Dáil Éireann debate -
Thursday, 21 Mar 1963

Vol. 201 No. 2

Committee on Finance. - Vote 54—Health.

Minister for Health (Mr. MacEntee)

I move:

That a supplementary sum not exceeding £152,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1963, for the Salaries and Expenses of the Office of the Minister for Health (including Oifig an Ard-Cláraitheora), and certain Services administered by that Office, including Grants to Local Authorities and Miscellaneous Grants.

The main reason for this Supplementary Estimate is that an additional sum of £160,000 is required under subhead G for the Health Services Grant to health authorities. As the House is aware, the cost of the health services is borne 50/50 by the local authorities and the Exchequer. In consequence of the fact that the accounts furnished by the health authorities to my Department in the course of the year showed that the expenditure on health services will be £320,000 more than was originally estimated by them, it is necessary for the Dáil to vote a further sum of £160,000, being 50 per cent. of that £320,000 under this subhead.

The predominant cause of this increase is the continued impact of the eighth round of salary and wages increase on the finances of the Health Authorities. More than 80 per cent. of the additional provision can, in fact, be attributed to this cause. The only other major factor is the rising cost of medicines, both in the dispensary services and in hospitals.

The expenditure under subhead I is related directly to the expenditure of the voluntary agencies to which grants are paid. In the year 1962-63, the costs of these bodies increased, almost entirely as a result of increases in the remuneration of their staffs. This was particularly marked in the case of bodies conducting institutions and employing nursing and domestic staffs. It is, accordingly, necessary to seek additional provision of £1,800 to cover the increased grants to be paid from the subhead.

Deputies will recall that in the spring of 1962, outbreaks of smallpox occurred in England and Wales. I found it necessary to include in a Supplementary Estimate presented towards the end of the financial year 1961-62 a sum of £4,400 to cover the cost of additional supplies of vaccine in order that adequate safeguards against infection should be available in this country. The epidemic in Wales continued into the year 1962-63 and it was necessary to continue the additional purchases of vaccine. As a result, the provision of £1,500 included in the Estimate prepared before the outbreak in England and which was based on a normal year's requirements, has proved to be inadequate. An additional sum of £10,100 is required.

In introducing the Estimate for Health on 10th April last, I dealt with the question of the training and qualifications of health inspectors which is one of very considerable importance in relation to the prevention of danger to health from food and drink offered for sale and indicated that I intended to set up a training board to organise a suitable course for pupil health inspectors.

In October last, I set up such a Board; the members include persons holding senior positions in the medical, veterinary, educational and administrative services. As a result of the work of this Board, a course of training which will extend over four years commenced in January last, the theoretical instruction being provided by the Dublin Vocational Education Committee. The Vocational Education Committee have the services of a trained health inspector tutor who has undergone special training abroad, and practical training will be provided by assigning students to health authorities during the course of their training.

There are ten students, selected by the Health Inspectors Training Board, attending the course, and the provision which is now being requested is required to cover allowances to be paid to the students, the cost of the tutorial services and travelling and incidental expenses. The total of these costs for the current year is estimated at £1,110, and as the original Estimate contained only token provision of £10, the amount now required is £1,100.

The total of the additional provision required for the services to which I have referred is £173,000. Against this, it is possible to set a sum of £21,000 representing estimated savings on other subheads of the Vote. These savings, which are very small relative to the total Vote, arise under a number of headings, the largest single item being a saving of £10,000 in the provision for the salaries of officers of my Department due to the existence of vacancies in certain posts.

The net amount of the Supplementary Estimate is, accordingly, £152,000.

I recommend the Estimate to the House.

Mr. Dillon

We have no objection to this Supplementary Estimate but it seems necessary to draw the attention of the Minister and the Government to the fact that the growing burden on the rates indicated by the excess of £160,000 provided here for grants to health authorities, implying an increased burden on the health authorities concerned, is becoming a growing hardship for the people, particularly of rural Ireland. It is a really desperate situation when in a county like Mayo, people in towns and villages, in the houses and shops, are being called upon to meet a rate in excess of £3 in the £.

