Deputy Dowling moved the adjournment of the debate. The Deputy has 17 minutes and the time remaining for debate on the motion is 40 minutes.
Private Members' Business. - Health Services: Motion (Resumed).
Debate resumed on the following motion:
"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."—(Deputy Ryan.)
I mentioned just before the debate adjourned on the last occasion the ever-increasing demand for better services and better systems. This demand is always evident when a system has been in operation for a period. The ever-increasing demands on the health authorities for new drugs and new services are noticeable each year during the estimates period when an assessment of the situation in respect of the coming year's services is made and given to members of the health authorities.
It is difficult to understand this motion particularly when it is in the name of the Fine Gael Party. I referred to it as a cleansing of conscience, because at the last estimates meeting of the corporation when this matter was discussed a motion was moved by two Fine Gael members, one of whom, Deputy Ryan, seconded the motion, that there be a reduction in the Dublin Health Authority demand for £789,106 on 5th April last year. This gives some indication of the thought given to the problem by the people who have put down this motion. On the one hand, they seek to have better services, and, on the other hand, they have little concern for the people who are really affected.
The system that is in operation must be worked until such time as an alternative system is devised. If the motion had been accepted and implemented it would have meant that less money would have been available to the widow, the orphan, the sick, the unemployed and the disabled. This substantial reduction of £789,106 would have meant that a considerable section of the citizens of this city would have to suffer because of the Fine Gael motion.
We asked the Minister to pay, not the ratepayers.
This was a reduction in the demand of the Dublin Health Authority.
From the ratepayers. We asked the Minister to pay instead.
It was a reduction in the demand. Our function on that occasion was to strike the rat for the health authority and the Deputy sought a reduction of £789,000 in the demand. However, when the matter was finally put before the city council it was carried with the Fine Gael Party voting against the estimate. I am sure the weaker sections of the community are aware that the real intention behind the Fine Gael motion is publicity. In relation to health and other problems of our citizens we are seeking services for the lower income groups, but this motion clearly indicates the mentality of the Fine Gael Party and shows that they have no regard whatsoever for the people who are in need and in dire need in some instances.
The need for change is both evident and necessary. The Minister is drawing, to some degree, on past experience in a desire to bring into effect a system which will have lasting advantages when the changes come. The first Coalition Government collapsed as a result of trying to implement a Health Act. This shows the need for a cautious approach and a comprehensive study of the problems which arise in the alteration of an existing system. The amount of work which the Minister is doing is unknown to the great majority of people either in the House or in the State. He has made untiring efforts to acquire the information which can be shown from past experience to be both necessary and desirable in making changes which will be accepted and of benefit to the nation as a whole.
There are many defects in the present system as operated by the Health Authorities. In some cases there are people getting services, who in my opinion are not entitled to them; while, on the other hand, there are many people who are entitled to services and who are not obtaining them. The position must be spelled out clearly so that citizens will be fully aware of their entitlement and will not be discouraged by Fine Gael speakers who have described people seeking services as "paupers". Citizens are as much entitled to health services as to any other service provided by the central or local authority. When you refer to people who apply for medical services under the Health Act as paupers it only leads to people depriving themselves by not wanting to be classified in this particular manner by some sections of the community. They are entitled to them by right and for that reason there is no reflection on anyone who has to seek assistance from the health authority. If what Deputy Ryan has stated is correct, that his desire was to see the maximum amount of money made available, this £789,000, which he sought to have the Health Estimate reduced by, I wonder would he have had the courage to come into the Division lobbies and vote for the necessary financial resolutions if a tax increase was necessary in order to provide this money. We have seen, when going into the Division lobbies, that on no occasion have the Fine Gael members ever supported financial resolutions which would make money available to finance health services or any other services of that kind.
