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Dáil Éireann debate -
Tuesday, 6 May 1969

Vol. 240 No. 4

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).

Before the House adjourned on Thursday evening I was speaking of the serious drug problem which seems to exist in the city of Dublin and in other parts of the country. I stated that the problem seems to be getting progressively worse and that drugs are being peddled in clubs, schools, public houses and other places where young people meet. I thought the time had come when everybody interested in the welfare of society, in the welfare of our young people—and this included not alone the parents or relatives of these unfortunate people but also teachers, clergy, politicians—should take an active part in trying to eliminate this scourge which seems to be gripping our people. Taking up any of the daily papers one sees headlines on this subject: "Gardaí in City Swoop"; "Nearly Died After Drug Party"; "Drugs. Desperate Men Answer SOS".

It looks as if we of this generation have failed the young people. This situation is an indictment of our failure to provide adequate ways and means for these young people to get rid of their superfluous energy. I believe prevention is much better than cure. I am not certain that the Minister has anything to do with it, but I believe there should be more clubs, sports fields, et cetera, properly supervised, so that our young people could meet and engage in more healthy recreation and pastimes. If they did, it might keep them away from drugs.

We are rather slow in dealing with the drug problem. Sufficient clinics to treat drug addicts should be set up and set up immediately before the problem gets any worse. As far back as 18th October, 1966, I raised this question in the House. I asked the Minister for Justice when he intended to introduce legislation so that clubs where drugs were available could be subject to the same controls as dance halls. The Minister said he had read the report in the paper to which I had referred and that the Garda had no knowledge of the kind attributed to them. He further told me he had no legislative proposals under consideration in relation to clubs of this kind, but that the Minister for Health had already stated in reply to a question on 5th October, and I quote: "that he intends to introduce legislation in relation to the possession of certain drugs and related matters." That is almost three years ago, and although I asked questions recently, we have not even yet been told that the Minister intends to introduce legislation but that a working party has been set up. Much valuable time has been lost, and we should have learned the lesson that they have learned in England. In England in 1962 they were saying there was no problem; now they all admit they are faced with what can only be described as an awful problem affecting the community and afflicting the youth of that country. I went on to ask the Minister was he aware that drug addiction was a potential danger among Irish people, that now was the time to nip it in the bud. I further asked him was he aware that as regards drug addiction Professor Wilson said in Trinity College on 12 the October, 1966:

If we do not make our plans now for its prevention, Ireland will have the same problem in the field of drug dependence that faces other countries in our western civilisation.

That was very good advice from Professor Wilson at that time, but the Government, in their arrogance, refused to listen to it. Is it not now the time to take steps to cure this scourge? Deputy B. Lenihan, when Minister for Justice, said, when the problem was brought to his attention:

I have no responsibility for hysterical newspaper reports or professors' reports.

That was Deputy B. Lenihan, Minister for Justice. Valuable time has now been lost in coping with this problem. Had the problem been tackled when that advice was given it would not have reached the dimensions it has today. Some years ago precautions were taken to avoid the introduction of foot and mouth disease into this country. Every credit is due to all those involved—the Government, the National Farmers Association and everybody else—for the manner in which they coped with the threat to our cattle at that time. Today we are confronted with a problem involving our young boys and girls who are sowing the seeds of their own destruction because of drug addiction and we should learn from what has happened in Britain and elsewhere. Clinics are urgently needed to deal with these young people and to prevent the spread of this scourge of drug addiction.

With regard to the assessment of means, I have been told that when people have money invested the dividends are reckoned at ten per cent or 12 per cent whereas in actual fact they may be only five or six per cent. The actual dividend percentage earned should be taken into account and not some utterly illusory figure.

There should be a new deal for nurses. The Minister must be aware of the unrest that exists at the present time. The Irish Independent today carries a photograph of nurses attached to St. Joseph's Hospital in Limerick taking part in a march through the streets. It should not be necessary for these dedicated people to take to the streets to draw attention to poor conditions and bad pay. They do very important work. We are all aware of that.

With regard to domiciliary treatment, I am one who believes that the old age pension should be increased to £5 per week. This is Fine Gael policy. Can the State afford it? It can easily afford it.

This does not arise.

I shall relate it to the Bill. If the pensions were increased relatives could look after these old people in their own homes. In Mullingar it costs £10 a week to keep an old person in a home; in Dublin it costs £17 or £20 a week. If these old people were kept at home the taxpayers and ratepayers would be saved their maintenance in homes all over the country. The increased pensions, too, would be spent locally. The majority of people are much happier in familiar surroundings, looked after by members of their family or their friends. It was Goldsmith who said:

And, as a hare, whom hounds and horns pursue,

Pants to the place from whence at first he flew,

I still had hopes, my long vexations past,

Here to return—and die at home at last.

Our old people would be content in their own environment and the State would save a good deal of money in taxes and rates.

With regard to the rates, Dr. Ryan, when Minister for Health in 1953, said that the health service would only cost 2/6d on the rates. We all know what has happened. Again, in 1965, we were promised that the rates would be stabilised at the figure they had reached then. That was another promise that was not kept by the Fianna Fáil Party.

I do not approve of section 48 of the Bill. Hospitals should be community hospitals. At the moment many people who contribute heavily to the cost of our health services gain no benefit from these services. A dispensary doctor is under no compulsion to attend to them should they be so unfortunate as to fall ill and require medical attention. These people should be allowed to avail of local medical and hospital services, instead of being compelled, as they are now, to go into expensive nursing homes. Indeed, when a hospital caters for all sections in a community the experience is that standards are maintained at a very high level. Community hospitals are the pattern in Britain and on the Continent.

I should like now to deal with the Brown Book which gives an outline of the future hospitals system and the report of the consultative council on the general hospitals, especially as it affects us in the Midlands. As a Deputy representing the Midlands, I certainly am not in favour of their report and I am prepared to oppose it here and anywhere else in this country. The people of Mullingar and of Westmeath are very much concerned at the threat to close our county hospital. What we have in Mullingar, we want to hold.

Mullingar has been neglected by this Government. Industries have gone to other parts of the country but we have not one Government-sponsored industry in Mullingar. We are proud of our hospital there and we shall do what we can to hold on to it. Irrespective of politics or anything else, everybody in Mullingar and in County Westmeath appreciates our wonderful hospital. We appreciate the dedicated care of and attention to patients in the county hospital from the county surgeon, the county physician, the good nuns who run the hospital, the doctors and the nurses. We do not want to see this fine hospital turned into a glorified convalescent home. That is an appalling prospect for County Westmeath. The public representatives of that county came together at a public meeting: we cannot lend our support to such a radical and far-reaching proposal.

Mullingar serves a vast hinterland. Very happy relations exist between the doctors and the staff in that hospital. There is a wonderful spirit of goodwill there which is conducive to the speedy recovery of patients. If they go away to a general hospital in Tullamore, as is envisaged in this report, those people will be merely digits in a larger institution: they will become just numbers in a book.