That situation continues to grow worse with the passage of each year and there seems to be no end to it. The House has too readily forgotten that last year, as a result of energetic representations by the agricultural community, a sum of £2½ million was provided to mitigate the impact of these rate increases on agricultural land. Since that was done, two things have happened—rates have increased by something in excess of the grant-inaid made last year but too many people forget that private residents and business people in the towns and cities got no relief so that they have to meet not only the increase which was mitigated to the agricultural community last year but the additional increase which is falling on them now, and for the small shopkeeper the burden is well-nigh insupportable.

The young married couple who built themselves a bungalow or house and for some years enjoyed the statutory remission of rates, now discover, if their valuation is about £20, that they are faced with a rent in perpetuity of anything from £56 to £60. That is a matter to which the Government must turn their mind and realise that while grants of 50 per cent provided for under the Health Services (Financial Provisions) Act, 1947, offer some relief, there is also a current indication of the growing burden which relatively poor people have to meet in order to keep a roof over their heads. I do not think the Minister told us what are the voluntary agencies referred to under Subhead I.

Mr. MacEntee

Agencies really concerned with foundling babies.

Mr. Dillon

They are voluntary bodies?

Mr. MacEntee

Yes.

Mr. Dillon

Most of these voluntary bodies are doing very valuable work and I am certain the House will cordially approve of such assistance as we are able to give them, on the assumption, which I believe is well founded, that their work is very valuable and is regularly inspected by the Department to ensure that it effects what in fact they are set up to do. Nobody will complain about the precautionary purchase of supplementary supplies of vaccine lymph consequent on the epidemic in Wales now happily passed.

I do not know the merits of the training scheme for health inspectors and therefore it is a matter on which I am not prepared to express an opinion. Subject to those observations, we have no objection to the passage of this Health Estimate.

Mr. Norton

I do not want to develop these views to any great extent but to those who see the Health Act administration, it is quite clear that complaints of a widespread character exist at certain points in connection with that scheme. One is the charge for persons who have to undergo hospital treatment; another is the condition, or perhaps means test would be a better description, governing the issue of medical cards. The third point of friction is the absence of free choice of general practitioner for the person who requires medical attention. It was because of complaints under these headings that the Dáil in its wisdom, decided to set up a Committee to examine the whole structure of the Health Act. It was also charged with the responsibility of making a report on the matter to the Minister and the House.

Most of us had hoped that the Committee would be able to discharge its duties in a shorter period than it has taken and it is now very clear from the recent discussion on the Second Interim Report from the Committee, that it will be some time before we get the Committee's final report. Responsibility in this matter is not entirely in the Minister's hands and, in fact, not even substantially in his hands. If the House is to do anything to remedy the existing defects in the Act, it must get a relatively early report from the Committee; otherwise it will fall to some other Parliament to apply the necessary rectifications to the 1953 Act. Could the Minister at this stage give us any estimate as to when we are likely to get a report from the Committee, and if he can, could he say when it is likely that it will be possible to introduce amending legislation, on the assumption that legislation is recommended by the Committee?

Sir Anthony Esmonde

When introducing this Supplementary Estimate, the Minister said that the greater part of the increase was due to the eighth round of wage increases. That would seem to indicate that the administrative costs are unduly high in relation to the health services. It poses the question: Are we getting value from the health services, which are lauded to the skies by so many members of the Dáil, if 80 per cent. of the Supplementary Estimate, which imposes £160,000 on the ratepayers, and likewise £160,000 on Central Government, is due entirely to administrative expenses? I take it that by administrative expenses, the Minister means wages payable to State employees and local authority employees in relation to their administration of the health services. It seems to be a hardy annual to have considerable increases in the money necessary to administer this Act. I do not think anyone can feel satisfied that the country is getting value from the Health Act as administered at present. One cannot attribute the blame to the Minister or his officials; it is entirely due to the fact that this Health Act is quite unsuited to the country.

