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.