I asked the Minister some questions about the setting-up of this consultative body; he resented somewhat the questions I put to him. We had medical men only on the board. I believe it was wrong to have medical men only on this consultative council. Surely some laymen, who would put the point of view of the layman, should have been considered? I asked the Minister if it was just a peculiar coincidence that all the surgeons on this consultative council got hospitals for their own areas. We have eight from Dublin and I think they got four hospitals in Dublin—two regional and two general hospitals. We had a few from Cork— and Cork also got them. We had a few from Limerick—and Limerick got them. Similarly with Galway. But, from Castlebar, Sligo, Tralee and smaller areas we had men on this consultative council and, lo and behold, they also got a general hospital in their respective areas. Had the Department their mind made up beforehand and were these particular people picked and told "This is the place where we want them" or did each man fight for his own locality or his own area and get a general hospital for his own area—and to heck with the rest of the country? Either one or the other happened because it seems to be too much of a coincidence.

Our hospital in Mullingar was opened in June, 1936, with a bed complement of 84. In 1969—33 years later —the bed complement is 103. We have cots for 21 babies including, I think, cots for 16 newly-born babies. The birth average per month is 45— approximately 540 a year—in the maternity section. There is an average of 66 medical cases per month and an average of 117 surgical cases per month in this excellent hospital. It is reckoned to be the busiest of the county hospitals so far as road accidents are concerned as it is located at the junction of three trunk roads. It might be no harm to remind the Minister that 304 male patients were admitted to the wards last year and 126 female patients, making a grand total of 430 cases taken into this county hospital last year. From 1st January to 18th April, 1969, 185 patients were admitted. Forty-six nurses are employed there; 27 domestics and, in all, 105 people are employed there. There is plenty of room for expansion in the hospital grounds. Plans are with the Department for the past five or six years as we felt the hospital should be extended. Westmeath County Council passed the plans which were then sent to the Department for approval but so far we have not got the approval.

Beside the county hospital, we have a newly-built county clinic where 12 persons are employed. As well as that, a new home or hospital was built by nuns in Mullingar recently with a bed complement of 100. Fifty-three persons, including the reverend sisters, are employed there. This home needs the presence of the surgical facilities nearby. One of the primary reasons the town of Mullingar was selected was because of the excellent county hospital close by. Also in Mullingar, we have Saint Loman's Hospital which serves three counties and has a bed complement of 1,050. This hospital uses the county hospital in Mullingar for surgical, medical and, indeed, sometimes, maternity facilities. The Minister is aware that there is a move on foot to give psychiatric nurses a surgical, medical and general nursing degree. There will need to be a local hospital in which to train Saint Loman's nursing staff. At present that is part of the Department's programme. As well as that, we have in Mullingar what was known in the past as the old County Home. Over the years we have spent well over £500,000 doing up this home and converting it into a first-class hospital. It is now called Saint Mary's Hospital and it also incorporates what was known as Saint Anne's, the old fever hospital. It has a complement of 230 beds, 25 nurses and a community of nuns. Those 230 old people in that hospital are constantly in need of surgical, medical and pathological facilities, X-rays, etc. If the general hospital is to be in Tullamore how are we going to get those patients over to Tullamore and back again? This general hospital should be in the town of Mullingar.

In Castlepollard we have Saint Peter's, which is a maternity hospital with 130 beds. It serves a wide area and there is a need for a surgical unit close by for maternity cases which are abnormal. Also, within a radius of seven or eight miles, we have Saint Joseph's Hospital at Coole, which has 100 beds. There is also need here for a surgical unit such as we have in Mullingar but we will not have it if the general hospital is to be in Tullamore. We also have South Hill, Delvin, erected about four or five years ago, and which has approximately 120 beds. Again, there is a need for a surgical unit close by to cater for acute surgical cases.

Another point in favour of keeping the hospital in Mullingar is the fact that Mullingar is convenient to Dublin, 48 miles away by road, or roughly an hour's run in a motor car, or a 20 minute flight by helicopter. There is a first class road to Dublin, which we have not got anywhere near Tullamore. I wonder is the Minister familiar with the winding road from Mullingar to Tullamore? It is one of the worst and most dangerous roads in the country. Leaving Mullingar and going west the nearest major centre is Ballinasloe, which is 40 miles away, and going north-west the nearest major centre is Castlebar, 84 miles away. If you travel north-north-west you have Sligo, which is some 80 miles away, and 30 miles to the north-north-east we have Navan. It is mentioned in the Brown Book that the old and infirm are more prone to accidents and need more surgical facilities than others. If you take surgical facilities away from Mullingar you will be denying those facilities to approximately 330 patients in St. Mary's and in the Sacred Heart Home. Another reason why we should keep it in Mullingar is because of its convenience to St. Loman's and the three outside hospitals which are within a distance of ten to 15 miles. It is in an ideal location for those hospitals which require surgical facilities so often.

We are entitled to ask what is to become of the emergency medical cases in the hospitals I have named. There is no transport either by air or by any other means for them and nothing can make up for immediate hospital attention where time is vital and surgical aid must be given at once. Everybody will agree that if people do not receive this immediate attention they may die before they complete the journey to hospital. No mention has been made of transport nor has there been any reference to the elements. In the last 20 years I have seen County Westmeath snowbound for six or seven weeks. If anything like that happens in the Midlands how does the Minister envisage these patients will be transported over narrow and bad roads to Tullamore? All around Mullingar there are main roads and it is natural to expect that they will be kept clear, or cleared fairly quickly, if we have snow or frost for the length of time we have had it in the past.

We must also take into consideration the fact that relatives need to visit patients fairly often. It is a help and an encouragement to patients if relatives are able to visit them every three or four days or at least every week. If the hospital is transferred to Tullamore people in Westmeath may have to travel 40 or 50 miles to visit patients in hospital. Even at present it may be a hardship for people to have to hire cars to travel to visit relatives in hospital.

The step envisaged by the Minister is a retrograde one. In Westmeath we made another suggestion to the Department and to the Minister. I know the Minister may tell me that the Government have only accepted this in principle but on 17th January the Minister said, in Athlone, that he entirely agreed with this. He also outlined the proposals in the report of the consultative council on general hospitals as to the future of the hospital system in the country. He stated that he accepted these in full and that it would probably take eight to ten years to implement them. He stated that Tullamore would have the general hospital for the area. I remember this well because I made a note of it. He said that the people of this area would get much better treatment in Tullamore than they had in the past. In the Dáil on 12th December the Minister used the words "in principle" and Deputy Tully, who is in the House now, stated "but can be changed" and the Minister immediately said "I did not say that".

We want to be told definitely what is going to happen. I know that there is a general election to be held very soon, perhaps on the 18th or 19th June, and we know that the Minister at present wants to quibble over this. It is only natural. We have such a thing as political expediency and——

Perhaps the Deputy would keep to the Health Bill.

I am not a quibbler.

I thought the Minister was going to refer to the general election.

We want to know where we stand as regards this hospital for Mullingar. The suggestion we made was that a general hospital should be built at Mullingar and another one at Portlaoise. In the Brown Book the council did discuss the possibility of having a general hospital in Mullingar and another in Portlaoise. If you look at the map I think you will agree that if there was a general hospital in Mullingar and Portlaoise it would serve the needs of the Midlands and of the whole country much better than by adopting the present proposal.