It poses the question to Deputies who are not on this Committee, which has been sitting for a considerable time, whether they are likely soon to reach some conclusion which may be of benefit to the country as a whole, to those who are in receipt of benefits under the Health Act, or can any hope be held out that there will be an easier and more facile administration of that Act. The £160,000, plus the money already spent this year and which is likely to be spent in the future, is largely responsible for the very large increase in rates imposed in practically every administrative centre in Ireland. Practically every county manager who comes to strike a rate has the same story to tell: "This is for the health services." It means that we must take a serious look at the situation. It will be necessary for the Minister and his officials to review the health services and to see that money which has to be spent on administering the existing Act is spent to good purpose. I should like the Minister to clarify the statement he made that 80 per cent of these costs are due to administrative costs.

Mr. MacEntee

I did not say that; I said, to the impact of the eighth round on wages and salaries.

Sir Anthony Esmonde

Well, now——

Mr. MacEntee

The nuance is slightly different.

Sir Anthony Esmonde

There may be a slight difference of words but the meaning is the same—those who are paid as State servants and local officials to administer the Act. Perhaps the Minister would clarify exactly what officials are involved and what their work actually is and their relation to the Health Act itself? The country is entitled to know that and so are the ratepayers and taxpayers, as well as the beneficiaries of the health services. The Minister may think that I am adversely criticising him.

Mr. MacEntee

No.

Sir Anthony Esmonde

I have always expressed sympathy in this House for the Minister for Health who has to administer an Act which cannot be administered, which, in my opinion, is unsuited to our conditions, and which is not giving us the benefits which we were promised in flowery terms when the Act was introduced, in the long debates during 1951 and 1952. It would be a good thing if the Minister could soon be in a position to give some indication that we may expect some sort of administration which will meet modern conditions and which will be suitable to all those concerned.

Another matter is the question of the vaccine lymph supply. We understand that there was a serious threat to the country, and indeed to Europe, in an outbreak of a virulent type of smallpox which was due to the fact that there is greater intercourse now with countries which have not got established health or sanitary services. This type of disease is gradually forcing its way into Europe. I am glad to say that we did not have any cases in this country and it appears that cases were dealt with very effectively across-channel. I believe the Minister and his Department had full liaison with the authorities concerned there and nothing was allowed to come in which in any way could create the possibility of the disease starting here.

Perhaps the Minister would indicate the percentage of people who were vaccinated during the crisis period. If he has not got the figures—I see him shaking his head—perhaps he would give us some idea of what the rate was because it is quite conceivable that we may be faced with a parallel situation at any time in the future, in view of the contacts that exist between the East and Africa, and Europe. I presume that the lymph in the Estimate was that used for vaccination by the health authorities and not that used for ordinary people, which was bought and paid for at ordinary commercial rates. Perhaps the Minister could indicate whether we have succeeded in building up the protection that has become necessary nowadays, and which had ceased to exist, to ensure that the public have full protection against the risk of this disease which was one of the greatest killers, and indeed one of the greatest causes of disfigurement, a century or so ago.

The provision, small as it is, for voluntary organisations is eminently desirable. These organisations collect private funds and are run by devoted people who work long hours and often do not get a very big return. I think the House will generally welcome any subvention the State may give to help such people. What I am wondering is whether the sum is large enough. I suppose it is only a small percentage of the entire sum that is paid throughout the year. Subject to those few remarks, I am perfectly happy to accept the Estimate.

