I do not accept the Deputy's contention that the standard of eligibility for medical cards in Dublin either is deliberately kept low to reduce pressure on the dispensaries. Surely the fact that there are considerably increased opportunities for employment in Dublin must be taken to be a factor? There is also the fact that a number of firms provide general medical services for their employees through doctors they employ for their own firms. I am glad to note in recent times that some of these firms are also providing a dental service as well as a medical service for their employees.
I accept that the work load on dispensary doctors in Dublin is very heavy. I therefore accept that there can be frustration from the patient's point of view. If a doctor has to examine a large number of patients within a given time, he obviously cannot give the same minute examination as he would like to give. This is a situation which, of course, develops where you have a rapidly increasing population in developing suburban areas. I think it inevitable that there will be some backlog of delay in catching up on this on the part of the health authority. I think the Deputy, and I would imagine all Deputies who are associated with Dublin Health Authority are, is aware that the Authority are conscious of the need to keep abreast of the requirements of the people by way of doctors. Dublin Health Authority has, in the main, been assiduous in reviewing the situation from time to time and in trying to correct defects which come to their notice.
Mention has also been made of delay in toning down selections. I share the Deputy's concern here. I think in a situation where acute cases are concerned, these are given priority and there are no grounds for complaints so far as these acute cases are concerned. There has been over-long delay in regard to chronic old cases which are a cause for concern. I have asked the Hospitals Commission to recommend to me what measures can be taken with a view to solving this problem.
Deputy Kyne also mentioned anomalies which arise from the school health examination scheme. These again are under examination at the present time and I am expecting a report shortly. I have also been concerned by the fact that by law a child examined in the course of a school health medical examination is allowed certain free treatment, whereas a child who is not fortunate enough to have attended the official examination in school and who has defects discovered privately by the doctor, is not so entitled. I would be inclined, without promising to do so, to abolish that statutory provision so as to make all children equal. However, I will not commit myself in this regard until I receive the report I have mentioned, and I will then make an announcement about my general intention. It is obviously desirable that all children should be treated equally on the basis that prevention is better than cure in so far as disease afterwards can be prevented if proper dental, medical and other services are available to children at the earliest possible stage.
I now come to Deputy Ryan's remarks in regard to the hearing aid service. He stated that there is only one type of hearing aid supplied and that people who get hearing aids discard them because they are useless. Not merely are these statements inaccurate but they are quite unfair. The hearing aid service is operated by NOR, National Organisation for Rehabilitation, and I do not have to tell Deputy Ryan anything about this organisation or the people who run it. I should like to tell him that there are four types of hearing aid being provided. There is a standard model which suits the majority of patients, a more powerful model which suits severely deaf patients, a wide band model, and a powerful one with a wide band range. The vast majority of people supplied with these are fully satisfied with them. Quite recently, the organisation called back 40 adult patients selected at random in the Dublin area. Of these, four had discontinued using the aids. One of these four had purchased an ear-aid privately; the other three, who were quite old, had discontinued using them because they found them too noisy. The aids were adjusted to cut down the background noise and the three patients in question are now trying to use them again.
It is, I think, quite understandable that old people will find difficulty in accustoming themselves to the use of hearing aids, but this applies just as much to hearing aids privately purchased as it does to those provided under the national service. I should add also that the organisation provides aids to the Council of Education Advisory Service for Deaf Children, and all children supplied with hearing aids are regularly visited and their progress marked.
I now come to the remarks made by several Deputies in regard to the ambulance services. I think it is now appreciated that it is the constant concern of my Department to improve the ambulance services and to continue to improve them to their highest possible level of efficiency. Might I here thank Deputy Clinton for the remarks he made this afternoon when he so rightly said that it was about time people stopped criticising the ambulance services as being inadequate? Indeed, I would commend his remarks, not merely to those Deputies who seem to be able to find some inferences of neglect whenever it suits them, but to other people outside the House as well.
As Deputy Clinton said, you cannot provide an ambulance at every corner. You cannot anticipate where the drunk will hit the telegraph pole; you cannot even be sure that it is a telegraph pole he will hit and, therefore, all you can do is provide a service and a means of communicating with that service, ensuring (a) that the service is of high efficiency, and (b) that as far as possible the communications will be as fast as possible. In this country and, indeed, in any other country where accidents take place in remote areas, there is sometimes an unfortunate time-lag between the happening of the accident and the ambulance service being notified. Sometimes this delay has very unfortunate results for the injured person. But, to be realistic about it, this is a situation which I think must remain indefinitely. All we can do is provide an adequate ambulance service with good ambulances properly equipped, expert personnel and the necessary backing of hospital services with it. I agree with Deputy Clinton that at this stage the ambulance service of this country is good.
