On behalf of the Fine Gael Party I move:
That Dáil Éireann is of opinion that the present health services do not meet the needs of the people, and that the method of financing them is unfair in the unjust burden which it imposes on ratepayers without regard to their ability to pay, and that as a matter of urgency existing services should be replaced by a comprehensive health service based upon insurance principles and which will provide without charge, and as of right, for all people within the scheme, full medical services with choice of doctor and free hospital, specialist and diagnostic services.
It is the second time in about seven years that we in the Fine Gael benches have proposed such a motion. Over the past ten years we have been pressing for the adoption of such a policy, such a health service. It has been an uphill fight with the roller of the Fianna Fáil Party trying to roll back the progressive Fine Gael health policy. It is very little comfort to the people who have been suffering in the meantime to receive from time to time an odd glimmer of an indication from the Government that at long last they are prepared to admit that there might be something to be said for the Fine Gael Party stand on the basic principle that a health service is best financed in the main by insurance contributions. The present health service, the present system, has come to us from the poor law guardians. It is a service that is wrongly based upon high-cost institutions which give medical attention in the last resort instead of being correctly based on low-cost home care of the first requirement.
If we had here what every European country with the exception of Finland, has, a medical service and a health scheme which would allow people to call a doctor of their own choice and get drugs and medicines at nil cost or substantially reduced cost we would require the system which operates in those other European countries with the exceptions of Finland and Ireland. Until we have, we shall have a continuation of a system which ensures that an essential human need like medical service finds itself perpetually in competition with every other service provided by the State, with every other service from the revival of Irish to the maintenance of an army, from farming subsidies to the maintenance or creation of prestige.
This is basically wrong. Even this week the Minister for Health found himself obliged, having received estimates from health authorities of their necessary costs in the next year, to reply to them saying that the financial situation is such that he feared we would not be able to provide the financial support necessary to maintain the services which they had put before him and asking them, therefore, to endeavour to prune the services and cut back on or avoid expenditure. Here we have the Minister whose prime care—and I know his natural disposition—is to provide a good health service and all the medical attention people need, saying to health authorities: "You are trying to do too much. It is in competition with other services that the Government have been asked to pay for. It will not do." The people who need doctors, in order words, must go without them and the institutions which are considered necessary to provide medical services will not be built this year because other things are competing with them. As long as we continue a system which means that health costs have to compete with everything else provided by the State or local authorities we shall have a mean, insufficient and inadequate health service.
We in Fine Gael are satisfied that it is within the capacity of any modern progressive State to apply certain techniques to ensure that health services are not in competition with other national and local services. We are also satisfied that the present system does not meet the needs of the people. It provides care out of institutions and hospitals for an average of 30 per cent of the population; the other 70 per cent must provide everything for themselves. In an urban area like Dublin only 16 per cent of the population get any medical attention or care or subsidised drugs outside hospitals and institutions. The remaining 84 per cent must care for themselves. We are satisfied that this causes serious hardship in many cases, that it means that many heads of families postpone getting necessary medical attention in the hope that what they regard as a minor illness may not turn out to be serious one. In many cases having got medical advice and having obtained prescriptions from doctors, many people do not get these prescriptions filled when they find the cost is beyond what they consider the family can bear.
On that account we have a situation in which 70 per cent of the people, without any help or assistance towards medical costs outside hospitals or institutions, neglect to get the necessary medical care for themselves until a stage is reached where the doctor must be consulted because of the gravity of the illness. The doctor then, in many cases, must consign the patient to an institution or hospital, that being the only place then capable of looking after him. This is basically wrong. That is why we in Fine Gael regard the present service as so inadequate in answering the needs of the people.
Today we should be debating the Government's much-promised but still undisclosed Health Bill to improve— to use their own words—our existing services. We were informed prior to the 50th Anniversary Meeting of Dáil Éireann that the Government proposed to introduce at that meeting the longpromised Health Bill. It was first promised in the autumn of 1965. We were promised on three separate occasions in the spring of 1966 that it would be before the Dáil and Seanad in the autumn of 1966 and would be law and in operation before the autumn of 1967.
These promises were broken like every other promise made in relation to the same Health Bill. On the great day of the Golden Jubilee of this democratic Assembly such a Bill was introduced. We of the Fine Gael Party informed the Taoiseach prior to that meeting, when we were informed of the intention to introduce the Bill, that we could not support a Health Bill which was based upon the Government's present White Paper because we regarded it as unacceptable because of the proposal to retain the poor law system as the basis of any future development and because of the Government's unjustified assumption that medical care outside of institutions did not cause hardship to most people.