Mr. Sherwin

I have only a few comments to make. During the discussion on the pay pause, one of the arguments used was the danger that might arise as a result of our goods not being sufficiently competitive. Now we are told there are grounds for further fear because of increased rates. That fact should have been quite obvious to all of us. Rates have increased by 80 per cent, due to wage increases generally. I take advantage of this Estimate to raise two other matters. When a man's income is being assessed under the Health Act, he may be earning only £12 or £13 a week as a tradesman, but may be compelled to pay £1 a day for hospital treatment, £3 for each X-ray and the top figure for specialist services, on the ground that his income, with that of two or three of his children is over the £800 mark.

It would appear that if a man has £12 or £13 a week and three or four daughters earn £3 or £4 each a week, his income is taken to be over £800. The unfairness here is that whereas the first £2 of each daughter's wages is not counted, the assumption is that anything over £2 goes to help her father to pay for his illness. That is not fair. A girl with £4 a week hands up £2 or £2 5s. at most and the rest of her money goes to pay clothing checks. Women get trading checks for, say, £30 at Christmas and they pay it back at the rate of 15/- a week. Girls in a family have to buy their cosmetics and when they go to one or two dances a week, they have not a "deuce" left on Monday. The Minister does not appear to know that.

Mr. Norton

Not at all.

Mr. Sherwin

He assumes that the daughter will hand over her buckshee couple of quid towards her father's illness. Be fair about it. The girls eat something—let us say, they eat £2 worth each week. The other £2 they have left is handed out for their hairdo's, their lipstick and their clothing. Women must clothe themselves. They are out to catch men and so they must clothe themselves. A man need only get a suit every two or three years but the women have to have their clothes. Their high heels fall down every fortnight. All this means that women with £4 or £5 a week have not a "deuce" on Monday. The Minister thinks they have nothing to do but hand their mothers a couple of pounds and hand the rest to their fathers, when they get ill, to pay the hospital bills. When assessing the family income under the Health Act, the incomes of such girls should not be taken into account until they have at least £4 a week each.

Mr. Norton

Is the person the Deputy refers to an insured person?

Mr. Sherwin

I do not know, but assessing the income on children's wages above £2 a week is nonsense.

Mr. Norton

If the father is an insured person, he could not be charged more than 10/-.

Mr. Sherwin

Some people are unfortunate in not having insurance and they are boned completely if they fall ill.

The other matter I wished to refer to is the problem of disabled people. I brought it to the Minister's notice last year that disabled people had only 22/6 a week, whereas they should be treated in the same manner as noncontributory old age pensioners or blind people who are in receipt of 32/6 a week. I conclude that the reason for the difference is that the disabled people come under the Health Act and that it is because of that that they are forgotten. They should have got the same increases as the other categories I mentioned but they have not had an increase in six years. I am now asking the Minister to keep it in mind because if he does not, I shall avail of every opportunity to bring it to his attention.

Mr. P. Hogan

(South Tipperary): I want to advert to one small aspect of this matter, that is, the question of financing the health services. We know that 50 per cent. comes from the rates and I suppose it is true to say that in our rural community 80 per cent. of the rates are paid directly or indirectly by the farming community. If you consider any small town or village, you will find that the people in them, be they publicans or grocers, derive their incomes largely through the welfare of the farming community. Leaving out the larger towns where there are people with big salaries and wage packets, that is the position.

That being so, let us look at the picture of farming incomes over the past ten years. In 1953, the total farming income was, speaking from memory, £107 million. That was the total profit in respect of farmers and their families. The last available figure was £117 million, which indicates an almost static income. However, during that period, rates in general, and in particular in respect of health charges, have mounted considerably. That is the main point I wish to advert to. It seems to me that the rating system as a fiscal means of payment of health charges is becoming more and more inequitable and must inevitably break down. Some other means of financing the health services instead of rates or in conjunction with rates will have to be considered.

I think Deputy Sherwin was ráiméising a bit. He often speaks ráiméis. He made a plea in respect of hospital charges. In connection with health services in this country, the average amount of money received is less than fourpence a day for everybody in all classes, lower, middle and higher. In my constituency in South Tipperary, 90 per cent of people who are treated in public institutions pay not one brass farthing.

