I move:
That a sum not exceeding £17,337,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1967, for the Salaries and Expenses of the Office of the Minister for Health (including Oifig an Ard-Chlaraitheora), and certain services administered by that Office, including Grants to Local Authorities, miscellaneous Grants and a Grant-in-Aid.
I should first like to thank the House for facilitating me in arranging to take together the Supplementary Estimate for Health for this year, the main Estimates for Health and for the Central Mental Hospital for the coming year and the motion on the White Paper on the Health Services and Their Further Development.
When speaking in the House in November on the motion put down by Labour Deputies in relation to the services, I indicated that an opportunity would be given for a discussion in the House on the White Paper proposals and I have thought that, to avoid duplicate debates on health policy this year, this discussion should be combined with the normal one on the Estimates. I am appreciative of the House's acceptance of this suggestion.
In previous years, the Minister for Health has commenced his introductory statement on his Department's Estimates by giving statistics in relation to births, deaths and marriages and the incidence of various diseases, and then has commented in some detail on developments in the various health services during the year which he was reviewing. I do not today intend to follow that precedent as I think that, with the White Paper before the House, Deputies will be more interested in the future than in the past, so it is mainly to the future of the health services that I will direct my remarks.
Statistical material such as was formerly given in the Minister's opening statement and information on hospitals construction projects have, however, been circulated in a statement to Deputies. I hope they will find this useful. One cannot sensibly discuss the future of the health services, of course, without referring to their past and, as I comment on the White Paper, my remarks will include some references to developments in the services during the past year.
The White Paper on the health services and their further development was laid before the House on 19th January last. As indicated in the introduction to it, the Government wish that the various proposals in the different parts of the White Paper should be the subject of wide public discussion before any final decisions are taken on their detailed development. Therefore, in opening my remarks, I think I should stress that the Government are not committed to all the details of what is in the White Paper. It represents what, in general, the Government consider to be the proper lines for the future planning of the health services, but we are quite prepared to consider modifications if, when we have heard the views of interested parties and have held consultations, these seem necessary. I expect that the process of consultation on the various proposals in the White Paper will be complicated and fairly lengthy and it will be a fitting prelude to these discussions to have this debate in the House. I am confident that at the end of the debate, the House will give its general approval to the proposals in the White Paper and that the debate will be of great benefit to the Government in the further development of their policy.
When speaking on 1st June last on the Estimate for Health for the current financial year, I told the House that I was undertaking a general review of the health services. In this review, I went back over the history of the development of the services and surveyed their general pattern, relying for this, to a great extent, on the documents which had been prepared for the Select Committee on the Health Services. I was struck by the complexity of the present services and felt, therefore, that before any major revisions of them were introduced, it would be desirable that their development up to the present should be explained in a White Paper which would also set out the factors governing further developments and then, in this context, the Government's proposals for the future. I would ask Deputies to note particularly the title of the White Paper—The Health Services and Their Further Development. This choice of title was very deliberate and, if you like, challenging. For what we think is needed is a progressive improvement of our system of health services, which we regard as basically sound—not a root and branch replacement of these services by a health service based on a different principle. I have on many occasions made it clear that I accept fully the main principles on which the present services are based, which are defined as follows in paragraph 15 of the White Paper:
In developing the services on the lines summarised above the Government did not accept the proposition that the State had a duty to provide unconditionally all medical, dental and other health services free of charge for everyone, without regard to individual need or circumstances. On the other hand, no service is designed so that a person must show dire want before he can avail himself of it.
Without departing from this main principle, the White Paper proposes many changes. Each of the present services is reviewed. Where a service is considered satisfactory by the Government, this is stated; where it is not, the changes which the Government think should be made are explained and justified. When, after consultations with the public representatives, professional organisations and others concerned, final decisions are taken as to the form of these changes, the Government will take steps to see that they are brought into effect.
