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Dáil Éireann debate -
Wednesday, 26 Mar 1969

Vol. 239 No. 7

Committee on Finance. - Vote 48: Health (Resumed).

Debate resumed on the following motion: "That the Estimate be referred back for reconsideration."— (Deputy Ryan.)

It is accepted now by most Deputies and people who have been concerned with the social questions of this country that there has been, and is, a very real need for reform in relation to health services in order to widen their scope and to extend their application. I do not think any Member, even of the Government Party, would disagree with that view. It has won general acceptance by the people, particularly over the last decade. It is, therefore, worthy of comment at this stage in this Dáil, when we are in the shadow of a dissolution, that in relation to this question of the reform of our health services the people have been expecting much and needing a great deal and have been given nothing but continuous stonewalling by successive Fianna Fáil Ministers for Health. I will not go back to the naughty days of Deputy Seán MacEntee, that dyed-in-the-wool Conservative who believed in giving nothing to anyone and who was perfectly satisfied with the poor law mentality of the outmoded dispensary system. Just take the last few years and the change of Fianna Fáil Ministers in 1965. The health trumpet was then sounded. There was to be a sweep of the Augean stables and there was to be a new look at health—all this, of course, in the aftermath of the discredited select committee established under the aegis of Deputy MacEntee, that was designed to talk and do nothing and which committed health into the limbo of forgotten things—but now with a new Fianna Fáil Minister for Health there were to be more promises and there was to be a situation in which a change was just around the corner. Then we had the White Paper on Health Services published in 1966, a document which was a compound—it might have well prompted the song "Lily the Pink"—of various notions put together and called a policy. It was, of course, patching up the cracks in the Health Act policy designed to give a little bit of improvement here and there but maintaining the old Fianna Fáil policy of extending grudgingly the dispensary approach to medicine.

The White Paper of 1966, we were told, was published so that it could be considered by Deputies and that Deputies, if you please, could read it, study it and then after two or three months' deliberation contribute wisely to the debate on the new health legislation to be introduced in the month of November of the year 1966. However, the legislation did not come in November and it is my belief that there was little intention that it should come. There was a change of Government and a change of Taoiseach around that time, so we had no Health Bill in 1966.

There was no Health Bill, either, in 1967. Again, the matter was under consideration, active or otherwise, and, meanwhile, the White Paper was there as if the White Paper was going to tackle the difficulties and assuage the anxieties of people who wanted to see a change in our health legislation. We went through 1967 and at the time of the local elections in that year we were told that the Government had just not been able to get around to introducing the Bill but we were promised that it was coming in the autumn of 1967. By then, of course, the people would have voted in the elections. Again, the Bill did not come. The autumn of 1967 lengthened into the winter of that year and in the concluding session of the Dáil before the recess at the end of 1967, the matter was raised and we were told that we would have it in the spring. The Health Bill, they said, was bound to come in the spring of 1968 but in the spring of 1968 there was still no sign of the Bill and so the spring of 1968 went into the summer and, again, in the autumn of 1968 we were promised that the Bill would come in November but it did not come last November.

When the fiftieth anniversary of the First Dáil was commemorated in the historic building of the Mansion House, the First Reading of a Health Bill was introduced by the Minister for Health—significant, I wonder, or was this a charade being played on the people of this country? The Bill was introduced and the Second Reading was ordered for the next week when we would reassemble here to resume the work of this Dáil. What has happened to that Bill? Where has it gone? Is this more of the situation in which the health and the needs of the people are being made a political football by Fianna Fáil?

There will be no Health Bill; there will be no improvement of our health services as long as the present Government remain in office. They have been playing tricks and introducing gimmicks in order to deceive the ordinary poor people of this country. The Health Bill will be talked about but the attitude will remain "Live horse and you will get grass"; there was jam yesterday but never jam today. The new health proposals of the Minister do not exist and are not intended to be implemented. They are talked about now just because this Dáil remains in session this week and may or may not resume but certainly no major legislation will be passed through this House before the dissolution.

I wish to make my protest in this House from these benches while I am still here because I have no doubt that after the dissolution it will be the responsibility of my colleagues in Fine Gael to bring about this much-needed reform. This attitude on the part of the Government is bad, wrong and discreditable. It would not be too bad if it were not for the fact that the refusal by the Government to act is a political refusal—the action of small men afraid to admit that the Opposition in this case is perfectly right.

I have in my hand a memorandum prepared by me for presentation to the Select Committee on the Health Services. It is a memorandum that runs over ten pages. It relates to general medical services and, on behalf of my Party, was submitted by me to the Select Committee some four or five years ago and circulated to its members. It had an effect similar to the effect of the atomic bomb on Hiroshima because it blew the Select Committee in smithereens. They disappeared back to their respective posts. Back to the Custom House went Deputy Seán MacEntee surrounded by his various cohorts and advisers and for weeks afterwards they studied this document inside out. They studied it from different angles and the result was that the Select Committee never met again.

Were I to put the details of that document on the record of Dáil Éireann, it would weary the House although I feel sorely tempted to do so. I wish to bring some of it to the notice of the House. On page 2 of that document the case was made that, apart from Finland, Ireland is the only country in western Europe which, at the moment—this was four years ago—under its health services made no provision for the general body of wage-earners and persons of limited means in relation to the expenses of general practitioner medical care and of necessary drugs and medicines and medical applicances—the only country, apart from Finland, that made no provision for the general body of its wage-earners in relation to these essential services—and this was only talking about general medical services.

The document went on to point out:

It is true, of course, that in Ireland a general medical service with free drugs, medicines and appliances is provided under the dispensary system for poor people but this does not apply to the vast majority of persons who, on any reasonable assessment, must be regarded as having limited means.

It appears from an account of Health Services in Western Europe that in most continental countries comprehensive and compulsory health insurance schemes are in operation applying to the vast bulk of the population and provide, inter alia, almost complete cover in respect of medical fees and the costs of drugs and medicines. This is important:

Details relating to the countries covered by the account show that in the United Kingdom, Denmark and Sweden——

May I say, in parenthesis, that when we say "the United Kingdom" we mean and cover in relation to the people that part of our country at present comprised in Northern Ireland. The account shows that, in the United Kingdom, Denmark and Sweden——

—100 per cent of the population is covered; in Austria, France and Germany 9/10ths of the population is covered; in The Netherlands, Norway, Switzerland and Spain——


——4/5ths of the population is covered; in Belgium, three-quarters; and in Luxembourg, Portugal and Italy, the majority of the population is so covered. It appears that all of these countries—mainly by means of compulsory insurance—have recognised that there is a social need to help the individual not only in relation to hospital treatment but also in relation to medical care at general practitioner level and with regard to drugs and medicines. In addition, it is known that both in New Zealand and Australia the State has accepted the same obligation and is providing a general medical service available to the bulk of the population.

The document also directed the attention of the Government and the Select Committee to a report—then fairly recently available—of a commission established in England under the chairmanship of Sir Arthur Porritt who examined the workings of the British health services. That committee published in brief its findings. Having reviewed the working of the British health services, it said:

We therefore had no difficulty in reaching the conclusion that, basically, the concept of a comprehensive national health service is sound.

As has been pointed out in this document and as I wish to put on the record of this House, for this country—or for this part of our country for which at present we are responsible—these developments in so many other countries must pose for us the question whether we are doing enough for our citizens if we single out only the established poor and provide only for them a general medical service. To continue to provide in this manner is to decide to stay out of the mainstream of social welfare developments all over Europe, if not over the entire world. It is to decide merely to do what the Imperial Government and Parliament in the last century decided to do for the poor, sick, faminestricken Irish—merely to provide for the established poor; never to accept the obligation of the community to provide for the general body of wage earners and people in a comprehensive way. If we continue that approach, which, I regret to say, is the circumscribed, rather stunted Fianna Fáil approach as enshrined in the Health Act, if we decide to stay with that, then we are staying out of the mainstream of developments throughout Europe.

We made a token application—I presume we are still concerned with it—to enter into the new Europe under the Treaty of Rome. If we go into that Europe, if we ever get in, with our present health services then we shall go in as a limping poor relation. So long as we continue this approach— even at home, domestically—how can we ever be serious about our policy to re-unite our people? How could we ever approach a situation in which we are seriously inviting our fellow-Irishmen and Irishwomen in the North to join with us in a United Ireland if we do not accept as a State the same obligation as is accepted in Northern Ireland in relation to the provision of a comprehensive health service for the people?

This document having, in that sense that I have indicated, made the case for a change of policy, it then dealt with the existing policies. At paragraph 11, on page 4, we read:

With regard to the existing General Medical Service as available to 30 per cent of the population, I have on many occasions stated my grounds of criticism.

The criticisms, which were repeated there, referred to the fact that the dispensary system, which is the present general medical service system, involved means testing, involved the issue of medical cards and all the administrative paraphernalia that, in fact, had been and still are evoking considerable criticism throughout the country.

I have to refer to what is in the document and, since it was submitted by me, it appears as if it is emanating from me but I want to make it quite clear that I am not the author and that it emanates from the Fine Gael Party. In paragraph 12 (a) we read:

In my view with regard to General Medical Service, all limits, categories and restrictions should be reduced to a minimum. The aim should be to provide a comprehensive health service which will give General Practitioner medical care, with of course the ancillary services, to almost the entire population.

