or so and it may represent the sole assets of a widow and family, after the patient dies in hospital. There is over £1,000 there. In those circumstances, merely because the assets are there, does the Minister ask the House to accept that it is just and proper, because £1,000 may be get, that the mental hospital authority should sell out the land, put the window and family on the road and give them whatever may be left after the place is sold and the costs paid. I think it is asking the House to be far too patient——

That is not in the section at all.

That is in the section. That is the effect of the section. Under this section, a mental hospital authority is entitled to charge 10/- per day, £182 per year, and to recover six years in respect of such maintenance, which, as Deputy Dillon pointed out, totals£1,094. I think that is wrong. I think that the Minister has provid it to be wrong. Having regard to what the minister said, if 10/- per day were in fact charged by mental hospital authorities on patients who would be chargeable patients, then what would be raised by this section would be close on £145,500 or £150,000 but, in fact the Minister said what he hopes to get is something between £35,000 and £50,000. So that, even according to the Minister's inquiries, it is recognised that such charges would be entirely exorbitant and should not be paid. It is not proposed or expectecd that they will be imposed but the Minister feels that it is necessary that the authority should be there.

The Minister says the authority should be there because there may be cases in which the full charge could be exacted. Whom are we dealing with? They are persons who are described as being in the middle income group. Generally, better-off people are in a position to make other arrangements in the case of mental illness; they go to some of the voluntary mental hospitals or homes of that kind. They do not like to go to the district mental hospital and, if they can afford it, they avoid doing so. Ordinarily, the person who finds himself there is the person in respect of whom the health authority has a statutory obligation. These people are farmers whose valuation does not exceed £50, insured persons with an income limit of £600, and so on. These are the people largely to be found as patients there these are the people amongst whom the Minister thinks there may be certain groups who can afford to pay, or whose family can afford to pay, £182 a year for their maintenance, maintenance which may stretch over a lifetime.

I think that is not a sound argument, but the Minister says there must be a maximum, that we must have the right to charge this sum, in case some people may be there who may be found able to pay it. The minister goes on to say that effect of this will be something around 1/- a day on the patients. If his figures are in any way an accurate estimate, surely the 6/- at the moment is a sufficient maximum? Surely the very limit of 6/- now contained in the Health Act-which cannot always be collected and I should be surpriesed if it could be collected—is a sufficient ceiling? Is there not enough leeway there to allow managers of mental hospital authorities to exact money where money can be found?

In fact, if this charge is estimated to bring in £50,000 and if in fact it could bring in £150,000, the gap,to my mind, is so large as to make it not worth while proceeding with the section. In any event, if it is proceeded with, as Deputy Dillon has pointed out, whether we like it or not, whether we may as individuals approve of it is or not, we are giving the power and the obligation in many cases to managers of mental hospital authorities to collect the money where they have reason to believe the money can be collected. As public officers, they have the obligation to the ratepayers and to the mental hopsital authority to seek the money if it can be found. Whenever there is found an unfortunate family which has carried this affliction for many years, of the father or mother or some other member of the family being in a mental hospital, it is no good saying to them that they are not being badly treated if the only asset, the bit of property, is taken in payment of maintenance. They know well that their regard for their father, their regard for their neighbours and their general obligation to society, necessitated the maintenance in hospital of the person so mentally afflicted.

It seems to me that mental illness and its treatment should be regarded quite differently from other forms of hospitalisation. Different considerations apply and by reason of the duration of the treatment, the hardship imposed on those who have to pay can be considerable indeed.

To make a raid on the assets of the mentally afflicted is, in may opinion, the lowest from of theft. Here we see that, under this section, the section of the community which suffers probably from the greatest possible affliction is about to be made the subject of a demand by the Government for the confiscation of their assets or property. Everybody knows quite well that the mentally afflicted cannot be put in the same category as those suffering from any other from of illness. For that reason, I have always believed and maintained-it is not recently I was converted to it—that the treatment of mental illness should be free.

I have been associated with this in being a member of a mental hospital board for 15 years and I can speak on the subject with a certain amount of authority. It is only very recently that there has been clear evidence of substantial demands being sent out by mental hospital authorities, either to patients on their discharge or to relatives of patients at present there—and it can be clearly established that in more than a few cases, where certain patients were discharged, they were presented within 21 days of their discharge with very substantial accounts for their maintenance in the institution, accounts which had a very disturbing effect upon the patient. There was the disturbing effect of an honourable citizen being presented with an account which he was anxious to meet if circumstances would permit him to do so, but found it impossible to do so, owing to his financial circumstances.