I propose to be very brief. I do not welcome this Bill as it does nothing to alter the present position regarding payment for health charges through rates. I had expected that the Government promise that the health charges would be held at the 1965/66 level would be kept. There is no sign of that in this Bill. The present Dublin Health Authority estimate is a little over £12 million and on that body we are told that the normal increase from year to year is ten per cent, so that the ratepayers of Dublin city, county and Dún Laoghaire may look forward next year to a health estimate of over £13 million with only the same services as they get this year—nothing additional.

It is a little disconcerting to read the Minister's remarks as reported in the Official Report, volume 239, column 1652, where he says:

The Bill contains several other useful miscellaneous provisions. By the transfer, under section 42, of the administration of the Dundrum Central Mental Hospital to the appropriate health board we should achieve a much better use of that institution as it should greatly benefit by co-ordination with other psychiatric hospitals in the area.

Why has the hospital to be transferred to the backs of the ratepayers in order to have co-ordination—that is the word the Minister uses? Dundrum Central Mental Hospital was formerly known as the Criminal Lunatic Asylum. Its title was changed in 1961. It is the only institution of its kind in the State and it caters for those unfortunate enough to receive jail sentences and who are transferred there due to mental breakdowns. It also caters for offenders who are found unfit to plead or have become insane before proceedings take place. It caters for prisoners from three prisons, Mountjoy, Limerick and Portlaoise and it caters for the State in general.

Heretofore, the hospital was run by the State and financed by State funds. Under section 42, it now appears that it will be paid for in future by the ratepayers of Dublin city, county and Dún Laoghaire. I protest very strongly at that imposition, especially on Dún Laoghaire, but also on the city and county.

It is a retrograde step that children of higher income group parents who may be attending national schools will lose entitlement to hospital treatment on the ground of discovery at school health examinations. When people complained of the high health rate this was one thing from which you could say they benefited. Now it appears you cannot say anything like that.

There are three classes involved in the composition of the boards the Minister proposes to set up under the Bill: those elected by the local authorities, those elected by the medical profession and those appointed by the Minister. I should like the Minister to tell us how many doctors it is proposed to have and how many of his own appointees. It seems to me that the medical profession should be included in an advisory capacity rather than taking part in discussions on the board. Time may prove me wrong in that.

There is one other matter I wish to raise and that is the appointment of Mr. Garvin to the Dublin Health Authority. It appears to me that his appointment, which was made by the Minister for Local Government, should have been made by the Minister for Health under the Health Act. That would have meant that both Houses of the Oireachtas would have had a chance of discussing the appointment. I wonder if the Minister has considered the matter and if he agrees with my view that the appointment should have been made by himself and not made, as was the case, by the Minister for Local Government under section 52 of the Local Government Act, 1941.

It is customary to pay tribute at this stage to the many Deputies who took part in the debate and I do this gladly. First, I should like to congratulate the Labour Party for having adopted a constructive approach and, in particular, Deputy Kyne for his excellent keynote speech. The House has come to expect this sort of contribution from this particular Deputy. Labour as a Party and its individual members have contributed substantially to the discussion.

Unfortunately, Fine Gael as a Party took a destructive line. Their spokesmen were entirely destructive in their approach but there were sufficient backbenchers in the Party who made sensible and helpful contributions to enable me to congratulate Fine Gael also on the useful role they played despite the efforts of their leading spokesmen. Finally, I wish to thank the members of my own Party for their critical approach. We have never been afraid of self-examination.

To return for a moment to Deputy Kyne's speech—he raised a point that was reiterated throughout the debate, namely, that it was difficult to discuss the Bill without knowing the regulations that are to be made under it and he said that the Bill cannot properly be considered until the regulations are also available. This is a perfectly valid criticism. The view was expressed rather forcefully by certain Fine Gael speakers, in particular Deputy Ryan, that the Bill as drafted is merely evasive. I reject this and positively accept responsibility for the way in which the Bill is drafted and I propose to explain why.

It has always seemed to me that in matters connected with health, where one is dealing with human problems, the greatest flexibility is desirable. It is one thing to lay down statutory provisions in regard to, say, drainage work or hotel grants. Here, everyone is entitled to the protection of a statute and also to its exactitude. Where health matters are concerned it is an entirely different thing. One is dealing with human problems and human circumstances and these differ from case to case, from individual to individual, from family to family. So that my desire is that when the Bill becomes an Act the Minister will not be tied by statutory clauses which prevent him from exercising the necessary flexibility of approach.

It is the easy way out to cover everything by statute and then, when a particular case comes for scrutiny, to say simply that the Minister regrets that owing to the provisions of a particular section he is debarred from taking any action and is, in fact, powerless. This is easy, clearcut and inhuman. I want, instead, to have as many enabling clauses as possible so that the regulations, which, after all, have to be laid before the House, can be changed from time to time and can also be drafted in such a way as to take account of individual circumstances.

Indeed, it seemed to me that Deputy Corish in his speech more or less answered his own question when he began by saying that people were entitled to know exactly where they stand and protested over the fact that this Bill does not clarify the situation for people as to where they stand in relation, say, to eligibility and then went on to point out the injustice of the situation where a person was refused merely because he was earning a few shillings over the stated standard level. I hope that Deputy Corish will accept this as a valid point and that the House will accept it as valid and will accept that it is desirable as far as possible to have flexibility so as to be able to take account of human circumstances.

There is one other aspect of this which I should like to emphasise. One constantly hears my Party and this Government criticised adversely for giving away their functions to independent bodies. I have been subjected to obloquy by certain members of the Fine Gael Party in the course of this debate for accepting total responsibility and that means the responsibility of answering for every single thing that I will do and that my successors will do on foot of this Bill and answering here in the House. Nothing can be done at any stage on foot of this Bill except with total ministerial responsibility to the Oireachtas. It seems to me that Deputies like Deputy Richie Ryan should make up their minds what they want, should follow through the logic of what they are saying, if there be logic in it, and having done so, should make up their minds as to whether they want responsibility by the Minister to the House or not.

The regulations, of course, when drafted, will flesh out the Bill. They will as far as possible try to eliminate the present disparity of application of the 1953 Act as between one health authority and another. In this respect, surely, the regional boards should be a help since they will cater for very much larger areas than exist at present. Even so, as I have already said, I propose to draft regulations in such a way as to give the Minister and those who will have the job of applying the regulations the necessary flexibility to have regard to individual circumstances. Indeed, in this connection it is interesting to note that Deputy Fitzpatrick of Cavan abused me in regard to the maternity cash grant being actually spelled out in the Bill and suggested that it should not have been so spelled out, that this should have been done by regulation so that the cash grant could be amended from time to time as the Minister desires. Perhaps, those two eminent lawyers, Deputy Fitzpatrick and Deputy Ryan, would get together and make up their minds which approach they consider fair.

