When I reported progress, I was referring to the future hospital building programme and the cost of providing the extra accommodation. I know that the Minister referred to this in the course of his speech when he said that the rapidly rising cost of hospital buildings makes it imperative that all reasonable economies should be secured both in design of building and the utilisation where practicable of new techniques of construction. I think that any investigation of future needs should ensure that accommodation that is provided at enormous cost should fully be utilised. I do not know whether the Minister is aware, as I am aware, that accommodation has been provided at enormous cost and, in fact, has never been used over a period of years. I think there should be a very close investigation of existing hospitals and institutions in the country to ensure that no unnecessary extra building takes place.
I am aware of vacant spaces in existence over a period of years that have not been utilised. I know that various reasons and excuses can be advanced as to why it is not used but it is a disgraceful waste of public money that that should be so. I think that many arrangements could be made for a change of use. I think that in quite a number of institutions space is becoming available and this should be followed up very closely to see if it can be utilised for any of the purposes for which we require accommodation at the present time.
I said, earlier on, that I was impressed by certain things which the Minister had to say. I was particularly impressed by the present-day thinking and attitudes towards the care of the aged. There has been a complete change of outlook here over the past year or so and this is very welcome. At present, I think we should concentrate on providing institutional care and accommodation for aged people. I am glad the Minister is completely committed to the idea of doing everything possible to keep old people in their own surroundings. It is only in these surroundings that I think they can ever hope to be happy because people belong where they have spent their lives. I think that with half the comfort and half the care they would be much happier in their own surroundings.
I said before on numerous occasions that I visit quite a number of institutions where aged people are looked after and where they receive the most excellent care and attention, medical nursing and otherwise and yet, to me, they are not happy people. They are not happy because they are looking at the four walls of a room in an institution in which they have no interest. Every effort should be made to keep them outside.
We are all pleased to learn of the development taking place in many parts of the country, that various voluntary and charitable organisations and welfare societies are combining to provide the necessary social services to keep these people comfortable and happy in the surroundings of their own homes. The religious orders and charities generally have done wonderful work over the years. Indeed, they have not always got the co-operation and assistance they were entitled to expect from the responsible health authorities. It is quite obvious that there has been a complete change in outlook in this regard and the health authorities, at least in some areas, are co-operating as far as possible.
The Minister has listed many of the services which can be provided and the equipment which can and should be supplied. Of course, the needs of individuals very greatly, but if we get full co-operation from the health authorities and if the voluntary organisations work in co-operation and association with the health authorities, the number of aged persons finding their way into county homes and other institutions will be considerably reduced. Many hospitals in the country have been crowded out and silted up with elderly people who move in and stay there. The whole question of hospital accommodation is very important and it is so expensive to provide that every effort should be made to ensure that, for instance, accommodation in acute hospitals is used only by persons who require the sort of treatment obtainable there. When patients pass the first stage of treatment, there should be accommodation found for them in less expensive institutions where they could recuperate just as well and at a fraction of the cost.
It is lamentable and deplorable that more investigation has not been done in relation to this matter and that there is not first, second and third stage bed accommodation for patients. In an acute hospital, naturally, equipment is expensive and the staff must be expensive. The acute hospital, having done the main job, cannot move the patient. Patients have been in acute beds for three or four months longer than need be the case if proper arrangements were made to move them on and to reserve the acute space for the right type of patient.
There is one matter which should be a cause of concern to all of us. We made rapid progress in the eradication of tuberculosis over a period, as the Minister said, of 15 years. Then we come to 1964 and 1965 and we have the disturbing statistic that slightly over 2,000 new patients were discovered in each of those years. If we accept that state of affairs and make no intensive effort at final eradication, there is something wrong. This is evidence that we dealt with the problem up to a point but are not getting any further. There must be an all-out effort if this hard core of 2,000 is to be appreciably reduced. The special attention of county medical officers and of practitioners generally should be drawn to this figure. A special circular should be issued by the Department asking for their co-operation in ensuring that every case that shows clinical signs of tuberculosis is X-rayed and, where there is a positive result, that every contact is X-rayed. This is an important matter which deserves special attention if we are to finish the job that has been so well done in recent years.
The Minister also mentioned that only about 50 per cent of pre-school children were immunised against diphtheria. In referring to the health services generally, Deputy Gibbons recommended a pre-school medical service. If we had such a service, that other 50 per cent of pre-school children would be immunised against diphtheria and many other preventable diseases. This question is associated with the scarcity of district nurses.
