Health Bill, 1969: Second Stage (Resumed).

Debate resumed on the following amendment:
To delete all words after "That" and substitute "Dáil Éireann refuses to give a Second Reading to the Bill on the grounds that:
(a) it fails to provide a comprehensive health service available to everybody based upon insurance principles;
(b) it retains the injustice of financing half of the cost of health services out of local rates; and
(c) it gives, at the expense of local authorities and hospital administrators, excessive powers to central government."
—(Deputy Ryan.)

When the debate was adjourned, I had made a special plea for spina bifida and hydrocephalus and cytology. It is important that these diseases should be prevented rather than cured and that we should have preventive rather than curative medicine. This Bill fulfils a rather important function, particularly in relation to Part IV and onwards, in providing for thorough diagnostic services. On Wednesday last I pointed out the special position in regard to the diagnosing of spina bifida and hydrocephalus. Spina bifida is the condition of split spine and hydrocephalus is the condition of water on the brain. If either of these ailments is discovered within 12 hours it can be dealt with adequately. The importance of a quick diagnosis is to ensure that these terrible ailments do not take hold.

I gave many figures in relation to percentages. I pointed out that in 1956 some 90 per cent of the children who were born with either of these ailments died purely because we did not know anything about the diseases. Now this figure has been reduced considerably, due primarily to the medical procedures now being applied in the Richmond Hospital and Crumlin Children's Hospital, Dublin. I do not wish to take up too much of the time of the House repeating what I said on behalf of the victims of this type of illness. My contribution is to be found in the Official Report of Wednesday last.

I dealt with the special position of the parents of mentally handicapped or disabled children. I urged the Minister that before Wednesday next he should prevail on the Minister for Finance to increase the disablement allowance for those mentally ill or disabled children who remain at home and/or to give some considerable tax-free benefits to the parents of such children who are kept at home. I suggested that this should be done regardless of income. Mental illness, as we know, hits all strata of society regardless of whether the parent is poor, in the middle-income group, wealthy or very wealthy. I urged that if it was at all possible the Health Authority in the city and county of Dublin — an excellent and efficient authority for which I have always the highest praise arising out of my experience with them—should issue a medical card to each mentally-ill child or disabled person, and not specifically to the family, because in some instances the family are well enough off to look after themselves in terms of medicine. If they can afford it they can be members of the Voluntary Health Insurance scheme which is another excellent organisation. Once more I would appeal to the Minister for Health to urge the Minister for Finance to recognise the special position of the parents of mentally-ill or disabled children.

This also applies to adults. If a family with an adult mentally sick keep him at home their work in maintaining him at home should also be recognised. I was reading a series of articles by Mary McCutcheon in the Irish Independent. It was a first-class series of articles and well worth reading. She pointed out that mentally-ill children have emotions and experience the usual disturbances recognised in normal children. It has become fashionable to think that mentally-ill children are some type of vegetable, and I do not wish to use too harsh a word. This is not true. Psychologists, psychiatrists and sociologists say that they have the same emotions as normal children, to some degree.

We, as a society, have an important part to play here. Our function is that in the first instance we should ensure that mentally-ill children should be kept at home and that parents should be encouraged to keep them there. We would be discharging our obligations as a society to the parents of those children in that way. I do not think that at this point of time we are discharging fully our obligations to them. This is not to suggest that nothing is being done. Much has been done in the field of the mentally-ill and the disabled. Much has been done for paraplegics and so on, but much more must be done and we must keep on pointing out the areas in which we consider that more should be done until the position has been reached in which everything has been done that should be done.

I pointed out the need for an increasing awareness of the practice of cytology—the smear test on women. Some years ago I tabled Parliamentary questions asking that cyto-analytical centres be set up in which such women would be cared for from the point of view of pre- and post-maternity and so on. A situation has now come about where we are discharging our obligations to these pregnant, and indeed non-pregnant, women in cyto-analytical centres.

All of these are matters of which we are only now becoming aware. If, in this House, and outside it in voluntary organisations, we keep on pointing out the areas of weakness in sociological medicine and health, and if we in this House make moneys available to ensure that everything possible is being done to sustain the good health of our community.

We should become aware of the various ailments I have mentioned before, they run their terrible courses and before their consequences are felt in terms of human happiness. If we did so it would be cheaper in terms of human suffering and financially it would be much cheaper to prevent them than to try to cure them. This brings me back to the matter of cyto-analysis. When we take a smear test and realise the existence of cancer, would it not be cheaper to point it out at that stage rather than to cure or to attempt to cure terminal cancer at a later stage. Terminal cancer, by definition, of course, has its own terrible consequences and that is what I mean by human suffering.

These are points which must be made and I ask the Minister to remember them when he is replying. Deputy Dillon made the point that sometimes one has to keep on asking, to keep on urging, and that one may have the label of a bore, but I make no apology for mentioning some of the areas of health in which I am interested, and I take Deputy Dillon's advice.

At this point I come back to my friends, the paraplegics. The other day two of them came to me. One of them experienced some difficulty in getting a grant towards the conversion of a car; the other had difficulty in getting a grant for the purchase of a car. Both types of grants are freely available because of a very important provision brought in recently. The availability of these grants should be made known to the people suffering from this terrible defect which arises primarily from accidents. Such people are affected from the waist down and when people appreciate that, they will realise why cars have to be converted to suit such people. I have given the Minister details of these cases and I hope he will treat both as being of extreme urgency.

This applies to the blind also, though, of course, I am not suggesting that the blind should be able to drive cars. We have given encouragement in this country to people willing to engage in gainful employment. By engaging in gainful employment, such disabled people cease to be a burden on us. These people are entitled to involve themselves in gainful employment. The State owes them assistance—it is their entitlement. If we have paraplegics and blind people in gainful employment, therefore, why should we not realise our duty to them and put it into effect by way of encouragement, by giving them the various allowances to which they are entitled? Why should we not give them recognition by extending to them tax-free allowances? Why should we not treat them like normal persons when encouragement is the main thing they need?

I have made several efforts during my short term in the House to bring about that situation but without much success. I will follow Deputy Dillon's dictum and keep after it and it will come. But, for God's sake, let us recognise the disability and let us appreciate that those of them who are in gainful employment are not a burden on the State. Let us recognise their effort by allowing them something in terms of income tax.

I wonder will the Minister tell us when the White Paper on mental illness is to be produced? I look forward to hearing that from the Minister in his reply.

The dispensary service has been dealt with at considerable length by many speakers. The experience of a number of my constituents of the dispensary service has not been good, on the contrary. I always feel about State institutions—and imagine that a dispensary is an institution of a nature—that when you go into them they are dark and there is nothing welcoming about them. They are bare; they are clinical; they are mean. Why the State do not apply their minds to the creation of decent dispensaries I do not understand. They are used in the main by old and retired people. Can we not make these people more comfortable while they are waiting? In some institutions the length of time these senior citizens have to wait for medical treatment can only be described as criminal. I have on a number of occasions brought these matters to the attention of the Department of Health, with some little success I must admit but not very considerable.

I believe that as many of these dispensaries as possible should be knocked down and new buildings erected. However, we must recognise our priorities and we do not have that sort of money to throw around. Failing that, could we not send a couple of squads of decent painters in to brighten up some of the dispensaries? I do not suggest that we should have tassels and murals or anything like that around the place. Brighter colours and even knocking out some of the ceilings and putting in glass would not be a costly operation. Indeed the placing of a couple of decent chairs would help, as would the provision of magazines. There are many voluntary organisations that would be only too glad to supply magazines for people visiting dispensaries. I agree this affects constituents of mine, but the effect of this type of dungeon on the staff of the dispensary and on the medical profession is bad also. I know that my personal feeling when I go into a dreary building is a sort of automatic turning in on oneself. One thinks: "How quickly can I get out of this place?" I believe that by creating better dispensaries people would be willing to wait longer than they normally would.

I would ask the Minister to consider these few points in terms of the creation of a better type dispensary, in the first instance, and the placing of some awful dispensaries in some sort of worthwhile, habitable condition until such time as they can be replaced. Some of them must be replaced, as the Minister is aware. The staff suffer in a badly laid out building and it has a bad effect on work. I do not have to go into that; the Minister has paid people to tell us all that.

I came home rather late last night from a meeting in my constituency. I came in at the end of the Telefís Éireann sports programme. There was a plea on by a Mr. McDonagh of Bord Luithchleas Éireann for increased grants. I had already written to the Minister for Finance making a number of suggestions as to what he could do to give grants to finance sports activities, community centres and that sort of thing if he has the money available for it in the Budget. I made some of these suggestions to him in a long letter and last night I heard this gentleman, Mr. McDonagh, repeating almost exactly what I had suggested. I had no communication with him. I welcome his statement. If we examine it we will be doing a lot for physical education. The physical well-being of the individual is very important. I got a rather garbled version of it but I think what he was saying was consistent with what I had already expressed to the Minister for Finance in a long memorandum regarding assistance towards community activity and grants towards sporting organisations—Comhairle le Leas Óige is one—to encourage young people to take an active interest in sport.

In recent times this activity has been taken over by voluntary organisations and the more assistance we can give them in terms of capital the better. A healthy nation is a wealthy nation. I do not know who said that—perhaps it is original—but it is true. From health derives many consequences— active minds, active bodies—all for the betterment of the nation. We are still not very conscious of the great outdoors in this country, of the advantages of getting out and about our beautiful countryside. I would ask the Minister to examine Mr. McDonagh's statement, which probably appeared in this morning's newspapers, and do what he can. I would look forward to some statement by the Minister for Finance in his Budget in terms of a comprehensive programme, a more professional approach to the sporting activities of the nation. We are doing it piecemeal at the moment. Indeed, some of the organisations could examine their consciences as to more co-operation between one and the other. Coordination is very important. Pull together rather than pull apart should be the motto for these organisations. They should be coming together for the reasons I have outlined.

I do not wish to be political on this but I feel that the motion introduced by the Fine Gael Party which is a direct negative to the Bill is, to say the least of it, tragic. Whereas some of us might suggest, rightly or wrongly, that this Bill does not offer as much as we had hoped it would, nevertheless it does a lot and to put in a direct negative to it is, in my opinion, obscurantist. Let us go some of the way towards solving some of our many problems. Certainly, a political Party that puts a direct negative into Part IV of this Bill deserves nothing but condemnation and pity in my opinion. The wording of the amendment is:

To delete all words after "That" and substitute "Dáil Éireann refuses to give a Second Reading to the Bill on the grounds that: (a) it fails to provide a comprehensive health service available to everybody based upon insurance principles;

(b) it retains the injustice of financing half of the cost of health services out of local rates; and

(c) it gives, at the expense of local authorities and hospital administrators, excessive powers to central government.

