One of the points I would like to make in this debate is that there is so much accommodation needed for mentally handicapped and physically handicapped children that I do not think it is right that society should allow orphan children to remain in institutions and pay an average of £3 6s a week for their maintenance when there are so many potential, if I may use the word, foster parents who would be prepared to take a child into their homes. We all know that adoption is the right solution to this problem. That is not to be discussed in this debate but it is so closely linked with fosterage that it is very difficult to keep them separate.
There is one thing that I have been told in the last few days which I did not know and I feel it should receive the utmost publicity. Very often you find kindly people being encouraged to accept orphan children in their homes as foster children. They are paid these ridiculously low amounts by local health authorities for their maintenance. I believe that these people should be encouraged to adopt the children. I am told that if they do this they may still apply, if circumstances in the home warrant it, for the allowance from the health authority. I have no real authority for saying this but, if it is so, I believe that the Minister for Health, and his Department should notify all local authorities asking them to bring this fact to the notice of those parents who at the moment have foster children in their homes so that they may legally adopt them and still not have to take over the responsibility of society which they wish to share.
The criminal thing about this is that, while there are so many children in institutions, the demand to take them out, to have them fostered and adopted, if it is properly advertised, is greater than the number of children in the institutions. It just does not make sense to me that there are so many people who wish to adopt children and that there are so many children in institutions wanting to get out.
I know that certain societies have been in contact with the Department of Health recently. I know one firm of solicitors have been in contact with the Department of Health concerning a young girl. I do not wish to state the details here now but I feel that, if I did, there would be a lot of people in high places embarrassed. In the interests of all concerned I am refraining from going into the details. I have so much respect for the Minister for Health that I will pass copies of these letters to him and ask him to deal with them personally.
Some of the disadvantages of institutional life have been mentioned to me. One of the things that cannot be found in an institution is a mother. It is described here as a mother substitute. In normal families you have both male and female. You do not find this in an institution. It is usually all boys or all girls. A child in a foster home stands a greater chance of being legally adopted than a child committed to an institution. Incidentally, I understand that 432 children have been legally adopted by this method since 1953.
Adoption gives a new name to a child and a new security in life. One of the fears of a child in an institution is that something will happen when it reaches the age of 16 years of age. It does not have to leave at that age but there is this insecurity. If a child is in a foster home it can continue to live there as a member of the family. All these things have a telling effect on the personality of a growing boy or girl. I have no doubt that if we had found ourselves in this position we would have protested and would have what is commonly described as a "chip on the shoulder" complex.
A child in a foster home has a wider choice of employment. If a child is in a family circle his foster brother or his pal around the corned will mention that there is a messenger boy job down the street or a job becoming vacant in a local factory. This information is not readily available to a child in an institution.
In view of all these things I wonder why local authorities do not increase their contribution to foster parents. There are so many arguments in favour of fosterage and so many arguments against institutional life that we can no longer accept the situation where health authorities such as Roscommon get away with paying 11/6d a week for the maintenance of a child in a foster home and are prepared at the same time to pay £3 6s a week on average for the maintenance of a child in an institution. This is criminal and the sooner the problem is tackled and solved the better for all concerned.
The next point I wish to deal with is school medical inspections. In Donegal we have a school medical inspection and it is the greatest joke in any household. The school medical inspector arrives at the national school. Every child is examined, recommendations are made that teeth should be extracted or that the child should be seen by an eye specialist or some minor defect attended to. By the time that child is called he has either moved into the secondary school and is not eligible to be attended to under the school medical system or he has left school altogether and is in Glasgow or Manchester. The cost of inspection must be tremendous when we compare it with the actual services given. My eldest daughter had some slight defect in her ear which I knew nothing about. It was recommended at a school medical inspection that she should be sent to an ear specialist. She was taken from the national school before the school leaving age and went to a secondary school. Because she had left the national school and was now a student in the local convent, despite the fact that she was still under 14 years of age, she was not eligible for free medical attention. If you cannot perform the service, then you should forget about the inspection. It is a laugh; it serves no purpose whatever and the money could be better spent.
If a child qualifies for the school medical inspection, every defect discovered in that inspection will be attended to free, irrespective of the family. However, there is a ludicrous situation inasmuch as if the parent becomes alarmed as to the degree of the defect or illness before the child goes to school and takes the child to the local doctor or to a specialist, this invalidates the right of that child to avail of the school medical inspection system.
This is fair enough if the illness is not permanent, but in the case of physically and mentally handicapped children the right to avail of the inspection should apply prior to national school enrolment, because the treatment which a physically or mentally handicapped child will receive for the remainder of its life is more educational and physical training than medical. Therefore the Minister should accept a recommendation of the Donegal County Council — perhaps other health authorities have made the same recommendation—that a child taken to a school medical inspector, whether that child is on the roll of that school or not, should qualify for the facilities of the school medical inspection, particularly a mentally or physically handicapped child. There is one case I know of—I will not say where, but we can say it is not in Donegal—where the parents, who knew the regulations, had a child with a defect. Because they knew they could avail of the free school medical inspection they took the child to the inspector. Since it was discovered at a school medical inspection that the child had a defect, that child will receive treatment without charge for the remainder of its life.