Indeed, in the course of his long, rambling and silly diatribe Deputy Ryan missed the whole point and purpose of the Bill. At this stage I will say no more about his two hours and 40 minutes exercise, which was rightly attacked by Deputy Kyne, than to say that vituperation is a very poor substitute for constructive argument.

But later on in the debate Deputy T.F. O'Higgins chose to contribute and he cannot escape the criticism that he at one stage was himself a Minister for Health and that he had the responsibility for three years of dealing with these problems. Perhaps, he would like to hear what he said in 1956 when he was Minister for Health and had the responsibilities that I have today. He began by praising Deputy Dr. Ryan and I quote from column 243 of the Dáil Debates of the 11th April, 1956:

I think that the speech we heard today from Deputy Dr. Ryan was a very fine speech, a speech made by a man who has had years of experience in dealing with the subject of health and the provision of health services; and he joined with me in expressing the hope that we would see the end of dissention on these matters.

In the same speech, Deputy O'Higgins said that he had no apology to make to the House or to anybody else for the fact that he and his advisers had had long consultations with the medical profession with a view to working out a suitable system of working the Health Act of 1953. The then Minister for Health also stated that it was not a very fair approach for Deputies to criticise him because of the fact that the burden on the rates was increasing.

I deplore Deputy O'Higgins's contribution to this debate. He is, of course, very skilful at avoiding the gravamen of any issue and in skirting around the edge of subjects, scattering flowery verbiage to left and right. He gazes in myopic wonder at the self-created image of himself. He did nothing whatsoever to improve the knowledge of the people of this country as to what Fine Gael's proposals actually are in regard to the health services and neither did Deputy Ryan nor any other member of Fine Gael. Neither did Deputy O'Higgins choose to answer the questions I put to him in replying to a debate here a couple of months ago when I asked him to spell out for the benefit of the people how Fine Gael would finance a scheme which I then said, and now repeat, would cost a minimum of £70 million a year and possibly considerably more.

The fact is that when Deputy O'Higgins was speaking in 1956 as Minister and asking for an end to dissention, he was in the DC3 age of a £7 million contribution by the State. We have now reached the supersonic age of approximately a £30 million contribution by the State to health services. In addition to that amount, the ratepayers will have to pay approximately £21 or £22 million this year.

If I am correct in saying that a comprehensive health service on the lines suggested by Fine Gael would cost approximately £75 million is it not a fact that to divide it in the ratio, one-third, one-third, one-third would involve the ratepayer in a greater and not a lesser contribution for this year than the one that all Deputies in this House have so bitterly complained about during the past month?

I share their concern about the burden on the rates and I also share the concern of Deputy Dockrell whose concluding remarks were to the effect that the increase in the cost of the health services bears very little relation to the amount of improvement in the health services. I shall refer here, if I may, to a report of a seminar held in Moscow in June or July last when this very point was made by distinguished professors. One professor pointed out that the upper trend in expenditure on health services is common to all countries and he also pointed out that the increase in the cost of the services was not reflected by a similar improvement in or extension of the services themselves.

The principal reason for this is that, in common with other countries, the administrative costs are steadily increasing and this is something which is not merely common to all other countries but appears to show no sign whatsoever of abating. The demands for increased pay for various workers and in particular nurses, come from every side of the House and from members of the general public also. To take that as an example, Deputies even went so far as to say that nurses were being treated shabbily. Perhaps, this is true, but I know that their pay and conditions have been improving considerably during the past few years. I had great pleasure in applying the 9 per cent, eleventh round increase to nurses and I was glad to be able to agree to the implementation of the arbitrator's recent award. At the present time, negotiations are in progress with a view to reducing the fortnightly working period from 85 to 80 hours, it having been reduced two or three years ago from 90 to 85 hours.

I would not claim even at this that nurses are being adequately paid but I am pointing out that the impact of an all round increase to them is considerable. The eleventh round alone involved something in the region of £625,000. I should like in this connection also to point out that I as Minister do not have a direct function and that the claims are dealt with either through negotiation with the County and City Managers Association or by arbitration in the event of this failing. At the present time—I think Deputy L'Estrange referred to this—there is agitation by the psychiatric nurses in regard to their conditions and pay. This is the subject of Labour Court deliberations at the present time and I have no doubt whatever that as a result of the Labour Court recommendations substantially more will have to be paid to the psychiatric staff and I would be the last to say that they are not welcome to it. I am merely emphasising that to pay more to staff does not necessarily mean a better service and I am illustrating the broad statement I made that the total cost of our health service, while increasing rapidly, is not necessarily reflected in comparable improved services.

To return to the subject of the financing of the health services, I was to some extent disappointed with Deputy Corish's otherwise very helpful speech. I was looking forward to his spelling out for the people his Party's proposals for financing their scheme. The Labour Party brochure which was issued recently seemed to indicate that no part of the cost of their suggested comprehensive health service would be paid for out of rates. On the other hand, Deputy Corish clearly stated that some part of that cost, indeed, would have to be borne by the rates. I should like to know what part, what proportion. I feel the people are anxious for an answer to that question too.

I was also disappointed that no clear statement was made for the benefit of the House and of the people as to how the social fund which is to take care not merely of health matters but of social welfare matters as well should be built up. How much the levy would be of individual income, what proportion of our people would be excluded from the obligation to pay the levy? Those are questions which all our people are entitled to have answered. It is not enough nowadays, where we are spending what are vast sums of money—I regard £1 million a week as a vast sum of money—simply to get up here and say our services in regard to this, that or the other are insufficient and should be improved, that the public need and are demanding a comprehensive free health service. You must tell the people how they are going to pay for it because words will not pay it for them. You must spell out for them how this is to be done.

I am not offering any objection in any way to Deputy Corish's speech or, indeed, to his Party's general contributions. I am merely asking them kindly to let me know, to let the House know and to let the people know exactly how their comprehensive health system will be financed. I am saying with regard to Fine Gael that at this stage they should be ashamed of themselves trotting in here with half a dozen different sets of proposals, one from Deputy Esmonde, one from Deputy Dillon, one from Deputy P. O'Donnell and none from Deputy Fitzpatrick, who refused to give his ideas when I challenged him in the House on this.

The Minister knows the Labour Party policy.

I know the Labour Party policy. I do not know, the people do not know and the people have not been told how the Labour Party propose to finance a free, comprehensive health service. The people are waiting for an answer to that question.

We have spelled it out.

They require to have the manner in which it is to be financed spelled out, which has not been done. As for Fine Gael, I must tell them the people will not accept the undetailed proposals on the lines they have been suggesting for the past few weeks. They seem very confident about winning the next election. Maybe they will. I do not know. They always seem to be confident about winning the next election but they rarely do. Indeed, if I could have a few million copies of Deputy Ryan's keynote speech on behalf of Fine Gael printed it would give students of Irish politics a number of good reasons why Fine Gael have been in the wilderness for so long and are very likely to be left there by the people after the next election. I say now, and I repeat what I said before, instead of fulminating here and indulging in abuse let the Irish people know exactly, precisely and officially on behalf of Fine Gael how those proposals are to be translated into LSD. I have to have money to administer the services. When they are sitting over there they do not have to have anything but verbiage.

