Committee on Finance. - Health and Mental Treatment (Amendment) Bill, 1965: Report and Final Stages.

Question: "That the Bill be received for final consideration" put and agreed to.
Question proposed: "That the Bill do now pass".

(Cavan): The Bill which is now about to pass merely proposes to enlarge the definition of what is commonly known as the middle income group. Heretofore a person whose income exceeded £800 ceased to be in the middle income group. That ceiling will now be increased to £1,200. A farmer whose poor law valuation exceeded £50 heretofore ceased to be entitled to the benefits, such as they were, which were enjoyed by the middle income group. That poor law valuation is now being increased to £60. So far as the Bill enlarges the definition of the middle income group, we approve of it. As I said on Second Stage, however, the Minister freely admits that the Bill does nothing to relieve the great injustices and great hardship imposed on sick people, those who need medical attention, hospitalisation and surgical attention. The Minister, I understand, freely admits that illness imposes great hardship in this country and that the State so far has done nothing to relieve that hardship. This Bill certainly does nothing and is a grave disappointment in that respect.

For several years past, there has been a cry in the country for a proper health service. The Government have been called on to provide such a service. On the assembly of the 17th Dáil, the Government were confronted with a demand for the replacement of the Health Act of 1953. They did not really seek to defend the Health Act of 1953 but, instead of replacing that Health Act, they set up a committee to advise the Minister. That was at the end of 1961. Through the period from the end of 1961 to 1964 this country experienced the farce of that committee being obstructed by the then Minister for Health. He used it as an implement of obstruction, as a method of shirking his responsibilities, as a method of saving the face of the Government which had fallen down on the health services.

Mr. O'Malley

Of course, all these statements are grossly untrue and unfair.

(Cavan): The Minister will have an opportunity of denying them.

I should like to intervene to say that only what is in the Bill may be discussed on the Final Stage.

(Cavan): I intend to conclude very shortly but I am making the case that what is in the Bill is not very much and that a great deal more is required. That was the position during the term of the Seventeenth Dáil. In this Eighteenth Dáil we have a new Minister for Health. He admits very frankly, as I understand it, that there is a great deal to be desired in the health services but what does he promise us? —not a Bill to improve matters but a White Paper.

I conclude by asking the Minister when does he intend to tackle the problem? When does he intend to do something concrete? When does he intend to give the people the health service which they so badly need?

I should like to discuss a matter that is in the Bill and to record the fact that the Fine Gael Party found itself in a very difficult situation in that, for once, the excellent Rules of the House seemed to militate against our putting forward amendments seeking to include in the middle income group persons of a higher poor law valuation than £60. These amendments were ruled out of order because they would have imposed a charge on the Exchequer. That places us in the position that all we can do is talk about that situation and make it clear that we do not agree with the limits imposed by the Minister and the Government in this Bill.

The poor law valuation is used under this Bill as a measuring rod to decide who shall get the benefits applicable to the middle income group as operated under the 1953 Health Act. We regard the use of the poor law valuation as unsatisfactory because the poor law valuation varies widely throughout the country and many factors affect it, such as whether or not a person owns a lot of buildings, which could be old and decrepit; whether the premises were rented from a very unjust landlord in days gone by or whether they were rented from a very fair landlord. All these factors tend to change the circumstances in individual cases.

We want to register the fact that we believe that a valuation of £60 has no direct relationship to an income of £1,200 a year. Even though the poor law valuation is a bad guide to adopt in this matter because of the variation throughout the country, in no case would one find a farmer with a valuation of £60 who had an income of £1,200 a year. In most cases one would find that such a farmer had a much lower income.

It is very hurtful to us to be placed in the position that we can do nothing about this matter except talk about it. We do want to make it clear that what we desire is a proper health scheme financed by insurance contribution or voluntary contribution and which would give the beneficiary a far better service and make him the customer. According to the old saying, the customer is always right. We want a scheme which would make the beneficiary the person who was on top in this matter. In the meantime, while the Minister wants to improve slightly the existing system, we go along with him, but we do want to say that his method is not our method of doing it.