It goes on then to indicate the kind of cover that should be provided and it contains this statement:

The present Health Act was designed to give some form of medical help or service to roughly 2.4 million people, or some 85 per cent of the population. I think this proportion of the population should be taken as comprising those who have limited means and who require the benefit of a publicly organised comprehensive health service. I would envisage that people in the remaining 15 per cent of the population would be free to become participants in the service on a voluntary basis but on terms which would involve no cost to the tax-payer. This large proportion of the population would fall into the following categories, but are so divided merely for convenience and to enable some of the suggestions which I made to be clearly understood:

(1) Old Age Pensioners, Widow and Orphan Pensioners, Home Assistance Recipients and others in receipt of Assistance, Unemployed, Sick and Injured workmen, landholders solely dependent on their holdings where the valuation does not exceed £15.

(2) Persons insured under the Social Welfare Acts.

(3) Farmers up to £50 Valuation.

And the fourth category relates to selfemployed people. The service which was suggested in this document provides for the free choice of doctor, for the ancillary services, for drugs and medicines and medical appliances at a subsidised cost. The financing of it envisaged a weekly contribution which would range from 1/9d. per week to 2/- per week and which would be graduated in relation to the different categories. It would carry under the insurance fund, without charge, all the people in the first category, that is, all people in receipt of any form of assistance or pension, sick and injured workmen and so on.

The cost of the scheme at that time is fully worked out in the document. I do not say that it represents or could represent the cost now and there would have to be adjustments and changes. The document concluded with this statement:

I believe that the adoption of such a Scheme will remove the dissension and controversy which has been associated with Health Services over a number of years. It will in addition ensure that proper and uniform standards can be attained without undue hardship to contributors, and without a strain on local Rates. In this regard it is important to refer to the fact that many of the existing present-day health services will no longer be financed partly out of Rates and will be a charge on the Insurance Fund. This will result in a not insignificant reduction in the level of local Rates.

As I say, I have not attempted to give the full details of this document but I want to say that this document was presented to the Select Committee and has been available to the Government since. It contains a workable proposal for the reorganisation of health services, which is financially possible, which is within the resources of our people, which will remove the cost of personal health services entirely from local rates and which will permit an expansion of these services to more people, with higher standards. It is a proposal which is already in operation in one form or another in every country in western Europe except Finland, and which is already partly in operation in Ireland. In these circumstances I ask why has nothing been done to introduce a scheme of this kind in the last five years? I suggest that the reason is quite clear, that Fianna Fáil did not want to admit that Fine Gael were right. If you procrastinate long enough, if you prevaricate sufficiently, some day somehow things will come to a climax and now at this moment the dilatory approach of Fianna Fáil to health, their political stonewalling over the years, their refusal to change course or accept advice, are all resulting in the reaping of the whirlwind. The patience of the people has been finally exhausted and in every part of Ireland today people are pointing to the size rates have attained and the cost of health services. People will no longer tolerate a situation in which they are told "live horse and you will get grass. Go home, let us strike the rate and we will do something in the coming year." They have heard that far too often and this time they are seeking to prevent the rate being struck in many parts of the country.

I want to make it clear that I have the most profound sympathy for the afflicted ratepayers. I can appreciate the sense of injustice they feel and the sense of neglect that must concern them. The rating system as a system of taxation is inequitable and unjust. It applies to people living in similar houses, one beside the other, one of whom may be a married man with seven or eight children and who may have had considerable hardships and difficulties and perhaps a limited income, while his neighbour may be a single man with a large personal income, but nevertheless under this system of local taxation each head of the house pays the same amount——

Of course, the question of rates would be a matter for another Minister.

I appreciate that but I am merely indicating that once we use a system as inequitable as that in order to finance partially our health services then obviously we will provoke the sense of grievance which any unjust system of taxation will arouse.

We, therefore, put forward the policy we have advocated consistently: personal health services should be removed from the rates. In that way a significant reduction will be obtained. Other things also should be done. We believe that it is inappropriate to use the poor rate as a source of financing the cost of maintaining and running our general hospitals throughout the country. At the moment, the cost of running and maintaining the TB and general hospitals in each health authority area is financed as part of the health services. In other words, it is partly financed through rates and partly through central taxation. In our view this is a wrong approach. We believe all general hospitals throughout the country should be run and financed at the cost of the Exchequer. There is no reason why it should not be so. An Irish citizen living in Dublin, as a member of our community, has an equal and joint interest in the running of a hospital in Carrick-on-Shannon or Manorhamilton—why should he not? It is an Irish hospital; Irish citizens are being treated there and it is quite wrong to have an approach to the running of what are national hospitals on the basis that they are the particular responsibility of particular citizens living in a particular rating area. This is not the correct approach. The cost of all general hospitals should be the responsibility of the Exchequer. That will mean increasing taxation but at least general taxation will remove the inequalities of particular taxpayers. It will envisage a taxpayer's circumstances, his dependants, his losses, income and so on. General taxation will mean that there will be more equity. I do not suggest it will be perfect; it cannot, but it will bring a degree of equity in regard to financing necessary services of this kind.

Nobody would suggest that An Fórsa Cosanta Áitiúil or any part of the Defence Forces that happened to be stationed in a particular place should be financed by the ratepayers, the local people. That would be daft because our Defence Forces are the nation's responsibility and the cost is provided by the nation and paid for by the people generally through taxation. Why should it be different in regard to our health services? Are the Defence Forces to be one thing and a national charge, but our health services, where the very future and welfare of every person in the community is directly involved, another? It is absurd to carry on in this old-hat way merely because this was what the good Victorians did, using the poor law rate— abusing it really because this rate was envisaged originally to provide for the poor in particular areas and it gave the rich dowagers and corpulent lords and dukes a comfortable feeling when they went back to their well-appointed houses to know that the poor were being well looked after by the poor rate that was being raised by them. That poor rate was abused over the years. More was added to it. It was made to pay for roads, services, for the health of the people, for the cost of running institutions and the different asylums they had. It came to be used for all these things and the poor law rate ceased to be a means of providing merely for the shelterless, unharboured paupers in a particular area and became a system of raising finance in ease of the Central Fund.

We have reached the limit. In the course of the abusing of the poor law rate many unfortunate people have been hurt and we should not continue this injustice. The Fine Gael Party's view is quite clear. We should endeavour to get back to a just approach in financing our health services. We should try to remove them from the exigencies of local rates in particular areas and get them away from the yearly ache represented in the striking of the rate each year. We should try to make them uniform in application by providing for personal health services on an insurance basis and we should make the cost of our institutions and hospitals a national charge. If we proceed to approach this problem on that basis we can make real progress. Of course, it will not be done by this Government. It will not be done this side of a general election.

Nor the other.

I can assure the Minister it will definitely be done this year if the Government have the guts to dissolve the Dáil.

Is maith an scealaí an aimsear.

Tóg bog é. Fan go bhfheicir. We are committed to this reform in health legislation and we will bring it about. It cannot be brought about without a dissolution now. It is regrettable that is so and regrettable that there have been so many wasted years, years in which fruitful change could have been brought about, in which reform could have become a fact; years in which there could have been an orderly expansion of our health service, wasted years, years in which there has been a bit of patching here, a bit of oiling there, removing of aches here, there and elsewhere, grudgingly conceding some help for the rates in this county or that, unimaginative efforts to patch and repair a machine that was not working well. That is what we have had. This is the dynamism we have had from what was once described as the youngest cabinet in Europe.

Let us get away from that. A visitor of great standing, when he spoke here, recalled that it was once said in Leinster House that there were rarely new ideas. That was President John Kennedy recalling the view expressed, I think, by the Duke of Leinster referring to this House shortly after it had been built. I do not know whether that is accurate now but there are no new ideas in the Fianna Fáil Party regarding this matter of health, no new ideas, no new policy, no possibility of reform. It is not the Minister's fault. He is the fall guy in this matter——

I will not accept that. Who the devil do you think you are?

I am who I am. So is the Minister. The Minister is the fall guy in this particular matter.

I will not accept Deputy O'Higgins's attempt to remove the responsibility from me. I accept the responsibility.

It is a free country. I am going to say that whether the Minister likes it or not. The Minister is the fall guy in this matter. He is not allowed to do anything in relation to changing it. The money was not there last year and the money is not there this year. He is a fall guy. Of course he knows very well, because Deputy Seán Flanagan is a man of intelligence and a man of courage, what should be done but he is in handcuffs. He will have to sit and listen to what I have to say, breathe deeply, get angry but there is nothing he can do, sweet fanny adams. The Minister for Finance will not allow a change because it would be too costly. When Deputy Seán Flanagan became Minister for Health after the White Paper was published he found all the money was going to education and he could do nothing except keep on saying: "Well, next autumn or the following spring— some day—you will see something being done". Now when the whirlwind is blowing he can do nothing whatsoever. He is a fall guy. He has to bear the brunt of the angry ratepayers, of ordinary people who have been neglected not by him but by those who went ahead of him. It is a pity because the Minister is a person for whom I have a real affection. I am sorry to see him in that position. I am sorry to see him put in a position in which he has to bear the brunt and pay the penalty for the sins of others. So it is with the fall guys in this world. All I can say is there is a change coming and perhaps in the next Dáil the Minister from those benches can make sure——

This is really funny. Labour are taking over as the real Opposition. It is over there you will be sitting.

Deputy de Valera should go back to writing funny articles in his daily fun forecast but do not let him start interrupting me.

You are just funny.

I do not know whether I am funny or not.

Ask the people outside and they will tell you.

I am quite willing to do so. I have asked them already.

Ask them. You will see where the Labour Party stand.

Would Deputy de Valera care to encourage the dissolution now?

I am sure the Deputy's advice would be taken and he will find very rapidly where he and the Labour Party stand.

The Deputy has more sense of perspective with regard to his own importance than other people have.

That is a remark in a vein which I do not understand. Perhaps the Deputy might translate it later.

Deflate and you will get it.