There are a number of specific points I think I should deal with. Before doing so I think it is only right to say that I would have no hope whatever of being able to deal with all the points made in the course of this very long debate. Deputy O'Connell made a very long speech in which he praised the Bill for certain things and also dealt at some considerable length with what he stated were omissions from the Bill. I do not think he was right because it seems to me he misunderstands the purpose of a statutory instrument which, after all, is not an essay of general intent on the part of the Minister or of the Government but is, as I say, simply a statutory instrument to enable policy to be carried out. Deputy Barrett, for instance, suggested there should be a consolidated Act on the health service and if this was going to cause more delay it would, perhaps, be a good idea but it seems to me that this is a job for the future. It is quite a tedious one as I know, having been involved in a couple of consolidation measures in this House in recent years.

Deputy Ryan suggested that the first appointment of doctors to the health boards should be by election, and not, as proposed, by appointment by the Minister. There is only a practical difficulty preventing this happening. In fact, there were discussions between my officials and the representatives of the doctors on this very point and they agreed with the procedure proposed in the Bill simply because the health boards will not be in existence at the beginning. Therefore, the best compromise was to have a limited period of office for the first appointees and establish the necessary election machinery during that time so that election could take place thereafter. It was also suggested by Deputy Ryan that officers of the Department of Health would be appointed as members of boards. I wish to make it quite clear that it was not intended that any member of the health boards should be from the Department of Health.

Deputy Esmonde made the point that the Bill is designed to increase the power of the Custom House. I do not know how a doctor could say this, because he ignores the fact that the medical profession is being brought into health administration on a wider scale at all levels through membership of health boards, regional hospital boards and Comhairle na nOspidéal. In fact, what the Custom House is doing is delegating power to outside bodies with professional representation.

Deputy James Tully, with many other Members of the House such as Deputy Michael P. Murphy and, perhaps, half a dozen others, expressed grave concern about the loss of power of the local representatives as a result of the formation of health boards. Indeed, towards the end of his speech, having called me a dictator, an autocrat and having employed several other words of similar connotation, when he knew there was one he left out which he hated to miss, he turned to one of his colleagues and got from him the word "totalitarian". He was quite happy to sit down when he knew he could add that one to the other words which described me. He had said I was dictatorial, autocratic, arrogant and now totalitarian.

I want to say this about the health boards. There is obviously something in the point that by creating health boards and abolishing the local authorities we are certainly making a radical change in the structure of the administration of the health services in this country. All I wish to say about it—and, perhaps, this will be more appropriate on the Committee Stage— is that when the regional idea was first discussed three years ago there was general acceptance on its validity and, indeed, that acceptance included Deputy O'Hara of Mayo, who made quite a strong attack on the health board idea in the course of his very useful contribution to this debate. I am not saying anything to Deputy O'Hara for having changed his views since 1966. He may have been wrong then, and right now. We had a measure of acceptance of the idea of regionalisation three years ago. There was, indeed, widespread acceptance of the idea of active, close co-operation between elected representatives—doctors and lay people—on the lines that were set out in the White Paper at the time. The real point here is that where hospitals are concerned, it is obviously necessary in the interests of the public that this service should be as efficient and streamlined as possible, particularly when one considers the increase in the cost of hospitalisation. It is also obviously desirable that the local authorities should have their say in hospital administration and in all the other work of the health boards. I can think of no better way of ensuring that than by having a minimum of 50 per cent of the board elected representatives of the people, and having, in addition, local committees which would, perhaps, be exclusively, though not necessarily exclusively, elected representatives who would advise the board in regard to a particular area. Where doctors are concerned it is an excellent thing that they should be directly involved in the administration of the health services in which they have such a stake.

I want to make it clear that I have no apology whatever to offer to the House for having ministerial nominees on the boards. I do not see why the Minister, whoever he may be or from whatever Government he may come, should not have the right to choose his own nominees for the board when the State is paying the greater proportion of the cost and will continue to pay a still greater proportion as the years go by. The Minister's nominees will not constitute a very large section of the board. Fifty per cent or more of the elected representatives take care of so many nominations; 30 to 35 per cent will be elected representatives of the medical profession. That does not leave the Minister with a great deal of leeway, but only with 15 to 20 per cent of the membership of the board. The Minister might nominate fewer than that when we see how things work out. I have no apology to make for that.

I do not regard it as dictatorial except on the basis that a Minister acts in an irresponsible way. I am not prepared to assume that I or my successors, from time to time, will so act. Therefore, I totally reject the charge that these people will be simply the Minister's hatchetmen, or that it will be a case of "jobs for the boys", as was suggested by some Deputies during the debate. I should hope that the nominees of the Minister would be lay people of considerable standing who would be likely to give valuable advice and help to the board in the exercise of its very onerous duties.

Another matter which I should deal with is the misconception of Deputy Tully in regard to Party political representations from various county councils on the health boards. The Deputy seems to have missed the fact that in rule 2 of the Second Schedule it is specifically laid down that each political Party on a local council may secure proper representation on the health board.

This is a clause which gave rise to an amusing incident in Ennis where a certain Party have rather a monopoly of power in the council. One of the Independent members of the council suggested to me that that particular Party might take all the seats on the council if the Minister did not make regulations to the contrary. When he suggested that that would be the farthest thing from the thoughts of the Fianna Fáil councillors, I had one of the compensations of political life, a good laugh.

To finish with, the whole question of the health board, if Members of the House can come up with a better idea or a better system than that suggested by us, I should be more than willing to consider it. Incidentally, I do not accept the view put forward by a distinguished columnist in the Irish Times to the effect that the creation of regional hospital boards is still another example of the decay of rural Ireland. I do not think that is so. On the contrary, the points made in the report of the consultative council on the general hospitals service—the Fitzgerald Report—are based on inescapably right arguments and are valid. They call for a radical re-organisation of our hospital services in the interests of better services to our people. Regional hospital boards, therefore, are not properly attributable to rural decay, though that may exist for other reasons.

It surely does.

Deputy John O'Leary asked me not to split the Kingdom of Kerry. I would have to take refuge in Newfoundland or some such place if I attempted to do that. I merely wish to reiterate here what I said in Kerry, that the Kingdom would not be divided. It seems that Kerry and Cork would form a suitable health board region but that will have to be thrashed out during deliberations on the Committee Stage or later.

A number of Deputies, including, I think, Deputies Murphy and Creed, suggested that county managers can listen to representations from members of county councils and that the CEOs of the new health boards will not be approachable in the same way. There is nothing to stop a member of a board from making representations to the CEO exactly on the same lines as a member of a county council does to the county manager at the present time.