Other parents who do not know they can avail of this inspection, although they may be at a much lower income level than the parents who know, in their anxiety to have the defect dealt with, will take the child to their own doctor or to a specialist. If the defect is subsequently discovered at a school medical inspection it does not follow that the same facilities will be afforded as in the previous case, and the parents will be asked to subscribe according to their means for the treatment of the ailment. This is an anomaly in the health services, and I know the Minister will be sympathetically disposed to deal with something which is not fair.
There is another anomaly I wish to mention. Middle-income group patients may elect to go to the local hospital whether they are attended by a private doctor or their dispensary doctor. If they go under their dispensary doctor they can claim the right to be charged a fee not exceeding 10/- per week. If they elect to go under the private doctor then they will be charged the full rate and will be classed as private patients; they will lose their middle-income group status. This applies only in hospitals that are run by that health authority. The patient could go to the private doctor, ask to be treated as a private patient and, instead of going to the hospital run by the health authority, be sent to an extern hospital If he enters an extern hospital instead of his own local authority hospital, he does not lose his status. I understand that these are regulations which the Department of Health allow health authorities to make. They have allowed the Donegal County Council to do it and I think it is wrong. The health services report which was laid before the Dáil in January, 1966, when the late Deputy O'Malley was Minister for Health, states at page 59 in relation to the cost of our health services:
The Government, having studied the issue, are satisfied that local rates are not a form of taxation suitable for collecting additional moneys on this scale. They propose therefore that the cost of the further extensions of the services should not be met in any proportion by local rates.
That was stated three years ago. At this very time almost every local authority in the country is protesting against the cost of the health services. The people in Dublin are protesting in the streets and asking the members of the Dublin Corporation not to strike a rate until the Government remove the cost of the health services from the rates. There is a similar situation in various local authorities throughout the country. We had a discussion on these lines at the recent estimates meeting in County Donegal. I must say I am in favour of the attitude adopted by various local authorities inasmuch as I feel strongly on this point. The system of collecting money by rates was never intended to finance health services on the present scale. In County Donegal the rate is £5 3s 6d in the £; £2 2s 2d of that is the cost of the health services.
The Fine Gael Party have revolutionary proposals in their policy document in regard to health and more will be heard of them in the not too distant future. The Government accepted the report on the health services in January, 1966, and the White Paper was debated at great length here three years ago, and the Government indicated, as quoted by me from page 59, that something would have to be done. I do not know when that something will be done but the sooner it is done the better. People in other parts of this small island have taken to the streets in protest against many things. I should not like to see that happening here, but people have the right to protest.
The present system of taxation on a rates basis is not a fair one and the sooner it is changed the better. As an interim measure the Government might be interested in accepting full responsibility for the upkeep of extern hospitals. If they are not prepared to transfer the cost of the health services to central funds they might, perhaps, accept responsibility for the extern hospitals. That might be difficult but, certainly, the problems would not be insurmountable. I expressed this opinion at a local estimates meeting and a member of the Fianna Fáil Party agreed that this would be a way of transferring the cost from the local authority to the extern hospital. If the cost of the extern hospitals were the full responsibility of the Department of Health then the hospitals would cease to be our responsibility. This is not the position in relation to many aspects of our health services. For example, the Department of Health will not allow the county manager to transfer a patient to an extern hospital unless he is unable to provide a service for that patient in his own local authority. It would be exciting to speculate as to the possibility of extern hospitals being made the full responsibility of Central Government.
I should like now to refer to one matter affecting Donegal, a matter that is nothing less than a national scandal. There was up to recently a hospital in Killybegs, St. Columba's. It was the property of people other than the county council until about ten years ago. The Donegal County Council had an option to buy it and they bought it. Tuberculosis has been eradicated and two, three or four years ago it became very obvious that St. Columba's hospital would cease to function as a TB unit. A committee in Donegal dealing with the problem of the mentally handicapped made overtures to the county manager and the county council. Members of the county council, including myself, tabled motions in support of the proposition that the hospital when it ceased to function as a TB unit should be handed over for the purpose of accommodating mentally handicapped children. Now, somewhere along the line, an association known as CERT succeeded in convincing a sufficient number of county councillors that they had a better claim to the hospital. Many reasons were put forward by officials as to why St. Columba's Hospital was unsuitable for mentally handicapped children — but people dealing with the everyday problems of mental handicap, people whose opinion and advice I accept and respect, could see nothing wrong. In fact, they had nothing but praise for St. Columba's Hospital. With the slightest of alterations it could have been made to cater for 60 mentally handicapped children. A religious order was interested in coming in to manage it. However, CERT, a hotel training body, persuaded the council, by a majority of one, to change its mind. This caused a certain amount of frustration to those dealing with the problem of the mentally handicapped and they were forced for their needs to buy an hotel. Let me put on record here now my very deep appreciation of the help the Minister gave; without our asking he made finances available for the purchase of the hotel.
I do not know who took the decision about Killybegs. The hospital was handed over to CERT, free; gratis and for nothing by the Donegal County Council. I am told the hospital could have catered for 60 mentally handicapped children. Last week I read in the local newspapers that the conversion of the hospital has cost to date £160,000. This is nothing short of a public scandal and I have tabled a question to the Minister about it. I hope he will see fit to have a public inquiry into the cost of converting a hospital into an hotel and causing the association dealing with the problem of the mentally handicapped to buy an hotel to convert into a hospital. This is an embarrassing scandal and someone must accept responsibility for it. I know the Minister had little or nothing to do with it, but I sincerely hope he will expose those responsible.