The question of relieving the ratepayers was mentioned. We know there are ratepayers in this city who are finding it difficult to meet the additional demand in rates but we also have groups in this city, big business concerns, petrol companies, cigarette companies, breweries and other people making contributions to the rates who cannot be allowed off the hook in any way. Those people have an obligation to our city and to our citizens in whatever section of the city or the country they operate. They must make their fair contribution. However, I agree there are some ratepayers who, unfortunately, are finding it difficult to meet those increased demands. The Minister made his views known to the members of the health authorities, to the members of the three rating authorities when we met him recently in the Custom House. He was frank and his views were met him recently in the Custom House. He was frank and his views were accepted by all the members of the deputation which met him on that occasion when he explained in great detail the problems there were and he explained the cost of the necessary alterations and indicated at the same time that the examination was proceeding and when it did come he would then be in a position to make his statement.
Deputy O'Higgins mentioned that since 1957 this has been the Fine Gael approach. It is amazing that he did not refer to the years before 1957 when he was then in a position to carry out alterations and to introduce a new health system. When he was Minister for Health Deputy O'Higgins failed to live up to his responsibilities. He failed during that period to devise a new system. He failed to do anything other than implement a system which he then considered satisfactory. As I said before, there is no doubt that change is necessary, change is desirable and change must come. The Minister is bringing about this change and I am sure when he has his examination completed, when he has reached satisfactory conclusions with all the Parties concerned, he will introduce something which will be satisfactory to all.
I should like to congratulate the Minister on his work and assistance to the aged in this city. Most of his work is done without any publicity whatever. It is only people close to the Minister and to the organisations, both voluntary and local, who are aware of the wonderful work done without any trumpet sounding in order to publicise himself. He is always seeking improvements and he is one man we can be sure will bring into operation an effective system, when he is in a position to do so, one that we can be proud of and even if it takes some little time longer it is just as well to ensure that all the facts have been correctly gathered and that the mistakes made by a previous Government will not be made on the next occasion.
I shall be brief.
The concluder on the motion has 15 minutes and will be called at 6.25 p.m.
The motion under discussion in this House for the last few evenings will in my opinion do good whether or not everybody agrees with it by highlighting the weaknesses in the existing services. I am afraid, like some of my colleagues who spoke, I am not quite clear what Fine Gael mean by saying "a comprehensive health service based upon insurance principles". If that means that the people through insurance are to bear the whole cost, then I think it would not be a scheme which would be very acceptable or very easily worked. I am sorry it was not possible to have the Labour amendment discussed because I feel sure Fine Gael will agree that a system "Financed by the State from taxation and graded social welfare contributions from all earning members of the community and operating in conjunction with the social welfare services" would be a much better system. It always puzzles me, when something like this is being discussed by the House, to find people on the Government benches prepared outside this House to criticise the system, the Minister and everything else and to throw bouquets here at the Minister.
I am quite sure that the Minister for Health, like his predecessors, is anxious to do everything he possibly can to provide good health services for this country but Ministers are part of the Government and they can only provide the service which the money they get will allow them to provide. The present Minister is on record as having stated that he preferred the Labour approach to this than the Fine Gael approach and I think he even said to that of the Government. That showed he is a very intelligent man because the approach which we have to health services is, first of all, that we must realise that the health of the people is the important thing, secondly, that in order to ensure that the health of the people is properly looked after money must be found and, thirdly, we state how we consider the money should be found.
Time and again I have heard people inside and outside this House referring to the number of man days lost through strikes. It seems to me a favourite comment of those who want to criticise the workers of this country that they lose more man days in strikes than any other country in Western Europe. I think that is the usual expression they use. Nobody ever seems to bother counting the number of man days lost through ill health which could be and I believe should be prevented.
I have noticed, as a trade union official, that since it has been possible during the past few years to negotiate sickness payments on a fairly wide scale for workers in various types of jobs, the number of man days lost through ill health has dropped considerably. The reason is quite plain; before sickness payments were introduced, these people had to work as long as they could and eventually, when they became ill and if they had not a medical card, they were not able to get the medicine they required. Now that they know they will be paid if they are away from work for a relatively long period they can leave off work and obtain the medicines they require. A result of this is that they are back at work in a much shorter time than was possible before the sick pay scheme was introduced. This matter can be easily checked with employers and doctors.
