There are a few points to which I should like to refer on this Estimate. One of the things which I welcomed in the Minister's statement was the fact that in the near future he intends to issue a booklet on the health services. I think this is necessary because in spite of the fact that the services have now been in operation for some years there is still considerable confusion not only amongst the general public but amongst public representatives in regard to what people are entitled to under these Acts. I find that generally people do not appreciate the fact that even if their income does not qualify them for a medical card, nevertheless, in certain circumstances, they can get that card for a specific purpose and thereby derive the benefits which were envisaged when the Act was brought in.
There are other matters which also give trouble such as the fact that people find it confusing that an old age pensioner who has undergone a severe means test before he can qualify for his old age pension is not automatically entitled to a medical card. It would need to be explained that the medical card is governed by the income of the house rather than the income of the individual.
Another knotty problem, to my mind, is the awarding of a disability allowance. It seems to lie entirely at the discretion of the manager and on the recommendation of his investigating officer and seemingly there is a very wide difference as to the type of person who is eligible for disability allowance. I should like to make a plea for the person who is completely unable to work. I have such a person in mind, a person who is crippled with arthritis. He would cost the State a considerable amount of money if he were committed to a home. He is living at home and even with the disability allowance his maximum weekly income is 30/-. The local authorities inform me that they have no power to give him more. I find that difficult to believe because 30/- bears no relation to the cost to the taxpayer and the ratepayer if such a person had to be kept in a home.
There are many benefits to be derived under the Health Act but people find it confusing that ophthalmic or aural services are not included. While I know it would cost the Exchequer money, it is something which the Minister should keep before him because until such time as all the different services can be taken in in some way, the Health Act will not achieve its full purpose.
I was very glad to see that the Minister paid considerable attention to mental illness. There is of course a new awareness amongst the public in relation to this illness and a great change in their attitude to mental hospitals and mental diseases generally. I know that in Cork, which I suppose is not very much different from other centres, an increasing number of people are going voluntarily to the R.M.S. of the hospital and the numbers attending the out-patients' clinics have increased lately on account of the number of voluntary patients going there. This is a very good trend and the more publicity directed to informing the public of the facilities which are available, and of the necessity for early attention to mental illness, the better, because it will serve a very useful purpose.
After 25 years of agitation, a new addition is being erected to the Cork hospital and it certainly will fulfil a great need. I would stress again the need for more publicity to inform people of the facilities in hospital clinics both for intern and extern patients. Such publicity would have very beneficial effects.
The White Paper issued a short time ago about the mentally handicapped shows that the Department is very much concerned about something which up to recently has been hidden away and forgotten and is now rapidly assuming a very great importance, and rightly so, in our midst. We have two organisations in Cork—one of which very rightly received mention in the White Paper—which are doing a tremendous amount of good work. One started as a post-polio committee but has now turned to mentally handicapped children of both sexes. It has a day school and a residential school for such children and it is expanding its activities all the time and deserves great credit. Another activity there is the cerebral palsy clinic. The committee for that was started in 1955. It was a small committee and opened a clinic in two small rooms in a back street. As far as I can recall, it then had 14 patients. Through voluntary efforts, it was able to open a clinic in the centre of the city in 1958 and at that time it included a small school. There were 39 patients and 11 students in the school. They were mainly drawn from Cork city and the immediate suburbs.
Now we find that the clinic is much too small. Instead of 11 pupils, there are now 39. The children are attending pediatricians and medical officers are sending them there not alone from all parts of Cork city and county but Tipperary town, Limerick and even Kilkenny. There are 70 children attending the day clinic. The position is now embarrassing and a new school is an immediate necessity. The room that has been used was turned over for daily attention to these children. It is a well-known fact that success in the treatment of cerebral palsy, as in other diseases, depends on regular treatment at a very early age. I would say that there is only one residential clinic in this part of Ireland and that is the one situated at Bray and for which there is a waiting list.