The White Paper proposes a number of important changes in the general medical service. It is intended to introduce a choice of doctor in the service and, we hope, a choice of chemist; it is intended that the limits for the categories eligible for the service will be clearly defined, instead of being subject to individual local interpretations of a rather vague legal formula, as at present. It is proposed that there should be better arrangements for helping the middle income group in obtaining drugs and medicines prescribed by general practitioners, where hardship would be involved in buying them privately, and it is intended to proceed with the further development of the district nursing service and to provide a home help service, particularly for the aged and chronic sick. These radical changes in this service will pose a number of problems. The most outstanding of these is, of course, the fact that at present we have permanent salaried district medical officers in about 550 dispensary districts throughout the country. One of the big problems in bringing in this scheme for choice of doctor will arise from the arrangements which will have to be made to fit these into it. In some areas, particularly in the West, the dispensary doctors will have to be retained on a salaried basis because, in practice, there will be no choice of doctor. However, in most of the country we must look forward to the eventual abolition of the post of dispensary doctor, and existing holders must be fitted into the new scheme with due regard to their present position and pension rights. I cannot say now what the exact answer to this problem will be, and indeed there may be a number of answers varying from area to area. I have, however, promised the Irish Medical Association, when they sought clarification of my intentions in this regard, that I will attempt to ensure that permanent and pensionable district medical officers who continue to provide, in their present areas, services on the scale on which they provide them at present will not suffer any decrease in remuneration from public funds as a result of the change in the service, and I expect that, in the event, the present dispensary doctors will be satisfactorily fitted into the new service.
This question is only one of many which, in the coming months, my Department and myself will be discussing with the Irish Medical Association and the Medical Union. I cannot, therefore, give the House today a detailed picture of how the service with choice of doctor will operate. I can go no further than what is stated in paragraph 44 of the White Paper, which shows that the Government will aim to provide, for the category eligible, a service not outwardly distinguishable from that which doctors provide for their private patients.
Obviously, if this is the aim where the doctor is concerned, we should also try to make similar arrangements with the chemists. Discussions with their representatives are, in fact, proceeding now and I hope that we will be able to negotiate a satisfactory and economical scheme under which, as far as possible, persons can bring their prescriptions to any convenient participating chemist.
It is generally accepted that there are many people in what we call the middle income group who can afford to pay fees to their family doctor but cannot afford to pay, without hardship, for the drugs and medicines which he may prescribe. The present law allows health authorities to help in circumstances like these and my Department has, on a number of occasions, reminded the health authorities of this power. However, I think that, particularly with the other changes which I have just mentioned, we should have a more formal scheme under which persons in the middle income group will have the right to assistance from the health administration in specified circumstances, where hardship would be involved in meeting their entire needs privately. I do not think that the present arrangements under which a person is dependent on a subjective local assessment of hardship is entirely satisfactory. It is intended, therefore, to specify a fixed sum and where a person in the middle income group has found it necessary to spend that amount in a fixed period, in buying drugs and medicines, he will be entitled to get assistance in further purchases. Legislation will be necessary to introduce this change. As stated in the White Paper it is not intended that the legislation should set out the details of the scheme but that these should be fixed in regulations made later.
Finally, in relation to the general medical service, the Government propose that legislation should be introduced to permit the Minister for Health to fix limits for eligibility. Paragraphs 51 to 53 of the White Paper dealt with this. There has been much dissatisfaction with the application of the present legal formula under which eligibility for the service is determined locally and in accordance with varying standards, the application of which is illustrated in the table shown on page 28 of the White Paper. I think that the specification of limits, which will be made public and, indeed, widely publicised, will represent a big step forward.
The intention is that the limits will be specified by regulations which would be subject to the approval of each House of the Oireachtas. The Dáil will therefore have an opportunity in the future to discuss the actual limits, so I do not intend to say anything today on what these might be.
Side by side with these changes in the constitution of the general medical service, the development of the district nursing services will be speeded up, so that the doctors working in the new service will eventually have available, in all districts, nurses to help them. The need for a home help service, especially for old people and for the chronic sick, is also recognised and it is intended to provide for this in the legislation.
All these changes will be expensive. They will involve much planning and preparation before they can be made but I am satisfied that this will be well worth while and that the money put into the improvement and development of the general medical service will be well spent.