I do not suffer from inflation. Other august people do and they get deflated. Unfortunately when you stand on the ground you do not just blow up. I have always kept my feet on the ground. As I say, the Minister has had his purgatory on earth in relation to this matter of the health services. He will be relieved from his purgatory whenever the dissolution takes place.

I would like to end on this note: I said the Minister is a person for whom I have a high regard. I should like to say in relation to this yearly review of the administration of the health services under the chairmanship of the Minister that every Deputy, and I can say this quite genuinely from my knowledge of my Party, has found in the Minister a person of courtesy and understanding and indeed real sympathy in relation to any of the matters that have been brought to his notice. I think that is in keeping with the high standard that has always been exercised and shown by the Department of Health and its officers. I, personally, would like to say in relation to one matter which I brought to the Minister's attention that I received the greatest courtesy and sympathy, which are always acceptable, but, more important, the complaint was remedied very rapidly and remedied in a way which was both just and appropriate. I would like to say that very genuinely to the Minister and in that respect to congratulate him on the manner in which he runs his Department.

It is not my intention to speak at length on this Estimate but I would like to mention a few matters of local interest which come under the Department of Health. I would like to refer to the cost of health services on the ratepayers of Galway. At present we pay something over £5—£5 Is or £5 2s—on the rates and £2 of this is attributed to the health services. It is an enormous cost on the ratepayers of the county. When we asked our county manager to contact the Department of Health to ask the amount of the health grant which we would receive this year we failed to receive any acknowledgment of the receipt of the representations by the county manager in this regard. It was only by telephone on the morning on which we were striking the rates that we received a guarantee from the Department that the health grant would not be any less this year than it was last year. This is poor consolation. I would like to tell the Minister that £2 is put on the rates in Galway for the health services. The health services should be financed on some other basis because it is almost impossible for our people to meet the rate demand.

I would like also to refer to dispensary doctors. In County Galway when a post becomes vacant a doctor is appointed on a temporary basis. I have put down many questions in this House regarding dispensary doctors in East Galway. If the doctor resides in any part of the area, it is OK but I would ask the Minister if he would consider asking doctors to reside in the part of the area where the greatest population is. In Dunmore we always had a dispensary doctor residing there but that is no longer the case as the present dispensary doctor resides in Milltown in the far corner of the area. It is a very big dispensary area and people on our side of the parish are not altogether satisfied that the dispensary doctor is fulfilling her duty. In fact, nobody could find fault with the doctor in question in any way in the world but the location she is in geographically in relation to the dispensary area makes it almost impossible for her to serve the needs of the community from Milltown. I would ask the Minister to make a recommendation that dispensary doctors should live in the centre of their areas or where the greatest number of people live. This is very important.

The Minister is well aware that there is no security in the position of temporary dispensary doctor. If a doctor is temporary in one area his service in that area does not count when he goes to another area. The salary of a temporary dispensary doctor at the moment is £1,200 and in a county like Galway where 46 per cent of the people are holders of medical cards, in those circumstances it is very difficult to get doctors to stay in the area. It is a very big problem.

I should like to refer to the care of physically and mentally handicapped children. There is a voluntary group in County Galway who have collected approximately £10,000. This money is lying idle due to the fact that they are not receiving help from any other source. In fact, they have set up a school in Galway City to cater for mildly and moderately physically handicapped children. The Department is not contributing its share. At the moment I doubt if it is contributing anything to that school. I would like the Minister to look into that. There was a meeting recently in Galway to which the local politicians and private individuals interested in these children were invited with a view to doing something about this problem. There are acres of ground available at the Galway Regional Hospital where a building could be erected for those children. We should provide the necessary facilities for them because there will be more of them born today and tomorrow. In the past if people had a child like this they hid it away. Today, due to education, they try to help the child. The facilities available to educate these children are almost nil. I have met many of the parents of these children and they are deeply distressed because there are no facilities available to educate these children and prepare them for some walk of life.

Many Deputies have suggested that health charges should be removed from the local rates. My opinion is that this would be taking your hand out of one pocket and putting it into the other. Whether health charges are on the local rates or on a national basis does not make much difference. Health services should be based on the scheme proposed by the Fine Gael Party. Voluntary health insurance works very well indeed. Health services should be paid for on a contributory basis by those who can pay. Today people are demanding more and better services all the time. In many aspects the service that exists is top class but people are inclined to abuse a lot of things they have. The system we have at the moment is the kernel of the problem and we should change to the system advocated by our Party, that is to put health services on a contributory basis. That would be better for the country in general.

I should like to be associated with the remarks of Deputy T.F. O'Higgins in relation to the Minister and his Department. I, too, have always found the Minister most courteous in every way. I would ask him to take note of the problems I have mentioned. They are very important and were not introduced for any political motive.

One of the great drawbacks in the Department of Health is that in this Department, as in many other Departments, the Government have been for many years content to play politics. About four years ago the then Minister for Health announced with trumpet calls that he was preparing a new charter for health. Great things were to be done; everybody was to be happy; people were to have better services; medical practitioners were to have better times; nurses were to have the time of their lives. This was announced and after plenty of ballyhoo the then Minister decided to issue a White Paper. The White Paper was duly issued and people on this side of the House who asked when the Minister intended to introduce his scheme were told that they were being cynical as usual, that Fine Gael would see that this was no empty promise and that when the new Health Bill would be brought in it would be the cure for all ills and Fine Gael would never again be able to raise the matter here.

The White Paper, if it is only taken out for an occasional airing or to see that the months are not eating it away, must now be getting a bit stale because it is three years since it was introduced and nothing has happened since. I earnestly hope that the Minister, who seems to be quite a rational and reasonable man, will do what he can to press forward with the new Health Bill. We cannot hope for its introduction in the lifetime of this Dáil, and we do not know who will be here when the new Dáil assembles. However, please God, they in their time will see this Health Bill introduced.

In the Third Programme recently issued by Fianna Fáil they refer, at page 197, to one of the achievements in the field of health, that is, the reduction in the number of deaths from TB. This is something to be welcomed by everybody, but it is something for which Fianna Fáil should be slow to claim credit. Everybody knows the war on TB was started by the first inter-Party Government, and that Fianna Fáil directly or indirectly impeded the efforts of the then Minister and the then Government to press ahead with the scheme. If there were nothing to the credit of the first inter-Party Government except that by their initiative and courage, they were successful in the eradication of TB, then that would fully have justified the existence of that Government.

The Third Programme makes scant reference to the Voluntary Health Insurance Board. Of course, even Fianna Fáil could not have the audacity to claim credit for the setting up of that board. Everybody knows that it is a lasting monument to the then Minister for Health, Deputy Tom O'Higgins. The only way to provide proper health facilities is to accept the Fine Gael recommendation of a contributory scheme. This scheme, when originally thought up and announced by Fine Gael, was derided and rejected out of hand before it was even examined by the Fianna Fáil Party. Anybody who has taken the trouble to listen to different pronouncements over the years will realise that Fianna Fáil are gradually coming over to this idea of an insurance scheme and do not regard it as the evil thing they considered it to be when Fine Gael first mooted it.

There is no need for me to stress the burden which the health services are placing on the rates. The Minister was annoyed last night when Deputy P.A. O'Donnell reminded him that on the introduction of this health scheme the then Minister told this House it would not cost more than 2/- in the £. At the moment the figure is nearer to £2 in the £. In Dublin it is over 33/-. I am sure the Minister is very well aware of what happened last Monday night when the Dublin City Council met to strike the rate and that he is also aware of what is happening in Dún Laoghaire and in several other councils.

The people feel that there is no need to make the health services a full charge on the rates and that something will have to be done if they are expected to bear the burden of the rates. Even the 33/- in the £ in Dublin does not allow fully for the cost of the health services. The Minister stated in his speech here that he was providing more than 50 per cent of the cost of the health services, and I should like to quote what he said at column 284, volume 239, of the Official Report of 12th March, 1969:

In reply to this criticism I would point out that the percentage extra assistance given to the rates over the statutory 50/50 division of cost varies from four per cent to eight per cent for individual health authorities, averaging roughly six per cent over the whole country.

I do not agree that this is true in the case of Dublin Health Authority. I do not know the position with regard to other health authorities, but Dublin Health Authority provide services which should be, and really are, under the heading of health and for which they receive no aid. They provide supplements for disabled persons and allowances to social welfare recipients who are in need because their social welfare payments are being held up. It is also well known that old age pensioners in Dublin are provided with turf, but in very many cases they are unable to collect it and Dublin Health Authority contribute money for the delivery of this turf to these people. When all services are taken into account I think it is true to say that Dublin Health Authority do not get the full 50 per cent, not to mention 55 or 56 per cent, as the Minister says.

Again, if I may quote from column 290 of the same volume of the Official Report, we see that there are certain things which the Minister is now thinking of introducing under the heading of the health services which were not heretofore introduced:

I have recently introduced a new scheme which is designed to give a fillip to the development of community social services in general and specifically to increase substantially the financial assistance given by health authorities to voluntary bodies which care for the aged in the community. I have encouraged and authorised health authorities to give grants within a total of £50,000 in the current year and £75,000 next year towards the running costs of voluntary bodies providing community services for the care of the aged.

These are services for which the Dublin Health Authority have long been paying and for which they have received no grant from the Department of Health. Again, at column 291 of the same volume, the Minister says:


meaning the health authorities——

——will be free to support social services which in a narrow context might not be considered as health services but which do, in fact, make direct and real contribution to the health and well-being of the old people. This scheme, taken as a whole, gives to the local health authorities the capability, the responsibility, and the scope for initiative in developing community services for its aged.

Everybody will welcome this new scheme of the Minister's. It is true to say that this has not existed heretofore.