We regarded the 50th Anniversary of Dáil Éireann as a singularly unsuitable occasion to introduce a Bill which sought to enact once again as the basis of health services a system which has come down to us from the days of the poor law guardians, singularly unsuitable I say because the first democratic programme of the First Dáil said that the poor law system was an iniquitous system and that the first task of any Irish nation having achieved its independence would be to abolish the iniquitous poor law guardian system.
In the event, the Government indicated that they had not made up their minds exactly what the basis should be for the financing of the future health services. Therefore, in the hope that even at the 11th hour and the 59th minute the Government might do the right thing, we did not divide on that great occasion of the golden jubilee of this House, but if when the Bill is circulated we find that it is proposed to retain the objectionable features of the present poor law system with its means tests and its class distinctions, its exactions from people when they are sick and in need, its limiting of health services to one-third of the population and making ratepayers of small means pay for services which are denied to them, we in Fine Gael will oppose the Bill ruthlessly because we regard any future development of our health services so conceived as basically wrong, inhuman and stupid from the economic point of view.
The present health service is geared so that only three out of every ten people get any help from it unless persons are so seriously ill that they are in hospital. Only five per cent of the total national bill for health services goes on providing medical attention outside of hospital; 95 per cent of our public health bill is payment for the maintenance and care of people in institutions and hospitals and only five per cent of the total health bill goes in paying for services outside of hospitals for 30 per cent of the population. This ought to make it clear that a mere ten per cent increase in the public health bill would provide for 90 per cent of our citizens full medical care outside of hospitals and we in Fine Gael are satisfied that if 90 per cent of the people were fully cared for outside of hospitals and institutions huge savings would result in hospital costs which would, if not more than compensate, certainly substantially compensate for the increased cost which a full medical service would impose.
These are simple sums in arithmetic. The tragedy is that the answers have not yet been worked out or have not been accepted yet by successive Ministers for Health and for Finance in the Fianna Fáil Government. As the Minister knows full well, the cost of maintaining people in hospital these days will vary from £20 to £30 per head per week and the tragedy is that in many cases if £3 per head per week were spent on those people in good time in their own homes they would never have ended up in hospital at all. It is only by a proper development of our home care of people and only by adequate subsidy of the high cost of modern drugs and medicines outside of the hospitals that we will get the kind of medical service which is so urgently required.
One of the great and inevitable tragedies of our present health services is that overworked doctors, particularly dispensary doctors, are obliged by the nature of the system to shove people into institutions and hospitals because their own case-load, the number of patients they are expected to look after, is so great that they could not possibly give people outside of hospital the kind of care and attention and frequent calls which their illnesses would require.
At present, in urban areas where there is no need to maintain separate State-appointed dispensary doctors because there are sufficient doctors available, there are many dispensary doctors with as many as 8,000 patients apiece. The figure is 8,000 when you associate with the number of medical card-holders the number of dependent children in their families. The result is that in many growing suburbs where there is a large population of children the dispensary doctors are required by law to give medical attention for 1½ hours per day in the dispensary to anything from 100 to 140 persons. It cannot be done. It is a physical impossibility. It is no exaggeration then to say that our medical services at the moment do not answer the needs of the people.
In relation to so vital and personal a matter as health, people ought to have a choice of doctor. That is a right which is available to any person of means who can afford to pay for the services of a doctor. It is entirely wrong to withhold that right from people who have not got the means to pay for a doctor and it is wrong to say to them that if they avail of the health service provided by the State and the health authority they must go to a particular doctor and no other. It took many years of fighting from the Fine Gael benches to get a reluctant Fianna Fáil Government to accept the principle of choice of doctor but it was accepted four years ago in the Government's White Paper and since then they have done nothing to implement what they then accepted as necessary, vital and the right thing to do. We consider that their delay is unforgiveable.
As we speak of the need to abolish the dispensary system in areas of high density of population, so we reiterate our conviction that the dispensary service or some system of that kind must continue to operate in areas of low density of population because we do not want a situation to arise in relation to the medical services of this country such as has arisen in relation to dental profession in particular and some other professions where professional men are not available in the more remote areas of the country because there is not an adequate living in such areas for them. Of course, the State must continue to pay the salaries and allowances and maintain premises for the medical profession in areas of low density of population. But there is no justification for trying to adopt a uniform system or trying to evolve a service suitable for a remote area and making it the only service available in an area of high density of population and high density of doctors as well.