It is important that the good that is in this Bill should be recognised, and there is a lot of good in it. There are improvements to be made on it, and I am sure the Minister would be the first person to make that point. No one suggests it is perfect. I will have a number of amendments to propose to the Minister on a number of sections. I always feel that the substitution of the word "shall" for the word "may" in a section makes it far more definitive. The Minister may say this is merely a matter of semantics. If it is, "you shall do something" rather than "you may do something", I think it is stronger. The word "shall" is more demanding and more definitive. However, for what the Minister has done in this instance I should like to thank him, and I assure him that he will have my views on Committee Stage.

This Health Bill is being discussed by some Deputies—those who are present to discuss it—in an atmosphere of unreality because here we have a proposal introduced by the Minister in the dying days of this Dáil, and he has pretty sound grounds for believing it will never become an Act. In any event he has informed the House and the country that it is not intended to be operated——

Have I got to listen for another hour and a half to this rubbish? Would the Deputy grow up and behave like a responsible person?

I would ask the Minister to behave himself.

I will behave myself but if I have to listen to another hour of this rubbish——

The Minister can leave the House if he does not want to listen. Do not interrupt me. The impertinence of it.

I will not listen to another hour and a half of this rubbish.

You can "hold your whisht". The Minister can listen or leave the House.

This is irresponsible nonsense.

The Minister cannot abolish the Dáil. He would like to abolish it, as the Minister for Local Government abolished the corporation.

Will the Deputy grow up and behave in a responsible manner.

I grew up a long time ago—when the Minister was in swaddling clothes.

Let us see the Deputy prove it.

As I was saying, here is a Bill introduced by this angry old man, a Bill that is not intended to be operated until someone gives him money. The Minister is going to erupt, but he will have to take his medicine. I told him before and I repeat now that he is a fall guy, and a fall guy he is being made. He is the fall guy for all the deliberate disowning of responsibility by successive Ministers for Health in Fianna Fáil Government. Deputy Seán Flanagan is carrying the can for them all. He is put in now, in the dying days of this Dáil, to produce this mouse and expect people like Deputy Andrews to say: "Thank God for this little thing". The Minister has not got the money to operate it. He has not the time to bring it in. It will never be an Act of the Oireachtas. It is only an act of deceit. That is all it is intended to be. The Minister has invited me to scourge him and I intend to do so.

The Deputy is not fit to do it. I defy him to say anything constructive. We can talk until 10.30 p.m. and I defy him to be constructive because he is not fit to be. This is all utter rubbish and nonsense and it is no credit to a person who sat here for three years.

Let us look at the Explanatory Memorandum written by this angry Minister who has a guilty conscience. It states:

The Bill is primarily based on the proposals for changes in the health services and their administration contained in the White Paper, "The Health Services and their Further Development" (Pr. 8653), laid before the Houses of the Oireachtas in January, 1966.

Shame on the Minister, and on his colleagues. Shame on every member of the Fianna Fáil Party. Three years and four months ago a White Paper on the health services was circulated which was designed to say to the people as was once said by a foolish man to his horse: "Live horse and you will get grass".

A White Paper was introduced by the then Minister for Health with a promise made solemnly in this House that it would be incorporated in legislation in the spring of 1966. Of course it was not, and then we were told it would be incorporated in legislation in the autumn of 1966. Of course it was not. The man who made that promise then became Minister for Education. He scooped all the money and Deputy Seán Flanagan has been there holding the can for him ever since, battling away like Stonewall Jackson, battling away but doing nothing because he was not allowed to do anything. We had the years 1966, 1967, 1968, and now, in the shadow of the dissolution, this Bill is produced. It is no wonder that from the moment I got on my feet the Minister was anxious to shout me down.

He had a a guilty conscience.

I defy the Deputy to say anything constructive.

The Minister knows what I am going to say and he is afraid of me.

I am not afraid of the Deputy or any other O'Higgins. The Deputy should get that into his skull. I am defying him to be constructive and responsible but he is not fit.

This Bill is not intended to be passed. This is an amendment to the Health Act, 1963. What does it do in relation to the things that matter to the people? It gives a choice of doctor for those who are entitled to full eligibility. Notice the change of term—a choice of doctor. In 1957, when I was Minister for Health, I announced that it was my intention to introduce this change which is now in this Health Bill in 1969. A Fianna Fáil Minister is now doing something which I announced as Ministerial policy 12 years ago. I am not surprised that the Minister feels vulnerable on this score.

There is to be a right of appeal in relation to eligibility for the health services. That was also announced by me 12 years ago. I announced also an intention to change the basis of eligibility. These decisions were taken by me within three years of the operation of the Health Act of 1953 but nothing was done. Unfortunately, I was not there to see that it would be done. I was succeeded by a Fianna Fáil Minister and there have been a succession of them there since. Now, 12 years later, trotting in here comes this poor man pulling the lame duck which is the Health Bill of 1969 and we are all supposed to put our heads to the ground and say: "Ah, Minister you are so kind. It is a pity you have not a few shillings to be able to put it into operation but you are great to do it." We have often heard of the mountain being in labour, but this was a tough old mountain in labour for a long time and what a little mouse it has produced.

We intend to regionalise our health services. It is amazing what the Department of Health can do. We had the Health (Miscellaneous Provisions) Act in 1947, the Health Act of 1947 and then the Health Act of 1953. County councils were changed to local authorities and then changed to health authorities, and then in 1960 there was a proposal to have four unified health authorities. All this was going on while, throughout Ireland, in order to avail of the health services a person had to scrub around, write to Deputies, touch the forelock to county councillors and all the rest of it in order to get a medical card. If a person did not get the medical card then he was not entitled to general medical services. But there were great changes in the authorities presiding over him. The county council became the local authority, became the health authority. There was the bunching of health authorities into different groupings, all these trappings and this facade, and here today there is more of it. We intend to regionalise the administration of health services. The health authorities are going and we shall have regional boards and then a whole lot of consultative committees under them. What a lot of rubbish and nonsense, all intended to provide a crutch for a health policy that has failed, all intended to bolster up the policy enshrined in the Health Act of 1953 which has been demonstrated to be a complete and utter failure.

The Health Act of 1953 used divide people into lower income group, middle income group and higher income group. What wonderful change is now proposed? There is full eligibility, limited eligibility and no eligibility. These are the new categories produced by this Minister on behalf of this Government. I suppose people will feel so much better off when they are told: "You are a person of full eligibility instead of being a person in the lower income group". That is a profound change. It will make people feel better off, I have no doubt, but what does that change of verbiage conceal? It conceals the fact that we are continuing on a system of health services which depends on means, depends on segregation of people into income groups and demonstrates a recognition by the State of a responsibility merely to those who can establish lack of means.

As an amendment of the Health Act, 1953, this Bill is all right. Had the inter-Party Government not left office in 1957, this Bill, in this respect, would already have been known as the Health Act, 1957, for the Health Act was being changed and the amendments had been announced by me to provide choice of doctor, to ensure that in relation to entitlement under the Health Act it was only the person's own income that was to be involved, to provide a right of appeal, and to make the various other minor detailed amendments which this Bill now contains.

The pity is that Fianna Fáil thinking on health has only reached by 1969 the degree that we had reached 12 years ago. Why I am angry with the Minister and why I intend verbally to chastise him is the very slow job it is for us to educate Fianna Fáil Ministers for Health. This Bill, with these amendments, represents the needs of the moment as much as a walk on the moon would represent a pre-dinner exercise. It is completely irrelevant. It has nothing to do with the changes now required—a few petty little amendments, but what remains? A continuance of the daft system whereby the quality and standards of health services will continue to be financed 50/50 by local rates and the Central Fund.

Does that not show what a bankruptcy of ideas is the condition of the Fianna Fáil Government? Let every ratepayer throughout the country realise that under this proposal, introduced in the dying days of this Dáil, the Fianna Fáil Government intends to continue the financing of health services from rates. So far as the law is concerned, the situation ordained in this amendment is that 50 per cent of the cost of the health services in each local area will be financed by the rate-payers. Let the people of Dublin appreciate what is involved. Let the Dublin Deputies understand that. This Bill represents a decision by this Government to continue on a health policy which has clearly and obviously failed over the 16 years it has been in operation. Therefore, we have in this Bill, in so far as the health services of the people are concerned, the minor amendments within the Health Act code which were announced and decided upon 12 years ago.

We have the abolition of health authorities. We have the gathering in of areas of administration under a new umbrella body called a health board. That, of course, means unscrambling the Dublin Health Authority, the Cork Health Authority, the Limerick and the Waterford Health Authorities. All these eggs will have to be unscrambled again. There will be health boards in place of these with all the multifarious assortment of advisory committees. A huge administrative umbrella will be raised over a puny health service. This is all window dressing. This is so much make believe. This is more of the deceit being practised in relation to this important matter of health.

The Minister could well forget his boards, his regions and his consultative and advisory committees, and all that rubbish and tommy rot, if only he had the guts and the courage to appreciate that the one change the people need is the introduction of a really comprehensive health service based on insurance That will solve all the problems. There will then be no need for a vast umbrella, a huge administrative machine parked here and there all over the country. An insurance fund can be set up. It can be administered. The Minister can give people the same rights everywhere and he can ensure uniform services all over the country. He can remove health services from the exigencies of local rates.

All that, of course, involves one fearful step, the admission by a Fianna Fáil Minister that the Fine Gael Party was right, is right and will continue to be right. Of course that admission will not be made. Whatever the Minister for Health might like to do he will certainly not be allowed to do that. He will not be allowed to take the big step of admitting that Fine Gael have been right all the time and, therefore, the miserable deception continues. The people are crying out for reform. They are crying out for some equality of standards and for the kind of health services they see their poor, beleaguered fellow-citizens in the North enjoying. They are crying out for these and the cry has become so claimant that, for appearance sake, because an election is due, a Bill is introduced by a sleight of hand performance in the hope that people will believe that it represents a serious attempt at re-organisation of health services and that it will in time become an Act. The fact is that it never will become an Act because it was never intended that it should pass into law. Even if it did, the money is not there to operate it. This is as disgraceful an episode as I have ever experienced in my 21 years in this House. It is making a charade of the needs and requirements of the people. It is done out of political expediency. The regrettable thing is that it is done by a man who is made the conduit pipe for this kind of performance. He is the fall guy.

I will not accept any backhanded compliments from the Deputy.