About three or four years ago— I think it was in 1965—the Minister for Health at the time announced that there would be no further increase for health charges on the rates. Everybody was delighted. Everybody thought that at no time in the future would there be an increase for health charges on the rates whereas the Minister said later that he meant only in that particular year. Now, if the members of Fine Gael misunderstood the Minister's announcement, there is no blame due to them because the Fianna Fáil members of Dublin Corporation were of exactly the same opinion. I remember quite well the Fianna Fáil members in Dublin Corporation asking: "What will Fine Gael have to say now, next year, or the year after, if the rates go up? They will not be able to blame the health charges". They indicated that the Minister had taken away all the ammunition and left Fine Gael with nothing for which to blame the Government if the rates increased; they were deprived forever of throwing out this scare of the Health Act being responsible for the increase in the rates. Fianna Fáil members were of the same belief as everyone else and it is no shame to Fine Gael members that they misunderstood, remembering that the members of the Minister's own group also completely misunderstood.

The Minister has asked local authorities to make reductions in the health estimates. He emphasised here that he wants a reduction in the estimates but he wants no reduction in the services. If he does not want a reduction in the services how does he propose that local authorities can effect a reduction in the estimates? The only way that I can see is by doing what the Minister has asked—reducing the estimates without reducing the services. If they do that then it is obvious they were not up to this giving real value for money. Fianna Fáil speakers have stressed that, if one wants better services, then one should not later come in here and crib when asked to pay for these better services. They say you cannot have a service unless you pay for it. But now the Minister is asking us to reduce the estimates but not to reduce the services. Surely, if this can be done, it is a reflection on what has been happening up to this and it is an indication that the services have not been administered as economically as they could have been and should have been.

There have been complaints from several Deputies about school medical services breaking down or being practically non-existent. Quite a number of people in Dublin are under the impression that if a child is examined and there is no cause for complaint but the child some months later is found to be suffering from some illness he or she will not be eligible to be treated under the school medical services. I have been informed by the principal of one of our leading schools that this is not exactly true. The child may be treated under the school medical services if he or she gets a note from the principal. Apparently this is something of which a large number of parents are not aware. The Minister and his Department should take steps to make it clear to parents that they may avail of these services. Very few parents go to the trouble of consulting with the principal of the school. Possibly in some cases the principal does not make it clear either. This is something the Minister and his Department could well clarify for the benefit of parents.

There are one or two points on which I should like to make some comment. First of all, I want to express my disappointment at the delay in introducing the new Health Bill, which is urgently needed and which has been promised for so long. There is a general desire all over the country to see an end to the present antiquated, inequitable and totally unsatisfactory health system we have at the moment. The situation has now reached the explosive stage because of the additional burden on the ratepayers. So far as my constituency is concerned—the Minister is aware of this—the problem of financing the health services is becoming very serious and the Minister is receiving a deputation tomorrow from the Limerick Health Authority to discuss the whole question of the financing of the health services there. The burden of rates has become so intolerable that we have now reached the stage at which something drastic will have to be done. I sincerely hope the Minister will be able to see his way to giving a supplementary grant which will go some way towards relieving Limerick ratepayers of this intolerable burden. It is costing Limerick Health Authority 20/- more per day than they are receiving from the appropriate health authorities to maintain patients from outside County Limerick in the regional hospital. This is an intolerable situation and something will have to be done to remedy it.

Like others who have spoken, I have considerable experience of medical cards. This is an abominable system and wholly inequitable. It is a degrading system. The time is long past when this detestable system should have been abolished. The Government have fallen down on many things in recent years but in nothing have they shown greater failure than in their complete inability to devise and implement proper health services. During the past four or five years the Government have tried to find an alternative through what has come to be known as the "O'Higgins Plan". Eventually, the health services will, I hope, be based on the O'Higgins system.

I was particularly interested to read in the Sunday Times this week that a great deal of examination is being undertaken by the various Parties of the health services in England and I was particularly impressed to read that the spokesman on health for the Conservative Party has come up with a new system to finance the health services in Britain similar to the “O'Higgins Plan”.

On the question of the medical cards system, I understand that the unfortunate officials of health authorities have been placed in a terrible position. Deputies have referred to public representatives bullying the officials to persuade them to give medical cards to people who may or may not be entitled to them. As far as I am concerned, and I have had as many representations to me on the matter of medical cards as anyone else, the officials of the Limerick Health Authority have tried to administer the Health Act in the spirit in which the health services are framed. I am sure most Deputies have found cases of unfortunate people whose incomes may be a few shillings above the statutory limit or of small farmers whose valuations might be £1 or £2 above the limit, who are deprived of medical cards. It is heartbreaking to find people in need of medical and surgical treatment but who because of their fear of the costs and their inability to pay do not get the treatment they require.

Last week I had a letter from an elderly lady in my constituency who is not entitled to a medical card and whose local general practitioner has recommended surgical treatment for her as a matter of urgency. However, she felt she could not afford to pay for the operation. The present Health Act is unable to cater for such cases and I hope that before long we shall see the end of that abominable system of medical cards. There is an impression abroad that people who are not entitled to medical cards are getting them and that others who should have them have not got them.

I do not know what kind of mess the Minister has been making in recent months of his dealings with the Medical Union and the Medical Association. I understand the introduction of a new health service is being held up because the Minister and the doctors are unable to agree. I understand that the main bone of contention is the question of the payment of doctors. Recent proposals put forward by the Minister in this respect are ridiculous. I understand that the Minister expects the medical profession, the GPs, to provide a service which would make them absolute slaves—a 24-hour service on a capitation basis.

A capitation basis is a bad thing because it would lead to a situation in which doctors would be inclined to take on the maximum possible number of patients whom they could not efficiently deal with. I believe the feeper-service is the fairest and most equitable system and that it would lead to better medicine all round. However, whatever the hold-up is I urge on the Minister the desirability of arriving at agreement with the medical profession because there is no doubt that the success of any new health service will depend on the full co-operation of the profession. That co-operation will be forthcoming but the Minister must first of all realise that doctors cannot be expected to provide a 24-hour service at what is a ridiculous rate of remuneration.

Failure to introduce a new health scheme, which we have been awaiting for so long, has led to serious problems in many dispensary areas throughout the country. In my constituency a number of dispensary posts had been vacant and in recent times the Minister has filled some of them by permanent appointments. Other vacant posts are to be advertised. Nobody knows the basis on which the Department select certain dispensary posts to be filled. I know a situation in Cappamore where the medical officer retired on reaching the age limit. The post was advertised on a temporary basis and a doctor practising in England applied for and got the post. He brought his wife and family to Limerick and one year later, after that man had set up in practice and been acting as temporary MO, the post was advertised as a permanent appointment and another doctor got it. The poor unfortunate who had come back from England had to pull up and go.

There are other such situations in my constituency. There is the case of Caherconlish. There, the dispensary doctor was killed in a car accident and during the past two years the Limerick Health Authority have been unable to find a temporary doctor to fill the post. After the Cappamore incident I do not blame any doctor for refusing to take on a temporary post in an adjoining area. Now, the Minister has decided to fill the Caherconlish vacancy on a permanent basis. The whole system of the filling of dispensary posts in the past two years has been ridiculous. It will create further problems when the proposed new health scheme comes into operation.

There is another situation in Limerick which has been brought to my attention. It involves the dental health service there. People in need of a certain type of dental service have been waiting two years. I have in mind cases of people who are in need of dental treatment but because of medical conditions such as heart or chest ailments they cannot be provided with the dental treatment they require until they are hospitalised. We have a dental clinic in Limerick with beds available but there is no medical doctor and no medical service attached to it. The result is that within the past week I had to approach the chief dental officer concerning an unfortunate man who has been waiting two years to have a dental operation performed, and this cannot be done. I know another case of a lady who had had a brain operation and was urgently in need of dental treatment. This would require her being hospitalised and being given a general anaesthetic. She would also require post-operative care which was not available. That is an appalling situation, which should not arise. The Minister is well aware of this because the matter has been brought to his notice by the Limerick Health Authority and by the chief dental officer in Limerick. The clinic is there and the beds are there, but there are no medical officers available in the dental clinic. There is no personnel available to provide post-operative care.

One aspect of the health services to which every Deputy refers when speaking on this Estimate, and one with which most people are concerned, is the question of mentally handicapped children. In my opinion it is a most heartbreaking situation for a Deputy or a public representative to be confronted with when an unfortunate parent seeks his aid to have a child admitted to an institution. Despite the tremendous work done by religious orders and by voluntary bodies in this field, we still have not anything like adequate facilities available in our instituations to cater for these children. This is a situation which merits top priority, and I sincerely hope that the Minister, or the Minister in the new Government which we will have in the course of the next couple of months, will tackle that problem in a realistic fashion, and that we will be able to reach the stage where adequate and proper services will be available for these unfortunate afflicted children.

I have been asked to be brief and I will try to be brief but I find it a little difficult on an Estimate like this. I will confine most of my remarks to the problems in my own constituency. The first matter I should like to mention is the question of the hospital in Ballinasloe which, under the new plan, is to be done away with. We feel in South Galway that this would be a great tragedy because the Portiuncula Hospital, which is comparatively new, has given tremendous service since it was opened about 20 to 25 years ago. It has got all the facilities. Unlike Athlone, which is the bigger centre of population, it has a resident surgeon, gynaecologists and the lot, and also a training school.

Even at this late stage I should like to appeal to the Minister, as I understand there is to be some rearrangement in connection with the various hospitals, to do his best to include the Portiuncula Hospital. In East Galway we feel that if it goes we will not only lose a hospital but we will also lose lives because from wherever it is—the nearest will probably be Mullingar— to Galway is too big an area to have without a hospital for emergency cases and things like that. I appeal to the Minister not to forget Portiuncula in the rearrangement of the hospital services.