There was disagreement as to whether the CEO should be a doctor. Deputy L'Estrange came down firmly on the side of having a doctor as CEO, Deputy Hogan O'Higgins said that one or two might be desirable, and our view is that what is important is that the person appointed as CEO should be a first-class administrator because administration, after all, will be the principal function of the CEO. I am sure doctors themselves would be the last to suggest that by acquiring their MB and other degrees they thereby acquire administrative wisdom as well. If a doctor happens to have suitable administrative ability there is no reason why he should not be a CEO, but I would expect in the normal course that the vast majority would be laymen. I must make it clear that a person will not at the same time be a county manager and a CEO. That is a misconception expressed by a number of Deputies which I should like to put at an end.

Deputy James Tully mentioned the adverse effect on County Meath of the partial attempt at equalisation of the rates burden which I undertook last year. This was envisaged in the White Paper. It is very difficult to do but I do not regret having tried to do it and I will continue to do it in the future because I believe the poorer counties should have anything that is going in leeway and that the richer counties should be willing to recognise that right.

Deputy Timmins made a very brave speech in the circumstances. He spoke directly after the former Minister for Health, Deputy O'Higgins, had regaled the House with his third piece of utter rubbish in the past three months. In the course of his speech, Deputy Timmins asked about the 10/- a day hospital charge. He was not the only Deputy to do so. Deputy Kyne had mentioned it earlier on. The question is whether it is worth keeping power in the statute to make a charge on the middle income group as at present. The 10/- a day charge is not in fact extracted in many cases but only a proportion of it. It yields £750,000 a year, less £150,000 for the cost of collection, and the £600,000 net which accrues is worthwhile.

I consider it better that we should incorporate in the Bill clauses which will enable us from time to time to have regard to changes in the value of money and which will have regard to the situation of our people and their ability to pay. I should hope that the time will come when fewer people will be even applying for medical cards, because at the present time a very high proportion apply for medical cards not because they cannot afford to pay their family doctors but because the cards represent an insurance against the cost of hospitalisation should they become ill. I believe the vast majority of our people could afford to throw away their medical cards if they could be given an assurance in regard to hospital charges when illness arrives.

That is nonsense. The Minister is completely out of touch.

I am entitled to offer my opinion on these matters and it is an opinion only that I offer.

The Minister is out of touch.

The distinguished Deputy Dr. O'Connell can have his own views. I say this in regard in particular to my own people in rural Ireland. I am perfectly satisfied that most of them who have medical cards would be perfectly willing to give them up if they had an assurance as to what would happen should one of their family find it necessary to have hospital treatment.

The Minister should ask his colleagues in Dublin.

The next matter I should like to deal with, but only briefly, is the subject of drug addiction, which was mentioned by Deputy L'Estrange, and others.

As the House knows, a working party on drug abuse is sitting at the present time and I should hope will report to us in the near future. I think the situation in this country is that we do not yet have a serious problem in regard to drug addiction. Any opinion offered in this must be offered with some diffidence, but I believe that what the potential of the problem may be in the future is one thing; what it actually is at the present time is another. In the meantime I would prefer to offer no concrete opinions other than the one I have expressed, and I have expressed that merely because I believe that the working party should not be badgered into producing a report by a particular time because of the urgency of the situation. I believe that, if they produce a good report, a month or two months, at the present time and having regard to the present situation of this problem in this country, will be time well spent.

I, therefore, reject the statement made by Deputy L'Estrange that we have failed our young people. This is an extremely delicate, sensitive area of human behaviour and Deputy L'Estrange and others might choose to realise that we are operating under a system of individual free will and that mere governmental action in this or any similar sensitive area is not guaranteed to achieve success or indeed to prove useful at all. At the same time, I do think that by establishing certain facilities and by appointing the working party, which will report soon, we have taken cognisance of the situation in a responsible way and we have not failed our young people or indeed any others in that regard.

Various Deputies mentioned extension of payment to people looking after their parents, their old. I must say I have sympathy with this point of view and hope that the representations I made to the Minister for Social Welfare in this matter will be favourably received. I should like to see, and I hope will see very soon, a considerable improvement in the way we apply benefits, allowances and so forth to the handicapped and to people who have to give up the possibility of employment—which also imposes a handicap on them—and various other categories.

The election is not far away now.

I do not yield to anybody in this matter. Enshrined in this Bill, as the House can see, is my determination to try to ensure that people who suffer from disability, handicap of a long-term nature, will be relieved of the financial burden involved and that the healthy community should accept the burden of paying for them.

I also think that our children should be given the best possible start at the earliest possible moment. That is why there are radical changes suggested in regard to the child health service. In the first place, the statutory requirement that children be discovered at a school health examination is to be eliminated so that the children will not be told that merely because they were not examined at the school health examination but by their family doctor they are not entitled to treatment. This is an example of the inflexibility in existing Acts which I wish to put an end to in the present Bill.

Hear, hear.

I have no apology to make for the other changes which involve taking away certain existing rights from the higher income group in regard to the child health service. In reply to Deputy Percy Dockrell, I do appreciate that this is taking away something; but in return we are giving to these people, irrespective of their income, the right to absolutely free treatment should their children require hospitalisation as a result of mental or physical handicap or other long-term or permanent disease. I am perfectly certain that if Deputy Dockrell asks his neighbours, and he has many of them in the higher income group, they will regard this as a much better situation than the present one where they can get a free service for their children if they are discovered at national school but then, because of their income group, they have to bear the full weight at least for a time of hospitalisation for a physically or mentally handicapped child. We want to put an end to the situation where, irrespective of income, children represent a severe continuing burden on their people.

Where the middle income group is concerned we want to put an end to the fear of excessive cost of drugs. This obviously is not merely in regard to permanent or long-term disease but is also in regard to a long, acute illness, perhaps stretching over a matter of months. This can represent a considerable hardship and again without actually spelling it out in the Bill, but enabling ourselves to do so by regulation, we are trying to ensure that people in the middle income group will not have to pay more than a reasonable amount to cover the cost of their drugs. It was suggested by many speakers that we should remove this burden from the middle income group altogether. With this I do not agree. Just as I made the observation in regard to the people in my own county, in Donegal and elsewhere, who have medical cards and who do not really want them except as an insurance against hospitalisation, so I do not think it is desirable that we should offer completely free drugs to people in the middle income group. Indeed, I would not exclude the possibility, after discussion here, of charging some small fee to the lower income group for their drugs, though no decision in this regard has yet been made.

I now turn briefly to the vexed question of the Fitzgerald Report, which I touched on earlier, to say that I am conscious of the fact that this is a highly explosive subject, particularly for Deputies and other public representatives who come from areas where a change in the function of existing hospitals is recommended—places like Mullingar, Monaghan and elsewhere. I do appreciate that Members of this House, county councillors and others are now, and will in the future, be subject to very strong pressures from local interests to preserve their hospitals, to preserve their amenities and facilities. "To save our hospitals; to keep our very good doctors and our surgeon and his staff: to prevent downgrading"—that is just a representative selection of the phrases that have been pouring into my office in recent months since the Fitzgerald Report was published.

Perhaps I should read briefly, as Deputy Carter did, from the first part of one of the more important paragraphs in the report. At page 17 the report says in black type:

There are altogether 169 separate hospitals providing acute medical, surgical and maternity services. Most of them are inadequately staffed and equipped. In County Hospitals, the single consultants in surgery and medicine are isolated from colleagues in their fields. Many maternity patients throughout the country have not convenient access to the services of a consultant obstetrician. Inadequate operating theatre, out-patient, laboratory and radiological facilities are keeping patients in hospital longer than necessary.