The Minister will accept what I am dishing out or else leave the House.

A Cheann Comhairle, I will not put up with this from Deputy O'Higgins.

Then leave the House.

I am responsible for this. The Deputy had better be here later on. I defy him. He will be away off.

The Minister may be responsible or irresponsible, but he is a member of the Government and he will do here, in the exercise of collective responsibility, what the Government tells him to do. If the Minister is worth his salt, I am certain that he was trying to get the Government to permit him to bring in a Bill as far back as two years ago. Of course he was not allowed to do that and it is only when the heat is on, when it is suddenly realised that it is not a question of Deputy Flanagan, Minister for Health, alone in the hot seat but that the whole Government are in it that clearance was given to the Minister to introduce this measure.

The Deputy will kindly continue to treat me as Minister for Health and leave any backhanded compliments to my individuality out of it.

I will continue to say what I have to say, and without the Minister's permission. I am elected here to say what I have to say and, if the Minister is hurt, then he brought that hurt upon himself. Had he held his tongue he might not have suffered the chastisement he invited from me.

This is a lot of irresponsible nonsense.

I do not know whether or not it is nonsense. That is for the people to decide.

They will. Let the Deputy not worry.

I am quite sure they will. I could discuss this Bill in detail, but there would be no point in doing so. It would not be an exercise in reality. I do not know if there will be a Committee Stage. If there is, I suppose we will go through the motions of imagining that we are legislating seriously. The plain fact is that this is intended to be a bit of window dressing to conceal the fact that for so long so little was done by so many Fianna Fáil Ministers.

I am sure it is very difficult for any Minister for Health to bring in a measure which will please everybody, the more so when one remembers the hopes that were raised by the White Paper published in 1966. If one compares the present measure with the 1953 Act it is true that there are certain improvements in the Bill before the House: there is a choice of doctor for medical card holders; there is the abolition of the special charge for out-patients; there will be assistance where drugs are needed by those of limited eligibility; there is an increase in maternity cash grants and children pre-school age will have the benefit of medical examination. As far as the Bill as a whole is concerned, that is an end of improvements. It falls short of the promises implied in the White Paper. Not alone does it fall short of the hopes that were raised by that White Paper but in his Budget statement, the Minister for Finance said:

The cost of the health services is rising so rapidly that it is necessary to consider alternative methods of finance in order to reduce the amounts now charged on the taxpayer and the ratepayer. A detailed examination is being undertaken of the feasibility of introducing an insurance or contributory scheme to finance at least part of the costs of the services available to the middle-income group. It will extend to the question of eliminating the hospital charges for which middle-income patients are now liable.

I feel that, in that statement, there was hope that in this Bill we would have a very frank discussion on how our health services should be financed.

When the Minister introduced the Bill and reiterated the Government's determination to continue having the health services financed on the basis of 50 per cent from the State and 50 per cent from the local rates he drew what one might say were the old battle lines of the past ten years so far as our health services are concerned with the result that our minds are somewhat diverted from the merits or the demerits of the measure. Resolutions from local authorities all over the country will be found in the Department of Health asking the Minister to get away from what, in fact, he has once again indicated as the method by which our health services will be financed. He certainly had an outstanding opportunity on this Bill to evolve a new and more satisfactory method of payment for our health services. Had he done so, the Bill would have been discussed here in an open way instead of along lines on which this matter has been discussed for so long.

I do not think it is possible to over-emphasise the strength of the opposition throughout the country to the present method of financing the health services. In the White Paper of 1966, the Government said they were satisfied the local rates were not a form of taxation suitable for collecting additional money on this scale. That point of view is very strongly held throughout the country. One might say that Dublin Corporation were not living up to their responsibilities when they refused to strike a rate in view of the Health Estimate but, to my mind, their action reflects the strong feeling that exists throughout the country on this whole matter. I believe that the only thing that has prevented people from going further in that respect is a sense of helplessness. I do not want to say that any one Party has all the answers to this problem. I consider that each Party and possibly each one of us has a worthwhile contribution to make towards improving this scheme and this Bill.

Even at this late stage, I should be glad if the Minister would reconsider the manner in which he proposes to finance the health scheme. Under this measure, he will have power to provide supplementary grants towards the operation of the new boards he proposes to set up. It is not sufficient, at this stage, merely to make a blunt statement as to what he can provide in this context in view of the contents of the White Paper and the statement of Deputy Haughey, Minister for Finance, on 23rd April, 1968, when introducing the Budget for the financial year ahead. Budget Day is the measure of truth for this House and for our country. That statement by Deputy Haughey on that occasion gave hope that the Government were prepared to move away from the old system but, once again, we have it in this Bill and, while the Minister has certain powers under the Bill, it is not sufficient merely to say that he may or may not do this or do that. The Minister should spell out exactly what he intends to do. He should state clearly the contribution the Exchequer is prepared to make towards the cost of our health services.

We have been told that the cost of our health services has increased by 50 per cent over the past four years. It must be agreed that most of that increase falls under the administrative side of the health services and that, in fact, there have been no great extensions to the health services proper. Though the Minister claims that the increases are being borne equally by the Exchequer and by the local rates, nevertheless, by virtue of various forms of taxation such as PAYE, a considerable proportion of the money provided by the Minister for Finance to help to finance local authorities finds its way back into the Exchequer and, in reality, the net cost of the health services is borne to a far greater degree by local rates than by central taxation.

Under this Bill, 50 per cent of the members of the new health boards will be appointed by the Minister as will, also, be the chairman and the vice-chairman. When I first heard that health boards were to be set up I hoped the Minister would restore some of the powers originally held by the old Boards of Health before the County Management Act was introduced. It appears from this Bill that the same type of thinking that was responsible for the County Management Act, 1940, is now determining the functions of the new health boards. To ensure that health boards will be effective and efficient and, furthermore, to ensure that public representatives will have a reasonable "say" is not an easy matter having regard to the numerous services provided by the health authority. Nevertheless, more power should have been given to the health boards and at least they should be allowed to elect their own chairman and vice-chairman.

These boards will be composed of professional people, people engaged in the administrative side of the local and health authorities and public representatives. It was a retrograde step to include in the Bill necessity for the Minister's sanction for schemes put forward by the health boards. In view of their composition, I believe them capable of very worthwhile improvements and recommendations and they should be allowed some of the powers contained in the City and County Management Act, 1955. They should not have to seek the sanction of the Minister in respect of every little thing they feel should be done.

The right of appeal against the decision of an executive officer is certainly a step forward but it will lose its effectiveness if the Minister decides that another officer of the board who, in the first instance, refused the application for a service will hear the appeals. The Minister should examine how other Departments of State operate and should not allow a situation to arise where an executive officer of a health board will decide a case in one particular way and then an officer of the same board will be asked to hear an appeal. Certainly, if the Minister allows that to happen, people will lose whatever confidence they may have in the right of appeal.

Some people feel that members of a health authority cannot make representations in cases where applications are refused. This is a retrograde step and public representatives should have a right to find out exactly why people are refused facilities to which they are entitled. I am not saying that because I think people should ask public representatives to make representations but because public representatives have a duty on two fronts. They have a duty to the people who elected them and a duty to find out why people who made applications for various services were refused. They also have a duty to let the people know why they were refused. Most of us have always found the officials to whom we have made representations to be courteous when dealing with our representations and as a result public representatives have a duty to explain to people who feel aggrieved, that things might not be as bad as they felt or that in many cases they were genuinely——

They will not be stopped. They will have every right to find out the reasons.

Will a public representative have the right to look through the reports regarding a particular application?

No, I do not expect so.

Then the public representative would not be able to find out from the manager of the health authority or the official concerned why there was a refusal.

He would, but at the moment he has not go the right to see the documentation. He has the other right and will continue to have it.

In certain respects too much power is being given to the executive officers and the Minister and too little consideration to the work done by public representatives over the years. The more we move in this direction the sooner we will arrive at the undesirable stage of democracy by dictatorship. A change which I should like to see made is in regard to the 10/-a day charge made on the middle income group for hospital services. I do not know what the exact cost of removing this charge would be but from my experience I think it would not be greater than £500,000. When one considers the time and money spent on investigations and re-investigations, sending out reminders and bills, then the collection of this sum is hardly warranted. Another point is that the salaries of home assistance officers should rank for a 50 per cent recoupment from the Exchequer and not be a 100 per cent charge on the rates in view of the fact that most of the time of these officers is spent investigating matters relating to health services and, therefore, it hardly seems fair that this particular part of the administration of the health services should not rank for such recoupment.

The Minister's decision to take into account only the income of the husband and wife in applications for medical cards and to ignore the incomes of other people in the house is a most desirable step. His decision in regard to the payment of disability pension allowances is another move forward. The Minister will be aware that in many cases where people apply for this allowance they have no income and when they go to hospital for treatment they receive the allowance for eight weeks but people can be in hospital for four or six months and, perhaps, the Minister could extend the period of full payment or at least allow 50 per cent of the original amount for another four months. This is not something which would break the State or cost a great deal but it would make a very great difference to many of the people involved.

In his Estimate the Minister dealt with the extra provisions he hopes to make in the next couple of years for mentally-handicapped children in institutions. It is generally felt that the parents of such children have to bear a very heavy burden and the Minister should provide treatment for these children free of charge irrespective of the parents' incomes. I know that the county managers generally have been very lenient in this respect and that they use the flexibility clause in the Health Act in a very generous way, but as the State is bearing the greater proportion of the cost of institutional treatment for these children it would not impose an undue burden on the Exchequer if the Minister went a little bit further and provided treatment free of charge for all children irrespective of their parents' income.

The question of appointing dispensary doctors is one that in many counties has been put on the long finger. I do not know what the position is throughout the country but in my own county there are four permanent posts vacant. The sooner the Minister decides in which particular areas or districts he can provide a choice of doctor the better. I am sure he will agree that it is unreasonable to have these four posts vacant in my county particularly as two of them are in adjoining areas. I am sure he will understand the difficulties people have in getting doctors when they want them. Most of these posts are filled on a temporary basis and the situation has been dragging on for a very long time. In Wicklow it has been dragging on for five or six years and the Minister should make up his mind where he is going to have the groups of doctors proposed in the Bill and when he will have these posts filled. In some counties he has allowed permanent dispensary doctor posts to be filled as far as I am aware. Some four or five months ago I remember reading in a Sunday newspaper advertisements for particular counties and certainly they were not for remote areas or on the western seaboard. In Wicklow we have been told that the Minister is not prepared to sanction the permanent filling of these posts but he should have the matter decided finally.