I know we are waiting for a new Health Bill which it is hoped will solve the problem of the dispensaries. There is a large area in my constituency in which there is no doctor. In fact, at one stage in the town of Gort there were seven vets and no doctor. Looking over the west end of my constituency I can see that there are umpteen vets dotted around the place but no doctor. It seems to be funny thinking on our part if we consider animals before humans. We have had a problem in the Ardrahan dispensary area for a number of years. There was a doctor there. The area was amalgamated with the Gort area and the doctor is now living in the town of Gort which incidentally is left without a dispensary doctor too. The Ardrahan man will be going in there.

The nearest dispensary doctor is in Loughrea. There are two doctors there. Since the Tynagh mines opened, and over the past couple of years, Loughrea has become a very large town. It also has St. Brendan's, the county home, and only two doctors. Those two doctors are well occupied and find it difficult to go to Ardrahan and other areas outside the town. For that reason, even before the Health Bill is brought in, every effort must be made to get doctors for this dispensary area. It is no good saying that the posts are advertised and no one applies. No one would apply because of the ridiculous salaries which are offered in some areas. The salary must be made attractive. Life in rural Ireland is not very attractive for a professional man with children to educate. He has to be induced to go there. He is not going to rush there. It must be made attractive and this must be done rapidly or we will find ourselves in the West of Ireland—and God knows we are bad enough in the West of Ireland—without any doctors but with plenty of vets. This seems to me to be putting the cart before the horse.

I am being very brief because I promised I would be. Every Deputy who spoke said a word for the mentally handicapped. In Galway we have the second highest number of mentally handicapped in the country. Great work has been done by voluntary organisations and by religious orders in my constituency, but we could still have many more schools for mildly retarded children, and schools for severely retarded children. Now £90,000 is being paid for our County Galway children in institutions around the country. I know a religious order, and the Minister knows it too, which is anxious to open a school for mentally handicapped children. It is a teaching order with experience of handicapped children. Under the rearrangement of the secondary schools the Order lost its secondary school. It has the building and the personnel, and all it needs is the financial assistance which one must have in a case like this.

This is for severely handicapped children?

Yes. The sisters in charge and the people in the area are anxious to see the Minister after Easter. I will speak to him again about that, but I would appeal to him to think about it between this and then because we have the second highest number of mentally handicapped children. I think the highest number is in the Minister's own county of Mayo.

The nuns in Clarenbridge are anxious to open a school for girls. Boys are nearly always catered for but perhaps that is because there are more mentally handicapped boys. We have some mentally handicapped girls. Some of my constituents have mentally handicapped girls and they cannot get them in anywhere. It would be a great help to the parents if we could keep them in our own county. This would facilitate bringing them home for holidays and visiting them. Visiting them is very important because these little mites need more affection than healthy children. If they are a long time away from their parents holidays can be a very emotional experience, and terribly upsetting if they have forgotten their parents as these children will. They have not got the same capacity for remembering as ordinary children have. So, a school close at hand would be a great advantage.

Much has been said during the course of this debate about the burden on the rates because of the health services. Anyone who lives in County Galway knows that we have now reached the stage where we will not be able to pay our rates any more. I remember when I was a child—it is a long time ago now, but not all that long—my grandmother used to say that the time would come when the rates would be as high as the rent. Rents are now non-existent and the rates are phenomenal. I do not know the answer, but we cannot continue in the way we are going now and I believe there could be some saving. I believe there is abuse at various points in the hospitals services. For example, I know that in the regional hospital the patients look on the ambulance as a sort of taxi service, even though they may have private cars at their doors. The doctor will ring and say that an ambulance is to be sent to such-andsuch a place, and they consider that their right. I have heard ambulance drivers and nurses saying that when they arrived there were three cars in the yard, perhaps the cars of sons and daughters. Somebody would even drive behind the patient in the ambulance. It should be impressed on people, perhaps by the dispensary doctor, that the ambulance service is only to be used for stretcher cases and for medical card people who have not got cars. Anybody who can bring a patient themselves to hospital should do so. It is a terrible abuse to use the ambulance service like a taxi service. Sometimes when a situation arises where there is an emergency the ambulance is off ferrying somebody to a dental clinic or something like that, which is something patients could travel to by bus or car.

I should also like to mention drugs given out to patients at home. Patients do not take all the drugs they get. It is a notorious position, but one does not finish the drugs usually. The doctors in the dispensaries are too liberal with drugs. Bottles of various sizes are handed out to patients who take about ten doses of them and the remaining amount is then left on the dresser or the dressing table and is not used. They then run out-of-date and another batch has to be got. Doctors should give the minimum amount. They should give expensive drugs, if necessary, but it should be impressed on the patients that the drugs are expensive and that they should use them. They should be told that if they do not take them they should leave them back to the dispensary and not have a situation where heaps of drugs are stacked up in houses when nobody is using them. There is an abuse of the health services in this. These are small savings, and I know one could be penny wise and pound foolish but the people should not subject the health services to such abuses.

The same point applies to the hospitals. Much money is spent in hospitals that need not be spent. There is much waste where there need not be waste. Speaking of hospitals prompts me to mention the nurses and the nursing profession. Last week three young nurses came to me here in the House. They had just qualified with the last batch in November or December last. Until they were qualified these youngsters in a Dublin Health Authority hospital lived in the hospital but they are now expected to fend for themselves and are paid £2 per week to pay for their digs and their food. That is not even sufficient to pay for their digs. They are saving their wages for falderals, for blouses and skirts and such like—and it is very hard to blame young girls for thinking of clothes with their first-earned money. If these young nurses are not properly nourished then they will pick up infections in the hospital and ruin their health. Something has to be done about it. The living-out pay is far too small. The pay for any nurses, in or out, is far too small. They work long hours in fairly hard conditions. They should get a reasonable figure for living out. £2 per week would not keep you in peanuts, never mind digs or food. This will have to be looked into. The health authorities are not the only ones to blame. The voluntary hospitals are just as bad. They have the same system where a qualified girl is put out immediately after qualification with very little to pay for her food and her digs.

There is not a Deputy in the House who does not get as we do in the West of Ireland a large number of social cases. Every weekend in my constituency I meet people who tell me that a relation, perhaps an uncle, is in hospital and that he must come home but that there is nobody to care for him at home. He is just a social case. It sounds a nice word, but it is one of the saddest things that I know to say that a man or woman who has lived a long time and who has worked hard should be labelled a social case and shoved from one place to another, just because he or she has no one to care for him. We have St. Brendan's County Hospital in Loughrea. It is an excellent one and is better than some of the other institutions in my constituency, but it is bursting at the seams. There are four rows of beds in the wards and it must be impossible for the nurses and the doctors to work in them. I must say for this hospital that it is beautifully kept and the patients are extremely well cared for. It is a question of the authorities saying: "We cannot get another person into St. Brendan's and you will have to wait until someone passes on."

It is a peculiar position. Some of our elderly people are being taken at Merlin Park Sanatorium. There are units there closed and they will not be opened because the RMS says he cannot get nurses for them to look after the social cases. I had a case last week of a man of 94 years of age who was in Merlin Park Hospital. He was living alone but had one nephew, a bachelor, living near him. He was sent home because we could not get him into Loughrea Hospital because there were not any beds. Merlin Park will, I think, make arrangements to take him back soon, but something must be done. If the units are free in Merlin Park and if enough salary was offered people would work there, even part-time. Married women would take part-time employment there. Everyone knows that married working women get little or no income tax reliefs. Perhaps the Minister would have a word with his colleague, the Minister for Finance, to make it more attractive, and then they would get nurses.

There were many other small items in my mind, but I promised I would not be more than five minutes. I will leave it at that. I should like to ask the Minister not to forget the Portiuncula Hospital and the hospital at Clarenbridge.

First of all, I should like to thank all the Deputies who contributed to this debate and to say that, in the main, it has been a very constructive and enlightening one from my point of view though perhaps in the last few hours, with some notable exceptions—the last two speeches in particular—the debate might be said to have become unnecessarily repetitive.

So many points of detail were raised by various Members that it would be impossible for me to deal with them in the course of this reply. I can, therefore, only undertake to the various Deputies that any matters of detail to which I do not refer now I will deal with in correspondence or otherwise by contacting the Deputies concerned as soon as possible. I must say when Deputy Seán Moore was speaking earlier on and he mentioned that health was no burden on the rates in London I had a rather impious thought that there is an easy solution to my problem in this regard. In London and in England generally education is a considerable burden on the local authorities, though health is not; but when I mentioned to my colleague, the Minister for Education, the possibility that, say, 50 per cent of the cost of education would be imposed on the rates while the entire cost of health would be taken off the rates he gave me a rather hard look. Many Deputies spoke, as Deputy Mrs. Hogan O'Higgins has just done, on the cost of drugs and medicines in the general medical service. Indeed, I think all Members of the House agree that, irrespective of the cost of these drugs and medicines, if they have the result of keeping people out of institutions of any kind, the money involved is well spent. This is true economically as well as socially but, of course, the economic is by far a secondary consideration.

Deputies on all sides of the House referred to wastage in the general medical service. I ask: how much wastage in fact occurs? How many doctors are too casual about the prescriptions that they are giving to their patients? How many doctors are giving drugs supplied for the use of medical card holders to their private patients? How many patients are misusing the rights and privileges which they enjoy of free drugs and medicines in the manner in which Deputy Mrs. Hogan O'Higgins has just described? How many of these people realise the obligation under the Seventh Commandment not to steal from his neighbour? There is no difference between the misuse of expensive drugs supplied by the taxpayer or the ratepayer who is simply one's neighbour than taking the money directly out of his pocket.

