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——