Before reporting progress, I was trying to spell out the serious defects of the Government decision to welsh on a previous undertaking to stabilise the cost of the health services so far as the rates were concerned, at the 1965 level. Perhaps it is not fair to put it in that way. There was no exact undertaking given that this should be done for all time, but when this announcement was made about freezing the rate at the 1965 level, it was expected by all that this was the first step in an effort to stabilise rates. It was so felt and so stated, particularly because we had been already told that the whole question of rates was under consideration for some considerable time. The people felt this was a genuine step to keep rates from rising every year. I think it fair to say that the explanation as to why this announcement was not made until, in the Dublin area, at any rate, it was impossible to have it included in the rate estimates for this year, has not been satisfactory. The Minister expressed the view that it would be the same as last year, that there would be no increase and that any increase would be met by the Department, and I am quite sure he thought that to be true.
It is widely suspected that this announcement was held back deliberately so that the rate in the present year, when there are local elections to be held, would not be affected. That is a serious business. I see no good reason why it could not have been anticipated. The cost of the health services has been rising each year at a fairly high percentage. I have the figures here: in 1962-63, there was an increase of 15 per cent in Dublin Health Authority area; in 1963-64, an increase of seven per cent; in 1964-65 an increase of 24 per cent; and in 1965-66, an increase of 12 per cent.
It is easy to see a pattern there. Fairly steep increases could have been anticipated in present circumstances where improvements in staff salaries and conditions were being agreed and where expenses generally were moving up. The announcement could and should have come in time for the health authorities to prepare their estimates so that the demand for the present year would reflect the full cost that the rates were expected to bear. In Dublin Health Authority the deficit for the present year is £432,000, but this must be carried forward, and the effect in the next year is that the demand will be £1,633,703. That is the estimated cost and that is based on only a five per cent increase in health charges during that period. Based on the experience of previous years it could quite easily be much more than this.
The effect that would have on the three rating authorities would be to increase the rate next year for health alone by 8/1d in the city, 5/4d in the country, and 3/6d in Dún Laoghaire. Excluding any increase this year in the health services, we have an increase of 3/6d in the county rate. We anticipate an increase of about 7/6d in the corporation area which would mean that the increase in the corporation rate would be 11/- in the present year if the full rate was abstracted; and in the county it would probably be 5/- to 6/-, and in Dún Laoghaire about 5/-.
That gives us some idea of where we are going, by keeping the cost of the health services or the partial cost of the health services on the rates, and some decision will have to be arrived at soon to change the whole basis of paying for health services. At the moment we have no regard whatever to the ability of the people to pay this extra rate year after year, with the ever-increasing cost of the health services. The Minister said something about investigating the possibility of finding the money for health services on an insurance basis. I think he said he was getting out some information on that, and the sooner it arrives the better. Certainly the present basis for the payment of the health services is anything but satisfactory and needs to be investigated thoroughly and very soon. I know that the intention is to keep the cost of the rates in the poorer areas of the country as low as possible, and it is quite understandable that that should be done. However, it certainly has come as a very great shock to the ratepayers in the Dublin region to have such an increase in rates, and they will get the full shock not this year but next year.
Many Deputies have commented on the White Paper and have expressed disappointment that more progress has not been made in relation to implementing the undertakings given in that White Paper. While I have been quite impressed by some passages in the Minister's speech in relation to other services on which I hope to comment before I sit down, I, too, feel there is far too much uncertainty for far too long in relation to this White Paper and the undertakings given. The Minister's references to them, to me at least, represent a retreat nearly from the undertakings given in January, 1966. It is like a lot of these announcements: when they are made people get the impression that they are going to get the benefit of it tomorrow. They imagine that what has been announced as a long-term plan that has not been clearly spelled out is a benefit they are going to enjoy, if not tomorrow, certainly in the very near future.
There were many things promised in the White Paper. The only thing that seems to be taking shape— and that is taking shape very slowly—is the choice of doctor. I was one of the people on the Select Committee on the Health Services—the ill-fated Select Committee, let me say—for a period of over three years. There must have been much valuable information collected during that period. There were many submissions made, but this is one that was made very frequently, choice of doctor. One can easily see that there can be only a limited choice of doctor, that there are certain areas where there just cannot be that choice. That seems to me to be quite an easy decision to make but so far it is still under consideration. There does not seem to be any good reason why it should take so long to make a decision on that aspect of the health services.