I rose to point to the increasing injustice of the health services as they affect the whole community and particularly as they affect the individual farmers. In my constituency, our two main expenses on the rates—apart from roads, of course—would be health and gravitation of water supply schemes. Some people, because their valuation is over £50, can never benefit by any hospital or domiciliary health services. Some of these people are also so situated geographically that they will never get a water supply. Yet, these costs are mounting every year, particularly the water supplies. Here again, there is a gross injustice not alone to the farming community in general but as between one group of farmers and another.

Mr. Carter

As a member of the Health Committee which was set up to study this problem, I want to make one or two brief remarks. I disagree with my colleagues opposite who say the Health Act is not working. It is working reasonably well and, because of that, people are inclined to demand too much.

Medical cards have been mentioned as well as many other matters on which I do not intend to dwell at the moment. Fault was found with the method of financing the health scheme. That was a big problem. Fault was found with the scheme of block grants allocated to local authorities. What is this House to do about that problem? That is a problem applicable not merely to this country but to other countries: it is a very pressing problem in Britain.

If you take away the power of payment from local authorities you also take away power of administration from them. Do those who suggest the health services should be wholly a national charge also suggest we should back up that by administration and take away all authority from, so to speak, the local health committees and invest the power in this House?

The Department of Health worked very well and very cautiously during the year to prevent any imported disease. The measures taken by the Department in regard to the smallpox outbreak in Britain and outbreaks of other infectious diseases were timely and adequate. We hear a good deal of criticism about the Health Act but in the same breath we usually hear a demand for more services. If people demand services under any Act they must realise that the services must be paid for at some level.

As far as I can see, the motive of the Opposition is that if the services are not paid for at local level they must be paid for at central level. What does it mean? It means that either you transfer the obligation from the local authority to the central administration or vice versa. In the end, it amounts to the same thing. In Britain, they nationalised their health services and they had great trouble in administering them.

The cost of drugs and medicines has been mentioned. The British had to impose a charge and a second charge where drugs were steeply rising in cost and where the authorities thought there was excessive use of drugs, excessive recourse to demand for drugs and a good deal of wastage. We must consider the wisest method in the long run of administering the health services. If we want to curtail the cost we must also curtail our desire to make demands which would have the effect of increasing costs.

Mr. MacEntee

Deputy Dillon, quite properly, I think, called attention to the increasing burden of the Health Act falling upon ratepayers. Everyone must be concerned that the health services are costing so much not merely to the ratepayers but also to the taxpayers. We are hit from the right and from the left. When we complain of the rising cost of the public services we must ask ourselves which of the services we are prepared to do without.

It is true that there has been a substantial increase in the rates and in the taxes but, as Deputy Dillon and every member of the House knows, the increase in the rates has not been due solely to the health services. There have been increases in the rates arising out of the housing programmes of the local authorities, the road programmes of the local authorities, and the vocational education programmes of the local authorities. All these services are responsible for the increases in the rates. It is, I think, taking a rather lopsided view to try to put the full responsibility for the increases upon the health services.

What Deputy wants to restrict or limit the health services further? I do not see anybody putting down a Parliamentary Question asking me if I will reduce the expenditure on the dental services, on the ophthalmic services, and so on. On the contrary, the only questions put down to me are questions urging me to expand the health services, to provide more and better health services and, of course, more expensive health services.

I am glad, as Minister for Health, the House takes a very keen interest in these matters. However, I think I am entitled to remonstrate with those who ask for bigger, better and more expensive health services and at the same time complain when the cost of these services rises.

Deputy Esmonde deplored the fact that I had to bring in an Estimate asking the House to provide £160,000— just half of the increase in the cost of the service over what had been estimated for it. Not merely did he deplore that but he ascribed all of it to administrative expenses. The Deputy was not correct. He not merely ascribed the whole of it to administrative expenses but also blamed the local authorities and held them responsible for the whole of it as well.

