Wait until we see it in thousands of pounds. I am quite sure that the reason for this sudden decision is as the Minister fairly said. I am not quarrelling with him for not telling the truth. He told us in Navan —not in Leinster House—that he proposed to do it and he can now tell us that he told us so. We will see what the position is when the figures come up.
The Minister has given mortality statistics. There are a number of surprising features. One is that the rate of deaths per 1,000 of the population in 1966 was .6 per cent higher than in 1965—12.1 as against 11.5, which seems rather odd. The rate of births per thousand, at 21.5, is down on 1965, when it was 22.1. Possibly there is a reason for this which I do not know.
The Minister, as his predecessor did, points to the fact that deaths from heart disease are continuing to rise. He told us that the number of deaths from heart disease, in 1966—I suppose certified—was 11,772 as against 11,210 in 1965, which is a horrifying position. I am just wondering is this like deaths from cancer, that they are now appearing to be far more numerous because modern diagnosis is able to discover more accurately the cause of death rather than the position some 30 years ago when a person might write a death certificate that death was due to some peculiar internal pain.
The number of deaths from cancer is 5,129 as against 4,979 in 1965, a very substantial increase. That is an alarmingly high figure.
I am sure the Minister must be giving very great attention to the question of TB. The provisional figure of deaths from respiratory tuberculosis, at 306 as against 302 in 1965, must cause a certain amount of unease. Even if there has been only a slight increase, it is too bad that the incidence of TB, which we thought was practically wiped out some years ago, should appear to be rising. As I have a friend in a TB hospital, I had occasion during the year to visit it and was horrified to find a number of relatively young persons, mostly young to middle aged, suffering from the disease. A number of them had been discovered as a result of the visit of the mobile X-ray unit to their areas. A number of them had been discovered in the normal way. They became ill and TB was diagnosed.
Perhaps it would be possible to put on an extra effort in order to get back to the happy position that obtained some years ago when TB was almost completely wiped out. It is just too bad that the incidence appears to be increasing. I am quite sure that the Minister is concerned that that is so. He is the only person who can exert the necessary pressure to have it wiped out. It may be said that the figure is relatively small as compared with 20 years ago and as compared with the figures for cancer and heart disease. Nevertheless, TB is a disease that could increase at an alarming rate, and it would be too bad if it again reached epidemic proportions.
The care of the aged has been referred to briefly by Deputy Burke. That is a matter that takes up a lot of the time of those of us who serve on local authorities. Some years ago I, with some colleagues, put a proposal before the local council that there would be a fixed sum paid to persons over 70 years of age who have no means other than the old age pension, living in their own homes, so that the persons with whom they were living, usually members of their own family, could afford to keep them. The proposal was defeated. I can never understand why the local authority is prepared to pay £5, £6 and £7 to keep an old person in a home whereas if these people could get £1 or 30/- per week they would be quite content to remain in their own homes.
It is no use for the Minister for Health to say they prefer not to put old people into institutions. That is a platitude. Something definite must be done about it. I with my colleagues attempted to do something practical about it but it just did not work out. We often find a man and wife and family living in a house with an aged parent who is in receipt of a very small pension which certainly does not pay for food, clothing and other necessaries, not to mention contributing to the upkeep of the house. It is very hard for those who do not know to understand the difficulties that beset these people. Are they to deprive their young families of what they are entitled to get—more space, more food, more leisure—because they have to look after the old people, particularly if they are bedridden, or are they to put the old people in the county home and be called hardhearted for doing so? This is one of the major problems of our time.
I am afraid that we have not got a great reputation for kindness to our aged people. We pay lip-service to them. Many of us find that the old people finish their days somewhere other than in the home in which they were reared and in which they reared their family. If people stopped to think for a few minutes they would realise that the young people of today are the pensioners of tomorrow and the way that they treat their parents is an example to their children as to how they may be treated themselves. It might make a difference. Even putting it that way, we must understand that it is a very big problem for a man and his wife with a young family to keep a grandmother or grandfather and to look after them in a small house. If there is shortage of space or of money the tendency is to send the grandparent to the county home, if there is any room there.
At present, with the assistance of the Department, we are building a new wing to the county home in Trim. Recently, somebody was so sarcastic as to write to the Irish Times saying that we would have the swankiest poorhouse in Ireland. We are not proud of the fact that we have to have one of these places, but we have to have them and, even with a number of beds, which will be almost 500, divided equally between men and women, we still will have quite a number of people who will be seeking admission and finding that there is no place available. The problem, therefore, is threefold and it will have to be faced up to. Unfortunately, so far, the tendency has been to sweep it under the carpet where it cannot be seen. So long as these old people are not in a position to kick up a big row, the attitude is to leave them there: the problem will eventually sort itself out; they will die.
