The Minister to conclude.
Committee on Finance. - Vote 54—Health (Resumed).
Debate resumed on the following motion:
That a supplementary sum not exceeding £565,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1962, for the Salaries and Expenses of the Office of the Minister for Health (including Oifig an Ard-Chláraitheora), and certain Services administered by that Office, including Grants to Local Authorities and miscellaneous Grants.—(Minister for Health).
Before the Minister concludes, could I ask just one question? I shall make it very brief. Could the Minister say who in a Health Authority is responsible for the general behaviour and conduct of, say, a dispensary or other doctor within the local authority—the county manager or the medical officer of health?
The County manager, because he has the final responsibility.
The Minister should look into it.
It is quite clear that the responsibility lies with the county manager. The county medical officer, of course, has advisory functions, but final responsibility for discipline and such matters lies with the county manager.
I do not think it is right that the county manager should be responsible, because in many cases a city manager or county manager is reluctant to check or reprimand generally a medical officer or dispensary officer who does not seem to be acting as he should. There may be many complaints about dispensary doctors or other medical officers and there is great reluctance by managers, who are laymen for this purpose, to appear to interfere in the discharge of a doctor's duties.
Any cases that have come to my knowledge from a local authority have been dealt with on the authority of the county managers, who have taken responsibility, for instance, for suspending doctors. Where, of course, clinical judgment in the treatment of a patient is concerned, not even the county medical officer will interfere with the discretion of the district medical officer. The responsibility for seeing that the district medical officer is available for the service of the patient however rests finally on the county manager, and in fact the medical officer does not come in in a matter of that sort at all. He might come in in relation to the general administration of health services in the dispensary area.
The Minister is satisfied with that system?
I am satisfied that that is the system which obtains.
Which is approved by the Labour Party.
I am happy about it.
Think about it.
Why?
Because it is not satisfactory.
I really rose to deal with the speeches made on the Estimate, and I am not going to say that I have very much complaint about the tone of the speeches, though there was a suggestion on the part of Deputy O'Higgins that he was reserving his fire for another occasion. I hope that when that other occasion arises, his fire will be just as ineffective as it was when he brought in his famous motion to condemn the health services, root and branch, on the ground that they were inadequate. This is a matter, of course, which is under consideration in another place and I do not wish to say more about it.
When it is sub judice.
I do not wish to expand on that particular theme at the moment. The Deputy made the point to-day, however, that the Supplementary Estimate represented an increase of some six per cent. on the original provision, and agreed that it was due to the fact that under what is now colloquially known as the eighth round, there had been considerable increases in the wages and salaries of officers, employees and officials of health authorities. Then the Deputy put the point to me that he found it hard to understand why these eighth round increases had not been allowed for when the original Estimate was brought before the House. The original Estimate was put before the House at the beginning of the last financial year, and the eighth round, as we know, did not begin to manifest itself until, just before the Dáil was about to be dissolved in preparation for the general election. As I am not a prophet, I could not prophesy six months in advance what would be the trend of remuneration in this country. Unless I had that prophetic insight, I would not have been able to make the allowance which Deputy O'Higgins suggests I ought to have made some six months before the eighth round started to come into operation and this demand began to manifest itself.
The Deputy then suggested that, in fact, though the theory was that the central authority bore 50 per cent, of the expenditure upon the health services, in this Supplementary Estimate provision was being made for only about 45 per cent, of the expenditure. He had overlooked the fact that there is a carry-over in each year from the preceding year of five per cent. and that in the end, when the final accounts are adjusted, the central authority does bear 50 per cent, of the expenditure on the health service.
It should be 100 per cent.
That is very interesting. The Deputy emphasised how heavy would be the impact of these eighth round increases in wages and salaries on the ratepayers, but what about the impact on the taxpayer if the Deputy's principle were to be accepted, if the taxpayers all over the country had to accept the responsibility for twice the amount which they are at present defraying? It will be very interesting when the Budget comes before the House next month——
This is going to be a great Budget, we are getting so many warnings about it.
——to see what the concern and the solicitude of the Opposition for the taxpayer will be. At present, in order that they might take advantage of current sentiment in the country, the position of the Fine Gael Party would seem to be that they do not give a fiddle-de-dee for the taxpayer. At the moment they do not give a tinker's damn—and that is not a curse—for the taxpayer.
It is not a prayer anyway.
They do not give a crack of their thumb for the taxpayer, but next month we will hear them bleating if by any chance the taxpayer will have to bear a heavier burden in order to maintain the public services as they are. At present the policy of the Fine Gael Party appears to be to transfer everything from the ratepayer to the taxpayer. There is perhaps an ideology behind that, because in the main the ratepayers are either the owners or occupiers of property. What the Fine Gael Party now stand for is that the burden of taxation should be transferred from property and imposed on persons. That is the principle which lies behind this demand that the taxpayer should bear the whole cost of the health services. Apparently the present policy—nobody knows what it will be tomorrow—of the Fine Gael Party is to shower bounties on a privileged section of the community at the expense of all the others.