When we turn to the hospital services, it will be seen that the White Paper does not propose any comparable changes. With the extension of the eligibility limits, to be effective from 1st April next, under the Health and Mental Treatment (Amendment) Act, 1966, these hospital and specialist services will be available to over 90 per cent of the population. Hospital care is, of course, a burden which can be met privately only by a small minority and the cost to public funds of these services is at present very considerable—about £24 million for this year. While the White Paper does not propose any radical change in the hospital service itself, it does underline the fact that, when we have expenditure of this size on hospitals, it is important that we should see that the money is well spent, that the hospitals which we have are used to the best advantage and that there is proper co-ordination between the various hospital services. I will be saying more on that when discussing the administrative proposals in the White Paper.
I expect, having regard to earlier debates in the House on health policy, that I will be criticised for not proposing the abolition of the charges for intern hospital care at present levied on some in the middle income group, This, I should say, was carefully considered by the Government but I do not think it would be reasonable to abolish these charges. The revenue from them is quite considerable— almost £½ million a year—and I think that paying the charges imposed should cause little hardship, when we bear in mind that the maximum charge is ten shillings a day, that the maximum is levied only in a minority of cases and that the average stay in hospital is only a few weeks. Indeed, now that the income and valuation limits for eligibility for the hospital services are being increased, I think it reasonable that there will be some increase in the income from these charges and that endeavours should be made to this end.
Deputies will note, on the other hand, that it is proposed to abolish the charges for out-patient specialist services, which are at the rate of 7/6d for X-rays and 2/6d for other specialist services. This may seem inconsistent, but the object of this abolition is to encourage the use of out-patient services instead of intern hospital services where this is appropriate. In any event, the administrative costs involved in collecting these small sums are disproportionately high.
The White Paper stresses the need for proper planning and co-ordination of our hospitals. While much has been accomplished in the field of hospital building to meet the country's essential needs, the extent of the requirements still remaining to be met is quite vast. For very good reasons the main concentration in the past was on the provision of accommodation to cater for patients suffering from infectious diseases, the establishment of modern hospital buildings for the acutely ill, mainly outside Dublin and Cork, the making available of a considerable amount of accommodation for mentally handicapped persons, the establishment of certain special hospitals such as St. Luke's Hospital and Our Lady's Hospital for Sick Children, Dublin, and the National Medical Rehabilitation Centre at Dún Laoghaire and the provision of much needed accommodation for maternity patients throughout the country generally. There are a number of major sectors, however, towards which we must now direct our energies.
The teaching hospitals are of special importance and the White Paper has announced the Government's intention to make further progress towards the provision of suitable buildings to meet their needs. Galway has already been provided for. The new St. Vincent's Hospital at Elm Park, Dublin, which is expected to be completed by the end of 1967 or early 1968, the new Coombe Maternity Hospital, which will be ready this year and a major extension which is in progress at Holles Street Hospital will further improve the standards of treatment and teaching facilities available in Dublin. I am taking steps to establish in the very near future a special body representative of the Cork Health Authority, University College, Cork, the Department of Education and my own Department to plan and erect a major general hospital and a new dental hospital in Cork, and, towards that end, to organise the holding of an international architectural competition to select a suitable design. Preliminary planning work is already under way in connection with the proposed replacement of the present St. Laurence's Hospital on a site at Cabra. In addition, the Central Council of the Federated Dublin Voluntary Hospitals are formulating basic policy in relation to the erection of one large hospital to replace a number of their smaller units.
The Cork General Hospital and St. Laurence's Hospital schemes have been on the mat for a long time and quite a lot of planning work was carried out up to about ten years ago. Progress in medicine does not stand still, however, and, in view of the very large financial involvement and the great importance of these projects, it is essential that our planning concepts be completely reassessed to ensure a better anticipation of future needs in the light of developments in the practice and teaching of medicine and in the structure of the population.
In regard to the mentally handicapped, the recent report of the Commission on Mental Handicap indicates the extent of the accommodation which the Commission considered should be provided. It would be unwise to attempt to estimate the cost without a more precise definition of the manner in which the new accommodation should be provided, whether it should be at existing centres or in entirely new ones, and whether some existing institutions now used for other purposes could be given over to the mentally handicapped. If the accommodation were to be provided at entirely new centres the total cost would be not less than £5 million. I hope to issue soon a White Paper in which proposals arising from the Commission's Report will be set out.
