We all appear to have become very health conscious in recent years. It would be no harm if we threw our minds back and gave credit to those who really did something for the health services of this country. When this State was established we took over hospitals, some Victorian, many archaic, and many in a deplorable condition through lack of building or reconstruction as a result of lack of capital during World War I. The old Cumann na nGaedheal Government—and I do not think they ever got the credit they deserved—set up the Hospitals Sweepstakes Trust and as a result many millions of pounds were poured into the building of new hospitals and the renovation of old hospitals. We remember how at that time the Bill legalising the Hospitals Sweepstakes was bitterly opposed on many grounds, but without the millions of pounds which we received from the proceeds of the Hospitals Sweepstakes I wonder what condition would our hospitals be in today, and I wonder how many hospitals we have got would never have been seen. We took for granted the flow of funds from the Hospitals Sweepstakes and we never gave credit to the people who first initiated them, and made them a success, and had the foresight to introduce legislation here to legalise this method of procuring funds.
We had a change of Government in 1932 and things were let drift. Nothing was done for the health services for at least ten years, or possibly 12 to 14 years, after Fianna Fáil came into office. We find that in 1945 the median age of death of those suffering from tuberculosis was 30.6 years. The first inter-Party Government took office in 1948, and the first thing they did was to acquire buildings in an endeavour to eradicate the dreadful disease of tuberculosis. The House will recollect that at that time the Minister for Health was instructed by the Taoiseach and the Government of the day to acquire buildings for the purpose of housing and giving hospital treatment to sufferers from TB.
In my own county, an industrial school was taken over and made available to patients who suffered from TB. Regional sanitoria were set up throughout the country. As a result, we find that, instead of 30.6 years being the median age at death in 1945, it had risen to 58.8 years in 1964—practically double. The first inter-Party Government deserve credit for that and for endeavouring to wipe out human tuberculosis in this country. They succeeded in doing so with the result that some of these sanitoria are now being closed down. Even in my own county, the sanitorium taken over in 1948 is now about to be closed through lack of patients, thanks be to God.
The policy of Fianna Fáil is "Anything you can do I can do better than you". While we were in the actual process of drafting the Health Act, the first inter-Party Government went out of office and, in 1953, the Health Act, 1953, was introduced. We were assured by the then Minister for Health, Deputy James Ryan, who is now a member of Seanad Éireann, that that Health Act would cost 2/- in the £1 on the rates: He said it in this House. I myself heard him say that it would cost 2/- in the £1. Let us look at the graph of costs of health services since then. In 1947-48, the health services cost £5.7 million: today, they cost £30 million and it is now proposed to add another £4¼ million to that figure. All during the time, we have had a falling population in this State.
When the turnover tax was introduced here, I distinctly remember saying, that the ramifications of its introduction, particularly on local rates, would not be felt for some time. Looking at the graph published on page 57 of the White Paper, we find that while the average increase in health services from 1947 to 1962 was approximately £1 million per year, there was a jump between 1963-64 and 1964-65 of £5 million. Can anybody tell us or can anybody seriously suggest that we have got value for that extra £5 million spent in that particular year? I do not think so.
While we accept this White Paper, we say it does not go far enough and it has come too late. While we accept it, we do not accept the method of raising taxation for the purpose of implementing what is contained in that White Paper. We think that the health services of this country should not cost the taxpayer and the ratepayer £34¼ million in the year. I am aware that the Minister has told us, in writing, and has also stated in the White Paper that he is satisfied that the local rates are not a form of taxation suitable for collecting additional money on this scale. He says, also, that the cost of further extensions of the services should not be met in any proportion by the local rates. He gave an undertaking that the Government would ensure that the total cost of the services falling on local rates in respect of the year 1966-67 would not exceed the cost of the year 1965-66. The Minister has given us that undertaking. I certainly would accept that he will keep his word.
Yesterday, in Donegal, we had the unfortunate privilege of striking a rate representing an increase of 6/1½ in the £1. We in Fine Gael who are on that council proposed that we should defer striking the rate until after the Budget until we would find out if the Budget would have any impact on the rates. We were then assured that any additional cost which may be incurred in the health services as a result of further taxation which may be imposed in the Budget would be borne by the Minister and, on that undertaking, we struck this rate. I presume the Minister will carry out his undertaking and that, if expenses are incurred as a result of the imposition of any further taxes, the local rates will not be asked to bear them. I am glad to have the Minister's consent to that statement of mine and that he agrees with it.