I now turn to the question of the ambulance drivers mentioned by Deputy James Tully. There is a claim for increased pay and better conditions of service which has been on hands now for some considerable time. I have been most anxious to help the ambulance drivers in their claim which I regard as well-founded. To that end, I met the representatives of the unions concerned and subsequently saw the County and City Managers Association. Last month, the managers sent a letter to the liaison officer for the unions asking him to nominate representatives to meet the managers for a discussion. I shall be only too glad to use my good offices again, if necessary, to bring these parties together. The situation, so far as I am concerned, is simply that, subject to the ambulance drivers doing and passing the driving course, about which the House knows, the ambulance drivers will be entitled to a fair increase in their remuneration and this will be on a national basis. If there is any further help I can give to assist the processing of this matter, I shall be glad to give it.
A slightly different situation arises in regard to the remuneration of local authority staffs over the operative date for the tenth round increase. I think it was in regard to this particular matter that a member of the Labour Party, a Mr. Ó Murchadha, saw fit at Roscommon a couple of months ago to launch a vicious attack upon my predecessor, who is the present Minister for Education, and myself. This worthy gentleman was perfectly well aware—and, if not, he ought to have been well aware—that the decision in regard to this matter was a Government decision and that both my predecessor and myself were merely carrying out the instructions of the Government and were therefore not in a position to vary the terms of the decision.
A number of Deputies referred to the inadequacies of our public dental services. This was merely repeating what I had said myself in my opening statement because I am gravely concerned about the fact that our dental service in many areas is indeed unsatisfactory and requires considerable improvement. The fact that agreement has recently been reached on a new scale of salary for public dental officers will, I hope, be a help. There are 25 vacant dental posts at the present time. If we fill these vacancies, we could immediately effect a considerable improvement in the understaffed areas, one of which, indeed, is my own county of Mayo, another being Donegal. We are most anxious to provide a fully satisfactory dental service.
I have been turning over in my mind the suggestion that dentists should be asked, or perhaps obliged, to give the public health service a year of their time after they qualify. At this stage, I am not prepared to say any more than that I am giving this consideration. The House will be aware that, in recent times, there has been a very considerable brain-drain from the western European countries to the other side of the Atlantic and that, at the present time, this is being operated deliberately on a selective basis in the United States.
We all know, and are acutely conscious, that it costs us a great deal of money to produce a doctor, a dentist, an engineer or an architect. We are naturally aggrieved if, as a matter of policy, any big nation should use its vast resources to select our brains, if we have paid to train them, and do so without return or offer of return to us. Furthermore, we have a serious manpower shortage, especially in the dental field. I should be slow to take steps on this side, but, as I say, I am attracted, to some extent anyway, by the idea of making it a condition of qualification that the dentist should give the first year of his service to his own country but, of course, on the basis that he will at least adequately be paid. I would have, I hope, further ideas to offer on this problem at a later time.
In regard to the suggestion by Deputies James Tully and Healy that more use should be made of private dentists, I should certainly listen very carefully to anything Deputy Healy might mention in regard to a matter on which he is an expert. Some 16 authorities have already made arrangements with about 16 private dentists to hold treatment sessions either in health authority clinics or in their own surgeries, but other health authorities have no such arrangements, sometimes because the private dentists are not particularly interested in sessional work and sometimes perhaps because the matter of remuneration could not amicably be agreed upon between the parties concerned. I do not think it would be wise of me to say anything more about this matter at this time.
Deputy Mullen stated that children in Cabra and Finglas have to travel to Cornmarket when they need dental attention. I may have been mistaken but I thought at the time that Deputy Mullen said "Common Market" and I was relieved to know that at least they do not have to go to France. However, as I pointed out in reply to a Parliamentary Question on 1st December last, there is, in fact, a clinic at Ballygall Road, Finglas, where a dentist attends regularly, and the question of providing an additional clinic or clinics in the Dublin area is under review by the health authority, who, of course, are the people having primary responsibility. I understand that they intend to put up another clinic in Cabra as soon as they can get suitable premises. They already have a total of 25 equipped surgeries in 18 different clinics and also recently purchased a mobile dental trailer unit. They also have an arrangement with the Dublin Dental Hospital for treating patients who are eligible.