I want on behalf of the Labour Party to say that we are in agreement with this limited amendment of the Health Act because we are in agreement with anything that will tend to bring health legislation to the stage that we desire, where it will provide a free for all health scheme.

The Labour Party did not table any amendments to this Bill for the simple reason that they realised that such amendments as they would have proposed would have suffered the same fate as the Fine Gael amendments because they would impose a charge on the Exchequer. It is practically impossible for an Opposition to introduce an amendment that would be accepted because of the Rules of the House. We felt it was pointless to agitate and to indicate all the changes that we desire in the Health Act in the debates on this Bill. We have stated during the course of the Bill that the aim of the Labour Party is to have a free for all health service on a contributory basis.

The fact that the Fine Gael Party now agree with that represents a conversion, not of Fianna Fáil to a Fine Gael policy, but of Fine Gael to a Labour Party policy. Please God, I shall live to see such a scheme introduced in this House with the help of a Fianna Fáil Minister.

Whatever support the Government may need for the introduction of such a scheme, be it in connection with the financing of the scheme or any other aspect, providing we are satisfied that the necessary funds will be collected in proper proportion to the ability of the people to pay, we will certainly give that support, as we support this Bill.

Mr. O'Malley

I gave an undertaking on the last occasion when this matter was before the House that I would deal with the eligibility for general medical services of persons in receipt of non-contributory old age and widows' pensions. I have today sent out the following circular to every health authority in the country and every member of a health authority will get a copy. It reads:

I am directed by the Minister for Health to refer to previous communications from this Department directing attention to the fact that non-contributory old age and widows' pensions are granted on the grounds,inter alia, that the pensioners are regarded as necessitous on the basis of standards laid down, as a matter of public policy, by the Oireachtas, and suggesting that recipients of non-contributory old age pensions and their spouses and recipients of widows' non-contributory pensions should automatically, on application, be regarded as entitled to services under section 14 of the Health Act, 1953.

These recommendations were endorsed during the debate in Dáil Éireann early this month, on the Committee Stage of the Health and Mental Treatment (Amendment) Bill, 1965.

The Minister intends to deal fully with the matter in the proposed White Paper on the Health Services which, it is expected, will be published shortly. In the meantime, he notes that Managers of Health Authorities, at a meeting with officials of the Department held on the 20th October, 1965, agreed that applications for medical cards from recipients of non-contributory old age or widows' pensions would receive special and sympathetic consideration and if, in a period commencing on that date, in the case of any such application it was felt that the circumstances did not warrant the issue of a card, particulars of it (without specifying names) would be reported to the Department. No such particulars have since been notified to the Department and I am to request you to confirm that, in the interim, all such applications have been granted, and further, to indicate the numbers of such applications refused in the period commencing the beginning of the present financial year and ending on the 19th October last.

Additional copies of this circular are enclosed and the Minister requests that a copy be furnished to each member of the health authority.

I suppose there is no point going over all the ground again but there are one or two things I feel I should cover. As far as I could gather Deputy Donegan seemed to think a valuation of £60 bears no relation to an income of £1,200. He did not specify what the valuation should be raised to, whether it was to £75 or some such higher figure.

We had an amendment down for that figure.

Mr. O'Malley

I think the amendment was on different lines. However, be that as it may, Deputy Fitzpatrick criticised the fact that I was bringing out a White Paper and not bringing in an Act. Fine Gael cannot have it both ways. They are objecting, I understand, to a trade agreement being signed— it has just been signed I imagine in Great Britain—between this country and Great Britain until the Dáil has an opportunity of discussing the terms.

(Cavan): That is a nasty comparison. We can discuss the Minister's Bill, we can try to amend it but we cannot discuss a fait accompli in the form of a trade agreement.