I am glad to learn from the Minister's statement that a training course is now in progress with the object of increasing the number of district nurses. Consideration should be given to the question of giving further assistance to the Jubilee Nursing Association—I think there is another name for it. This is an organisation that gives excellent service. In any district I am aware of where there is a Jubilee nurse, the amount of work done by the nurse is simply fantastic. Recently I attended the annual meeting of the Jubilee Nursing Association in one area in County Dublin. It is worth describing the amount of work done by one nurse. The nurse, of course, is totally overworked and the association would gladly appoint a second nurse, who is badly needed, but cannot see that it would be possible to raise the necessary funds to enable them to do so. I realise that a large percentage of the money is provided by the health authorities but the voluntary element is very important and the people are kept in touch with the nurse.
I shall now give some idea of the work done by this nurse: number of general cases seen during the year, 206; number of visits to general cases, 1,720; number of visits to infants and children, 2,606; number of welfare clinics attended, 44; number of school children examined for school medical examination, 305; number of school children prepared for school medical examination, 208. That is an amazing amount of work for one nurse to perform. It indicates the great need for stepping up the nursing service which, of course, is also associated with the efforts to keep the aged out of institutions and to help to care for them in their own homes.
The high percentage who took the vaccine against polio has been referred to. That has been possible only by reason of the intensive effort made and I know that a very intensive effort was made in the Dublin area. All the pressures were brought to bear and we had this first-class result of which we should be very proud.
Reference was made to the conditions in mental hospitals and the decline in the number of mental health patients. I have been very impressed by the improvements which have taken place over the last few years in the area with which I am especially acquainted. Until recently, conditions in these institutions could be described as nothing short of deplorable. They were completely overcrowded. Due to the small number of doctors employed and to the fact that in one institution you could have as many as 1,850 patients, it was completely impossible to sort the patients out and have any kind of active treatment for them.
I am glad to say that positions for doctors in these institutions have been made more attractive. Now there is an effort to sort out the geriatric patients from those really mental, to provide active treatment and to get as many out as possible. If we continue making progress at the rate made in the past few years, we will go very fast indeed. It is not before time. I know the accommodation is completely inadequate, but the out-patient approach and the active treatment approach will reduce significantly the number of people who will be permanently in these institutions.
The Minister referred to the unit for emotionally disturbed children at St. Loman's. I believe this unit is doing excellent work but I understand the cost is enormous. Apparently, there is no way of reducing this cost. The Minister said it was regarded as a priority to set up a provincial unit for this type of work. The information I have is that it is very important that these institutions be within reasonable range of the family from which the child comes. There is serious objection to taking children a long way from their own homes. I do not know how accommodation is to be provided unless that is done. In any case, I personally believe it is far better that accommodation should be provided, even at a considerable distance from their homes. The disturbance they can cause at home in certain circumstances is enormous.
It is time we gave up criticising the ambulance and accident service. No doubt for many years it was deplorably inadequate and our ambulances were not equipped to deal with accident cases. Now I believe that certainly in the Dublin area, the ambulances are equipped and the crews are trained and equipped to deal effectively with accident cases. It is wrong criticism to say the service is still not up to standard. There may be certain parts of the country where improvements could still be effected but the service in the Dublin area does not leave much to be desired. I hope the new arrangements which have been come to with the hospitals in relation to accident cases, especially at night, will prove to be effective and that the team work expected of them will be available to the unfortunate victims of these accidents.
The dental service is something that needs to be examined. I heard of a case recently of an applicant for assistance towards a repair job on dentures. They cost £1 and eventually, after considerable time and agitation, the person got 2/-. That is something that needs to be looked into.
I was rather disappointed about the setting up of the special unit in the Dublin Health Authority area for the investigation of cervical cancer. I do not know why it has taken so long to bring this unit into being. There was considerable difficulty about staffing the unit because the salary offered was insufficient. I know the Department stepped up that salary but, quite frankly, I do not know what the present position is. I think the unit is still not set up on a working basis. I know there are a couple of technicians employed and there is some sort of temporary arrangement which, I think, is not fully effective.
That more or less covers most of what I wanted to say except one further point the Minister should look into. There should be some sort of an agreed veterinary and medical policy on the use of antibiotics and other drugs. There is a fair amount of indiscriminate use of antibiotics in agriculture today. That could have serious repercussions. There should be some general understanding about the use of these drugs. It is possible that not only could similar drugs be ineffective on people who have used these agricultural products but they could have very dangerous reactions. It is a matter that requires attention as soon as possible.