The existing scheme is a very slight improvement on the old red ticket scheme, which still operates in some areas, in that people who are entitled to treatment just cannot take it. For instance, I spoke to a man last night who is a son of an aged and widowed mother. This man can work only in the area where his mother lives as he is not in a position on her account to go away to work in Dublin or elsewhere. As a result of this, he is as often unemployed as he is at work. He has no medical card and when he recently developed a rash on his face he went to a doctor who charged him 15/- and gave him a prescription. When he took this prescription to the local chemist he was told that it would cost 18/- to have it compounded. As he could not afford to pay this, he is still going around with the bad rash on his face and wondering what kind of health service we have in this country. This type of case can be repeated over and over again and, whether we agree or disagree with the motion before the House, the mere fact that the various aspects of the health services in this country can be debated and that the shortcomings can be pointed out makes it a worthwhile motion.
Finally, I should like to refer to the present system where the Minister is in the position that he has notified health authorities that estimates which they submitted in October last of the requirements for health services for the coming year must be pruned because of the fact, he says, that the money is not easy to get or some such phraseology. The plain fact is that under the existing scheme which is a very poor one most local authorities will be unable to finance it from the amount coming from the rates and the 52 or 54 per cent from the State unless the State comes up with some more money because there has been an increase in costs of approximately 25 per cent since last October.
Sometimes my heart goes out in pity rather than in anger to Deputy Dowling because he is to be pitied. He is the first person who will be rejected by Fianna Fáil when they are on the slippery slope. The poor unfortunate individual comes in here and to other assemblies trying to do the bosses dirty work. A sample of this was given here today when Deputy Dowling suggested that in the Dublin Health Authority last year, in common with my Fine Gael colleagues, I endeavoured to reduce the amount towards health serwhat I wanted was that the £789,000 be paid, not by the ratepayers of Dublin, but by the Minister for Health in accordance with the undertaking given by the Government in the White Paper published by them three years ago when they said that the cost of health services on the ratepayers would not exceed that which was borne by the rates in the financial year 1965-66.
This year, we have repeated that again in the Dublin Health Authority and I am sorry to report that our efforts to make the Government fulfil their obligation of three years ago was defeated on the casting vote of the Fianna Fáil chairman because, without his vote, we would have succeeded in placing the responsibility for the increased costs of the health services on those who had undertaken three years ago to pay it—the Government.
If they will honour their often repeated undertaking to the ratepayers of this country, not alone the ratepayers of Dublin but the ratepayers of the whole country, to relate the cost of the health services borne on the rates to what was borne in the year 1965-66, then every ratepayer in the country and that, of course, includes every rentpayer whose rent includes a percentage of the rates, the rate for the forthcoming financial year will be about 7s 6d less in the £. That undertaking was given by the Government.
It was not.
In the White Paper which was published more than three years ago the Government accepted that local rates were not a form of taxation suitable for collecting additional money to pay for health services. Twelve years ago, we asserted that the rates were not a suitable system for collecting money to pay for the health services. Indeed, as far back as 1951, Deputy John A. Costello who was then Taoiseach, speaking in Kilkenny, said that it was his view that the rates were not a suitable form for financing the health services and that it was feasible to construct a system of national health insurance which would provide for this country the type of health service that the people want.
Be that as it may, the Government set out deliberately on a policy to prevent the people getting the health service and the system of financing it that they wanted until, as I say, in January, 1966, they published their general confession and admission of having been wrong up to then. They said that they did not regard the rates as a suitable form of financing the health services and they undertook not to put the health services on the rates. If they had honoured their undertaking, every ratepayer and rentpayer would be paying about 7s 6d less in the £ in the forthcoming financial year. The Minister has been rather blandly indicating during recent months that he had apparently at least got the members of the Government to accept that a proper health system is necessary. Here, a Cheann Comhairle, I would like to interject that we in Fine Gael are in favour of graduated contributions. We believe contributions towards the health services and social services should be related to a person's capacity to pay. This scheme, now accepted as a respectable scheme and a scheme of insurance contributions, was violently, viciously and persistently attacked during the last general election. The then Taoiseach, Deputy Seán Lemass, speaking in his own constituency in which this Dáil is situated, stated that the Fine Gael health scheme was "a typical, harebrained Fine Gael scheme". He said that the Party had committed itself to an ill-conceived scheme to finance extension of the service by what he calls a poll-tax. Again, at Ardee, County Louth, on 3rd April, 1965, and I quote from the Irish Press of the 4th April, 1965, which bears, inter alia, a photograph of yourself, a Cheann Comhairle——
That would have no connection with the motion.