The truth is very different. The greater part of this £320,000 is represented not by increases in remuneration of the administrative officers engaged in the health services —it does not go to those who administer the Acts—but of those who operate the services, the dispensary doctors, the hospital staffs, the nurses. We have increased the salaries for their patients. It was very unfair of Deputy Esmonde, who is generally very fair and balanced in his criticism, to distort the picture in that way.

We have substantially increased the salaries of dispensary doctors. We have increased the salaries of the nurses. We have increased the salaries of all those engaged in the mental hospitals and, of course, we have increased the salaries of the professional men attached to these institutions. We could not have done less. Quite frankly, I would like to have been able to do more but if I had done more in order that I might, as somebody said today, be able to make good any deficiencies that exist in the personnel of these organisations, look what the cost would have gone up to. The rates would have gone up and taxes would have gone up as well. The fact is we must have regard to our economic circumstances, strike a balance between what we would like to have and what we think our people can afford to pay for, and what they can afford to pay for will, unfortunately, always fall very far short of what we would like to have.

Another point which Deputy Esmonde made, which, again, was incorrect, was that he ascribed the whole of the increase to the rise in the cost of the local authority institutions and the local authority services. That, of course, is not so, not as far as Dublin is concerned and, to some extent, not as far as Cork is concerned. The fact is that a very large part of the expenditure on health services in the city of Dublin goes to defray some part of the cost of the voluntary general hospitals and, in so far as Dublin is concerned, a very great part of this £160,000 is represented by the increase in salaries of those who are engaged in the nursing profession in the hospitals.

Does anybody want to reduce that? If you complain about this increase in expenditure, surely it is logical to assume that you want to decrease the salaries of the nursing staffs in the hospitals or that you want to reduce the amount of capitation grants which are paid to certain members of the staffs of these hospitals? I do not say Deputy Esmonde wants to do that but I say it is the logical conclusion which one must draw when a complaint such as he has made here today is uttered. I know he does not want to do that; neither do we. On the contrary, we have been trying to make the nursing profession more attractive to our young women. The newspapers are flooded every day with advertisements painting in glowing terms the attractions of the nursing profession in Great Britain. We are in competition with that sort of thing and because we are in such competition and wish to see that our institutions are properly staffed, we must, to the extent to which we think our people can afford it— that must, of course, be the final arbiter in these matters—improve the conditions of those who are engaged in providing the health services. If we jib at doing that we must ask ourselves do we want to reduce the standard of these services because that is the only way in which we can possibly economise in relation to them.

Deputy Esmonde also asked for some information which I should like to give him. In regard to smallpox vaccinations there were 8,280 in 1960, 10,700 in 1961 and 305,000 in 1962. Therefore, the experience in Great Britain has provoked a salutary reaction here. May I say, in passing, that this problem of infectious diseases which for a great many years was almost a negligible one will probably increase in gravity and cause whoever happens to be in charge of health a great many headaches in the future?

Mr. Dillon

The Minister, I presume, refers to more rapid travel.

Mr. MacEntee

Yes, more rapid travel and sometimes the prejudice which has grown up in some quarters against such preventive measures as vaccination. I gave some figures to Deputy Dr. Browne which will appear in the Official Report in due course indicating the rather apathetic approach which our people have made to the need for protecting themselves and their children against polio. The figures are very disappointing to me. There was no charge made in general for these services. The vast majority of people did not have to pay but, unfortunately, the vast majority of them who ought to have done so did not avail themselves of this service. It only indicates that this problem of infectious diseases is likely to become a graver one than it has been in the past. Deputy Norton raised three matters on which he wished to have some information——

Mr. Norton

The Report of the Committee.

Mr. MacEntee

——charges for hospitalisation, the means test for medical cards and free choice of doctor. All these matters have been actively considered by the Select Committee.

Mr. Dillon

And by the Fine Gael Party.