Our major institutional needs relate to the provision of suitable accommodation for the mentally ill and the aged chronic sick. We are making progress in regard to the latter. Many Deputies will be aware of the work already done at Mullingar, Mountmellick and Stranorlar and of the work in progress at Castleblaney, Clonakilty, Ennis, Longford and Trim. Similar schemes are soon to commence at Athy and Castlebar. Planning work on improvement schemes at other homes is also well advanced. The extent of the problem generally may be judged from the estimates of the cost involved —about £3 million for work in progress or sanctioned, and about £8½ million for what still remains to be done.
We can anticipate that the Commission on Mental Illness, which is expected to report this year, will have a lot to say in regard to the physical environmental facilities available for the mentally ill. The existing hospitals are, in the main, almost one hundred years old. They were designed in an era when the concepts of care were utterly different from those consistent with current medical standards. I am sorry to say that the buildings in many instances have not been well maintained and that there is a pressing need for improvement of the standard of patient comfort. I do not wish at this stage to anticipate in any way the line the Commission may take in regard to new hospital facilities for the mentally ill but I have little doubt from my own knowledge of existing conditions that we will find ourselves facing a very heavy capital programme in this field of activity also.
From preliminary assessments which have been made in my Department, it seems clear that the capital cost of financing even the programme of works so far approved will be formidable. The coming years are bound to bring to light other needs, and all this points to the need to establish priorities and to concentrate available resources on the achievement of the more urgent objectives. This is a task to which I have been giving attention.
In my general review of the services when preparing the White Paper, I took a special interest in how they apply in the case of old people. The aged must have proper health services and this I will regard as a high priority in developing the White Paper proposals. Of course, this object will be partially attained in the general development of the various other services. For example, the general medical services will, when the new limits are prescribed, be available free to a majority of old people. Over one-half of those over 70 years of age will automatically be entitled to this service as recipients of old age pensions. Again, hospital and specialist services will be available free, or at modest charges, for practically all old people. as it is to be assumed that very few who are over the age for retirement would have an income exceeding £1,200 a year. In the case of these services, one problem is in seeing that the old people know of their entitlement and that they can readily use the services. This involves a co-ordination of activities by a number of bodies and Government Departments and the Minister for Health is to be given responsibility for seeing that this co-ordination is effective.
I have already arranged for the appointment of an interdepartmental committee with representatives of my Department and the Departments of Social Welfare and Local Government and I intend that a wider body should be established on a national basis with representatives of the various voluntary bodies operating in this field. There is a tremendous amount of goodwill throughout the country towards the aged and there is a great amount of good work being done by various voluntary bodies. I can assure the House that I will take very seriously my responsibility for seeing that the public services and the voluntary services are co-ordinated so that they will offer to the aged all the help and solace they can.
The White Paper does not dwell very long on the other health services and neither will I. Our services for the health care of mothers and children are, on the whole, satisfactory and no major changes are suggested in them. In fact, the only major change proposed is that the rate of the maternity cash grant will be increased from £4 to £8 and that there will be a double grant where twins are born and so on.
Our dental, ophthalmic and aural services are not satisfactory and, for practical reasons, it has not been possible to extend these to the middle income groups as was provided for in section 21 of the Health Act, 1953. We cannot expect to be able to make such an entension immediately, but it is part of the policy under the White Paper that, as soon as the facilities are available, this extension will be effected. Therefore, I hope that, in the not too distant future, comprehensive dental, ophthalmic and aural services for the middle income group will be available.
