When I moved to report progress, I was referring to what I consider to be a very important announcement made by Deputy Donegan in the House this morning. It was important in so far as it seemed to indicate a radical change of policy on the part of Fine Gael towards the manner in which the health services are to be provided for those of our people who may require them. Until the Deputy spoke, I had been under the impression that the attitude of Fine Gael towards our health services remained what it had been heretofore. Indeed, I felt that attitude had been manifested by them in the course of the debate more strongly than ever, and particularly in the attitude which they adopted towards the proposals in the Budget.
In that connection, however, one must remember that, as I have said, Fine Gael have been from the outset, at least since 1946, opposed to the general approach of the Fianna Fáil Party and the Labour Party towards this problem of providing health services for our people. I indicated how they opposed the Health Bill of 1946, the Health Act of 1947 and the Health Act of 1953 and how they broke up the first Coalition because the then Minister for Health, Deputy Dr. Browne, their colleague, had decided to try to introduce a mother and child service.
As I said, that appeared to be the general approach of Fine Gael until just this morning. They appear to be still opposed to health services for the people, and to the extent that the individuals concerned are unable to meet the necessary outlay to the policy of providing them at the public expense. While clamouring for an extension of the service, they refuse, at the same time, to allow the Government to raise the necessary funds to meet the expenditure involved. That, of course, is a rather more subtle approach than that which they had adopted hitherto. In just the same way as they are clamouring for higher and more extensive health services, they have been clamouring for higher pensions, greater assistance for the farmers, more for civil servants, etc., etc. but they refuse to take the responsibility for financing their demands.
If Fine Gael had their way on 10th April last and last night, there would have been no money for any of these things which they advocated so vigorously yesterday afternoon and this morning. There would have been no money to meet the additional £1½ million which is to be expended on the maintenance, improvement and expansion of the health services this year, for they voted against imposing the taxes to provide the money.
Emphatically, I want to say that I do not think our health services in their present state of development are as extensive as they could be, if more money were made available for them; nor do I say that in some places and in regard to certain services reasonable ground for complaint may not be found. But in my experience complaints are becoming less frequent, less substantial and less well-founded. I am hopeful that the services as they exist will rapidly improve as experience is gained and the defects of organisation and procedure are remedied.
The important thing to remember in connection with the debate which took place this morning is that the 1953 Act broke new ground and the defects in its operation can be dealt with only as they manifest themselves in practice. We had no previous models to go on when we introduced the present extensive service. Much has been done to remedy these defects in most areas. The services, indeed, taken by and large, work smoothly.
Our biggest problem remains, that is how to deal with those who do not know their rights under the Act or who, knowing them, in an endeavour to secure something to which they are not entitled, try to evade the limitations imposed by the statute. I have no doubt that we shall solve that problem, perhaps, by imposing on all who administer institutions, functioning under the 1955 Act, the onus of proving that before a patient, who was entitled to hospital services under Section 15 of the Act, elected to avail of the private or semi-private accommodation available in the institution concerned, was informed as to what his precise obligations would be, if he did so. Under a proviso of this kind, the "chancer" would have no chance, and the innocent would be safeguarded against exploitation.
But let me assert again that the 1953 Act broke new ground. Indeed, that is, perhaps, an understatement. In fact, so far as the middle income group is concerned, the 1953 Act represented in its special purpose a social revolution. This may appear to those who are not aware of the facts a sweeping statement and hard to justify. Yet the truth is that before the 1953 Act, the State made no provision whatsoever to meet the special needs for hospital and nursing care of the middle class— perhaps lower middle and middlemiddle class — if one, in this classless society of ours, classless, that is, from a social point of view, may use such terms. Before the 1953 Act, the State was concerned to provide only for the medical needs of very much the lower economic strata in society. Outside that economic condition, only the most meagre, if indeed, any provision at all, was made for the needs of any individual who might be classified as otherwise than among the very poor.
If such provision were made at all before the 1953 Act, it was made only in respect of individuals who were compulsorily insured under the National Health Insurance Acts, and then only to a very limited extent. Outside this limited sector, no provision whatever was made for the special needs of those who were definitely outside the pauper zone. There was no provision made at all for the farmer, for the small shopkeeper, for those in the less well-paid grades of the State and local authority service or for the self-employed person.
