I move that the Bill be now read a Second Time. This Bill is concomitant with the Social Welfare (Amendment) Bill and the basic reason for introducing it is the same, namely, to give entitlement to approximately the same number of persons, to the benefit of services under the Health Act, 1953, as were so entitled when the Act was introduced. It will be recalled that the Bill to provide these services was introduced in 1952 and became law, not without opposition, in 1953. Under it general institutional and specialist services, the maternity and child health service and the mental treatment service, became available to persons and their dependants in one or other of four categories. Roughly speaking, these categories, which together make up what have become known as the lower and middle income groups, at the moment are composed of persons insured under the Social Welfare Act, 1952; other adult-persons whose yearly means are less than £600; farmers the rateable valuation of whose holdings is £50 or less; and persons outside these three categories who cannot, without undue hardship, provide the services for themselves and their dependants.
The number of landowners with properties not exceeding £50 in valuation has not sensibly changed since 1952. On the other hand, the number of persons within the remaining categories who were eligible for health services in 1953 has contracted substantially, because so many people are earning so much more. The effect of this has been that many wage-earners for whose benefit the 1953 Act was enacted have ceased to be eligible for an important group of services which it was intended should be made available for them. The aim of this Bill is to restore to those thus extruded the benefits which under the original Act they were entitled to. Perhaps at this point I should stress that irrespective of the level of their earnings persons who can demonstrate hardship will, as heretofore, be eligible for the institutional and specialist services.
Apart from the intrinsic justice of reinstating all those for whose benefit these health services were originally provided, I should like to point out that the amendments of the Social Welfare Acts proposed by the Social Welfare (Amendment) Bill would make the assessment of entitlement a more complicated matter than it is at present if we did not make the income limitations under both codes coincide. At present, in so far as insured persons seeking health services are concerned, it is necessary only to establish that the appropriate contributions have been paid under the Social Welfare Acts. Once this fact has been established, it is not necessary to make further inquiries into the person's means or into the means of the members of his family residing with him. Eligibility in this context is related to insurance under the Social Welfare Act of 1952. Unless the Health Act is amended to change this reference to cover the 1952 Act as extended by the Social Welfare (Amendment) Bill, which the House has just passed, those within the £600 to £800 limits would not become entitled, as insured persons to Health Act benefits. It would, therefore, be necessary to establish, in relation to each person in non-manual employment insured under the Social Welfare Acts, whether or not his annual income were above or below the old level of £600. To attempt so to distinguish between the persons paying insurance contributions under the Social Welfare Acts would be administratively difficult and costly.
In the case of the second category —non-insured adult persons whose yearly means are less than £600 and their dependents—the case for increasing the limit is, if anything, stronger than for the insured. In the case of a person claiming entitlement under this, the assessment of eligibility is made on a family basis, which is not the case under the Social Welfare Act. This, of course, makes it relatively more difficult for a non-insured person to establish his entitlement to the services; and it would be indefensible further to disimprove his position vis-a-vis the insured by not making a corresponding easing of the income limit.
In the Health Act, 1953, yearly means for the purpose of determining eligibility for the "under £600" group includes the means of any unmarried son or daughter, stepson or stepdaughter living with the applicant. It has been represented to me that it is unfair to take all the income of such persons into account. A typical case might prove the point. Take for example, a married couple. The husband retired with a pension of, say, £3 a week. Living with their parents are a son and daughter who are working and earning, say, £9 a week. Because the family income under the law as it stands is £12 a week, or £612 a year, the parents are ineligible for services under the Act while the children, if they are in insurable employment are eligible. Both the children might be saving to get married and, reasonably enough in those circumstances, not handing up all or even the major part of their earnings. It is hard, I think the House will admit, to justify refusing services to the parents in such circumstances. The extension of the family income limit from £600 to £800 will no doubt improve the position in such cases, but I feel that something more is required and, consequently, sub-section (4) of Section 1 provides that wherever the family includes more than one member with an income, the first £100 of each son's or daughter's income will be disregarded in calculating the aggregate of the family income. I feel that the figure of £100 is a fair compromise between the interests of the family on the one hand and of the ratepayers and taxpayers on the other. It is not unreasonable, however, to put a limit on the number of hundred pounds to be disregarded in this fashion and the limitation imposed in the Bill is £300.
It is difficult to say how many people will be covered by the new provisions or what the additional cost will be, but it is estimated that the benefits of the Act may be extended to about 80,000 additional persons and that the additional cost will be of the order of £120,000, half of which will be borne by the Exchequer and half by the ratepayers. I am reluctant, as I have made clear in the past, to add substantially to the public expenditure on health services, but I feel that the additional charge must be accepted.
This Bill, as I said at the outset, will in effect bring back within the scope of the services provided under the Health Acts a considerable number of persons for whom it was intended to provide such services when the 1953 Act was passed. Clearly it involves no departure in principle from legislation which has already had the approval of the Oireachtas. In those circumstances I trust the House will see its way to give the Bill a Second Reading.