I am not sure. It is certainly under the heading "Scope of health services improved". It says that Deputy Childers, a member of the Fianna Fáil Administration, refused to believe that the people would want the Fine Gael health scheme, one-third of which was to be collected by means of a poll-tax levied on all insured persons. Here we have scorn and condemnation being heaped on the basically sound, truly Christian, and financially respectable Fine Gael scheme of insurance contributions. I fail to understand how the present Minister could have dared, last week, to criticise the Fine Gael Party for what he described as the articulation of a health policy without stating how it was to be financed. There is not time, in the few minutes allowed to us in proposing and replying to a debate of this kind, to spell out the details of the system of financing the services; but we have given the detailed figures time and time again in written memoranda to the Select Committee of this House which met for years and never published a report. We have given them to the Department. The Minister admits he has the Fine Gael memorandum. That memorandum has been seen and examined by financial and insurance experts throughout the land and has never been found wanting because it is basically sound and is based on the tripartite contribution which we think to be proper—one-third from the employee, one-third from the employer and one-third from the State. This is the way in which we in this country can build up a fund to finance the personal health services, to provide that we will have what we apparently need, which is a proper system of health care outside hospitals and costly institutions.
At the moment five per cent of the total maximum health bill is in respect of services provided outside hospitals and costly institutions. That five per cent of the total bill is applied to only 30 per cent of the population. All it needs to bring sanity back into the health services and to get away from a system which is unduly costly, because it is based on costly institutions, is an increase of ten per cent in the total health cost. That is a sizeable sum. It is £5 million. If brought into operation it would reduce the flow of unnecessary entrances to hospitals and costly institutions which at present is maintained at flood peak because we are the only nation in the developed world which has a health service based on institutions instead of basing it on the needs of human beings, most of whom are well all the time, and most of whom are capable of being looked after when they are ill in better surroundings and with greater possibility of recovery in their own homes at substantially less cost.
When the Minister was contributing to this debate he was at pains to emphasise that he was not anxious to take over ownership or control of the voluntary hospitals, which hospitals contribute the greatest amount of institutional care and skill, particularly in urban areas, to the health of our people. It seems to me he is embarking on the same slippery slope which the Minister for Education embarked on in relation to secondary education. The Minister wants to acquire the voluntary hospitals by stealth. He wants to provide that the religious orders and others in charge of them will be no more than caretakers without power.
What is the Deputy's evidence for that statement?
I am basing it on the Minister's proposals which are in conflict with the Fitzgerald Report.
The Deputy must be responsible some time. He does not know what he is talking about.
I believe that the Minister wants the religious orders and others who are running the voluntary hospitals for years to be caretakers without power, donors without a say, labourers without a voice and experts without influence.
That is total nonsense.
The Fitzgerald Report at page 42, chapter 4, provides for a Consultants' Establishment Board which makes it clear that the primary function of the board should be to consolidate consultants' appointments and to approve the creation of necessary new consultant posts. The Minister is proposing a new central authority which is not to be a consultants' board but a hospital coordinating authority.
The Deputy has not got his facts.
It would take away from the consultants and from those who have conducted the voluntary hospitals for years an effective say in the appointment of consultants in the voluntary hospitals. The appointment of consultants, which ought to be done in full, frank and equal consultation with the voluntary hospitals and also with the teaching hospitals in consultation with the university authorities——
What kind of consultation does the Deputy think we have been having?