The report uses even stronger words on page 20 at paragraph 3.5:

We are satisfied that the present structure of our hospital organisation is outmoded and is now a hindrance to good medicine, good teaching and economic operation. We believe that if it is to be adapted to meet fully the requirements of modern medicine this can be achieved only by radical changes, involving a departure from many long established concepts in regard to organisation, staffing and operation of hospitals.

I believe that the arguments in this report are inescapably right, as I said before.

The Minister is accepting it then?

As the House knows, the Government have accepted in principle that these recommendations are correct. Perhaps I should refer to something Deputy Hogan, who is a surgeon himself, pointed out. He said that when he was going through university they produced a pathologist and that was all there was to it. Now there is no such thing as a pathologist. There is a biochemist and a haematologist and half a dozen others. In his time there was also a general surgeon. Now there is no such graduate, and there never will be again.

These are the realities of the specialisation that has taken place in medicine in the past few years. I share with Deputy Dillon and others certain misgivings in this regard. It is not necessarily a good thing that this narrow specialisation is taking place but, unfortunately, I do not control it and we do not control it, and that is what is happening. We therefore have to take into account the developments in medicine and try to streamline our hospital structure accordingly.

Deputy Hogan accepts the principles behind the Fitzgerald Report. He accepts them because he is aware that people like himself and his counterparts throughout the country will be irreplaceable in years to come when they cease to hold their present position. There is no doubt in my mind that, as a result of these changes, there will be less of a feeling of contact between patient and hospital than there is today. There is no doubt whatsoever that the close personal relationship that exists between a surgeon in a relatively small county hospital and the communities throughout the country can no longer exist then. The surgeon will certainly be a much more impersonal figure in the hospital in the future than he is today, but that is how medicine is developing.

I should like Deputies to read this report, and read it in full. It is not often that Deputy O'Hara does not do his homework but he admitted that he had not read the Fitzgerald Report when he was making certain observations. I should like Deputies to read that report.

I am a little short of staff now.

I want to suggest to Members of the House that it is easy to be a follower of public opinion, but we should be leaders of public opinion and not sheep. Members of the House, and others outside it as candidates whenever the election is held, could make political hay at my expense and at the expense of my Party because of the recommendations in this book. I do not think they are doing a service to themselves or the people in their locality by trying to hold on—on behalf of these people and for the wrong reasons—to the hospitals which this book rightly says are outmoded and which, if no action is taken, except to try to keep them open, will fade out in about ten years anyway.

I would hope that Members of the House will be responsible enough to stand up in the areas affected and say: "The report is right. I appreciate that you do not like having to send your child who is suffering from appendicitis, 20 miles further than you would have had to send him last year." Appendicitis, which was referred to by various delegates, is specifically mentioned in the report. Statistics prove that the mortality rate in respect of appendicitis is significantly lower in hospitals of the type suggested here which are fully equipped and have all the necessary staff and ancillary services, than it is in hospitals such as those which Deputies are imploring me to retain. I intend no adverse criticism of any person operating in any one of these hospitals. I have nothing but the highest admiration and esteem for them and the wonderful work they have done.

I accept that what these experts say is true, and that we should try to end a hospitalisation system which has grown up over the years and is now outmoded and involves gross duplication and, above all, involves in acute surgical cases lack of facilities to which patients appear to me to be entitled. Members of the House should remember that hospitals do not exist for doctors. They do not exist for relatives. They do not exist for nurses or nuns. They exist for the patients. If Members of the House and other public representatives keep that fact in their minds, and are clear about what is recommended in the Fitzgerald Report, I think they will not be prepared to fall in with emotional local attitudes, and they will become the leaders which they were elected to be.

Has the Minister any views on the private beds in our own county hospital in Castlebar and the private fees charged? I had something to say on that a number of years ago. I was not afraid to shout about it. Has the Minister any comment?

That is something which can be dealt with as a matter of detail at a later stage. I am appealing to members of the House and other public representatives in this regard. I have said in reply to questions about Wexford, Mullingar and other hospitals, that obviously it will take a number of years to complete this whole process. I have also said—and I meant it—that discussions will take place with representatives of the hospital authorities and also with health authorities in regard to the proposed changes.

It is possible that the consultants in their report overlooked vital matters which they should not have overlooked. It is possible; in my opinion it is improbable, but that is something on which I remain to be convinced because I do have an open mind. I merely have a desire to create a hospital structure which will give the patient a better service, and it is immaterial to me if the location of a particular hospital is shifted 10, 15 or 20 miles provided that the principles laid down in the report are still capable of valid application. What I am not prepared to contemplate is a departure from the recommendations which would be so radical as virtually to retain the present outmoded hospital system which the report rightly recommends should cease.

Alone of all the Members who contributed in this debate Deputy P.J. Lenihan drew attention to the nature and purpose of the community health centre. Too many people have accepted that to change a hospital from a county hospital to a community health centre thereby automatically involves its downgrading. Deputy P.J. Lenihan drew attention to the value and merits of the community health centre and explained what it is all about. I should like to thank him for that and take the opportunity of saying a few words myself to spell them out. In the first place, the community health centre, when established, will bring consultants for outpatient sessions in a way and on a scale not now practised. This is bringing specialist medicine to the doors of the people.

This is Labour Party policy that the Minister is expounding now.

I said before and I repeat now—in spite of Deputy Ryan and others saying here that I have refused to accept the insurance principle—that not merely will I accept an idea from Fine Gael or the Labour Party but I will thank them for it. The only interest I have is in providing a better service for the people, and I will stand up on any platform and thank the Labour Party, the Fine Gael Party or any other party or individual who suggest ideas to improve the service for our people. In addition, maternity, medical, psychiatric and geriatric cases will be catered for in the community health centre. The general practitioner will be integrated in the work of the community health centre in a way that does not apply in any county or district hospital at the present time. He does not have to hand his patient over to anybody under the community health centre idea but can continue to accept responsibility alone or shared when his patient goes in for treatment.

They will, therefore, have to continue to be hospitals even though they may be called community health centres. If it would suit Deputy Treacy or others who complain about the disappearance of hospitals in the whole of Tipperary, to call them hospitals instead of community health centres, I do not mind; that is only nomenclature. All that is leaving is facilities for acute surgery, but through the community health centre you are bringing medicine to the people and integrating the general practitioner in the service in a way that has not operated before. When the people come to realise what the community health centre idea is, instead of objecting to the downgrading of their hospitals, they will be bursting to be the first in the queue for the establishment of a community health service in their own areas.

I hoped that we would be able to avoid silly and unnecessary political controversy at local levels about this matter. I have no personal axe to grind in this thing because we do not have any such controversy in my own county. However, in an effort to avoid creating unnecessary political controversy I have already given an undertaking that I will set up pilot community health centres in two or three areas of the country and in that way try to demonstrate for the benefit of the public the advantages of the community health centre idea as envisaged in the Fitzgerald Report.

