The most disturbing feature of this Estimate is the magnitude of the increase which we have to face every year. The increase is now very high. The provision for the coming year is £17,800,000. It is all the more significant and all the more surprising when we realise that we are a very small community of some 2,850,000 people, and that only a small percentage of our people benefit from the health services. Perhaps, the Minster in his reply will give us the exact figures. From a reply to a question here during the year, I think the figure is 28,000 in the lower income group. I must say that I am ignorant of these facts and I should like to have them from the Minister.
With the Minister I sympathise in his expressed desire for economies in health administration. I fail to see where they are to come from because health administration, from its very pattern, will inevitably be costly. If we could segregate the figures for administration from the figures actually paid out in benefits, we would be in a better position to understand where economies could be effected.
We have to realise that health legislation is operated through a whole system of officials down the country. Every county council has its health authority and in that health authority there are officials who have to make records, inquiries, investigations. They have interviews of various kinds so that it is a long and involved process. It is very tedious and complex for the officials who have to face up to these responsibilities. We have a health authority in Cork and what is amazing about the officials in that health authority is the complete intimacy with which they handle the various problems and the extraordinary objectivity and impartiality they show. They are also efficient and competent. It is a tribute to the officials both in the health authority and the sanatoria. The sanatoria section have been amalgamated since the 1st July. I cannot see, therefore, where we are to secure economies in view of that pattern in the service.
The Minister mentioned a booklet which he intends to provide. I am sure he is aware that some local authorities have already provided a very simple little booklet giving in their respective local areas the names of the hospitals and the types of service available. I humbly suggest that if the Minister is going to issue a booklet now, the cost will run into thousands of pounds. He says he will see that there is one in every home. I can assure him that 70 per cent. of these will not be read. Many of them will not be understood by the people who claim benefits. Eventually, the people looking for information about the health services will have to go to the officials concerned or to the public representatives for the area. Therefore, I think it is a waste of time and money.
I should say that if such a booklet were issued by the respective local authorities, it would have a local appeal. It would be local in its character, containing the names of the hospitals and so on and the location of the services would all be set out in that booklet. For that reason, it would have a far greater attraction than the booklet which the Minister contemplates issuing in the near future.
I have no doubt that the idea behind the issue of the booklet is the very best. The Minister wants to be helpful and to give the information to the people seeking it. I do not think they will look for it in a text book of any kind. No matter how simple the book is, it is for those people an abstract text book and they will not be inclined to follow it. We ourselves get reams of reading matter connected with the various Departments. Personally, I do not read a fraction of them. I have not got the time. Many of the people will be preoccupied with business. Their wives will be preoccupied with domestic matters. They will simply not have the time. With the radio, the advent of television and all the reading material, such as magazines, available, they are not going to fall back on such a heavy subject as health legislation.
The Minister gave encouraging figures about the incidence of tuberculosis. We are all very glad that the measures taken in recent years obviated the danger of a scourge from that disease again. The figures given in regard to heart disease and cancer are rather disquieting and offset to a considerable degree the very encouraging position in relation to tuberculosis in this country today. Of course we shall have to wait for greater research to get the real line on those, but I hope eventually, like tuberculosis, the scourges may be conquerable, to a certain degree at all events.
The Minister dwelt at length on his hospital building programme and his policy is to be cautious and to build up a certain reserve fund, except for expenditure for essential needs. I agree with the Minister on that. I think his policy is sound and correct. We do not want to see hospitals dotted all over the country. We have redundant sanatoria now and they will be gradually converted to uses for people suffering from other diseases. In the course of time many of those may become redundant with the advances of medical science and with the advanced treatment we now have in regard to various diseases. It is true that there is overcrowding at the moment in some hospitals but doctors have told me, in Cork at any rate, that if only they could get rid of the chronic patients there would be no overcrowding problem. Some of those patients remain on for months and even for years. Some of them have no homes to go back to or, if they have homes, there is nobody there competent to take care of them, or the people in the home do not want to have them back.
That is a problem that focuses attention on the necessity for finding homes for aged persons. I am glad that the Minister has that in mind. It is one way of relieving pressure in the hospitals and providing some comfort for these people in their old age, away from the hospital atmosphere. These homes could be run by a community or by committees and they would be places in which these people would be very happy.
The Minister also referred to mental hospitals. There is urgent need for extensions to some of these hospitals. He also mentioned the voluntary hospitals. Considering that the voluntary hospitals have given such valued service to the people for centuries they should be an important consideration with the Minister and his Department. I know that some voluntary hospitals have plans for contemplated extensions and are awaiting grants or sanction to go ahead with these extensions. Would it not be more sensible, and a better method of meeting their demands, to get them to reassess their plans so that they could be carried out over a period of years and would not impact too heavily on the Hospital Trust Funds. These demands could be implemented gradually over a period of years, and, at the same time, save the reserve which the Minister has in mind.
I was rather disappointed that the Minister did not put greater emphasis on the voluntary health insurance scheme. I know many people in the middle income group who are participants in the voluntary health insurance scheme and they believe that the independence and the security it gives them for the future is an attraction. They are quite happy and content to remain on in the scheme even though they may be eligible for benefits under health schemes for the middle income category. It was a pity that this scheme did not take precedence over the Health Act. We would be in a much happier position to-day if that had been done. However, I suppose we learn by degrees.
In the Civil Service they had a health service of their own. They made a contribution to the health services and it was a magnificent one but unfortunately it had been known for years that the health services were to be made available and those who wanted dentures or medical treatment waited until this scheme was in operation and, I have been informed, the demands impacted so heavily on the fund that chaos resulted. The teachers' organisation have a magnificent health scheme and, for a very paltry sum, the benefits are most generous. I think the only way we can economise in health legislation is to encourage those groups and organisations to look to the individual, independent insurance scheme of their own. In that way, they will be making provision for themselves and they will be helping to restore that independence and dignity of the human person which these health regulations have tended to destroy so much over the years.