The Minister was proposing to require the submission of names to him so that he might have his say in the appointments being made. We regard this as an endeavour to take over control and ownership and management of the voluntary hospitals and to take them away from the devoted care of those who have successfully operated these institutions for many years. We think there are things far more urgent requiring Ministerial attention and to which the Minister ought to be directing his influence and power, and that is, basically the organisation of a developed health service which would meet the real needs of our people. We do not have to change this whole structure of our health institutions in order to have a proper and fair health service. We do not have to endeavour to create difficulties with the hospital managers, owners and the medical profession to bring about radical and much-needed improvements in our health services.
What we need is a totally different frame of mind on the part of the Minister and the other members of the Government. What we need them to do is to base a health service on what Fine Gael believe to be an essential matter of principle—on the capacity of the people to pay when they are earning and not when they are without income, and also on the basic principle that our health service should be so orientated that it will give relief and assistance of the first resort to people when it can be of most value, so that the Government will not continue to do as they have done in the past, delay it until the unfortunate victim has fallen over a cliff, when he is no longer in need of ambulance and hospital services. That has been a daft, stupid health policy and we in Fine Gael are firmly opposed to it.
Motion put.
The Dáil divided: Tá, 38; Níl, 58.
Tá
- Belton, Luke.
- Belton, Paddy.
- Burke, Joan T.
- Byrne, Patrick.
- Clinton, Mark A.
- Collins, Seán.
- Connor, Patrick.
- Coogan, Fintan.
- Cosgrave, Liam.
- Costello, Declan.
- Costello, John A.
- Creed, Donal.
- Crotty, Patrick J.
- Dockrell, Henry P.
- Dockrell, Maurice E.
- Donegan, Patrick S.
- Donnellan, John.
- Dunne, Thomas.
- Farrelly, Denis.
- Fitzpatrick, Thomas J. (Cavan).
- Gilhawley, Eugene.
- Governey, Desmond.
- Hogan, Patrick (South Tipperary)
- Hogan O'Higgins, Brigid.
- Kenny, Henry.
- L'Estrange, Gerald.
- Lindsay, Patrick J.
- Lyons, Michael D.
- McLaughlin, Joseph.
- O'Donnell, Patrick.
- O'Donnell, Tom.
- O'Hara, Thomas.
- O'Higgins, Michael J.
- O'Higgins, Thomas F.K.
- Reynolds, Patrick J.
- Ryan, Richie.
- Sweetman, Gerard.
- Timmins, Godfrey.
Níl
- Aiken, Frank.
- Andrews, David.
- Barrett, Sylvester.
- Blaney, Neil T.
- Boland, Kevin.
- Booth, Lionel.
- Brady, Philip.
- Brennan, Joseph.
- Brennan, Paudge.
- Briscoe, Ben.
- Burke, Patrick J.
- Calleary, Phelim A.
- Carter, Frank.
- Childers, Erskine.
- Colley, George.
- Collins, Gerard.
- Crinion, Brendan.
- Cronin, Jerry.
- Crowley, Flor.
- de Valera, Vivion.
- Dowling, Joe.
- Fahey, John.
- Fanning, John
- Faulkner, Pádraig.
- Fitzpatrick, Thomas J. (Dublin South Central).
- Flanagan, Seán.
- Foley, Desmond.
- French, Seán.
- Gallagher, James.
- Geoghegan, John.
- Gibbons, James M.
- Gilbride, Eugene.
- Gogan, Richard P.
- Haughey, Charles.
- Hillery, Patrick J.
- Hilliard, Michael.
- Kenneally, William.
- Kitt, Michael F.
- Lalor, Patrick J.
- Lemass, Noel T.
- Lemass, Seán.
- Lenihan, Brian.
- Lynch, Celia.
- Lynch, John.
- McEllistrim, Thomas.
- Meaney, Tom.
- Millar, Anthony G.
- Molloy, Robert.
- Mooney, Patrick.
- Moore, Seán.
- Moran, Michael.
- Nolan, Thomas.
- Norton, Patrick.
- Ó Briain, Donnchadh.
- O'Connor, Timothy.
- O'Leary, John.
- O'Malley, Desmond.
- Smith, Patrick.
Tellers: Tá, Deputies L'Estrange and T. Dunne; Níl, Deputies Geoghegan and Mrs. Lynch.
Motion declared lost.