One other matter to which I should like to refer relates to married nurses working in various institutions throughout the country. It is certainly true to say that many district hospitals would not be able to keep going if the services of these nurses were not available. The Minister should do something similar to what his colleague the Minister for Education has done in regard to married teachers. If he is not prepared to do that he should at least ensure that these people are paid salaries commensurate with their ability and experience. Surely he will agree that it was hardly reasonable to expect people who have been nursing for 15 or 20 years to come back and work in these institutions at the bottom of the scale. In view of the problem that exists in regard to these areas, particularly small district hospitals in rural areas, the Minister should look at the position and see if he can sanction the appointment of these people on a permanent basis and pay them salaries in keeping with their experience.

Finally, I exhort the Minister, even at this late stage, to go back to the Government and tell them that throughout the country there is a very strong feeling against the present method of financing the health services. I say in all sincerity that even reasonable people are objecting strongly to the method that has been employed through the years to finance health services. While on a number of occasions recently in the House the Minister said he was having discussions with the Minister for Finance in connection with this matter, I think even the Minister for Finance himself does not now consider the position to be as gloomy as it was when the Minister for Health was trying to get some money from him some months ago. Therefore, I exhort him to take health matters out of the old battle-lines of the past and see if he can recommend any rational manner in which health services can be financed in future and so get us away from the system which has caused so much dissension over the past 15 years.

It is hardly necessary for me to say that the Bill falls very far short of what we in these benches would wish it to be. All of us who are public representatives, and particularly those of us who are local public representatives, have a very keen interest in this measure. Therefore, although some of us covered the field pretty comprehensively only a few weeks ago, we feel called upon again to comment on the Bill. It is difficult to do so because the Bill contains so little detail.

It is nothing more or less than a modification of the White Paper on health which we received, I think, over three years ago. There is nothing more specific in the Bill than was in the White Paper. In some instances some worthy objectives in the White Paper are either excluded or treated very lightly in this Bill. I find it strange that, after three years notice of the Government's intention, we should have such a scanty Bill, one so devoid of detail or elaboration in any form.

The Minister, his Department and the Government have had three years to consider this measure. It is difficult to understand that at this stage, with the Second Reading of the Bill in progress, consultations with those who must operate the Bill, or Act when it becomes law—the medical profession and the dentists—are still only in the elementary stages and that consultations with the local authorities have not even begun nor have we got notice that they will begin in the near future. Consultation with the local authorities who have been operating under existing Health Acts and who will be very largely affected should have been considered essential before the Bill was introduced. It is hard to understand what the Government have been doing for the past three years. I hope that the Minister will be able to give us more details on the next Stage but, assuming that it will be taken soon, I doubt if he will be in a position to do so. In these circumstances it is difficult for us properly to address ourselves to this measure. However, we must take it as we got it for the moment.

That is my first criticism of the measure and the second is in regard to the proposed reorganisation of the services envisaged in the Bill. I completely agree with the suggestion that those who operate the Health Act— doctors, nurses and medical people generally—should have a say in the management of health authorities or regional boards or whatever they may be. It is part of our policy as a Party that those who operate the services, whatever they may be, should have a say in their operation. Therefore, we do not oppose in any way participation by medical people in whatever capacity in the new health boards but we believe that in order to safeguard democracy local public representatives, the direct representatives of the people—and after all this and every other such Act exist or should exist for the people whose health is our concern—should form the majority of any board set up. This is the only way we can safeguard the rights of the people. By abolishing this system and by substituting a board on which the Minister is responsible for a majority of the members we take away this right of the people.

We should be very careful to ensure that any Health Act we pass has the confidence of the people. I contend that the present health services do not have the confidence of the people, particularly those who do not qualify for full eligibility or part eligibility, as this Bill describes it. Those of us who are public representatives and attend local meetings and meet our constituents are told by people generally who have not been allowed full eligibility under the Health Act of those who are far better off than themselves and who have medical cards. They blame the local assistance officer, or the system, but the fact is that they have no confidence in the system, no confidence in the Act or those operating it. In health, as in every other department, we must ensure from now on that any legislation we enact will have the people's confidence, that it will be operable and that it can be seen by the people it is intended to help to be a just system.

I do not think that this Bill in any way removes the built-in criticisms associated with the old Act. I do not know why, in the case of the new regional boards, it is left to the Minister to appoint the chairman and vice-chairman. Surely this is regression in democracy? Surely any board should have the right to have its members appoint its chairman and vice-chairman and other officers. I was interested when the Minister in reply to a question across the House stated, I think, that local public representatives would be able to ensure that justice was meted out in the issue of medical cards.

Yes, and written appeals also.

The Minister referred in his Second Reading speech to the functions of the chief executive officer that he proposes should operate under section 16 of the Bill. He said that the chief executive officer under that section would perform his duties on behalf of the board and in accordance with their decisions and directions except in respect of certain things in which he is specifically given functions by the Bill. These will be mainly decisions on individual applications for services and control of officers. I think local public representatives, as members of an advisory committee—only very few of them will be members of the body proper—have a very important function to fulfil in that they have a forum in which to air grievances. This is a vital outlet. I think the chief executive officer under this Bill can tell them that this or that is his reserved function, that they have no right under the Act to interfere or make representations. I do not say all the chief executive officers do this but under the Bill they are empowered to deal arbitrarily with applications and are not required to have recourse to public representatives or anybody else, even those on the board, in that respect.

There are several limitations on the powers of the boards. Section 30 envisages limitations in regard to supplementary estimates. Normally, that might be a very good thing. Perhaps most members of health authorities complain that supplementary estimates have to be resorted to during the year but I have known occasions when this was necessary for very urgent reasons and I should hate to think that a detailed and protracted correspondence would ensue between the Minister's Department and the board before money could be provided to finance very essential services. This has been our experience not only in respect of health but in respect of local government generally. It is indicative of the situation that exists between the Department of Local Government and local authorities.

Nobody will deny that the choice of doctor for all patients is a very good thing. However, at the moment it is very vague. Indeed, if one reads page five of the Minister's introductory statement, one would think that it was an Opposition Party policy on health and that the responsibility for implementing the policy might be something to worry about tomorrow and not today. The Minister is very vague in some of the statements appearing on that page. After three years of waiting for this Bill we should have something more definite.

The problem of deciding who is eligible for benefit and who is not will still be with us. The very degrading investigation of means which is at present in operation is to be extended to the middle income group. It is good that help is being given to people in the middle income group to pay for costly drugs, but the administrative costs involved in ascertaining whether the amount of the expenses incurred within a specified time exceed a specified figure and deciding whether the person is qualified for benefit would far outweigh the advantages. When the Minister decided to assist the middle income group, he should have cut out the means test. If this were done, the cost in the long run would be less.

We are glad to hear that, in determining eligibility for benefits, the income of other members of the family will not be taken into consideration. We can deduce from this that there will be a very large increase in the number of people qualifying for benefits. We have no idea of what the income limit will be but we know that the health authorities are, at the moment, operating a rather stringent system and that a man and his wife, whose joint income exceeds £11 per week, do not qualify for a medical card.

I wonder what the Minister will do with regard to the agricultural community. He certainly cannot determine their eligibility for benefit on the basis of their valuation because valuation bears no relation to economic circumstances at the moment. These are some of the details on which we should like clarification from the Minister either in his reply to this debate or on Committee Stage.

Reference has been made to group practices by doctors. These would work very well in city areas but they would be rather difficult to operate in remote areas. Unfortunately, there are some dispensary areas for which there is no doctor. In some of these cases a permanent appointment has not been made pending the implementation of this Act and it has not been found possible to get a doctor who will take the post on a temporary basis.

Speaking of temporary appointments, I would ask the Minister to do something in this regard. There is a great deal of unrest among the people because of the service they get as a result of these temporary appointments. Very often a doctor appointed in this way may, through no fault of his own, live far away from the dispensary area and in some cases the people in the area will not know the doctor's telephone number or his address. This is a dreadful situation and I ask the Minister to do what he can to ensure that appointments are made in such areas with the least possible delay. The Minister says that this legislation will not be implemented before mid-1970, but this is far too long to wait for this situation in remote areas to be cleared up.

I agree with those who stated that the minimal charges for hospitalisation should be discontinued because it is not worth the administrative cost of collecting it. I hope the Minister will listen to what we are saying and abolish that charge.

In dealing with this Bill, we note the omission of several things which are very dear to us. The White Paper on health referred specifically to dental treatment but there is only a very scant reference to the problem in the Bill. No arrangement has been made for the extension of the dental service. Sufficient dentists cannot be got to operate the school dental service. The result is that children of ten years and upwards—the children who most need treatment—cannot have it. We have got to cut our service down to that. A dental service like that is a farce. Perhaps this is caused by the scarcity of dentists. Maybe they prefer to go to some other country where they may get more money. It behoves the Minister to address himself to this situation and to see that we have proper dental services in this country.

We have had very little reference to the care and treatment of aged people in hospitals and to home nursing and general nursing. The care of our old people is vital. Something should be done for those people who have given up employment to care for their aged relatives. I know there is something given under the social welfare code if they have 156 contributions, but it is very small. Some of those people who have given up jobs to care for their aged relatives should be given some compensation. Some of them have not any stamps when they come from abroad and they cannot get anything here. Those people are providing a service for the community which means a very large saving to local authorities. The old people would be in institutions and would be costing the community a great deal of money, but by virtue of the fact that those people are doing this work they are saving the community this money. Some scheme should be enacted which would give them compensation for performing this duty. Parents, as a right, look after some members of their family who may be incapacitated in some way but many adult persons who do this work should not be asked to exist in society with no money, no personal belongings and no assistance from the State. We should certainly do something to help those people who devote themselves to looking after their aged relatives. Those people who make this sacrifice should be given some help by the State.

There is very little reference here to the upgrading of our mental services and the abolition of the discrimination which exists between mental illness and general physical illness. Mental illness is an enormous problem in this country. It is especially so in County Cork where we have large crowds in mental hospitals and we find it very difficult to do much for them because of shortage of money. Mental patients should not be treated in this way. In Cork we have something like 2,000 patients in a building with up to 60 or 80 beds in a ward. I have said this before, and I repeat it again, that I think it is appalling that those people should be treated in this way. We should not allow this to happen in mental hospitals in this year of 1969. I know it costs a lot of money but there are things which must be done regardless of what shortage of money there is. There is a crying need for improvement in mental services and something should be done, whatever it costs us.