Finally, on the services, I would like to say a few words on the future of the preventive services. Since the begining of the present century, but particularly in recent years, very effective public services were organised for preventing the outbreak and spread of infectious diseases. We are very fortunate in the standard of these services. Take poliomyelitis, for example. There were only five cases of this disease in 1965, by far the lowest number since we started to keep complete statistics in 1942. As recently as 1960, however, there were 183 cases and 1955, our worst year, featured a total of 499 cases. It is certainly to be hoped that the trend of the last few years, showing a consistent fall, will continue. We share the good fortune of other countries in this relief and it is to be hoped that the present picture signifies a lasting diminution. This, indeed, is the opinion of many international experts on the subject who consider that the widespread fall in the incidence of poliomyelitis over the past few years is directly attributable to the introduction of vaccination procedures. However, a high level of immunity must be maintained if we are to avoid the danger of a resurgence of the disease and parents should know that it is unwise to neglect the protection offered for their young children, who are the group most susceptible.
There is welcome evidence that the public do appreciate this need. The nation-wide campaign of oral polio vaccination with the simple and highly effective "sugar lump" vaccine last year was very successful. The latest statistics from local health authorities show that of the one million, approximately, in the eligible age-group from six months to 18 years, about 80 per cent got the protection of the vaccination. I would like to take this opportunity of expressing my thanks to all who contributed to the success of this campaign and in particular to the chief medical officers and the public health staffs of the local health authorities.
It is still necessary to ask for the co-operation of those who have not so far availed themselves of this costfree and trouble-free service, and to underline the necessity for preserving the present substantial degree of community protection by ensuring that, as a matter of routine, every infant will be given this oral vaccination as soon as convenient after six months of age. Health authorities are continuing to make arrangements for this purpose.
What I have said about polio applies equally to other infectious diseases, notably diphtheria.
Some of the techniques developed for diagnosing and preventing infectious diseases can be used in the future in relation to some non-infectious diseases. There are complex issues in this approach to such diseases, involving medical research and health education on such things as the prevention of heart disease and cancer. I intend that the preventive services will in the future become geared for this. I also intend that the possibilities of "screening" of large sections of the population for hidden symptoms of disease should be explored and that services for such screening should be brought in where practicable for particular diseases. We recently introduced such a service for a condition known as phenylketonuria, which can cause mental handicap, and we are developing a similar service for cancer of the cervix of the uterus.
When, in my review, I had considered the services and the improvements which seem necessary, obviously I had next to tot up the bill and see what the cost of the specific improvements which I had in mind would be. This turned out to be quite substantial. A total of £4,265,000 is mentioned in paragraph 115 of the White Paper as the annual extra cost of some improvements already made this year and of other improvements proposed in the White Paper. As this increase would be additional to normal rises in the cost of the services, it seemed clear that it could not be financed in the traditional way, that is, on a 50-50 basis between the health services grant and the rates. The Government decided, therefore, that the cost of the further extensions mentioned in the White Paper should not be met in any proportion by the local rates. Other possible sources of revenue are being considered but it seems likely that general taxation must bear the major part of the increase.
As well as reaching this conclusion relating to the financing of extensions and improvements, the Government decided that, pending further consideration of the methods by which extensions of the health services will be financed in future years, they would make arrangements which will ensure that the total cost of the services falling on local rates in respect of the year 1966-67 will not exceed the cost in respect of the year 1965-66. In reply to a recent Parliamentary Question, I assured the House that no deterioration in the present health services would be permitted as a consequence of this decision to relieve the rates. On the contrary, it is my intention that the ordinary progressive improvement of these services should continue. Deputies will, however, appreciate that I am in no position to give carte blanche to local authorities in spending money on health services, so I have asked health authorities to obtain my prior approval for any departure from the estimates already prepared by them for the year 1966-67, except where there are increases arising from variations in general costs or in the levels of demand for existing services. Provision to meet the additional Exchequer liability arising from this Government decision is contained in Subhead G of the Estimate for 1966-67.
I cannot say, at present, what arrangements will be made on this aspect of financing the health services for future years. The White Paper refers to an examination of other possible sources of revenue. This will be a comprehensive serious examination of all possible sources but I should say that I am not too sanguine myself on the possibilities of finding another major source of finance for the health services. The most obvious possible alternative—and one which has often been advocated in this House—is insurance contributions. I have already expressed here my misgivings on this as a source of finance, but I am prepared to consider this afresh, to see if it would be possible to have some system of such contributions which would not have the disadvantages which have been mentioned here on previous occasions—that they are, in fact, a regressive form of taxation and would be difficult to collect from self-employed persons, including farmers.