Surely it is time that in these days, when our services are costing such an astronomical amount of money, each one should examine his or her conscience as to his public attitude to money. In the last analysis, there is no such thing as a free health service, comprehensive or otherwise, and may I quote from Deputy Dillon's very useful and helpful contribution to this debate a few days ago. I am quoting from column 811 of the Dáil Debates for Thursday, 20th March, 1969:

I want to remind Dáil Éireann of something which we are only too prone to forget, that the illusory yearning for a universal free health system has brought not only Great Britain but the United States of America itself to their knees financially. And the Labour Government in Britain has itself re-introduced prescription charges in order to stem the economic flood that was engulfing them. The USA, with its almost incredible resources, economically speaking, is finding that the programme designed for the protection of the old, Medicare, as introduced by President Johnson's administration, is overwhelming their resources and they have not reached out at all, comparatively speaking, to the able-bodied.

Deputy Dillon goes on:

I want to warn the House, God knows I am tired issuing these warnings and have earned derision at the hands of the Fourth Estate for reiterating them. The Minister for Finance has appeared on television in the past few days to tell us that we are on the verge of economic catastrophe.

Deputy Dillon goes on to say that this is the fault of the present Government and he is entitled to make that observation. He continues at column 812:

Everyone must sympathise with the clamorous demands that some relief be provided for the rates but relief of rates can only be provided by the Exchequer and the Minister for Finance says that the Exchequer is almost flat on its back. What Deputies are inclined to forget is that when you speak of the Irish Exchequer you speak of the Irish taxpayer.

I must say that I agree with this point of view and that I totally disagree with the point of view put forward by Deputy T.F. O'Higgins this morning and last night when he proceeded to replay the record that we now have almost off by heart in regard to a method of financing the health services which he says will remove entirely the burden from the rates. However, I propose to leave that matter alone for the moment.

The subject of drug abuse was mentioned by a large number of Deputies and, having listened to the very many points of view, I am convinced more than ever of the wisdom of my decision to set up a working party to advise me as to what steps should be taken in this matter. Members of the House have been sharply divided, for instance, on the value of education, type of education, the value of publicity and the type of publicity and so on that should be given in regard to this matter of the use and misuse of drugs.

I wish to say to Deputy Des Foley and others who spoke on this matter that, if he or any other Member knows of persons who can give advice to the working party, he should ask those persons to come along in answer to the working party's invitation and to do so as soon as possible. Some people outside the House have taken a very strong line in this matter. I hope that they are right. For myself, I shall be much happier when the working party reports and then we will all have the benefit of considering its recommendations. I think we shall then be able to decide whether the approach of Deputy Foley, who says that this matter of drug abuse by young people should be glamourised by maximum publicity and maximum education is right, or the approach of Deputy Ryan, who said we should not foster an unhealthy interest in the young in this matter.

I am convinced that the decision to set up a working party was the right one because, while I have certain views, I am not satisfied that they are backed up by sufficient knowledge. This debate has demonstrated that other Members of the House—each obviously talking from a sincere concern about the possibility of the abuse of drugs escalating into a national problem—have spoken from very different points of view and sometimes have taken diametrically opposite lines to each other. In conclusion on this matter, may I say that the working party has indeed been working. I hope to have their recommendations in the near future although I have not, in this case, set any time limit on their deliberations because I thought that this is a field in which to do so would be ill-advised.

The next matter to which I should like to refer was also referred to earlier today by Deputy T. O'Donnell. It was previously referred to by Deputy Kyne in his helpful opening speech on behalf of the Labour Party, by Deputy Ryan in his opening speech on behalf of Fine Gael and by Deputy O'Connell and others. I think it was Deputy O'Connell who referred to the offer to the doctors, which I published a couple of weeks ago, as an insult. Deputy O'Donnell was equally severe this morning in his criticism of the terms which he alleged were hopelessly inadequate. May I say that, since this debate began, I have received a communication from the secretaries of the Irish Medical Association and of the Medical Union rejecting the offer on behalf of their members. I do not propose to say anything more about the contents of the joint letter I received from the secretaries because they appended certain counter-proposals which I told them I would discuss at a meeting arranged to take place next week. I shall, first of all, give to the House approximate figures as to the earnings that a doctor would receive in the general medical service on the basis of the proposal that I made.

A doctor with 2,000 patients, of whom one-quarter are over 65 years of age, would have £2,125 by way of capitation payment. He would have, in addition, £800 as an advance towards his practice expenses and this, I think, although I am subject to correction, would be free of income tax and, if so, this would be the equivalent of a taxed sum of £1,200. One way or the other, he would also have £500 for what I can only describe as waiting time, that is, the time between the end of his ordinary eight-hour day and the night, when a special rate will apply.

The Minister mentions 2,000 patients. They are private patients and medical card patients?

No, 2,000 public patients.

For a dispensary area, are 2,000 patients necessary?

No, not necessarily. I am just taking that as an example. It is impossible to estimate how much this particular doctor would make over a year in respect of night calls, for which he is to be paid, on the basis of the offer, £1 per call. Perhaps this might be roughly £50. In addition, he has various items in respect of which he gets a fee for service. Therefore, taking private practice into account, he would earn over £3,000 a year, plus his private practice, plus his maternity fees, plus his certification fees, plus his immunisation fees, and I leave the House to guess what he would make on fees for item service such as stitching fingers, and so on. It may be that it is an insult to doctors to offer them a basic remuneration exceeding £3,000 a year on the number of patients I have mentioned. The only question I have to ask the Irish Medical Association and the Medical Union is this: what do they regard as a reasonable basic salary for a doctor in the public service? Do they consider that he should be paid a basic £20,000 a year to look after public patients, or £15,000 a year, or £10,000 a year, or £5,000 a year, or what figure do they regard a general practitioner is entitled to by way of a basic reward for looking after his now-called dispensary patients, who of course will cease to be that?

Is the Minister referring to doctors employed mostly in institutions or to dispensary doctors, or to both?

No. I am talking about the doctors who will take part in the new general medical service which will look after the patients now in the lower income group and looked after by dispensary doctors. Therefore, I do not propose to say very much more about that. I hope that, when I meet the representatives of the two associations next week, I shall have from them an answer to the fundamental question that I have asked just now and also the assurance from them that that answer does represent the view of the general members of their profession throughout the country. I do not think the offer is an insult and, furthermore, I do not think the remarks made by Deputy Dr. O'Connell in this House and elsewhere in regard to the offer are, or were intended to be particularly helpful.

I now come to the question of the mentally handicapped which, again, was referred to by almost every Deputy who contributed to the debate. May I say, first of all, that I am most appreciative of the compliments paid to me personally and to my Department in regard to the work that has been done in this field in recent years. I was somewhat surprised by the contribution made last night by Deputy Fitzpatrick in regard to our alleged failures. Indeed, I was also somewhat surprised at an editorial in the Irish Independent which referred to a crying need for new provisions for mentally handicapped children merely because this allegation was made in the House. I should like to set the record straight here. Four years ago a Commission on Mental Handicap made a report in which, on the basis of all the information they could get at that time, they recommended that a total of 900 beds be supplied throughout the country to cater for this problem and to cater totally for it as they saw it then. Within the four years that have since elapsed 880 extra residential places have been provided. Unfortunately, as the House knows, the problem has grown very much in the meantime with the result that we still require, as far as we can see, a further 800 places or so to be created. We are in the process of creating these over the next two or three years and I can only hope, as I said to Deputy Dillon in reply to a supplementary question some months ago, that the provision of these 800 beds will in fact then result in the total solution of the problem in the country.

However, it should be remembered and this is what I want to remind Deputy Fitzpatrick about, that it is not merely a question of money—and I again wish to reiterate that this is and has been a priority matter all during the last four years and it will continue to be a priority matter for the future— but you must also find people who are willing to look after handicapped people and in particular severely handicapped boys and girls. I am delighted to hear—although I had actually heard this before—from Deputy Mrs. Hogan O'Higgins, who has put it on the record, that there is an Order willing to look after handicapped girls at Clarenbridge. I can assure the House that I will be glad to meet the sisters and be glad to cooperate in every possible way provided the premises are suitable for the girls concerned. This is another matter about which we have to be careful. It is not just a matter of providing an institution for children, you must provide the children with more than a mere building; as well as staff you must provide the right atmosphere and the right ancillary help and the right numbers.

It has been very strongly urged on various Ministers for Health that small institutions are not the answer but institutions which cater for a minimum of 100 and preferably 200. In connection with the Galway situation the House may be aware that negotiations are taking place at present with a view to acquiring a very large institution in the city of Galway which, if acquired, and if we have the people to run it, would effectively solve the problem for the whole Galway area and indeed for much of my own county as well. I would join with Members who congratulated the sisters and brothers throughout the country for their wonderful devotion and kindness to the cause of these unfortunate people, and to the nursing staffs in all these institutions who have been equally kind and hardworking in the same cause.

Before I leave this subject might I mention that the Department of Health have also made very significant advances in the case of children at day schools. As the House knows, this is not my responsibility but the responsibility of the Minister for Education. I was happy to hear at a symposium in Sligo recently that the work being done here is very considerably in advance of the work being done in the United States, in Britain and in other countries throughout the world. It was very pleasing to hear that and I can confirm that it will continue to be the policy of the Department of Education to provide the necessary day schools and the teaching staff to run them.