The effect of this, as Deputy Gibbons put it so fairly this morning, is very upsetting. The uncertainty is very upsetting especially for doctors who are in temporary appointments. The provision of health centres and a decision in relation to the building of health centres is being held up until this whole question is settled. There may be more in it than I can see, but I am surprised that a decision has not been reached on these matters, particularly the state of the health services, before now. The whole tenor of the Minister's references to the White Paper was that the White Paper provides a pattern for the future. It is an uncertain pattern and statements should not be made and false impressions created if we have no clear conception as to how the proposals adumbrated can be implemented. Statements are made and undertakings are given that certain developments will take place. At the time at which these statements are made, there is obviously no clear route to the particular goal. Then someone sits down to work out how we will arrive at that goal.
There has been some discussion about administration of the health services on a regional basis. I have some doubts about this: I have expressed these doubts before. The health services in the Dublin area are administered on a kind of regional basis. On the whole, they have been satisfactory, but I have always thought that the population covered by this particular region is too big and too unwieldy. In no other part of the world is there such a large population served by the one authority. As far as institutional services are concerned, there is everything to be said for administration on a regional basis. I fail to see why this cannot be satisfactorily worked by having institutions on a regional basis and the other services on the present county basis. The services in the institutions can be paid for on a services rendered basis. That sort of arrangement exists at the moment between the rating authorities in the Dublin region. I do not see why it should not work satisfactorily throughout the country.
There is no reason why institutional services could not be provided by one authority and paid for by another. My fear is that in setting up this new administration machine, there will inevitably be a divorce between the rating authority and the authority providing the health services. Unless there is a complete change from the present system under which the rates contribute approximately half the cost, this would, I think, be a wrong development. The possibility is that we would end up with a number of additional administration blocks, costing money. At the moment the local authorities run the services. Administration by these authorities will still cost the same and there will be little or no reduction in the cost of running the ordinary county services.
Referring back again to the Select Committee on Health, the one thing that was harped on time and time again was the means test. That was the serious objection raised by every group who came to discuss the health services. Nothing has been said to indicate that there is any move towards abolishing this means test. That is unfortunate.
The Minister referred to the building programme. An enormous expenditure is required if the necessary accommodation for the various services is to be provided. In the region about which I know most there is quite a building problem. Of course, the main problem is the financing of the building. There was reference to St. Laurence's Hospital. I can never understand what has happened where that hospital is concerned. Up-to-date accommodation is urgently required. It is disappointing that nothing has been done. It is the one hospital in which the Minister appoints the board. The mooted building has gone on for so long that it indicates to me, at any rate, that there must be something wrong. I asked a question about this at one stage and I was told that something like £65,000 had been spent on consultants to draw up plans, which have never been used. That is an extraordinary situation. As far as I know, there is more planning going on now but there seems to be no clear decision as to whether or not a hospital is needed. Surely, if it is needed, it should be easy to decide. Either we have the money or we have not. My advice is to give up talking about it, employ an architect and get on with the building.
The situation is much the same in relation to the federated hospitals group. It is obvious a large hospital is required to replace the five or six rather old hospitals providing certain services now. If it is decided to provide one hospital to give the same services, then there is no point in spending money on the old hospitals. But there is need to do something in these old hospitals immediately if the proposed hospital is not going to be provided. I know a decision has been taken to employ an outside group of experts to examine the situation and make recommendations in relation to providing the existing services under one roof, the cost and so forth. Even though I am a member of the particular authority, this is, in my view, a waste of time.
It is obvious a hospital is needed. It is obvious a hospital will have to be built and the money that will be spent on this investigation is utter waste. These are delaying tactics simply because the money required is not available. It would be far better to say: "Look, we know a hospital is required and, as soon as we can see our way, we will allocate the money, employ an architect and get on with the job". We have architects who are quite capable of planning hospitals and quite capable of giving good value for money. Hospital beds can cost anything from £2,000 to £10,000, depending on the extravagant outlook of those concerned. We have shown in certain buildings in Dublin that we can do a first-class job of building hospitals at quite a moderate fee per bed. We do not really need outside assistance at all to guide us in this work.