We have, of course already got another source of finance for our health services, that is, the Hospitals Trust Fund. The income into that Fund now provides over £3 million a year towards capital and revenue expenditure on hospitals. I do not think it likely that we are going to find another such fruitful source of revenue. After all the Revenue Commissioners have for many years been casting their net widely and it is quite unlikely that a source of revenue is available to us now which has evaded their diligence and ingenuity. However, I shall report on another occasion to the House on the results of my further examination of this subject.
The White Paper proposes that the administration of the services will be transferred from the present local health authorities to specially-established regional boards, with members nominated by the Minister for Health —these will include representatives of the medical and related professions and, where appropriate, the voluntary hospitals—in addition to members elected by the local authorities. This development is a logical sequel to the other proposals in the White Paper. From the financial viewpoint, it would be unwise to continue full local administration of the services, as at present, if the local authorities had not to worry about the increased cost arising from extensions and improvements of the services. Apart from this, it has become clear that the county is too small a unit for the organisation of many of the health services.
The White Paper deliberately avoids going into detail on the constitution of these regional boards and the areas which they will serve. I think this will be understood, as there is no point in going into these details until a decision is taken in principle on the establishment of these boards. The House will have an opportunity later, if this proposal is accepted, to discuss the details of the new regional administration. There are many matters to be considered before then—the exact delineation of the regions, the combination, within the membership of the boards, of the members of the local authorities, the professional interests and others, the training and qualifications of the chief executive officers of the boards, and the relationship between the boards and the central authority.
This development is, I think, the logical outcome, not only of the other proposals in the White Paper, but of the long-term trend in the administration of the health services. Originating in comparatively small organisations— the boards of guardians, the rural districts councils and the urban district councils—the health services have over the years, as needs required, become a function of bodies covering larger areas, that is, the county councils and the joint health authorities. It is clear that many of these are not large enough now and that it is necessary to accept the regional concept for the best administration of the services in the future.
Public comment on the proposals in the White Paper has in general been very favourable, but there has been some disappointment at the time-table which I have announced for bringing in the change proposed. I have explained that it is my aim that the legislation necessary for these changes will be introduced in the late autumn and that I would hope that most of this legislation could be brought into effect before the end of next year. Now this may seem a rather slow process, but any member of the House who has had the responsibility of office will know that radical changes such as are proposed in the White Paper cannot be brought in overnight, or in a matter of a few weeks, or a few months. The proposals for the 1953 Health Act were first published in a White Paper issued in July, 1952, and the major changes under that Act did not come into effect until 1956. The British National Health Service was first advocated in a White Paper published early in 1944; the National Health Service Act was passed in 1946 and the service did not, in fact, commence until 1948.
To return home again, the proposals on which the Voluntary Health Insurance Act of 1957 was based were published in a report issued in May, 1956, but the Act did not become effective until October, 1957. This is rather a better schedule than I propose, but then this Act was on a much more restricted plane than the White Paper. Finally, to quote what may be the most respectable precedent in so far as the Labour Party, in any event, are concerned, a White Paper was published in October, 1949, proposing changes in the social welfare services, but legal effect was not given to these until the Social Welfare Act was passed in 1952 and became law in January, 1953. These precedents show that the time-table which I have mentioned is a realistic one and does not allow for any dallying in bringing the White Paper proposals into effect.
I think we must recognise, in any event, that, at the present time, it would be unwise to impose the taxation needed to pay for the changes proposed. Indeed, it would have been easy for the Government to justify a decision to publish their plans for the health services only when times got better. However, the more responsible thing to do was what we have done, that is, to publish the White Paper, so that we can plan now for changes to be brought in when the money is available. I can assure the House that it is my personal intention to see that the detailed planning of these proposals and the preparation of the necessary legislation will be pushed on as rapidly as possible by my Department and I am confident that, in this work, the full co-operation of all involved—the local authorities and the many professional bodies concerned—can be expected in the months ahead.