It is too bad that old people, who have reared their families at home and lived in a district and worked very hard there all their lives, should, at the end of their days, find themselves put into a county home, particularly put into a home where the men go one side and the women the other. I shall never forget an experience I had of two old people I knew well who were put into a county home. After a lapse of some years, I happened to be visiting it one day and saw the old man standing outside. He was very lonely looking. I went over and spoke to him. He told me that he was taking a last look at his wife's coffin which was going out on the other side. Over the years, while they had been there, they had not been able to talk or associate at all. It is too bad that that should be so but that is modern life and I suppose that that is the way things must be. If there is any way out of it, it should be avoided.
If the Minister says there is a hope at all of trying to keep those old people in their own district, then I am all with the Minister. Old people can become very lonely. If they get out of the circle of their friends and acquaintances, they may make new acquaintances but they seldom make friends again. It is heart-breaking to see old people having to mope around the dayroom of a county home waiting for the next meal which they are not in form to eat and for the night when they will get some merciful sleep. The Department of Health will have to deal with this. Somebody will have to be courageous enough to face up to it.
In one local authority, an effort is being made to help those old people. One of the biggest problems confronting old people, if they are living alone, is housing. So often, we find the small farmer type, a person with a few acres of land who is just eking out an existence, living in very bad housing conditions. If the house starts to fall, they are unable to repair it. This local authority has devised a system whereby they purchase cedarwood homes which they set up on the site of the old houses. They let them for a nominal rent of 5/- a week to those old people, and, as soon as they pass on, the house is put on a loader and moved on to the next place where there is a need for it. At least it gives them a convenient house, a small house, a warm house, and the cost is very small. It may not be the answer to everything but the system might possibly be investigated by the Minister's Department with a view to trying to implement it on a wider scale.
The Minister says he is fully committed to the view that it is preferable, if at all possible, to keep people in their own surroundings and I am all with him in that view. However, they cannot stay there on the amount of money they get by way of pension, particularly non-contributory pension. The Minister might discuss with county managers, if he thinks fit, the possibilities of giving a fixed supplement to those people so that they can either use it themselves or use it to pay somebody to help them to do the housework or whatever has to be done around the place. It is money which would be well spent. It would reduce the occupancy of the county homes and I think it might be the answer to a lot of our problems.
It is all right to talk about voluntary bodies such as the St. Vincent de Paul Society, and so on, who already have more than enough to do. Anybody who knows of their activities is aware that these public-spirited people who go around to investigate these cases find they never have enough money to meet the requirements. There is always somebody they would like to help but they just have not enough money. The amount of financial help they are able to give to those people is terribly small. Therefore, I think the State should step in.
It is all right to talk about meals on wheels, and so on. Particularly in the country districts, it just is not possible to do anything like that. One goes about and it is amazing to find so many independent old people who have not had a decently-cooked meal for a long time. There is nothing they can do about it. They say: "We cannot blame anybody." They get whatever few shillings State aid they are entitled to. It is little enough to buy a bag of coal for 13/-, which they must buy, to pay the rent and the ESB bill. They have very little left for any type of comfort. It is really a very big problem. I am sorry if I am dwelling so very much on all this, but I believe it is one of the major problems of our time.
Reference has been made to the district nursing service. Every time we discuss this service, we are told that it is going to expand, that it will be useful, particularly for the people I have mentioned, that it will be useful to help the overworked dispensary doctor particularly during flu epidemics, and so on. However, it does not seem to be expanding. It still seems to be just a few people who are trying to do so much. Occasionally, we find an effort being made to start a service in a particular district and a crochety old dispensary doctor, who has been there for donkeys ages, feels he is being interfered with and will not give the nurse anything to do. After a few weeks or months, the nurse will return to the centre and say: "There is nothing I can do there." The people who refuse to co-operate from the medical end are few, but there are a few, and it does discourage those who want to help.
Big strides have been made in mental health. At present, some enlightened RMS are, in fact, setting up clinics throughout the various areas and giving the drugs and treatment at home level to people who, up to a few years ago, would be taken into a mental hospital and kept there for months and maybe years. This is a great step forward. I believe it can be expanded even more. This is the sort of system we must have. However, when people have to go to a mental hospital I think there is something wrong, that, above any service, mental hospital authorities seem to feel that, medical card or no medical card, they must get their money.