Again, it may be clerly understood that, unlike other forms of illness, mental illness requires very long periods of treatment and a person suffering from that unfortunate illness may have to be put into such an institution for his own safety or for the safety and convenience of his neighbours, relatives and friends. I do not feel that the Minister should argue the question or endeavour to demonstrate o us here the fruits that follow the observance of the Fourth Commandment of God. We all know quite well that children have an obligation to their parents in their illness and their distress, but we often have cases in which circumstances will not allow a family to discharge that obligation.

Then we have cases—I suppose there is a black sheep to be found in every flock—where someone will not have that regard for the Fourth Commandment which he should have. What is to be done in such a case? I have known of cases of which either the father or the mother of a family, for their own safety, were committed to a mental institution and when it come to the stage at which any member of the family desired to be married, there could be no marriage settlement arranged, because the owner of the property was declared a ward of court and numerous and serious legal difficulties arose.

I feel that that the step which was taken to imposes a charge of 6/- per day on mental patients was wrong one. Two wrongs do not make a right. It does not follow that because the Minister is about to increase it from 6/- to 10/-, it was right to have fixed 6/- at first It is amazing—and amusing—to hear some of the Government speakers saying that there is no difference between 6/- a day and 10/- a day, just as the Minister for Health said last night that 7/6 was so insignificant that it did not count and that if a person found 7/6 in his pocket, he would feel that there was nothing at all there. Then we hear Deputy Allen, who must have experience with local authorities and must have been associated with the mental hospital board n his area, and other Deputies with an intimate knowledge of rural Ireland, saying that a charge of 6/- a day on a mental patient being increased to 10/- a day is of no real significance whatever.

I respectfully submit, sir, that this means an extra charge on the patient of £1 8s. per week. It is all very fine for the person who has no assets or property and no relatives or dependents. In the event of such a person being committed to a mental institution, the difficulty probably will not arise. Again, as Deputy O'Higgins has pointed out, people are committed to mental hospitals who do not get time to settle their affairs or make arrangements to safeguard their property while in these institutions. Mental illness often strikes a person rather suddenly. Now we are going to give authority to the county manager to make a raid, so to speak, on the assets of the unfortunate afflicted person. I think, as has already been stated, that if there was a free, honest and frank vote on this section, there are honourable men in the Fianna Fáil Party who would vote against it. It does not mean that because the Fianna Fáil Party bring in crazy legislation everyone associated with the Party is of the same crazy mentality, or does not know that to increase the charge on a mental patient from 6/- a day to 10/- a day is wrong.

I feel that the Minister must be aware of that because the officers of his Department must be familiar with many such circumstances where, in the event of the death of a patient in an institution, a raid can be made on his assets. It will be more unfortunate if any holdings of such mentally afflicated person are to be sold out against the wishes of either the widow or the other members of the family who are entirely dependent on the holdings. I feel, and I think my feeling is right, that the mental hospital would have the first charge on the property. In the event of that, those dependents who are working hard, perhaps tilling and sowing from sunrise to nightfall, and desiring to eke out a living and build up a little home will find that their whole financial structure is to be disturbed on the death of the patient in the institution or on the demand for the full settlement of the mental hospital account.

In many cases the banks, or other financial institutions, such as credit corporations, will not come to their rescue in such circumstances. It is very regrettable that this House should give such authority. I can see that happening in the years ahead because most of us to-day who are familiar with the running of mental institutions know quite well that all that the mental hospital authorities want is the smallest chance to get in all the money they possibly can.

A county manager is not looked upon as being a good county manager unless he rakes in all the money he can. I admit some of them may be human enough, but in order to get a good stripe from the Department, they must rake in all they can. The more they rake in, the more cordial the welcome will be for them on the steps of the Custom House. I feel that when the mental hospital authorities are given such power, there is nothing to stop the Minister for Health from arranging a conference in the Custom House and getting the head of the section, or himself, to deliver a brief address on the terms of this Bill and saying that it is Government policy that such a sum should be collected and endeavouring to see that 10/- a day will be collected. He can say that the money is required for the relief of the Exchequer or to reduce the cost of health services on the community. Even a direction to this effect would not be necessary, as a hint from the Custom House is often more effective than a direction. I feel that if such a collection is to be made, the serious consequences and general inconvenience will be rather disturbing on the assets, and on the relatives and dependents, of mental hospital patients.