We did not have to set up a Committee.
That was shown in a division here last week. What will the position be when the Budget comes along and the House is asked to foot the bill is another matter.
We had not to invite the Opposition to devise a policy for us.
The Deputy also complained that of the total cost of the health services no less than 55 per cent. went in salaries and wages to maintain personnel. He seemed to think that was rather extraordinary.
I did not say that.
The Deputy says he did not say it. Then I must have misunderstood him. But, on the assumption that he did say it and that I did not misunderstand him or mishear him, I want to point out what that would imply. If the Deputy wishes to reduce the proportion which at the moment is spent upon personnel, it means one of two things: that either we reduce the remuneration of the personnel or else we reduce the strength of the personnel, that we cut down on doctors and nurses and hospital staff of every sort.
Cut down on investigating officers inquiring into means tests.
That does not arise.
It certainly does arise on the Estimate. That is what the Minister is dealing with.
How many investigating officers are there in a county? There are very many fewer than dispensary doctors. They are among the most lowly paid of the personnel.
Did the Minister say fewer than dispensary doctors? I would assert there are more county council employees dealing with health services than dispensary doctors in a county.
The Deputy is again trying to confuse the issue. He quite forgets a great many of these investigating officers are not under the Department of Health at all but are under the Department of Social Welfare and are investigating for the purpose of home assistance and many other things as well as medical cards. What I am saying still holds true. If instead of representing 55 per cent. of the total Vote, the amount spent on personnel were to be reduced, it would mean either a general reduction in the remuneration of all those engaged in operating the health services or else we reduce their numbers. I do not think the Deputy really wants that. I think he is only trying to make a debating point out of this so that people outside might say "We are not spending all this money on health; we are spending 55 per cent. of it on jobs." But the jobs are those of surgeons, physicians, dispensary doctors, dentists, school medical officers, nurses, mental nurses and of all those others engaged in ministering to the sick.
Another point raised by the Deputy, and, I think, by Deputy Dillon, and which was touched on by Deputy Esmonde, was the question of smallpox vaccination. The position is that we have been receiving vaccines from a large number of sources, but most of the vaccine being used throughout the country is that which is produced by the National Institute here. What is happening is this: a larger proportion of adults have been vaccinated than is customary and the reaction, I am told, of an adult to vaccination is much more violent than in the case of an adolescent; and in the case of an adolescent it is likely to be more violent than in the case of an infant. For that reason the reaction would appear to be, as I say, more violent than might have been expected.
Do not forget that considerable numbers of people have never seen vaccination reaction before and that many adults are being vaccinated for the first time. There is not any objective way of measuring the violence of reaction. The only thing about it is that it is much better to have a reaction when you are vaccinated than not to have any at all. It is an indication, at any rate, that you have got the minor attack—and it is an attack of fever—which is likely to provide you with a degree of immunity against this most dangerous infection.
Has the Minister seen any reports from medical sources that there would appear to be a difference with regard to reaction?
No, I have not received any in relation to any particular vaccine. As everybody knows, we have had reports that adults react more violently and the process is more painful than it may be in the case of infants, although we really do not know how painful the reaction in infants may be. I have no reason to believe that anything abnormal or unusual is happening here. It has been the same experience as in Great Britain where they have had the same sort of cycle: adults coming forward for vaccination for the first time and reacting painfully and violently to it. But, on the other hand, they secure a degree of immunity against what is a very deadly disease.
Has the Minister thought it necessary to advise people to have smallpox vaccination.
I am sure he has.
Does the Minister think it advisable that he should advise people to get this vaccination? Does he think the situation warrants it?
I do not think the situation is such that a general campaign should be embarked upon.
The same approach as usual?
Yes. I do not think, first of all, that there is any ground for panic. We have been immune so far. I am not going to say whether or not that immunity will continue because the situation here has changed, due to rapid transport and therefore we are more open to infection than we were ten years ago, but at the moment, as far as I can see, there is not any need to get panicky. There are measures we can take, should an outbreak occur in any area. I will say, however, that it would be prudent for any person going to an area in which there has been a recent outbreak to get vaccinated. It would be prudent, for instance, for any person going to certain parts of Britain or of the Continent to get vaccinated.
Would the Minister agree it would be prudent for people in this city, which may receive a number of visitors during the next few months, to see to the vaccination of their children?
Certainly. I agree with that.
Vote put and agreed to.