There is also very little reference to school medical examinations. Something should certainly be done to improve this. Those matters to which I have referred might be regarded as administrative complaints but I feel this is the right place to make them. I would ask the Minister to ensure that all those services I have mentioned are improved without delay. I would ask him particularly to improve health services for our children because, if we do not do so, we will have a worse problem when they become older. As a nation we certainly fall down in regard to our health services for our children and much could be done in this regard.

I want to add to what the last speaker said about our nursing service. Here we have a section of our people on whom everything depends. We cannot operate our health services without our nurses. Let me say that I consider that they are the worst paid in our community. Some people may say that their wages are not too bad but for the skill which nurses possess I want to say, as a woman, I consider that they are very badly paid. They are nearly all female labour but, if they were not, they would be paid far higher wages. It does not matter whether they are female or male they should be paid according to the skills which they have.

We should concentrate on upgrading the whole profession of nursing. We should have diplomas and degrees in nursing and we should enable nurses to go right to the top of the scale, administratively or otherwise. I hope in regard to any board which the Minister may set up to operate this Bill when it becomes an Act that there will be some nurses on it. They could certainly contribute much to the success of those boards.

I suspect there are many other criticisms which I could offer and also many compliments which I could pay the Minister on this Bill, but I feel at this juncture I should not take up the time of the House with them but rather wait until the Committee Stage when we can deal specifically with our particular grievances. However, I would say this is another example of piecemeal legislation. It eliminates a few injustices and it rights a few wrongs, but the basic problem remains the same. It does not solve the basic problem of the people of this country. I think we have got to get away from the whole concept of piecemeal legislation, be it health or otherwise, and tackle the whole thing by way of legislation.

It is my privilege to follow the shadow Minister for Health in the Labour Party, Deputy Mrs. Eileen Desmond.

I am not that.

I beg your pardon. It is my privilege to follow the Deputy anyway. I listen to most of the Deputy's contributions in this House which are usually well thought out. Should the unlikely situation arise that this Party might be over there and the Deputy found herself on this side of the House, most of us would have great confidence in the Deputy should she be elevated to the office of Minister.

The only one objection I have to this Bill in its entirety is that, once more, there appears to be discrimination against married women. Whilst there is great improvement in relation to family incomes I think a married woman who is working for an income should be treated in exactly the same way as a husband who is working for an income. This discrimination extends right through our income tax code and many other codes within our land. I think it is incorrect to write off this Bill as piecemeal legislation. As some of the Deputy's colleagues might know, I think it was the great chairman Mao who said that a long journey starts with the first step and this is a first step.

The Deputy seems to know a lot more about it than we do.

It might be Confucius.

He would be more in the Deputy's line. He was a holy man.

There is no doubt in the world that if we improve our social services we can only improve them step by step. This is in no way piecemeal legislation. We go step by step as we have the money. We improve the services all the time as the Exchequer can afford to pay for them and as the gross national product increases. We cannot suddenly come along, as Deputy O.J. Flanagan suggested before he joined the Fine Gael Party, and print money to meet the cost of these services. There is some significance in the way in which this debate is taking place. The Minister said in his opening statement that this is largely a Committee Stage Bill. Leading speakers of both Opposition Parties have agreed with this. I do not know whether it is the Punchestown Races or what, but the Opposition Parties appear quite determined to prolong this Second Stage of the Bill for as long as possible. Maybe they want to block the implementation of these provisions. I just do not know. So far as I am concerned, I did not intend to speak on the Second Stage of the Bill and I am speaking from notes on the side of the Bill which I had prepared for the Committee Stage when the real work of this Bill shall be done. We can discuss this politically as Members of the Opposition have done, and I may as well follow suit.

Deputy Ryan, a spokesman for health, thanked the Minister for "this miserable measure", which he called a mean, small-minded, begrudging and niggardly Health Bill. That comes very well from Deputy Richie Ryan. I am sorry he has left the House. Deputy Ryan was the leading spokesman for Fine Gael in the Dublin Corporation when they refused to pay for the present health services. Now he calls this a mean, begrudging, small-minded, niggardly piece of legislation. Let him stand up and be counted when it comes to the time when we have to raise the money, be it by taxes on the pint or on the cigarettes, on income tax, or by putting it on the rates, or making the contribution stamp under the insurance scheme amount to £1 per week for the ordinary worker. Let him stand up and be counted when it comes to paying for these services which this mean, small-minded, begrudging and niggardly Health Bill shall provide.

You are not altering the situation in this Bill.

I will deal with your insurance scheme, the rates question and the provisions of the Bill as I go along. I prepared my statement for the Committee Stage. It is certain that we will not be able to improve the health services by delaying the Second Stage debate. I have read all the debates up to now and they were quite interesting for the first day or two. Then we started on the repetition. I will refer to some of the remarks in these debates at a later stage. The main demands that have been made by the public expressing their views in statements at meetings, letters to the Press, editorial comments in the newspapers or by political correspondents have all been dealt with in this Bill. The Bill deals with the free choice of doctor and the end of the dispensary system so that an individual can get his medicines and drugs from individual chemists. Deputy Ryan is afraid that this good piece of legislation will get on the Statute Book before the general election, whenever that may be, and he is determined not only to prevent that happening but also to use his influence to bring down the Dublin Corporation and to prevent another Fine Gael candidate getting the seat. The electorate know him and never give him many votes. He would serve his Party and the nation better if he would use his influence with his Party to enable this Bill to get through this Second Stage in the House quickly.

There may be some sections which will require long and detailed consideration on the Committee Stage. The Second Stage should be let through the House and not held up. I suppose it is unfair to say it is being held up because of the Punchestown Races. It is probably being held up by deliberate policy.

This Bill proposes many good things. When I was first elected to Dublin Corporation and became a member of the Health Authority I had the privilege of attending a conference in Belgium in 1955 or 1956. This concept of a regional organisation had become the thing in Europe then. So far as France is concerned, there has been a referendum recently where greater regional power has been turned down, but the concept was there in 1955-56 that to get efficient organisation and management of health planning or housing matters you had to work on the basis of a region, not on the basis of a city or a county but on the basis of a region in which a city was situated. All the delegates who attended that conference, representing countries not only in the EEC and EFTA but also some countries in Eastern Europe, voted unanimously for this scheme. It appears that these international conferences are not effective in getting Governments to take action because it has taken 12 or 13 years for the Government of this country to adopt a regional system for health authorities. Such a system will do away with a great deal of overlapping. It will bring about more efficient working of the health services and help reduce their cost. It will enable the Minister of the day, no matter who he may be, to bring in specialised, technical experts to help, advise and assist those people who are elected. This is something which is most important. I am aware of great waste, especially in our voluntary hospitals. I suggest this could be overcome by proper organisation, proper management and proper technical help and advice.

I am aware also of this defect in regard to our voluntary hospitals. A man may complain of tummy trouble and the doctor may not be quite sure what is wrong with him. He is admitted to a voluntary hospital on a Friday. On a Monday the blood test has been completed, on Tuesday the X-Ray examination is done and it is Wednesday before the cardiograph is available. All of this could be done in 36 hours. I am aware of this because it happened to me. I was a paying patient in a voluntary hospital but from the amount I paid I was aware that I was subsidised. I was in a private section of the hospital. How the money is distributed I do not know, because in my opinion I should have paid more. I am emphasising the delays and I know that it happens in the case of people who are admitted to voluntary hospitals under the health services. There is a terrible waste of time. In a business —the same should apply to medicine —when you have a building and machinery you must use that building and work that machinery around the clock, 24 hours a day, the only respite being on Sunday and that is on religious rather than economic grounds.

The Minister is discussing with the medical profession the question of how payments should be made to them. By the time this Bill will have become an Act it is possible to foresee that a satisfactory arrangement will have been come to because the difference of opinion between the Ministers and the doctors is not great, the door being wide open without any appearance of breakdown. In these discussions, the Minister should consider, whether it be through group practice or individual practice by doctors and physicians, how the bed-time in hospitals can be better utilised, because 70 per cent to 80 per cent of the total health bill is spent on voluntary hospitals. This is the big end of the expenditure on health and if expenditure on voluntary hospitals can be cut—I am convinced that it can be, having spent three or four years on a health authority—we can extend our health services greatly.

In section 4 (4) the Bill states that the Minister shall consult the council of a county, the corporation of a county borough or the Corporation of Dún Laoghaire before making regulations under this section which relate to the functional area of the council or corporation concerned. I suggest to the Minister that this subsection is not necessary. Up to now, local authorities have nothing to be proud of and the sooner the local authority administration of our health services is changed and improved the sooner we shall advance in our health services.

I hope that Dublin Corporation, the Corporation of Dún Laoghaire, Dublin County Council and the councils of some of the surrounding counties will be amalgamated into a region including Kildare, Meath, Louth and so on. It is the only way to do it: it is the only way we shall get efficiency.

I was a member of Dublin Corporation and Dublin Health Authority and I saw reasonable proposals put forward by the Department of Health but because a Fianna Fáil Minister made the proposals, they were obstructed and blocked because the Fianna Fáil Party did not have a majority on these bodies, and never had as far as I am aware.

The Minister is quite right in introducing these reasonable provisions. We must reorganise our health services completely and in their entirety. When one goes on to read subsection (5) of section 4, I do not think the Minister is taking too much power, as the last Fine Gael speaker alleged. He said the Minister is looking for dictatorial power. It is not so. The subsection states:

A draft of regulations which it is proposed to make under this section shall be laid before each House of the Oireachtas and the regulations shall not be made until a resolution approving of the draft has been passed by each House.

Therefore, it is obvious that the Minister will not get away with anything unless the Deputies over there are not doing their job and I am sure they will be on their toes to spot any bit of excessive authority the Minister might try to exercise, no matter which Minister he might be. Then we come to section 5. I am prompted to say to the Government that if other Ministers wrote into their various Acts protection for individuals similar to that which the Minister for Health has introduced here, I would be far happier because section 5 gives the greatest possible protection to the individual.

Of course, the Labour Party say we have two conservative Parties here. They repeated that allegation during the debate on this Bill. Let us come along to section 6 (2) and we find the enactments which are being amended. We have only to look at them to appreciate that Fianna Fáil Governments during the years have been progressive and liberal. One could call Fianna Fáil, accordingly, a socialist Party, depending on the interpretation one puts on it because every piece of legislation in the socialist field has been enacted by a Fianna Fáil Government.

In reference to the local committees to be set up under this Bill, I think everybody knows how local politics work. There is a situation in which the Minister must make regulations. Otherwise the thing would not work at all. In this instance, the Minister is quite right in his proposal to set up committees of the health board. I should like to give him a list to start with. He might, first of all, set up a committee to examine the ambulance services throughout the country. We need that straight away. I understand something is being done about it and it is essential. We need a committee to look after our sea and river rescue services. We need a committee to examine the problem of drug addiction. This has been advocated by other Members and I will not dwell on it.