It seems to me that the time has come when residential clinics will have to be envisaged for Munster, certainly for South Munster. Our experience in Cork shows that there is a great need for a residential clinic. Pediatricians are convinced that a child no matter how badly handicapped he may be by cerebral palsy or any such affliction should not be removed remotely from his parents. No matter how badly afflicted they are, they should not be too far removed from contact with their parents. Even if the Bray clinic were able to take all the patients seeking admission, it would be too far away for many parents to keep in contact with their children. There is a great need for a residential clinic in the Cork area to serve at least South Munster, if not the whole of the province.
I should like to pay tribute to the people who have given such tremendous voluntary service in connection with the cerebral palsy clinic and the other clinic I mentioned. With the exception of a small State grant for school furniture, the cerebral palsy clinic was built entirely through voluntary effort. At a time when so much is expected, or even demanded from the State, it is right that tribute should be paid to voluntary workers and subscribers. I believe that no matter how far we progress, there will always be a place here for the voluntary worker and subscriber.
I am sure the Minister and his Department know very well that the school dental service at present is merely touching the fringe of the problem. In his opening statement, the Minister said there was a scarcity of dentists. There are only two dental schools in this part of the country, one in Dublin and the other in Cork. I was very glad to learn that a new school is to be built in Dublin because the old one is entirely inadequate. However, it certainly is no more inadequate than the school in Cork. About 20 years ago, the average number of dentistry students in Cork was from four to six. Today, the University authorities are embarrassed because it is impossible to cater for all those wishing to do dentistry. Because there is not sufficient space at the North Infirmary Hospital, the intake of dentistry students must be confined to 12. The course takes three years and that means that 36 students must complete that course under the handicap of insufficient accommodation.
Five years ago, both the teaching staff and teaching methods of the dentistry school at the North Charitable Infirmary were reorganised, and that reorganisation has had really remarkable results. Each year, as I have said, there were 12 students, and of the 36 students over those three years, 35 succeeded in their final examination. I do not know if that record can be equalled, not alone surpassed, in any other institution, and that has been achieved when they were working, as I very well know, under tremendous difficulties. As I said, University College Cork are experiencing considerable embarrassment because they have to select those students who will be allowed to do dentistry from the very large number wishing to do it. The system there is something like this: The first 12 students in the pre-Med examination are given the choice of going for dentistry or continuing with medicine, and if they choose to go on for medicine, their place in the dental School is given to the next in order of merit.
At present when so many of our professional people are emigrating, we should consider that there is no more lucrative profession for a young boy or girl than dentistry. Without any doubt in Great Britain dentistry is at present a most attractive profession. According to the most reliable sources, the dentistry needs of that country will not be met for the next 20 years. I suggest that that is one of the reasons why the Minister is finding it difficult to get dentists for the public health services in this country. Apart altogether from the Department of Health, I believe the Government should make available to young people the means to enable them qualify in this profession.
I completely agree with the Department's attitude that the dental services should aim particularly at the preservation of the teeth of our young people. However, one has to recognise that there are people whose health or chances of employment sometimes depend on their having teeth and who have not the means of providing them for themselves. Therefore, it is only right that a percentage of the money available should be set aside for dental work. But that cannot be done until we have a 100 per cent. school dental service, and I would say that it is about 7½ per cent. at present.
In my opinion prevention is better than cure; and that brings me to another matter. This may seem strange coming from a Corkman speaking in Dublin, but I believe there is a great necessity for indoor baths in Dublin. Few exercises can do as much for the fitness and health of any young boy or girl as swimming. Some people will say that Dublin is near the sea and there are outdoor baths, but we must remember that in a climate such as ours there are only three months of the year in which such facilities can be availed of. I would ask the Minister to use his influence with the Department of Local Government and the Department of Finance to see that indoor swimming pools are provided particularly in the city of Dublin but also in other centres, such as Limerick, Waterford and Galway. Compared with other places, I am glad to say we are not too badly served in Cork. The reason I mention Dublin is that I can say, without fear of contradiction, that no city in Europe of its size and population is as badly off in this matter.
In spite of certain criticisms which have been coming in and which will come in, I can assure the Minister that most of us are looking very confidently to the future and to a great improvement under the unified health services. I think that was a step in the right direction and I have every confidence that when we meet here next year to pass the Minister's Estimate, we shall recall with satisfaction the improvement that will have been made under the unified health services.