I disagree entirely with this. Even in recent weeks, I have seen legal proceedings instituted against the son of a hard-working mother who unfortunately died in the mental hospital. He was under the impression that there would be no charge. He was married and had a family, but yet there was no hesitation in having this decent man served with a summons. After consultation with some neighbours on the morning of the court—and this only happened three weeks ago in Portlaoise —the account was settled with borrowed money. The money was borrowed from a neighbour because the man wanted to save his face and did not want to have headlines in the local paper that he was decreed in the District Court because he could not settle the account of his dead mother. What an appalling situation that a man should be placed in such an embarrassing position by the mental hospital!

I often feel, and I think my thoughts are based on a sound foundation, that the people in the Custom House are living as far away from people in rural Ireland as if they were residing on the comet that appeared in the northwestern sky about five weeks ago. Surely mental hospital authorities should have some regard as to whom legal proceedings are brought against in the case of mental hospital accounts. There was another glaring case in my constituency of a person who was the owner of property and when he died, it was expected that the property would go, in the ordinary way, to his sister who had worked hard and helped her brother down through the years. The property is now the subject of correspondence between at least half-a-dozen solicitors and I think counsel is expressing an opinion on the matter.

By the time the legal people are finished and by the time the mental hospital authorities have got their share, there will be very little left for the hard-working sister who gave the best years of her life to make that holding what it is. Under this section, the position in future will be that the mental hospital will put up the holding of any person who dies within the four walls of the institution if his dependents and relatives have no way in which to settle the very substantial accounts incurred. Despite what the Minister says, I have seen accounts running into three figures.

Before the Minister inserted this section, did he have any recourse to the accounts of the various mental hospitals throughout the country? Did he take into consideration the outstanding accounts of all these mental hospitals to-day? Did he take into consideration the efforts made by mental hospitals to collect accounts from dependents and relatives of deceased patients, relatives and dependents who are not in a position to pay? But, if that is the position to-day, how much worse will the position be as a result of this section? The charge is to be increased. Who knows but that the green light will be given from the Custom House to local authorities to make further collections?

This House is giving very dangerous powers to mental hospitals, powers which will have serious effects and consequences on the dependents of mental patients. A strong case has been made against the inclusion of this section in the Bill. The Minister should delete the section in its entirety. Goodness knows, when a raid has to be made on the public, the least one would expect is that those who are suffering from mental illness would not be subjected to such a raid. For that reason, I join with the other speakers on this side in warning the Minister that there will be very serious consequences if this section passes into law.

Having given that warning, I appeal to the Government and to the Minister to throw this section out. There are other ways of finding funds. There are other powers which can be given to mental hospital boards and authorities without giving them the power to confiscate a holding of seize the assets of a deceased patient. That way lies disaster, because such a step can lead only to endless trouble and family squabbles. This is a mean kind of theft and the Government should withdraw the section.

The members of the Fine Gael Party were criticised by the Minister and by Deputy Allen because of their opposition to this proposal to increase the charge for maintenance in relation to mental patients. When we availed of the power given to us by the 1953 Health Act to impose that charge some years ago, I would remind Fianna Fáil Deputies that they made no point at all in 1954 against the proposed charge, so far as mental patients were concerned. They must have slipped up on that.

It is obvious now that there is a very serious injustice so far as mental patients are concerned and the proposed increased charge will be a still greater injustice. Under statute, only destitute patients are entitled to free treatment because the existing legislation provides that the estate or assets of the mental patient must go towards his treatment and maintenance, be it a small shop, a small farm, a small business or any other limited assets. There is no option. The very minute the patient is certified, he loses control over his estate. Consider then the position of a married man with a wife and children. A charge is levied against his holding, or whatever assets he has, and, when he dies, his estate must go towards the cost of his treatment and maintenance in hospital. That is a statutory provision.

The estate or assets will be absorbed all the sooner as a result of the proposed increase to 10/- per day instead of 6/- per day. The very moment the patient enters the mental hospital, his estate, or assets, begins to dwindle because it will be absorbed in providing for his treatment and maintenance. The Minister said earlier that he did not believe there could be very heavy charges and very heavy hardships caused under existing legislation. I can give an example of a small farm of ten acres. A man was living on that farm with his two brothers. About 25 years ago, he was struck down with mental illness. The farm was heavily in debt. The two brothers continued to work the farm. They brought it out of debt.

It was they who should have been committed, and not he.

They brought the farm up to full productive capacity. They increased the stock. At the end of the 25 years, the farm was worth six or seven times what it was worth when the brother was committed to a mental hospital. At the time of his committal, it was worth about £200 or £250. When he died it was, as I say, six or seven times more valuable than it had been when he went into hospital. It is unjust that the assets of the patient on the day he went into hospital are not taken into consideration, instead of the enhanced value at the time he dies.