We need a committee to deal with venereal disease. We need a committee to examine chemical pesticides to decide whether they are poisoning our food and whether they may be the basic agent of cancer and responsible for the increase in cancer. I think they are a greater contributor to cancer than tobacco consumption. We should have a committee to deal with the problem I mentioned earlier, the waste of bed time in voluntary hospitals. We need a committee to point out whether doctors can be persuaded to work a shift system as in America. We need a committee to help the Minister for Finance to define which expenses are properly deductible on income tax claims. The Minister brought in a concession last year, or the year before.

I understand some people are not too happy about what expenses exactly are admissible. We have to investigate also where the higher income people get some assistance. In this Deputy Mrs. Desmond may be wrong. As I understand it, the Bill does provide for permanent assistance to the higher income group where permanent disability or sickness is entailed. As against that, leaving children out of it, I do feel that where people may have to spend many tens of thousands of pounds to keep themselves alive at least some contribution should be made towards this. I have raised this matter and so has Deputy Byrne of Fine Gael. Whether we both had in mind the same persons I doubt very much but I certainly am aware of a person who is making a great contribution to the national economy and who was nearly prevented from doing so simply by the cost of keeping himself alive.

The income tax allowance is a help in this situation but no matter how high an individual's income may be medical expenses may run beyond that. This is a situation where each individual's claim should be examined on its merits and if it can be shown that hardship not only to the individual but, perhaps, to those he employs will be caused by not granting him some assistance, then the Minister should seriously consider making a subvention or some type of grant.

There is also the matter of families who find themselves in great difficulty when the husband has had an accident in the time that elapses between the accident taking place and the court settlement. I do not think there is proper assistance given in these cases at the moment.

The main thing, so far as the publicity that goes out of this House is concerned, is that if we were to transfer the cost of the existing health services to direct taxation I feel we should examine who will, in fact, be the losers.

Hear, hear.

If this charge is transferred to direct taxation, then I am afraid the loser will be the ordinary worker in the street, the ordinary man who makes a purchase in a shop or who earns an income that is taxable. At the moment in my constituency in Kimmage, Crumlin and that area the valuation of corporation houses is around £12 per annum. The health charge that has been turned down by the corporation, the extra cost to those individuals, will be roughly twopence per week. That is what the corporation tenant would be asked to pay. The man with a valuation of about £24, which is the valuation in respect of the small dwelling acquisition type house built up to quite recent times, will be asked to pay about fourpence a week. The man who can afford a house of £48 valuation will be asked to pay eightpence a week. The man who is going to pay most money is the man who owns his shop, his industry, his business. All the big industrialists and big shopkeepers, in fact, subsidise the smaller person. If we take this away from property tax which it is now— something less than half the cost is paid out of tax on property—and put it on to direct taxation it means that the big property owner will get relief and the small direct taxpayer will be compelled to pay more.

If we take the Fine Gael suggestion of insurance we are talking about £50 million. What is the stamp going to cost? A pound a week? Another pound a week from the worker?

I read that. That is a fictitious figure. You are talking of £50 million and less than a million workers and you are talking about poor law valuations. I do not accept Deputy Ryan's figure and I read his document. I reckon that the least the worker would have to pay would be about 6/4d. I did not intend to speak on this Stage. Do you want me to look it up?

We will not put you to any bother.

I am glad Deputy Ryan is here because we have here the question of removal from the board in section 11. No doubt Deputy Seán Dunne has considered the constitutional situation of the provisions of section 11 but I am twice as sure that Deputy Ryan has considered this point of view. After all, he has done quite well out of raising questions and going to court about constitutional points of view. In fact, if Deputy Ryan's clients were to pay the Exchequer what they owe for the fluoridation action they could have the 10 per cent reduction in Deputy's salaries and the Exchequer would have even more money, the Exchequer would be better off. I am sure the Minister is perfectly safe here, that even Deputy Ryan will not take him to court on the constitutional aspects of section 11 whereby he may remove members from the board when he is satisfied ... I heard Deputy Costello talking about being satisfied on the Criminal Justice Bill too. It is quite clear that the purpose of the Opposition has been to delay and I am watching the clock so that I will not delay the House too long.

A great help.

It is provided, however, that the Minister may before establishing a health board, request the Local Appointments Commission to select a person for appointment as chief executive officer. I have yet to hear anybody from any Party in this House express suspicion about the impartiality of the Local Appointments Commission. The establishment of these commissioners has done a great service to this country and has raised many appointments way above the suspicion of political patronage. It is most unfortunate that attempts to prove political patronage when it does not exist, are bandied around this House time and time again, but I am glad that the commissioners at least are above this type of criticism.

Section 16 relates to salaries, conditions, remuneration, privileges, superannuation of officers and servants of the board. The only thing I am concerned about here is that in the event of a dispute, as I read the Bill, a decision on this dispute shall be determined by the Minister. I believe that these officers and employees of the board should have access to the Labour Court as is the intention of the Bill we discussed here last week. Officers whether in State or semi-State employment should be treated in the same way.

As I say, I welcome this Bill in its entirety. All the major issues of contention have been properly dealt with. I am sorry to see it being held up in the House. I have spoken after three or four Opposition speakers in succession. I heard Deputy L'Estrange making sure that he had four or five speakers to keep the debate going. The point is that the Minister has made provision whereby with the consent of the Minister for Finance he can pay money over and above the contribution which the Government might normally make to the relief of the rates. I am quite sure that as the service expands and as our national product expands, it will be within the competence of the Government to make a greater amount of money available for our health services.

When these regional authorities are set up, there should be no wholesale redundancy among the existing officers. When the regional authorities take over the number of people employed should be reduced by normal wastage where possible, or by making pensions available to them, perhaps, a little earlier than their normal time for retirement. Care must be taken to avoid Parkinson's Law under which work will expand to meet the number of people available to do it. This can happen and great care should be taken to see that it does not happen and, at the same time, that there is no wholesale redundancy. Normal wastage should be the order of the day.

I am glad to see that the Minister is taking compulsory purchase powers in regard to purchasing land for extensions. This is absolutely essential. In fact, so far as I am aware, some hospital extensions in Dublin have not been completed because this power was not exercised at the time.

As I have already said, the only objection I have to the Bill is to section 43. I believe that the wife and the husband should be treated as separate entities so far as their income earning abilities are concerned. I believe the wife should not be a second-class citizen. I believe this was not the intention when the Constitution was drafted in 1937. As time goes on, more and more the State will require the services of women to work to increase our productivity. With the industrial policies which this Government have pursued successfully in the past there is no doubt that the question of a manpower shortage will become a problem in the next ten or 12 years. Giving the children a chance, is a step forward. A boy getting married, or a girl for that matter, and earning an income, will put very little in the family purse when they are saving to buy a house or to buy furniture if they qualify for a corporation tenancy.

This has been a source of great distress especially in Dublin where a mother has been making provision for the family and where she has to pay the grocery bills. She expects so much money from each child. The son gets engaged and he says to her: "I reckon my food is worth 30/- and I will not be giving you the £4 or £5 in future." The mother then finds herself in difficulties with the rent or something else, and she is cut off from the health services. The Minister has certainly satisfied the majority of the people I talked to in Dublin in this respect. This will be a most welcome provision. Maybe we cannot do it this year, but I ask the Minister to consider seriously treating the income of the husband and the income of the wife as separate in the future.

Section 52 is a major step away from class distinction, and I appreciate it. In order to make the health services work we must plan from a base. We have to reorganise on regional bases. There are certain people like the Port and Docks Board, the ESB and CIE, getting privileges in regard to the amount of rates they pay. It has been suggested time and again that, once the ESB go into retail competition with the ordinary trader, they should not be given rating privileges. They are well able to pay without doing away with their competitiveness, and then we could probably do a great deal more for the health services without the imposition of an extra halfpenny upon the ratepayers or the taxpayers. This matter has been raised since the late Deputy Alfie Byrne was first elected to public office. It has been a matter of contention since the establishment of the ESB. This company have a rates remission of £311,268. That gives them a great advantage over the ordinary trader. The Port and Docks Board get the relief of £86,000. This is a matter which should be examined very seriously.

On the Supplementary Estimate the Minister gave us some vital statistics which are very promising. Births may not be going up as fast as one would like but marriages are increasing and deaths are decreasing per 1,000 of the population. We are making great progress in our health services.

This Bill is to be commended to the House and the public in general. It cannot be described as mean, small-minded, begrudging or niggardly. I hope the House will approve the Second Reading and let us get down to the important work on Committee Stage when, if there is any change or improvement to be made, we can make it. This cannot be done on Second Stage and obviously there is political filibustering going on at the moment.

At this stage of the debate I suppose it is difficult to add something to what has already been said in the House. I listened to Deputy Lemass and I was rather amazed that he accused the Opposition of delaying tactics. I intend to deal in my own way with what is in the Bill, with what I am pleased with and what is not in the Bill and about which I feel disappointed, and I have no apology to offer to Deputy Lemass or anybody else. It is the duty of public representatives in this House to discuss matters in this House on the basis of their own experience of working in constituencies and to point out to the Minister what their views are. I am sure the Minister would welcome this, and it is a pity that debate on a Bill such as this could not be discussed above Party politics. I propose to do that as far as I can. However, Deputy Lemass spoke about the delaying tactics of the Opposition Deputies and then proceeded to give us the longest speech we have listened to tonight. Deputy Lemass should look at his own Party and say why there was a delay, since the White Paper was issued, of three years in producing this Bill. This Bill is too little and too late. It is too little because there are things that should be in the Bill that are not in it. It is too late because it is three years since the White Paper was introduced and people expected much more than was in the Bill.

The Minister has stated in his opening remarks that he intends to provide unconditionally medical and dental services for all those people who cannot afford to pay for them. This is fair enough, but I do not accept that this Bill provides for those people who cannot afford to pay. In the application of the policy of the Minister about 90 per cent of the population have become ineligible for hospital services and 30 per cent for general practitioner services.

There is quite a lot of uniformity in the problems with which public representatives are confronted. I am glad the Minister is here because one problem I should like to bring to his attention is that of hospitalisation. Public representatives find from time to time that a patient of the lower or middle income group who is sent into hospital is not aware of the services that are provided for him and finds himself in a private or semi-private ward, thus placing himself outside benefit. I would say that 50 per cent of the people do not understand what they are entitled to. The doctors who attend patients should tell them what they are entitled to and that, if they go into a private or semi-private ward, this places them outside benefit and that they will have to pay for the hospital services that are provided for them.