The Government are satisfied that the plans in the White Paper are reasonable and that they can be financed out of our future economic development. Perhaps I should conclude my remarks on the White Paper by saying a few words on the relationship of these plans to our economic situation. The object of all economic development is, of course, to provide a better life for our people. It is not an end in itself and if we were to regard the accumulation of material wealth as our only aim, this would be entirely contrary to our past traditions. The primary aim of economic development, as I see it, is to give the people the means to meet their material needs so that they can live in dignity and independence. But independence cannot be complete. When sick, a person needs, and is dependent on, care given by others and this is often expensive and complicated to arrange. We must recognise that many people cannot arrange such care privately without financial help and that the State must, therefore, organise efficient health services for them—or see that they are organised. The Government will not, therefore, hesitate to propose that there should be allocated from the future increase in our national wealth a sufficient proportion to meet the needs of the health services. It is a challenge to us all to ensure that, when the State will thus wish to divert some of the fruits of our economic development from private consumption to public welfare, the people will accept that this is necessary. I am confident that they will and am confident, too, that when effect is given to the proposals in this White Paper, we will have in this country a logical pattern of health services which will meet our needs in accordance with our past traditions.
To turn now to the Estimates before the House, Deputies will see that there is a Supplementary Estimate seeking an additional sum of £900,000 to meet the liabilities on the Vote for Health in the current financial year. There is provision for increases of £980,000 in the health services grant to local authorities and of £20,000 under the subhead for the salaries, wages and allowances of the staff of my Department. These are offset by a saving of £100,000 in the Grant-in-Aid to the Hospitals Trust Fund. In regard to that saving, I might say that it does not reflect any cutback on capital spending. The programme of capital works within the year has proceeded according to plan.
The increase in the requirements under the heading of Grants to Health Authorities is, of course, a direct consequence of increases in the expenditure of these authorities, as now ascertained, over that on which the original Estimates were based. The estimated additional requirement of £980,000 is made up of £100,000 in respect of balances of grants for years prior to 1965-66 and £880,000 in respect of grants for the year 1965-66. Approximately £650,000 out of the total of £980,000 is attributable to increases in the remuneration of health authority staffs. The increases in the rates of allowances to disabled persons and to persons suffering from infectious diseases which became effective from 1st August, 1965, account for a further £151,000 of the additional sum and the balance of the Supplementary Estimate is attributable to increases in the costs of the health services under a variety of headings, including the estimated extra cost of hospital and specialist services for the additional group which became eligible for these services by reason of the raising of the income limit under the Social Welfare Acts from £800 to £1,200 a year, which became effective from 6th September last.
To turn now to the Estimate for the year 1966-67, Deputies will, of course, appreciate that it has not been possible to show in the 1965-66 column the effect of the Supplementary Estimate for that year which is now before the House and will no doubt bear this in mind when making comparisons between the figures for the two years.
There is only one new item in the Estimate—the provision in Subhead G for Supplementary Grants to Health Authorities to relieve the burden of health charges on the rates. I have already referred to this in my remarks on the White Paper proposals, and I do not think that it calls for further comment.
In regard to Subhead G generally, I might add that, in addition to making provision for the operation for the full year 1966-67 of the factors which I have mentioned which came into operation in the course of the year 1965-66—that is to say, the extension of hospital and specialist services to persons who become insurable under the Social Welfare Acts as a result of extended insurable limits, and the increased allowances under the Health Acts to disabled persons and persons suffering from infectious diseases— there is provision for the extension of eligibility for hospital and specialist services which will result from the operation from 1st April next of the Health and Mental Treatment Act, 1966. Under this Act, the valuation limit for farmers will be raised from £50 to £60 and the income limit for other self-employed persons from £800 to £1,200 a year.
The reasons for such variations as exist in the case of the remaining subheads between the provision proposed for 1966-67 and the figures for 1965-66, adjusted by the current Supplementary Estimate, will be apparent from the face of the Estimate and do not call for explanation. In conclusion, I should like again to thank Deputies for facilitating me in taking the Estimates and the White Paper motion together.