Mr. O'Malley

That is my point. The White Paper is not being introduced as afait accompli in the form of an Act.

Even the Minister cannot present us with an Act. It has to be a Bill.

It will keep the poor unfortunate people paying bills.

Mr. O'Malley

The White Paper will spell out exactly what the intended programme of the Government is in regard to health.

(Cavan): When is the Minister going to implement it?

Mr. O'Malley

I think when the Members of the House and the public read this White Paper they will appreciate that the Government have tackled the problem in a realistic and responsible way. It will not be a document, I can assure the House, which will in any way tend to put off or postpone reforms which are so badly needed. Deputy Fitzpatrick held up the Select Committee on the Health Services to derision and suggested that my illustrious predecessor, Deputy Seán MacEntee, was engaging in obstructionist tactics and delaying tactics.

(Cavan): A leading person in the Minister's Party platform wanted his removal from office.

Mr. O'Malley

That is not true either. I will say this, without any fear of contradiction. When I was preparing the White Paper, for submission to the Government, the points made and the evidence submitted, both oral and written by various organisations, bodies and individuals, throughout the country, who appeared before that committee, or submitted their views in writing to it, were invaluable to me.

It took five years for a White Paper.

Was the purpose of the Committee to enable a White Paper to be prepared?

Mr. O'Malley

Deputy O'Higgins does not understand the point I am making. I am not defending anyone.

I misunderstood the Minister there.

Mr. O'Malley

The point I am making, in so far as I am concerned, is that, in preparing my White Paper for submission to the Government, the ground work and information gleaned from submissions made to the Select Committee have been invaluable to me.

(Cavan): Surely the work done there should have enabled the Minister to draft a Bill for introduction here?

Mr. O'Malley

Deputy Fitzpatrick has a lot to learn about the situation in respect of the health services and the improvements which are necessary.

(Cavan): We meet them every day in the week.

Mr. O'Malley

This entire matter of the health services is such a complex matter that no single Act would ensure that my full hopes in respect of them would be realised.

Could I ask the Minister a question?

Mr. O'Malley

Yes.

If people had known in 1961, that a Select Committee, on which I sat, Deputy Kyne sat and the Minister sat, would sit for five years and then a new Minister for Health would produce a White Paper, would they have been satisfied?

Mr. O'Malley

I do not want to say this to the Deputy in any hurtful way but that is a stupid, rhetorical question. The implication is that a Minister for Health would be so sadistic that he would set up a body which would examine and take evidence for the sole purpose of delaying the implementation of better health services.

That is what he did.

Mr. O'Malley

Could anyone concede that such stupidity could exist or that anyone would have a mentality of that type?

Deputy MacEntee is exactly that type.

Mr. O'Malley

I can say this. If I ever do half as much work in the Department in such a constructive way as my predecessor did I will, I feel, have achieved much. I know the people on the other side do not see it that way. After eight months of first-hand information I feel he carried out his duties in a most exemplary manner. I do not like saying that because it sounds presumptuous but I would like to place it on the record of the House.

Finally, this measure is a further advance on the many improvements in health legislation enacted by this Government down the years. Every great measure in improving the health services of the country was introduced by Fianna Fáil Governments. The Health Act of 1947, the Health Act of 1953 and the various other minor, amending or improving Acts down the years, have, in the main, emanated from this Party. While, in this instance, we have not put in other measures which might have been desirable, I have pointed out that the White Paper will follow. It was thought more appropriate that they would be published in the White Paper. This Bill and the White Paper will represent a tremendous leap forward. In the ordinary course of events, where account would be taken of a drop in the value of money, the increase would have been from £800 to £1,000. Instead we have gone as far as £1,200 so we have gone beyond the usual category. I hope there will be no undue delay in publication of the White Paper and the House will have an opportunity of a further comprehensive discussion on the health services.

Question put and agreed to.