I have known medical card holders, people in the lower income group, to write a letter from a private ward saying they were worried about the bill. While there is a hardship clause in the Bill whereby representations can be made and the Minister's sanction given to the alleviation of hardship, this is a very cumbersome procedure and very few cases get through. If the people are looking for a private or semi-private ward for purposes of grandeur or any other such reason, then I have no objection to making them pay for it. However, due to the scarcity of hospital beds, people who may be involved in a road accident and who sometimes are removed unconscious to hospital, can find themselves in a private or semi-private ward, and when the bill is produced they have no hope of paying it. The Minister should tell doctors to instruct their patients as to what they are entitled to.

Deputy Burke stated the other night that in his constituency he played a major part in getting patients into hospitals. I believe that is so, but it is very wrong and an indictment of the system that public representatives should interfere with the admission of patients into hospital. This arises from overcrowding in all our hospitals. If a doctor says a patient is entitled to hospital treatment and so certifies him, hospital accommodation should be provided for him and neither public representatives nor anybody else should interfere with that procedure. I know admission officers in hospitals, house surgeons and hospital authorities are being tormented with this type of thing. I hate to see a situation where public representatives can get political kudos from this.

As a member of the Cork Health Authority I visit many of the hospitals in the city and county of Cork. We have a serious problem there in regard to the aged. Unless we make some accommodation available for them, this is a problem which will always be with us. Gone is the time, unfortunately, when the younger people took pride in looking after their old people. For economic, social or other reasons old people are taken into or sent into institutions. Throughout the country the old district hospital in the town has changed from what it was originally intended for. They are becoming more or less old people's homes. In my own town of Macroom there are two hospitals, one of which was the old district hospital and the other was a TB hospital. The district hospital is now being used for accommodating old people and I believe this is right. In order to minimise the agony of old people who are taken from their own homes, they should be accommodated in the environment in which they grew up and cared for by the people they know locally.

On the other hand, we have gross overcrowding in Cork Mental Hospital. Longstay patients in mental hospitals become institutionalised. As a result of representations to the Minister's predecessor, Macroom Hospital was made available to relieve overcrowding in Our Lady's Hospital in Cork and 30 patients were transferred to Macroom. I have seen the difference in these patients as a result of that transfer. It is a classic example of what can be done for the aged by way of rehabilitation. Some of the patients in Macroom are now going out to work for local farmers, earning £1 or 25/- a day. I believe the same thing could be done in other mental hospitals and hospitals for the aged, thereby relieving overcrowding in these hospitals.

The Minister or health authorities should provide some allowance for those who care for the aged in their own homes. Very often, as I said earlier, the aged are removed because of economic reasons. I came across two cases in the past week in which two old people would have been kept at home had there been some allowance given to enable those looking after them to employ outside help. One was an old lady of 90 years. Had there been an allowance she could have been kept at home and outside help employed to look after her. She was removed to an institution. This is happening all over the country. In many cases people have given up their employment to care for aged parents or relatives. I agree with everything Deputy Andrews said in regard to this matter. It is bad economics to put an old person into a hospital in which it costs the ratepayers or the taxpayers approximately £9 per week to maintain that old person when, if some allowance were provided which would keep even a tenth of these old people out of institutions, a big saving could be made.

There is a scheme of assistance in some cases.

There is home assistance. I asked the Minister recently if some allowance could be provided and he said he had no power to do so. Someone should provide an allowance.

One of the things that worry me is the cost of the health services. In 1965-66 the cost was approximately £33 million. Today it is £51 million. Though the cost has gone up the services have not been extended and very serious problems remain unsolved. I do not approve of medical cards. They are a badge of poverty. They mark those who hold them second-class citizens. Some substitute should be devised. When someone applies for a medical card the home assistance officer investigates the means of the applicant. When an applicant is refused those who made representations on his behalf are not permitted to inspect the documentary evidence submitted. Now it is very difficult for anybody— home assistance officer or anyone else —to be conversant with what happens inside a family. I have known small farmers to be declared ineligible for medical cards because, as a result of their industry, they had got a return from the creamery of £800 or £900 and that was taken into account. But the cost of producing milk was not taken into account. These reports should be open to public representatives for inspection, if those public representatives have authority from the applicant to do so. I feel very strongly about this.

I welcome the abolition of the dispensary system. In the proposed alternative system how will choice of doctor operate in remote rural areas? How will a patient living 20 miles from a town have a choice of doctor? The experience with the medical card-holder in the past was that he or she was not, in fact, availing of the services of the dispensary doctor. We all know it is necessary to have faith in the family doctor. If you have not faith in him, you do not have him or want to have him. I know of quite a number of cases where medical card-holders did not avail of the services they were entitled to from dispensary doctors.

With regard to drugs and medicines, I understand the Bill to read that, if a medical card-holder goes to a doctor and is in need of drugs and medicines, the prescription will be given to the patient and the patient will go to the local chemist's shop and have this prescription dispensed. How are the drugs to be provided? Will the local authority or the chemist provide them? Doctors are always anxious to prescribe the most modern drugs. Very often the new drugs are no different, except for a more fashionable wrapper or a different name, from drugs already in use. It is very difficult for the chemist to keep abreast of supplies of all the new drugs coming on the market. What check is on those drugs? From time to time, one sees the introduction of new drugs to replace old ones. It is very hard for the small chemist's shop in the outlying villages to keep a wide supply of modern drugs for this service. Deputy Lemass already referred to the impact of the health charges on the rates. This is a serious burden because health costs are going up year by year.

I can remember when a former Minister came down in 1960 to the first meeting of Cork Health Authority. He was questioned there as to what the impact of health charges would be on the rates. It is on the records of that meeting that he said it would mean from 2/- to 2/6d in the £; it is now over 30/-. I believe there is a case to be made for transferring a greater proportion of the charge from the local rates to the Central Fund because a lot of the services provided are regional in character and the Exchequer should bear a greater charge than what they are already doing. This is the reason Fine Gael are opposed to this Bill: I believe there is good foundation for it. We are all only too well aware of the difficulties amongst ratepayers today in facing the payment of rates.

There is a completely new approach to mental illness. I should like a lot more done in that respect. The most essential thing, in my opinion, is to try to relieve overcrowding. That could be done by the extension of the local district hospitals.

Deputy Mrs. Desmond mentioned nurses. I am not too satisfied with the system of recruiting nurses in the Cork Health Authority, particularly in Saint Finbarr's Hospital. Twice a year, we have approximately 140 applications for 16 vacancies for student nurses. There is a scarcity of nurses. Whether it is that there is a lack of training facilities for nurses I do not know but there is something wrong with a system where an interview board can select 16 from 140 applicants by a mere interview. Some of the girls who are rejected go over to Britain and return, after three years, fully qualified nurses and can take up a post in the very hospital where they were rejected three years previously. The Minister should look into that system as there appears to be something wrong with it.

I am not satisfied about the position of people in receipt of disabled persons' maintenance allowances. I understand that the wording of the Act is that, if a person is not in a position to be maintained by himself or by his immediate relatives, he qualifies for an allowance. Everyone must realise that the day of providing by the immediate relatives is gone.

There is a change in this. It is only the spouse.

That is a step in the right direction and I am glad of it. I believe that people have been rejected because of this who, in fact, would be entitled to an allowance. I am glad this clause will not now prevent people from benefiting. When cases were investigated and it was found that maybe a sister or some relative was living with the applicant then the applicant might be deprived of an allowance.

There is a great scarcity of dentists and it is very difficult to provide an adequate dental service. Our young children should be instructed, even by way of advertisements on television, on how to care for their teeth and on the necessity for such care. It is terrible to see young people of 14 and 15 years of age with a mouthful of bad teeth. It would be a wise step to have this matter brought to the attention of the children in the schools and, of course, through television and advertisements. It is necessary that there should be a consciousness in their homes of the necessity to provide for the care and protection of their teeth.

There is nothing further for me to say now because anything else I might say has already been said. I shall conclude by saying that people expected more from this Bill because, in 1960, when the White Paper was introduced, people expected that certain positive steps would be taken, steps which are now long overdue. Many of these steps have not yet been taken. I refer especially to the necessity for a change in the dispensary system. The health authority in Cork have not been able to get dispensary doctors for our dispensaries. We have even had a situation recently where a doctor was catering for three dispensary districts. One cannot blame doctors for being unwilling to take up temporary appointments. I am glad there has been some step forward in this respect because it is long overdue. I trust it will not be long until the dispensary service will completely be changed and our people will enjoy a service of the kind which Fine Gael believe should have been provided for them long ago.

I lost all the notes but I have made enough of them in the meantime. I commend this Bill to the House, despite all the literary and historical eloquence of Deputy Ryan. This Bill consolidates six Acts and it does this for a beginning. I should like to deal with a few things in the Bill, things that are right, things that are wrong. It is terribly important that health should be taken out of the realm of politics. The Minister has said that he is going to have at least 50 per cent of the people on regional boards taken from nominated bodies. I hope when he makes his regulations that he will give sufficient teeth to those boards to make sure they will act. As I say, like education or anything else, take this out of politics. That is the representative character of this Bill. We have at the moment a lot of things happening, we have the Fitzgerald Report, the Grey Book and the Brown Book. We have people cashing in in various ways. In Mullingar we have Deputy Corish's people cashing in and trying to keep the hospital in Mullingar. I am not interested in where the hospital is; all I want to see is a man coming home in a car and not in a coffin. Otherwise, I do not care two hoots what happens.

I should like to hear the Minister spell out what the community centres will entail. The phrase "community centre" is very important. In this community you will have a complete nexus of people from doctors to patients and so on. Most important of all, we will have an outpatients service. These are all spelled out in the report yet we are so terribly narrow-minded that we do not accept this. We want to have a status symbol in Athlone, Mullingar or wherever it is, but for goodness' sake let us send people home in cars and not in coffins. This is a most important thing to remember and it is the whole implication of the Fitzgerald Report. I know that what I am saying will be thrown at me in the Westmeath County Council but these things may happen in ten, 20 or 30 years time, for this is a blue-print for the future.