This, perhaps, may be a suitable moment to mention the subject of the control by the religious orders of their institutions in the future. This is a matter on which Deputy Dillon spoke most eloquently and in which he has been very interested in recent times. I have already given Deputy Dillon and the House the assurance that for the future it will be no part of my policy or the policy of my Department to remove from the ownership or control of the religious the institutions they run at present. Indeed, since I did mention mentally handicapped, perhaps there is confirmation of this in the fact that practically all the institutions which cater for the mentally handicapped are owned and operated and controlled by various religious orders, male and female—the Brothers of Saint John of God, the Brothers of Charity, Sisters of Charity of St. Vincent de Paul, the Sisters of Charity of Jesus and Mary and the Sisters of La Sagesse, who were specifically mentioned by Deputy Gilhawley. There has never been anything in the agreements entered into between the Sisters of Mercy, Irish Sisters of Charity, the Medical Missionaries of Mary as owners of general hospitals and the Minister for Health, as a condition of grants, that their ownership of the hospitals would be interfered with in any way. I hope this assurance will be sufficient for Deputy Dillon.

Recently, in conversation with certain religious some concern was expressed about the continued flow of postulants into their orders in the years ahead. The world is changing and sometimes not for the better. The fear has been expressed that without the flow of postulants into the orders, or indeed with the flow of postulants, but with girls interested in missionary work abroad rather than at home, the nuns and brothers may not be able to continue to staff their institutions as effectively in time to come as they are at present. This is something over which we have no control. It does not affect in any way the assurance I have given as regards policy towards voluntary hospitals.

I am much obliged to the Minister. I do not want to ask him anything off the cuff. I listened closely to his observations. He said there was no question of affecting the ownership of the institutions?

Ownership, operation or control.

That is an entirely satisfactory assurance.

Specifically, in regard to the mentally handicapped and the connection between phenylketonuria and mental handicaps, which was mentioned by Deputy Foley, if there has been difficulty for any parents in obtaining the necessary food for the children this is a matter which I would immediately draw to the attention of the Dublin Health Authority. I think they are, in fact, alive to the situation and that any difficulties that did arise were of a casual nature. PKU was also mentioned in connection with the cost of the food. The children concerned are normally treated under the hardship clause already in existence. I can give particulars to the House of the treatment of the children concerned in detail at any time. Thalidomide victims were also mentioned and in regard to this difficult problem, the principal concern has been to ensure that the limb-fitting arrangements were adequate through the rehabilitation facilities. This, I am glad to say, is the case.

Is the Minister aware that where a person in the lower income group is fitted with two artificial legs and manages to get a job and thus get into the middle income group, the local authority will not pay for the subsequent repair of the legs which sometimes amounts to over £80? I do not wish the Minister to comment because——

I am not aware of it but I can imagine it happening.

It seems a hardship when a fellow does make a struggle to overcome his handicap.

I think that suitable representations in the right quarters might deal with that problem.

I have made them.

May I ask the Minister does he know how many children are being treated for phenylketonuria?

About 50 in the entire country. It is very rare. The next matter I wish to deal with is the child health service which was mentioned in an excellent speech by Deputy Dr. Gibbons. It was also mentioned by Deputy Ryan and many other speakers, including Deputy Belton this morning. I fully agree with Dr. Gibbons' point of view that the desired extension as regards children is in the downward rather than in the upward direction. In other words, it is far better when we extend the child health service to extend it to the younger children in the pre-school age long before attempting to extend it to post-primary, secondary or university level. It is vital that any resources we have should be concentrated on the preventive side. As well as helping medically I hope this would be helpful educationally in making the parents more conscious of their obligations to their children at an earlier age. It is the intention, and this will be incorporated in the Health Bill, that defects discovered at any time during school age or, as I hope to extend it, at pre-school age, will qualify for free treatment. I wish to emphasise that, even as things are, if a defect is discovered at school but not cured until the child has left school the child still continues to be entitled, for instance, to orthodontic treatment even though at that stage he is attending a post-primary institution.

The desired extension is that, instead of making it obligatory that the defect be discovered at school medical examinations, in future when the new Health Bill comes into operation, if the defect is discovered by the child's GP at any time, it will qualify. In that way we remove a source of great irritation and annoyance in the past, an annoyance and irritation about which we could do nothing because the provision was a statutory one and therefore not amenable to Ministerial or other alteration.

In regard to the district nursing service I wish to repeat what I said in my opening remarks, that the target of 600 extra district health nurses should be achieved within the present year or, if not, very shortly afterwards. This, I think, has been a significant improvement in the health services over the past few years and one which, I think, can be justified on social grounds because district health nursing will surely again prevent people from having to disappear into institutions——

Hear, hear.

——and to that extent is again a most desirable social objective. Of course the district health nursing will cost us money and of course I would like to pay them more but you would have to come back again to the dichotomy evident throughout the whole debate of our desire to give more in every possible direction and the reality of the fact of having to pay. This to me has been also a priority development because of the social implications involved.

The next matter I should like to mention is the Voluntary Health Insurance which was also very much to the fore in the course of the debate. I wish to endorse everything that has been said in praise of the Voluntary Health Board and indeed gladly acknowledge the fact mentioned this morning that it was during the Ministry of Deputy T.F. O'Higgins that the necessary legislation was passed. Deputy Dr. O'Connell made what I think may be one very good practical suggestion and that was that there should be some form of no claim bonus associated with a compulsory annual medical check. Obviously to have a no claim bonus without the check would not be a very desirable development but I think this is a good suggestion and one which I will convey to the Board as well as the suggestion by Deputy Dr. Gibbons. I have forgotten exactly what it was but I thought it was a sensible suggestion at the time and one which I should like to bring to the notice of the Board.

The Minister will bear in mind that with those who retain good health it is not altogether unreasonable to ask them to bear their share of the burden on the unfortunates who fall ill. It is only for when we are sick we have to pay the premium. If I get through a 12-month period without any sickness I am not discontented.

Neither am I. I got my bill this morning and I am quite glad to pay it.

That is what the principle of the scheme seems to me to be.

I agree. Another matter mentioned, which is one of importance, was the question of the use in institutions of native fuel. There seems to be some confusion in the public mind as to whether Government policy in this matter had changed. I think it is true to say to some extent that the policy did locally as a result of the disastrous year of 1965. But the Government policy has not changed and I also have regard to the private producers of turf who have a very big investment in turf in various parts of the country and particularly in parts of the country where employment is notoriously difficult to obtain, including my own part of the country, and therefore where the employment is of national as well as of local value. I want to tell the House that I wrote on 30 Meán Fómhair, 1968, on the use of native fuels in hospitals and I addressed a circular to each health authority, each mental health board and the Western Health Institutions Board. I do not propose to bore the House with the details of the circular. I think it is sufficient to say I stressed that the Government policy has not changed and, in addition to consulting Bord na Móna, they should also consult private producers of turf before any decision is made to use oil or any other substance. Recently a case has been made to me by the representatives of Dublin Corporation that this is a policy not particularly appropriate to Dublin and that it might in their regard be alleviated. I undertook to look into this matter. I am getting in contact with Bord na Móna and I will communicate with Dublin Corporation. So far as I am concerned if it was quite clear there was no change in the general policy with regard to the use of native fuels I would not be against the Dublin Corporation's saving which would be involved only in the city.

Unfortunately during the debate Deputy Treacy accused me of insolence and of treating the people of Ballingarry, County Tipperary, and their problem with contempt. I think the exact expression used was that I was making a mockery of the people of Ballingarry. I think since I was invited to produce the letter I wrote to Deputy Treacy I should do so. I have it with me here. It is dated 21st February, 1969, and it will be obvious it was dictated by me.

Dear Deputy,

I have been for a long time concerned about the lack of suitable arrangements for medical services in the Ballingarry area. Indeed, the late Don Davern was the first to bring the situation to my notice. The position is that Local Appointments Commission advertised the post without success over a too long period but as a result of their most recent competition hoped to be able to offer a doctor to Ballingarry at last. I very much hope so. Frankly I do not think the people of Ballingarry could tell me anything I do not already know about their plight. Deputy Fahey has also concerned himself so all the public representatives have given me the facts and between them to say the least of it they are highly articulate.

Yours sincerely,

Seán Flanagan.

Does the Minister suggest that Ballingarry is the only place in Ireland where such a position exists? As he referred to it, it looked as if it was an isolated case but that is not so. The very town I come from has it for years.

The Deputy may put a question when the Minister concludes.

I have listened with great patience to a very long debate.

Hear, hear.

I am not prepared to listen to a Deputy who has not appeared in the House for the past six months.

If I was not here it was for reasons outside my control and it is none of your business.

The Minister is concluding.

I would ask the Minister to withdraw that because I am not prepared to accept any of his impudence.

The Minister should be allowed to continue.

If the Minister wants proof of why I was not in this House for any period I will present it to the chairman of the Assembly.

I did not intend to be in any way offensive.

You did not intend to be offensive. You were deliberately offensive. You have a job that you are scarcely able to do without being offensive to anybody.

I will leave it entirely to the judgment of the House as to whether the communication I sent to Deputy Treacy was in any way insolent or inappropriate.

The next matter I wish to deal with is the big one, namely, the question of the transfer of the cost of the health services from the rates to the Central Fund. This morning once again Deputy T.F. O'Higgins contributed on behalf of the Fine Gael Party and for the life of me I still do not know what the Fine Gael Party policy is. I am not making politics out of this because this has been almost exclusively an apolitical debate by people concerned about health services and about their improvement and about methods of paying for them. As I understood Deputy O'Higgins this morning his insurance scheme is to cover personal medical service only whereas the cost of the hospital service is to be loaded on to the taxpayer and taken exclusively from the rates. May I point out to the House that the cost of the general medical service is only one-tenth of the total cost of the health services at the present time? Therefore, all the suggestions that are made with regard to the improvement of the general medical service concern only a minute part of the service and refer to only a minute part of the service as well. The real cost of our health services is hospitalisation. At the present time, not in respect of this year but in respect of the next year, when the total cost of my Department will be almost £50 million in round figures the cost of the general medical service is £5 million and the cost of the hospital section of it is £45 million so that to load on the cost of the hospital service to the taxpayer would certainly vastly relieve the rates but would place on the back of the taxpayer a new and extraordinary heavy burden.