Deputy Healy also mentioned, towards the end of his speech, his concern about the oldest known building in Cork, namely Skiddy's, the old almshouse, and he came up with a suggestion, which I hope will be implemented that is, that that part of this building which could be preserved will be preserved. According to my information, the building itself is incapable of restoration and, of course, it is very badly needed by the health authority for a nurses' home. I do not like to have old buildings destroyed, if there is anything preservable in them and if the needs of our times as well as the aesthetics can be met together. It seems that there is an arcade which is now invisible to the people of Cork, never mind tourists, which could be put up elsewhere, perhaps in Fitzgerald's Park or some such place, and I hope Deputy Healy and those interested with him in Cork will pursue this so that if Skiddy's should go, at least some part of it will be preserved and be visible for and in Cork in the future.
Reference was made also to St. Clare's Convent in Stamullen, set up some 15 years ago by the Poor Clare Order in Newry to look after abandoned babies. Most of the babies in this home are maintained at the expense of the local authorities and, to assist the nuns with the running costs, several increases in the maintenance rate were approved and the present rate, which was fixed on 17th July, 1965, is £5 a week. I understand that on 7th March there were 71 babies in the home. Eighteen of these were privately placed and the relatives contribute for some of them. The other 53 are paid for by health authorities at the rate I have mentioned. The order, therefore, is receiving about £14,000 a year. I should like it to be more because these wonderful ladies are doing a great service to these unfortunate abandoned babies. If and when a case can be made for increasing the maintenance rate, the House can be assured that I will consider it sympathetically.
Deputy Clinton today, following up the remarks made by others earlier on, mentioned what he described as the hard core of tuberculosis patients which still remains and asked that I should take whatever steps are necessary to attract public attention, especially the attention of parents, to the need for immunisation and X-ray. I would be glad to send a circular to the health authorities as suggested by Deputy Clinton but I am glad to say that there are at least some hopeful signs. I have just learned from the Mass Radiography Board the figures of those who came forward for X-ray last month. It is the record figure of 38,611 and is the highest in any one month since the establishment of this service in 1951. Nevertheless, I agree that public attention should continue to be focused on this problem until such time as the disease is wiped out completely.
I now come to deal briefly with the references made to the efforts, some say "if any", of my Department in regard to smoking. I agree that I am not much of an advertisement but at least I am honest about it. When I was opening the "Home Truths" series on Telefís Éireann, I admitted that I smoked cigarettes and regarded myself as being virtually incurable from that point of view at this late stage of my life. There are people who, apparently, have more determination than I have who do manage to give up smoking when they are over 40. I am convinced that the most hopeful way to tackle this problem is by concentrating on the youth. I do not propose to delay the House with details of what my Department are doing in the way of issuing leaflets and so on and so forth. Most Deputies are probably aware that there were three of the "Home Truths" programmes which were devoted in one way or another to this problem of smoking. May I say that in all the countries that have tried to mount a serious campaign against smoking the success achieved to date has been disappointingly small? In America now there is a notice on every packet of cigarettes sold warning the public that the consumption of cigarettes may be hazardous to health.
I accept that smoking is hazardous to health and, indeed, I accept the compelling evidence of the connection between smoking and lung cancer, between smoking and heart disease, between smoking and bronchitis, but there are very strong forces operating, these being manufacturers of cigarettes who have an enormous vested interest in ensuring that their product will continue to be sold. Every time a concerted effort is made in any country to warn the public about the dangers of smoking, the cigarette manufacturers forthwith double, redouble and quadruple the money they spend on advertising their product in an effort to counteract the influence of the doctor or the politician.
If one accepts also that smoking is an addition to a drug, then it is not practicable to try to stop people who are confirmed smokers other than the occasional person who is frightened by his doctor into stopping smoking or who decides to stop smoking and has the moral courage to carry his decision into effect. I think the right way to approach this problem is to get at the youth and I think the right people to do that are teachers rather than parents—teachers in the school who are interested, because the children might think the parents were merely trying to stop them being manly when they grow up or some nonsense like that. In that connection, I believe children do now realise that smoking is injurious to their health. They realise their parents are not trying to make sissies of them by advising them or warning them against smoking. The only way we will ever make practical progress in this important matter is by concentrating our efforts on the youth, particularly through the teachers, as well as the parents, so that we will have more and more people who never have acquired the smoking habit.
I might add that, when I did mention smoking in my own few words in the introduction to the Home Truths programme, there was quite a flap because the amount of revenue involved for a certain organisation I am now going to praise is quite substantial. Incidentally, when I mentioned RTE in my introductory speech, it drew from a distinguished member of the Press Gallery an article suggesting all sorts of devious implications in my remarks. I do not know why my esteemed friend, that particular correspondent, decided to take so many meanings out of my simple remark, unless perhaps he was bored with writing about the farmers' dispute and thought he would inject a little bit of excitement——