I had a query some months ago about a person whose wife, an old age pensioner, had gone to a mental hospital. The old man was living at home in a town and trying to live on the amount of pension which he got. He was trying also to send some small comforts to his wife. Occasionally, he went the long journey to see her. He got an order from the hospital to sent on a contributory old age pension book. He spoke to me about it. I told him to do nothing of the kind. He showed me the letters which said that the mental hospital people had got permission from the Department of Social Welfare to collect it. There was nothing further about the matter until about a fortnight ago when he got a bill for £16. That man can pay the bill if he eats nothing for three weeks: it is really quite simple. All he has to do is eat nothing for a week. He has £15 of the £16 and I am sure that they will wait for the other one.
I asked the Minister about it and he said that most certainly the mental hospital authority were not entitled to collect the book. I have spoken to the Minister's secretary on the telephone and I have written to the Minister giving him particulars about it and I am sure that I will get a reply in due course. I did get an acknowledgement saying that the matter was being looked into. I would appreciate it if the Minister would point out to the mental hospital authorities that they are not above the law and that they are not entitled to try to take the only source of income which those poor old people have. Is it the idea that they want to have both the father and the mother in the mental hospital, because if the old man has to hand up his book and has nothing to live on, it will be either the local hospital or the local cemetery to which he will go pretty quickly? It is rather stupid that this should be the approach.
Another matter which requires attention is the shortage of beds in the various schools and institutions which deal with mentally defective children. Occasionally we find children of tender years in mental hospitals associating with patients who have grown old in the place. It is shocking that this should be allowed. I know that when Deputy MacEntee was Minister for Health some years ago he stated that he hoped to train a number of nurses for the purpose of opening some of the hospitals and old buildings which were being closed at the time in order to try to deal with this problem of mentally defective children. I distinctly remember his comments that it was not accommodation which was his worry but trained personnel. At that time some effort was being made to train them. It was a good many years ago and there has been a substantial improvement in the position but I understand that present accommodation for mentally defective children is so scarce that many children start on the register looking for a place in one of the institutions when they are four or five years old and the problem is solved when they reach 16 and they cannot then be taken in.
The new place in Delvin, County Westmeath, has been very obliging and did a lot of work last year to accommodate extra patients, but this still does not solve the problem. While the Meath local authority have no children in Mullingar Mental Hospital, they have quite a number in their own homes. Other local authorities have sent children to the mental hospital. There is nothing so sad as to see poor little children of seven or eight years of age rambling around a ward with a group of unkempt, filthy-looking old men who have been there for years. Apparently nobody worries about them and the only prospect for the youngsters, if they can think at all, is that down through the years before them they face an existence there where they will eventually turn into the same kind of creatures as those with whom they are associating. It is not good enough and it is not good enough to say that we have not got the money or the accommodation. We should make an extra effort to deal with this problem.
The number of mentally defective children is very large. The day schools which have been started, mainly by voluntary effort and with some assistance from the State when they are properly established, are doing an excellent job, but the amount they are able to do is only a fraction of what has to be done. Again, they will take in only those who are mildly handicapped. I do not know what the answer is. I do know that apart from those we know about, through the local authorities, there are literally hundreds, indeed thousands, of children who are not known about officially because their parents still stupidly think that it is some kind of slur on the family and they keep them away from everybody. It is too bad that we should have this attitude in 1967, but it is there and we have to face up to it.
If the Minister can do anything to try to resolve the position, he should do it and if money is spent in this direction, it will be very well spent. Recently I heard a statement by a doctor that the incidence of mental disorder among emigrants to Britain, and particularly among young people, was far higher among the Irish than any other race. I hope that statement is wrong and I would be glad if the Minister would comment on it. It has received wide publicity and I should like to know whether it is true or false. We should attempt to treat the mildly handicapped and those suffering from nervous breakdowns in their own homes. Some of the mental hospitals have been supplying such a service.
I was appalled after I had been a member of one mental hospital authority for a short time to find that up to about 1963 or 1964 women in the hospital were only supplied with shawls. I was told that this was done so that people outside would know that they were mentally afflicted when they left the hospital. I am glad to say that with the co-operation of other members of the authority, we stopped that practice. Certainly the type of clothing supplied to those who require clothing could not be likened to Paris models, to put it mildly. It would contribute greatly to an improvement in the mental health of girls and women in such hospitals if an effort were made to allow them to dress reasonably and also if facilities were provided for them so that they could have improvements made to their appearance, such as to their hair. It would help greatly because they are not too happy when they cannot have their hair done or have proper clothing.