Mr. MacEntee

By the Select Committee and by the Fine Gael Party. I do not want to become too controversial when I have to refer to these matters because the Committee represents all Parties in the House. I am not, I suppose, divulging any secret if I say we do not see identically eye to eye about everything but it is a fact that there is not one of these things which people want, relaxation of the means test, the abolition of charges for hospitalisation and free choice of doctor, which would not involve us in substantially greater expenditure which would have to be faced from the point of view not only of the taxpayers with whom this House is immediately concerned, but also the ratepayers with whom it is indirectly concerned.

The Select Committee have undertaken an enormous task. If I had visualised what would be involved for the members of the Committee, I would certainly have hesitated before I asked the House to charge any section of its membership with so grave a task. An enormous amount of research has been carried out on the services. The members of the Committee have devoted a great deal of study to them. I do not think there is any other committee of which I have had experience —and I have had experience of some —that worked with greater zeal, energy and enthusiasm. The Committee have, in fact, been meeting regularly. In the early stages, we met every week. Sometimes we sat twice on the one day, and on one occasion there were three sessions on the one day.

This has meant a great deal of study and discussion. We have had fairly detailed examination of witnesses who have appeared before us. I want to say in regard to this work, which is really supernumerary to the work which is done in the Chamber, that while it is no harm to try to spur us on, Deputies are really spurring a willing horse. I do not think the Committee should be expected to produce a report as though it were a case of drawing out of a hat rabbits which you had put into it. The members of the Committee have approached their task in a very objective way. Those of us who may have started with certain misconceptions find that our minds are becoming more flexible as a result of the discussions that have taken place, the submissions which have been made to us, and the evidence which was put before us. Therefore, I would ask Deputy Norton not to be too impatient with us. I can say quite sincerely that we are doing our best to produce a report in the shortest possible time.

In his criticisms, I think Deputy Sherwin—at the beginning, at any rate —rather over-simplified the situation until Deputy Norton corrected him, and pointed out that so far as hospital charges are concerned, if the patient is an insured person and particularly if he is a manual worker the question of income does not arise. With regard to the question of hospital charges falling upon those who might be described as the middle income group, the fact of the matter is, that despite what Deputy Sherwin said, if you have three members of a household earning, there is a limit on the income of £1,100 a year. After all, having regard to the fact that very few families have a permanent invalid, and that it is very rare for the majority of a family to have to avail of hospital services, I think it is reasonable that a household with an income of £1,100 should be required to pay something when they go into an institution. If there is any question of hardship involved, they can avail of the hardship clause. If they can satisfy the persons who are administratively responsible that, in fact, hardship does exist, they have the benefit of Section 15.

In regard to the disabled persons' allowances, there is, to some extent, an anomaly in the Health Acts. My personal conviction, which is becoming stronger every day, is that the Minister for Health should not have responsibility for this matter at all, that it should relate to another code, but it is there and we administer it. It is there because, when the Health Act was going through, there was no other Act, and a special Bill would have had to be introduced to deal with that problem. Make no mistake about it: it was a problem which had been long neglected, but there was no other ready, convenient means of dealing with it than to have that clause inserted in the 1953 Health Act.

Originally, the allowance was administered by the health authorities, and it was never intended to be a subsistence allowance. It was a subvention payable to a disabled member of a family, but the members of the family were expected to try to look after him or her, as the case might be, to the best of their ability. The disabled person's allowance was merely a subvention to provide him with greater comforts. The original maximum payable by the health authority was 20/- a week. It was subsequently raised to 22/6 and later to 25/-, so Deputy Sherwin was not strictly correct when he suggested that there had been no improvement in these grants. I think that is all I have to say and I am sure the House is very anxious to hear the Minister for Agriculture.

Mr. Dillon

The Minister has to deal with Vote 55.

Mr. MacEntee

It is a minor Estimate.

Mr. Dillon

I want to ask a question on it.

Vote put and agreed to.