On the other hand the proposal put forward by Deputy Richie Ryan, not so much in his contribution to this debate as on the Motion debated here a couple of weeks ago, was that there should be a comprehensive health service with general medical and specialist care for all the community and that the cost of this should be borne as to one-third by the taxpayer, one-third by the ratepayer and one-third by insurance. Might I, in this connection, point out to the House that if this were to happen the minimum that this service would cost in the year 1969-70 would be £70 million? Therefore, £23 million odd would have to be found out of insurance, £23 million odd found out of taxation and £23? million found from the ratepayers. At the present time the total contribution under our scheme by the ratepayers is £22 million so that a comprehensive service on the lines suggested by Deputy Ryan would involve not decreasing the burden of the rates but increasing it. One way or the other, whether it is a slight reduction or a slight increase, it should be obvious to the House and to the public that it would not involve a substantial reduction of the burden of rates in any event. As I said I do not know which of these two schemes is really the one that Fine Gael support but I do point out to the public that the one-third, one-third, one-third scheme does not involve a reduction in the rates and that the other scheme suggested by Deputy O'Higgins this morning involves an enormous increase in taxation.

If on the other hand we take the Labour Party's approach as outlined in the Labour Party policy document very recently published where the whole burden is removed from the rates, and on this the Labour Party are perfectly clear in what they say, the kind of service outlined here would cost their social fund something between £70 million and £90 million for the year 1969-70. Having regard to all the obligations that the social fund undertakes in this document I find it very difficult to believe that it would be possible for it to achieve them without a fantastic burden in taxation apart from anything that the social fund itself would contribute. Perhaps I should be more specific on this and point out what the obligations of the social fund will be: pensions of all kinds, contributory, non-contributory and widows'; unemployment of all kinds to take the place of the present unemployment benefit, unemployment assistance and redundancy payments system; benefits to complement a comprehensive health service. These are the main burdens that the social fund will have to carry and while the document is vague on it, it would seem to me that if it is successfully to carry these obligations the whole of the cost of the comprehensive free health service will have to be met out of general taxation. At the present time general taxation runs to roughly £26 million. To escalate that to a figure of £70 million to £80 million will give the House and the country some idea of what is involved in trying to keep our health services going.

Deputy Corry mentioned the matter of medical officers in Cork. As he knows, there were two special competitions held for permanent posts by the Local Appointments Commission in the past four years and, as a result of these, two posts were filled in Cork. Very recently I agreed to a still further easing in the stand-still and have recommended a number of posts to the Local Appointments Commission for filling. Three of these are in County Cork, namely, Bandon, Buttevant and Doneraile. I can only wait and see what the outcome of this will be, though I should say there are three posts in Wexford, which has been particularly badly hit recently by the departure of doctors, which I have recommended for permanent appointment in the near future.

Deputy Kyne spoke about the conditions of service and remuneration of nurses. I think it fair to point out that hospital nursing hours of duty were reduced from a 96-hour fortnight to a 90-hour fortnight in the past five or six years and were further reduced to an 85-hour fortnight a couple of years ago. As regards pay, as the House knows, there is conciliation and arbitration machinery, and the arbitrator has recently made an award. This is being considered both by the INO and the County and City Managers' Association and if agreement is reached I shall be happy to implement it.

Is the Minister aware that where a nurse finishes her eight hours of duty, if she is on ambulance duty she can be kept on for four, five or six hours over her time and the only compensation she gets for that is to get time off when the hospital authorities can afford to give it to her?

That is being adjusted at arbitration.

Those are not conditions of service; that is slavery.

This is a matter——

We cannot have these interruptions. The Minister is concluding.

You can have them from some Deputies apparently. There have been a number of them since you came in.

This has been a long debate and every Deputy has had an opportunity of speaking.

Deputies have spoken about the recommendations of the Fitzgerald Report, and I feel I should say a little on this matter, although it is not strictly relevant to the debate. To begin with, I should like all Members of the House to study the Fitzgerald Report and to grasp the principles which govern the recommendations made in it. It is easy enough to praise the report if one of the recommendations is the establishment or the preservation of a hospital in a particular area. Equally obviously, it is a matter of satisfaction for Deputy Fitzpatrick or any other Deputy from Cavan to point to the recommendation in the report and urge the Minister to have it implemented. It is equally understandable that Deputy Crotty, on behalf of the people of Kilkenny, should protest that the report is not satisfactory inasmuch as it proposes to alter the status of an existing hospital, a particularly good one, in Kilkenny.

The description "community health centre" used in the report may not have been too happy. One must remember that the people who prepared the report were very eminent consultants but were not politicians, and perhaps if they were politicians their nomenclature would have been worse rather than better. One way or the other, what I do wish to emphasise is that the report has been agreed in principle only and will be subject to detailed consideration. I can, for example, see a good deal of merit in the argument put forward by Deputy Crotty on behalf of Kilkenny. It is a different case from that of Cavan which would appear to be a very obvious centre for a general hospital, having regard to the location of regional and general hospital facilities in its vicinity and its geographical and other features. Therefore, to that extent, I agree with Deputy Crotty that these are two cases which are not on all fours.

Deputy Seán Collins was very stern about Bantry and said that, as far as he was concerned, it would be over his dead body that Bantry would be closed. Again there are obvious differences between the case to be put forward for the preservation of Bantry hospital and the case put forward on behalf of Kilkenny and Cavan. These are very difficult matters. The people of Mallow have expressed their dissatisfaction to me about having to amalgamate. All I wish to say on this matter is that I should like everybody —politicians and public alike—to treat this as a medical matter which concerns the people and not as a political matter and something to be used against me. I am not prepared to have the Fitzgerald Report turned into a political football. I shall simply say to the people in these areas who want to preserve their facilities, "Go ahead and do so", because the developments in medicine which will be taking place over the next fifteen years will effect considerable reorganisation in the hospital structure in any event and the major decisions that will be made in regard to the development of other hospitals will receive every possible consideration from me and from my officials in the future. Some form of reorganisation is essential and this ought to be admitted by everybody, whatever specific recommendations the report makes in relation to his area.

With regard to Lisdarn, it was certainly very high on the priority list of recommendations of the council that surgical facilities should be provided there. Where these facilities are necessary and recommended, there is no question of my Department postponing action. There will be no postponement because this improvement, structurally and otherwise, of our hospital service must go on all the time irrespective of Health Bills, recommendations, or anything else.

There were so many specific matters mentioned in the course of the debate that I do not really think I could possibly attempt to deal with them all. As I said earlier, I will undertake to get in touch with the Deputies in regard to matters of importance to them, personally or from a constituency point of view, to which I have not had a chance to reply.

So far as the financing of the health services is concerned, this debate proved once again that, no matter what improvements are made, the people will never be satisfied and will go on asking for more. If we are to give more in any sector of our health services then somebody must pay for that more. If the rates do not pay, the taxes will have to pay; if the taxes do not pay, then the rates will have to pay. If neither of these is considered suitable as a means of financing our health services, then there will have to be some system of insurance and the people will have to pay the insurance. One cannot make omelettes without breaking eggs. I am fully conscious of the fact that in recent years the development of the health services has placed a very considerable burden on the ratepayer and the taxpayer. That is why, when the White Paper was published three years ago, it was spelled out that the development mentioned could take place only as the economic situation of the country improved.

Where the Health Bill is concerned, all I want to say is that any taunts thrown at me by Deputy T. F. O'Higgins I accept; I have been just as irritated and annoyed over the delays that have occurred as has any member of the Opposition, especially since January last. I never realised, until I went through the experience, all the miserably silly things that could hold one up. The Bill will be in the hands of Deputies in a matter of days. Its implementation must obviously depend on the improvement in the economic situation. I have no objection to an insurance system as an aid to paying for our health services. Do I have to repeat that every time I speak? Or will I have to go back to television to repeat what I said on television to Deputy Richie Ryan? Not merely will I accept any suggestion of value from Fine Gael, the Labour Party, or anybody else, but I will gladly give them credit for it, because I agree with the Deputies, the 95 per cent who contributed to the debate, that health is not a political matter and should not be regarded as such. I do not think that Deputy Tom O'Higgins added anything to his contribution by repeating today the political charges he made this morning. I do not mind by what system we finance our health services, now or in the future, providing we can continue to improve them as we have been improving them up to this, providing we continue to provide better hospitals; though not necessarily more hospitals, and providing we continue to provide better facilities for the aged, the infirm, the handicapped and so on. I hope that after Easter I will spend as long on the Health Bill as I did on this Estimate because, if I do, I can be given all Stages in a matter of days in the knowledge that I shall have in the main support from the Opposition in enacting the Bill.

Once again, I wish to thank the Members of the House for their contributions. It might be invidious to single out any particular speech but I was very impressed by the contribution made by Deputy Clinton. Everybody who contributed, with the exception of, perhaps, two or three, did so because of a genuine interest in people as patients and as persons liable to suffering and disease. Very few contributed on the basis of a narrow political point of view. I believe the majority had the right view.

Motion "That the Estimate be referred back for reconsideration" by leave withdrawn.
Vote put and agreed to.