One of the principles—and it is a principle with which I agree—in this White Paper is that there should be a choice of doctor. But are we not makeing too much of this? Where are we to have a choice of doctor? The only places I know of where we can have a choice of doctor are in the cities or the towns of Ireland but certainly you will not have a choice of doctor in rural Ireland. Indeed, the position at the moment is that we are very glad to be able to say we have doctors in some of the dispensary districts of rural Ireland because some cannot find doctors. This White Paper will not be implemented for some years to come. Unfortunately, there is an unrest growing amongst the medical profession in the country through lack of directive from the Department of Health. We are told we will not replace dispensary doctors pending the implementation of the White Paper. We are also told we cannot say exactly when this White Paper will be implemented.
We have some dispensary districts at the moment where we cannot find even a locumtenens for the area and, if I might mention one, it is Aranmore Island, an island off the north-west coast of Donegal. We have neither doctor nor nurse on the island and we are unable to procure one. Some dispensary doctors have been unable to take a holiday because they cannot find a locum, unless the doctor in the adjoining dispensary district is prepared to oblige him. There is a growing unrest throughout the medical profession in this State through lack of some positive directive from the Custom House on this particular matter. We have only to look at the staffs of our hospitals throughout the country to observe the number of nonnationals employed there while our young graduates are finding employment in America and elsewhere. It is not because of lack of reasonable remuneration but it is through lack of some security of tenure that these young men are being driven abroad. I should like if something could be done to ensure that there will be a steady flow of our young graduates from the medical schools into the health services of this country.
Despite what we are spending on health services—£30 million—we find that the dental services throughout the State are completely unmanned. Most local authorities are unable to procure whole-time dental surgeons to man the posts vacant in their areas. We find even in the case of the school inspection of children that there is sometimes a lapse of three or four years between inspections in relation to the health of children in isolated schools. Recently, I discovered a case where the schoolteacher had not seen the school doctor for almost three years. On inquiry I found that owing to periods in which we had no assistant county MOH, we were unable to carry out the usual inspections that should be carried out in these schools.
Again, people entitled to dentures under the Health Act have been unable to procure them and many Deputies, particularly county councillors, are continually making representations to local authorities to ensure that dentures will be given to those entitled to them, but nothing can be done. I know people, holders of medical cards, who had teeth extracted three or four years ago but are unable to get the dentures to which they are entitled.
I think Deputy Davern referred to the nursing service. Jubilee and district nursing services are one of the greatest social amenities but there is an unfortunate tendency now to ignore these services and in many cases in rural Ireland where such services were provided, no attempt is being made to continue them. That is a tragedy, particularly when there is so much emigration. The young people have gone and there is nobody left to look after the aged when they need attention. District or Jubilee nurses are absolutely essential in those circumstances. If the Minister gave that minor branch of the profession his attention, something good might come of it.
I wonder what is the reason for the high cost of drugs. I fear that drug importers and those who have a monopoly in that regard are responsible. One has only to cross the Border to see the difference in the cost there. Has the Minister gone carefully into the question of the importation of drugs from the US? Has he tried to find out if there is not a monopoly of the agencies and also a monopoly in the importation of the drugs? That could possibly be the cause of the high drug prices here and should be looked into. I think the Minister did this once before and some good resulted in the case of a certain drug, the price of which was drastically reduced.
I sincerely hope that no district hospital built in the past 14, 15 or even 20 years, since the war, will be closed. In my own town of Dungloe, the inter-Party Government built a magnificent district hospital which we had sought for years. The Minister's immediate predecessor said it should never have been built and it was with the greatest difficulty that I persuaded him to advertise the appointment of a permanent medical officer. I do not think such a permanent appointment has been made or that it was advertised for a considerable time. I sincerely hope that hospital which serves a very poor part of the western Gaeltacht and provides much needed service, will never be closed.
I am glad something is being done for the mentally handicapped but if we are to get the medical services that we all wish to see—and that includes the Minister, I am sure—we should bear in mind that taxpayers and ratepayers cannot afford it and some other method of procuring money for these services must be found. There is no better method than that suggested by Deputy T.F. O'Higgins, namely, insurance. We know how well it has worked in the Voluntary Health Scheme for the middle or higher income group. Nothing is offered in this White Paper to the middle-income group other than that where there is excessive expenditure on drugs, there may be a State contribution. I am certain anybody in permanent employment would have no objection to paying a weekly contribution for a medical service and no employer would object to contributing, provided he was satisfied that in time of need the employee, his wife and family would be adequately looked after and dispensary, specialist or hospital treatment provided. That would be a much better way of paying for health services than asking the taxpayers to pay when this White Paper is implemented, if ever, over £34 million.
If the cost of keeping up the hospitals continues to rise at the rate shown in the graph published in the White Paper, the taxpayers cannot bear the burden. I remember President de Valera, then Leader of the Opposition, on one occasion when the Budget was being introduced by Deputy Sweetman interjected: "We have reached the limit of taxation". I wonder what he would say were he sitting in the same seat listening to the present Minister for Finance introducing his Budget tomorrow. Not only have we reached the limit of taxation at a local level but we have also reached it at the national level.