I hope that when the Minister is replying he will emphasise the fact that there will be no downgrading in hospitals. One other point about regulations. The L & H Deputy over there mentioned doing things by regulation. The Department of Health is an organic, growing thing but no more than a growing child how can you expect to regulate its development if you put it in a straitjacket? The Minister's regulations will be put on the Table of the House. As I say, you cannot put a growing organic thing in a straitjacket. We know how an amendment had to be brought in before because of the straitjacket idea. You must have a broad Act in order to carry out what is visualised in the White Paper and this will carry it out. The Minister will make his regulations and they will be laid on the Table of the House. I do not see any other way of doing something like this. It should be remembered that we will still have control over the Minister and if we desire we can challenge the regulations when they are placed on the Table of the House. You could not hope to carry out a task like this except on the basis on which the Minister is doing it. As I said before, I would like to see health removed from the realm of politics.

Everybody wants to take everything out of politics.

Wait a minute. Your man in Mullingar is trying to bring this into politics. Make a note of that.

We have a few of your men——

His name is Councillor Bennett.

I would not mention the names of your men.

The Deputy will appreciate that we do not like to mention the names of people who cannot reply.

I am sorry. The main thing is let us try to get this Health Bill through. There is a motion down that we throw it out. For what? what is the "Just Society"——

Read the motion. The reasons for throwing it out are given in the motion.

Did the Deputy read the motion?

I did of course but——

Refresh your mind.

I do not want to have my mind refreshed by an L & H Deputy. I read the Deputy's speech and it was lovely; it came straight out of University College, Dublin. Typical.

I did not leave through a lavatory window anyway.


That is a good L & H crack.

Perhaps we could come back to the Bill and then all extraneous matters will be out of the way.

I am not going to talk it out. There are plenty to follow me. I would commend the House to this idea of the community hospital and I would like the Minister to spell out what it means. We should indulge in no nonsense but we should look after the health of our people. There has been a lot of talk about looking after the aged but, for goodness' sake, can people not look after their fathers and mothers, or what kind of people are they? The Minister has brought some sanity into this question of eligibility for the health card. This is very important. Health cards can be got in Westmeath but not in Galway, Roscommon or other places. I also agree with the idea of an appeal but there should not be delays about this. We know that several months can elapse waiting for a decision. We know the way in which the Civil Service carries on.

In regard to the question of rates, surely something similar to what they have done in England could be done here? There should be a re-assessment of the position. It is most unfair that Leitrim or Mayo should have to pay more than some other counties. I hope the Minister will indicate how he is going to handle what I will call the health grants. In Westmeath 54 per cent of the total is involved for the health charges while some counties have a lesser amount and some others a higher amount. Perhaps the Minister would at least indicate his intentions. Are we to take it that autistic children and other children with mental health problems will be looked after?

The Minister has listened very carefully to the arguments put up by speakers on both sides of the House and I know that, in common with most of them, he must be rather disappointed with this Bill. He must realise that due to promises made by his predecessors people were led to expect a different Bill. But we must be thankful for small mercies and, so far as the Bill aims at doing something in the future for those who need medical services, we must welcome it.

I, and all who have experience of local authority work, want to see an expansion of the existing services immediately. We want to see preventive medicine—which was mentioned by many speakers—developed because prevention is better than cure and we want every effort made to prevent things happening when they can be prevented.

In my county, as the Minister probably knows, the dental service is far below strength. Our schools have only a partial dental service. The dental service for adults is practically nonexistent. I want to see the school dental service made effective from the day the child reaches school until he leaves school and have it carried from primary through secondary school. I want pre-school age children examined and given the facilities that exist for school-going children. Unless we do that—the Minister must be prepared to do it—we are leaving a gap in the service at the very beginning. When the child cannot be examined before going to school he goes to school with flaws and cavities and other defects that take more time to eradicate.

In Mayo we have a reasonably good ambulance service considering the territory it has to cover but, as the Minister knows, Mayo is not a county; it is a region. For geographical and other reasons ambulances have long journeys to make. We hope they can be sited in other areas so that full cover can be effected. The Minister and the Department are examining the possibility of having a new type of ambulance service to deal with emergencies such as casualties from road crashes and so on. I hope this idea will be pushed forward and that the Minister will try to get agreement between the different people concerned so that we shall have hospitals in strategic positions capable of dealing with this type of casualty and that we shall have an ambulance service fully equipped with radio, oxygen and recuscitation facilities to take people from the crash scene to hospitals designed to deal with them.

There is a great need for education as regards prevention of diseases. By that I mean television and radio can be used to bring home to people the facts relating to cancer and diseases of the heart. The Minister has spoken many times about the dangers of smoking but we have on television today the glamour girls, the sporty youths and the boys who flash along in hot rods and racing cars smoking this or that brand of cigarettes. The Minister, I know, would like to have this glamourised advertising eliminated but possibly his colleague, the Minister for Finance, might say: "Go easy, or I shall have to find £20 million or £30 million from some other source." If the Minister means what he says and if we are to make any impact on the smoking habit—I think it has been proved beyond doubt that smoking does contribute to an alarming extent to lung cancer—we must take positive action. If we are not sincere in this our young people will continue to go on committing suicide. This is something we should push forward. We have the means in radio and television and no effort should be spared to ensure that the message reaches all concerned.

The same type of education can be given in regard to heart disease, the dangers of overweight, of doing this or that that might contribute to developing heart disease or conditions leading to it. We can also use our newspapers to publicise the facts. Adult education in these facts is, I consider, one of the most important things needed. There is much woolly thinking about these matters and many do not realise that by being careful, by taking exercise, eating the right kind of food, keeping down weight and so on they could be happier and healthier and there would not be so much money needed from the Exchequer to pay for hospital services they might incur later.

Seminars for adults should be held throughout the country with doctors and nurses and other experts attending to explain to the public all the dangers involved. In the case of drugs I think it is also necessary to make a big effort. I know that a great deal cannot be done on television because of the danger that telling youth about all the factors involved might possibly make the position worse. But seminars should be held to explain to adults and parents the dangers of drugs and what they lead to. The sooner this is done the better. It should bring good results.

The Hospital Sweepstakes have contributed substantially to our hospital and health services being generally up to the present standard. Not only the general public here but people in many lands have contributed to this. Money has been flowing in from all the countries of the world to enable us to provide hospitals and services for our people. I should like to see something being done by us in return. Coming from the western seaboard I know that one of the greatest causes of anxiety and pain and the cause of the greatest loss in man hours is rheumatism in all its allied forms. The time has come when this country can make a contribution to world health by establishing a research unit to study the disease. By doing this, we would be only repaying the people of the world for all the money they have sent to us, whether it was sent legally or illegally makes no difference. A research unit could be set up in the west of Ireland, in, say, Castlebar or Galway.

I know that there are people in this country engaged in research into this disease and those, together with people from outside the country, could examine the situation. It is known that rheumatism in its many forms can be prevented if the knowledge is available and the right type of education given to the people. The Minister will agree that, since we have many suffers of this disease living on the western seaboard, the west of Ireland would be a suitable place to establish a research unit. It is not possible for us to do much as regards cancer research. There are other people who have greater finances and better facilities at their disposal for doing this, but we could do something very effective with regard to research into rheumatic diseases.

The Minister is to appoint regional boards to take over the work formerly carried out by local authorities and we are told that boards will have certain powers. If the Minister attempts to push this idea down the throats of local authorities, without first explaining very carefully what this will mean, the consequences may not be so good. The Minister must decide that representation from the local authorities will be composed of members of all Parties in proportion to their strength in the local authorities. Otherwise there will be trouble which the Minister does not readily recognise and this will not help in getting public opinion to accept the new changes because there will have to be a big break through before the proposals are accepted.

In concluding, I wish the Minister well with the Bill and I hope he will take into consideration the points that have been mentioned to him.

We have had a few milestones to health legislation since this Dáil was established but I suppose that the 1953 Act could be regarded as being the most important milestone in health legislation up to now. In that particular piece of legislation we got away from the poor law system. One of the big things in that legislation was the abolition of the red ticket. There was an attempt to get away from the pauper idea of a health service. We have been consistent in this House from our Party's point of view in progressive legislation, particularly in the fields of social welfare and health.

There was a great controversy in 1953 about the then Health Act. Looking back now it was a very mild piece of legislation, but all sorts of people saw great difficulties and even dangers in it. Some considered it to be an infringement of the rights of the individual and of the community in general. We supported that legislation. We supported the Fianna Fáil Government who introduced it. But, I regret to say, that there has been little if any progress since the enactment of the 1953 Bill. There has, of course, been progress in the treatment of disease. But this has resulted, not from anything the Department of Health have done, but from the efforts made in the field of research and in the improvements in medicines, drugs and treatment. Deputy Noel Lemass said that progress can only be made step by step, but the steps we have made during the past 16 years have been very small. At the same time, I readily admit that the 1953 Act was a substantial improvement. However, there has been dissatisfaction from the time of the enactment of that Act; one of the things which brought about some of this dissatisfaction was the eligibility of people to qualify for medical cards.

In this legislation, the Minister is proposing to do something about that. This will be welcomed by all Deputies and by all public representatives because one of the questions we cannot answer, when we are asked, is: who is entitled to medical care? We can tell people immediately if they are entitled to non-contributory old age pensions or certain other benefits, but people are very surprised when those who help in making the laws of the country cannot state specifically who is entitled to a medical card. When we are asked that question we have to say that we do not know the manager's decision. This is very annoying to people who believe that by reason of their contribution to taxation or, particularly, their contribution in insurance stamps they should benefit. Of course, this is a wrong notion. They believe that because they are stamping a card they are entitled to all benefits; but the sooner they get this out of their heads the better for themselves and for those of us who have to explain it to them.

Fianna Fáil and the various Ministers for Health have been dragging their feet in respect of health legislation. In 1961, health was one of the most important issues in the election campaign. It was regarded as such by every Party. In 1961, in order to satisfy some of the Independent Members and, I suppose, to seek their support, the then Minister for Health, Deputy MacEntee, decided that there would be a select committee appointed to inquire into the workings of the Health Act. This suggested improvements but, unfortunately, that select committee broke up, having met infrequently during a period of five or six years. It was so bad that the Labour Party representatives withdrew because it appeared to them that Deputy MacEntee was reluctant to make any changes whatsoever.

We placed a lot of faith in the late Deputy Donogh O'Malley when he produced the White Paper in 1966 and, even at this stage, we would place faith in the present Minister for Health, hoping that he would be prepared to accept worthwhile amendments. This brings me to a point made by Deputy Paddy Lenihan, when he said that we should take health out of politics. Everything we do in this House is political and we should not regard the word in the same way as people outside do. We should, on all sides of the House, try to make this Bill a better one. However, we will disagree on fundamentals.

Debate adjourned.
The Dáil adjourned at 10.30 p.m. until 3 p.m. on Wednesday, 30th April, 1969.