We do not think the present health service answers the needs of the people because the needs of the people are to obtain medical attention when necessary, without losing self-respect in the process. A system which debases the dignity of doctors and patients to a degree which requires people to prove, as a matter of law, that they are unable out of their own incomes, or other lawful means, to pay for the necessities of life—food, clothing and shelter—is a system which does not answer the needs of the people. It is a system which is harmful to the health of the people because people are naturally reluctant to use such a system.
Our nation is at the moment painfully conscious of the inconvenience and loss to national wealth caused by the current industrial disputes and the abstentions from work which those disputes entail. Year in and year out we lose in Ireland 14,000,000 working days through abstentions from work caused by illness. That is a rate five times greater than the average number of days lost through strikes. We are not assuming for one moment that we can ever reduce abstentions caused by illness to nil—that is not the fate of mortals in this world—but we ought to consider these figures and, considering them, we ought to accept the justification for a totally different approach to health services.
We, in Fine Gael, have found ourselves in violent disagreement with Fianna Fáil for very many years on issues of national priority and governmental responsibility. Fianna Fáil, in their First and Second Programmes, spoke of the priority which economic development had to get over what they regarded as subsidiary, or secondary, or less important, social development. We consider this to be wrong. We do not think you can have economic development to the exclusion of social development and vice versa. One goes hand in glove with the other. If we were to do something worth while about our health services and provide for all our people free medical care and substantially reduced drugs and medicines outside of hospitals, I believe we would cut significantly into that 14,000,000 working days which are lost annually. If the Minister is unable to prevail upon the conscience of his colleagues and, in particular, upon the conscience of the Minister for Finance, to do something radical in relation to the financing of our health services, might I plead with him to use the economic argument that the expenditure of another £5 million would be well justified if, in the result, we cut down on the number of working days lost annually through illness. If we could do it even by 2½ million working days per annum we would recover all the time that is lost, the production that is lost and the wealth that is lost through industrial disputes. That is not to say that we should not do something also about reducing, if we can, the number of industrial disputes, but it is certainly worthwhile trying to do something about what we are losing unnecessarily at the moment through absenteeism because of ill health.
The Fine Gael motion refers to the unjust burden which the present system of financing the services imposes on ratepayers without regard to their ability to pay. This causes me to return to the objection in principle which I voiced earlier, the principle of the poor law system which assumes that any property owner is a person of wealth and, on that account, must contribute to the support of paupers in the district in which the property is situated. The assumption that a ratepayer was a person of means might have been justified in the days when only people of means owned property. That day has, thank God, long since gone. There are many smallholders and many small owners of house property obliged to pay for health services from which they themselves are excluded because of their ownership of property. That is totally and unforgiveably wrong. We ask for the adoption of a comprehensive health service based upon insurance principles. We do this because such a system would remove health services out of competition with all the other services provided by the State.
We believe our people would respect an insurance fund, which could not be raided for any other purpose except the provision of health services. People would understand the costs involved if they had created for them a health fund which would pay for the services. So long as the cost of running the health services is confused with the cost of every other service and amenity provided by the State, so long will you get people complaining about taxation and so long will you find people trying to fleece the health authorities for every last penny they can get because they honestly believe they are paying too much for an inefficient service. I think they are justified in that belief. An insurance system assumes that you will receive from those who can afford to pay a small contribution at regular intervals, probably weekly. Then, when the rainy day comes, society and their neighbours will be able to come to the assistance of those who are ill through the medium of the fund created by their contributions. That is the doctrine of good neighbourliness. That is the doctrine of mutual help. That is the doctrine which sees society working as a family and the nation working as a brotherhood. It is a doctrine which is most respectable and it is a doctrine which would be acceptable to all sections of our people.
Where we in Fine Gael differ from the two other political Parties is on the issue of the mode of financing our health services. We appreciate, and we have so argued, that you cannot suddenly switch—nor would it be desirable suddenly to switch—all the cost of the existing health services from general taxation or from the ratepayers to an insurance fund. We do not propose that. What we do propose is that in relation to all further improvements in the health services, and particularly in relation to the domiciliary service which we have advocated, the contributions and the money paid, would come from people under an insurance system.
The Government apparently accept that the health services should be paid to the rate of about 45 or 48 per cent by the ratepayers, and to the tune of 52 or 55 per cent, or thereabouts, from general taxation. If I correctly interpret the most recent statement on the health services from the Labour Party, their view is that the cost should be transferred entirely to the national Exchequer.