The 1953 Act changed all that, so far as the hospital and specialist services are concerned. It gave to persons in all the classes I have mentioned the right, if they should so need, to be treated in hospital at the merest cost of maintenance, or where his economic circumstances justify it, even for less or much less than that, tapering down indeed to no charge whatsoever.
Before the 1953 Act, only persons in two special categories were entitled to the hospital and specialist services demanded by their physical condition. The first of these comprised persons who were literally paupers or only a few shillings per week removed from pauperdom. The second consisted of those who were engaged as employees, as wage-earners, in insurable occupations. Furthermore, while persons in the first category were entitled as of right to hospital and medical or surgical treatment for an indefinite period, for as long as their condition warranted it, persons in the seond category were not entitled to treatment free of charge for longer than six weeks.
Furthermore still, the right to hospital and medical or surgical treatment was confined to the insured individual itself. It did not extend to his wife or children. The position of the insured person and of all those who come within Section 15 of the 1953 Act is quite different. There is no statutory limitation under the Act on his stay in hospital. He is entitled to remain there until his medical advisers consider him well enough to go home. Next, not only is the insured person entitled to hospital and medical or surgical care, but if they should require it, his wife and children also are entitled to all this until they are fit and well again.
Apart from the development and expansion of the specialist services which has been made possible by the 1953 Act for everybody, this is the radical change which has been brought about by that Act. But again let me repeat that I regard the 1953 Act as having provided a foundation only. I think it is a sound foundation and one on which with confidence we may build.
I am hopeful that the Select Committee which the Dáil has appointed will accept that point of view; and that the recommendations which it will make for the further development of the services will secure the unanimous endorsement of the Oireachtas. If the deliberations of the Select Committee meet with this general acceptance, then this issue of the health services will be removed from the political arena.
Having disposed of the general position in regard to the health services, I should like to deal with some points relating to the administration of the code which were raised in the course of the debate. A matter to which many Deputies referred was the assessment of means and they complained there appeared to be a lack of uniformity not merely as between one administrative area and another but even as between one individual and another. On a number of occasions, I have indicated to the House that an apparent lack of uniformity or of consistency of treatment may arise. But let this be quite certain: nobody outside those dealing with his circumstances knows what the real circumstances of any particular applicant are.
The information is regarded as confidential. That is so because of the need to preserve a certain amount of privacy or secrecy in a matter of this sort. Deputy Kyne complained that the county manager would not make available to him certain information about holders of medical cards in some instances, or the circumstances of persons who had been refused medical cards in others. The position there is quite clear for reasons which arise out of the requirements of medical secrecy. Paragraph 2 4 (4) of the Medical Services (Amendment) Regulations, 1955, states:
A document which is obtained or compiled under these Regulations (or part or extract from such document) which contains the name of a patient shall not be published save with the consent in writing of the patient.
If Deputy Kyne had secured the consent of the persons about whom he was making the inquiry, and that consent had been expressed in writing, then perhaps the county manager, having been in a position to give him the information sought, might have done so. However, there is a certain difficulty even in that connection and it arises from the fact that the city or county manager is bound by a provision of the City and County Management Act of 1955 in relation to health functions concerning any particular person who has availed himself of a service.
This matter was raised in a query from a local authority which asked whether the regulation which I mentioned under the medical, services would apply to persons accepted for services. On legal advice, we indicated in a letter to the health authority concerned that to give the names of persons accepted for services under the Health Act would not be a proper procedure. Deputies will understand that there is justification for that decision in so far as if people, who were really in need of medical care, and were unable to provide it for themselves, knew that their circumstances might be made the subject of an examination, even by a member of a local authority, they might be deterred from applying at all and might deprive themselves of the service.
With regard to the assessment of means, as I have said, no one except the individual applicant concerned knows what his real circumstances are. Aftef full and careful investigation, it is for the home assistance officer to determine what they are. And sometimes, naturally, people are not too revealing about these matters, and do not treat the home assistance officer with the necessary candour. The home assistance officer may have other means than that of direct inquiry from the applicant, of ascertaining what his circumstances are likely to be.