Deputy Fitzpatrick and others asked questions about the method of appointing doctors. With the commencement of the service every permanent MO will be entitled automatically to take part in the service if he so desires, and in addition every other doctor who has more than a minimum number of years practice— I think two has been agreed—will have the right to participate in the new service if he so desires. After that there will certainly be restrictions on entry into the service. This is something that was objected to; I cannot remember what Deputy dealt with it. The reason for this is that under the present system the standard of entry into the service is high. Everybody who knows how the service operates will realise that this is so. We wish to retain at least sufficient control to ensure that a doctor will have a certain minimum experience and minimum qualifications before he will be entitled to participate in this service at all.

I do not foresee any real difficulty in applying this principle and I do not foresee any objection to it being forthcoming. We must keep up the standards of entry into the service so that, even with choice of doctor, a doctor will have to have minimum degrees, including, perhaps, certain minimum post-graduate courses as at the present time.

I think that covers at least the principal points that were raised in the debate. I should perhaps sum up by saying it is obvious from the temper of the House and from this debate that there is wide public dissatisfaction over the amount of rates that people have to pay at the present time. This has been expressed on all sides of the House. It is also certain that the improvement envisaged in this Bill will have the effect of substantially increasing the total overall cost of the services next year. For example, the mere fact that the means of the husband and wife alone will be taken into consideration in the future in regard to applications for medical cards and also in regard to applications for disability maintenance allowances will lead to greater expense. I cannot forecast. Indeed, I would shudder to think that the progression might continue on the same basis as it has over the past few years because, if it did, then the bill for health services next year would be something like £65 million.

The problem is a very serious one. People are demanding bigger and better services. I do not believe they are demanding a comprehensive free service but, through their representatives, they demand maximum facilities, for instance, for mentally handicapped children. The provision of these facilities is a priority and always has been. Money will never be an obstacle in the provision of facilities for the mentally handicapped. Money has never been an obstacle and Deputies like Deputy T.J. Fitzpatrick (Cavan) should remember, when they are speaking here, that they are in Dáil Éireann and not in the district court. If Deputy Fitzpatrick has any method of speeding up the solution to the problem I shall be glad to have it.

There are demands for other services. I agree the dental service should be improved. It has, in fact, been improved over the last 18 months, but it is not yet the kind of service we would like it to be. Further improvements in the service will cost more money.

I have an open mind on the question as to how the health service should be financed. I hope the deliberations of the inter-departmental committee will yield some practical help in the form of a workable insurance scheme within the next 12 months. I should like to think the solution is as simple as has been suggested by certain Deputies here. I only wish it were. The problem is a very serious one.

The emphasis in the Bill is on prevention, a charter for children, if you like, to ensure that our children will have the best possible opportunity of achieving good health. Radical changes have been made so that every income group will be protected from the effects of long-term or permanent disease. The precious gift of health enjoyed by those in regular employment puts on those in such employment the obligation of looking after those who are not blessed with the same good health. The obligation does not, in my opinion, rest on the State.

I disagree with the Deputy. I am expressing my philosophy. The Deputy has his own philosophy. I welcome the support I have got from the Labour Party. The aim is prevention and the emphasis is on the preventive aspect of our services. Through the reorganisation of our hospital services we hope to achieve the integration of the entire community, both at the community health centre and at the health board level; and we hope, in that way, to involve people more closely in their own health and that of their children. Nothing associated with this field of activity is easy. Everything about it is complex and expensive.

I hope the Members of this House will approach the Committee Stage of this Bill against the background of the assurance I now give that any worthwhile suggestions from either side of the House will be sympathetically considered by me provided they come within the framework of the general intentions of the Bill or are, perhaps, an improvement on what is already in it.

Question put: "That the words proposed to be deleted stand".
The Dáil divided: Tá, 49; Níl, 37.

  • Andrews, David.
  • Barrett, Sylvester.
  • Blaney, Neil T.
  • Boland, Kevin.
  • Booth, Lionel.
  • Boylan, Terence.
  • Brady, Philip.
  • Brennan, Joseph.
  • Brennan, Paudge.
  • Briscoe, Ben.
  • Browne, Patrick.
  • Burke, Patrick J.
  • Calleary, Phelim A.
  • Carter, Frank.
  • Carty, Michael.
  • Colley, George.
  • Crinion, Brendan.
  • de Valera, Vivion.
  • Dowling, Joe.
  • Egan, Nicholas.
  • Fahey, John.
  • Fanning, John.
  • Faulkner, Pádraig.
  • Fitzpatrick, Thomas J. (Dublin South Central).
  • Flanagan, Seán.
  • Geoghegan, John.
  • Gibbons, James M.
  • Gilbride, Eugene.
  • Gogan, Patrick P.
  • Haughey, Charles.
  • Hillery, Patrick J.
  • Hilliard, Michael.
  • Kenneally, William.
  • Kitt, Michael F.
  • Lemass, Noel T.
  • Lemass, Seán.
  • Lenihan, Brian.
  • Lenihan, Patrick.
  • Lynch, Celia.
  • Millar, Anthony G.
  • Mooney, Patrick.
  • Moore, Seán.
  • Moran, Michael.
  • Nolan, Thomas.
  • Norton, Patrick.
  • Ó Ceallaigh, Seán.
  • O'Leary, John.
  • O'Malley, Desmond.
  • Smith, Patrick.


  • Belton, Luke.
  • Belton, Paddy.
  • Burke, Joan T.
  • Byrne, Patrick.
  • Clinton, Mark A.
  • Connor, Patrick.
  • Coogan, Fintan.
  • Cosgrave, Liam.
  • Costello, Declan.
  • Costello, John A.
  • Crotty, Patrick J.
  • Dockrell, Henry P.
  • Dockrell, Maurice E.
  • Donegan, Patrick S.
  • Dunne, Thomas.
  • Esmonde, Sir Anthony C.
  • Farrelly, Denis.
  • Fitzpatrick, Thomas J. (Cavan).
  • Flanagan, Oliver J.
  • Governey, Desmond.
  • Harte, Patrick D.
  • Hogan, Patrick (South Tipperary.)
  • Hogan O'Higgins, Brigid.
  • Jones, Denis F.
  • Kenny, Henry.
  • L'Estrange, Gerald.
  • Lyons, Michael D.
  • McLaughlin, Joseph.
  • O'Donnell, Patrick.
  • O'Donnell, Tom.
  • O'Hara, Thomas.
  • O'Higgins, Michael J.
  • O'Higgins, Thomas F.K.
  • Reynolds, Patrick J.
  • Ryan, Richie.
  • Sweetman, Gerard.
  • Timmins, Godfrey.
Tellers: Tá, Deputies Geoghegan and Mrs. Lynch; Níl, Deputies L'Estrange and T. Dunne.
Question declared carried.
Amendment negatived.
Question: "That the Bill be now read a Second Time" put and agreed to.
Committee Stage ordered for Tuesday, 20th May, 1969.