Is the Deputy trying to say that a ten acre farm is an economic unit?

No. I do not mind whether it is a ten acre farm or a three foot counter. I am making the point that a small estate or small assets are absorbed from the day the patient begins to receive treatment. I put forward the example to show why the increase in this case is a hardship, particularly on people who have worked under a gentleman's agreement and improved the assets after the patient's committal. Consider, too, the position of aged parents who sign over a small shop to a son. He may be obliged to go into a mental hospital for treatment. Immediately the shop begins to be absorbed by the institution and the parents are left destitute. The same position can obtain in the case of a small farm. It will be absorbed at the rate of 10/- per day now instead of 6/-. I think there is a very strong case for the withdrawal of this section.

Question put.
The Committee divided: Tá, 70; Níl, 28.

  • Aiken, Frank.
  • Allen, Denis.
  • Bartley, Gerald.
  • Beegan, Patrick.
  • Blaney, Neal T.
  • Boland, Gerald.
  • Boland, Kevin.
  • Booth, Lionel.
  • Brady, Philip A.
  • Brady, Seán.
  • Breen, Dan.
  • Brennan, Joseph.
  • Brennan, Paudge.
  • Breslin, Cormac.
  • Briscoe, Robert.
  • Egan, Kieran P.
  • Egan, Nicholas.
  • Fanning, John.
  • Faulkner, Padraig.
  • Gallagher, Colm.
  • Galvin, John.
  • Geoghegan, John.
  • Gibbons, James.
  • Gilbride, Eugene.
  • Gogan, Richard P.
  • Griffin, James.
  • Hillery, Patrick J.
  • Hilliard, Michael.
  • Humphreys, Francis.
  • Kenneally, William.
  • Kennedy, Michael J.
  • Killilea, Mark.
  • Kitt, Michael F.
  • Lemass, Seán.
  • Loughman, Frank.
  • Burke, Patrick.
  • Calleary, Phelim A.
  • Carty, Michael.
  • Childers, Erskine.
  • Clohessy, Patrick.
  • Collins, James J.
  • Cotter, Edward.
  • Crowley, Honor M.
  • Cunningham, Liam.
  • Davern, Mick.
  • de Valera, Eamon.
  • de Valera, Vivion.
  • Doherty, Seán.
  • Donegan, Batt.
  • Dooley, Patrick.
  • Lynch, Celia.
  • Lynch, Jack.
  • MacCarthy, Seán.
  • McEllistrim, Thomas.
  • MacEntee, Seán.
  • Maher, Peadar.
  • Medlar, Martin.
  • Moher, John W.
  • Moloney, Daniel J.
  • Moran, Michael.
  • Ó Briain, Donnchadh.
  • O'Malley, Donogh.
  • Ormonde, John.
  • O'Toole, James.
  • Ryan, James.
  • Ryan, Mary B.
  • Sheldon, William A.W.
  • Sheridan, Michael.
  • Smith, Patrick.
  • Traynor, Oscar.

Níl

  • Browne, Noel C.
  • Burke, James.
  • Carew, John.
  • Coogan, Fintan.
  • Corish, Brendan.
  • Costello, Declan D.
  • Crotty, Patrick J.
  • Desmond, Daniel.
  • Dillon, James M.
  • Esmonde, Anthony C.
  • Finucane, Patrick.
  • Flanagan, Oliver J.
  • Giles, Patrick.
  • Hogan, Bridget.
  • Hughes, Joseph.
  • Jones, Denis F.
  • Kenny, Henry.
  • Kyne, Thomas A.
  • MacEoin, Seán.
  • McQuillan, John.
  • Mulcahy, Richard.
  • O'Higgins, Michael J.
  • O'Higgins, Thomas F.
  • O'Reilly, Patrick.
  • O'Sullivan, Denis J.
  • Rooney, Eamonn.
  • Tierney, Patrick.
  • Tully, John.
Tellers:—Tá: Deputies Ó Briain and Hilliard; Níl: Deputies O'Sullivan and Kyne.
Question declared carried.
Section 3 and Title agreed to.

When is it proposed to take the next stage?

I wonder could we have the next stage now?

Deputies

No.

Even with 28? Does that represent your opposition?

Seventy have to go home and do some thinking.

Are they all mental treatment cases?

They cannot afford to be mentally ill now.

The Minister's irresistible charm will persuade us.

It was the Deputy's fanciful figure.

The Minister will not get the Bill to-day.

Report Stage ordered for Wednesday, 12th June, 1957.
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