Dáil Éireann debate -
Wednesday, 26 Nov 1969

Vol. 242 No. 12

Health Bill, 1969: Committee Stage (Resumed).

Question again proposed: "That section 31 stand part of the Bill."

Mr. Ryan

The wish to improve our health services is not the prerogative of any one party. Neither should it be. The health of our people is a matter which transcends, or should transcend, partisan loyalties. There is, or there should be, general agreement that health services must be drastically improved so that the sick, the disabled, the infirm and the aged may receive better health services. This is the humanitarian and inescapable obligation of any society which dares to consider itself progressive or which dares to claim, or to believe, that it is Christian. Indeed, the genuineness of any society must be measured by the readiness of that society to pay the cost of providing the very best medical skill and attention, drugs, medicines and equipment to all who need them, without regard to their ability to pay at the time of need.

We, therefore, in Fine Gael, are unable to accept section 31 which gives no relief whatsoever to the large numbers in our community who are at present obliged to pay for health services, health services from which they can draw no benefit whatsoever because the test applied in assessing whether they should pay is the very same test which excludes them from benefit. The test applied is whether a person is a rated occupier and, if the person is a rated occupier, then the State lays it down that that person must pay towards the cost of health services.

The Minister and the Government are proposing to provide that the only statutory obligation on the State to pay for health charges will be to defray one half of that part of the expenditure of a health authority which the Minister considers he should pay and that half of the expenditure of the health authorities today is only 46 per cent of the total cost of health boards. By excluding eight per cent of the cost of health authorities the Government attempt to create the impression that they are paying as much as 56 per cent of the cost of health authorities but that is not so because what they are doing is selecting items they are deeming to be appropriate for State subsidy and if the services performed by the health authorities with their intimate knowledge of the needs of an area are outside the categories acceptable to the Minister for Health and the Minister for Finance for the time being, they receive no assistance from the State.

Therefore, we reject entirely the suggestion, after a decade or more of general agreement in this country, with the exception of Fianna Fáil, that rates are not a proper system of financing the health services, that Dáil Éireann and Seanad Éireann should be asked to approve once again the iniquitous proposal that the law should remain as it stand.

Under this Health Bill the State is not proposing to accept responsibility for one penny extra of the cost of the health services. The only comment that we can make is that perhaps they are more honest now than they were in 1966. The 1966 White Paper said that Fianna Fáil had accepted that rates were not a proper system of financing the health services. Having accepted that in a White Paper published at the expense of the taxpayer, they now come in here, having been re-elected to power on the basis of a specific undertaking to relieve the ratepayer, and again put the cost of half of the health service on the rates.

The nub of objections to the health service with its inadequacies and inefficiencies stems from the injustice of imposing half of the burden on a large number of people who are not in a position to derive any benefit from the service. Only one income earner in every seven is paying rates which means that only one in seven contributes to half the cost of the health service. While I am certain that of the number of people at present required to pay rates there are many who should be contributing as much and more towards the provision of health services for the less fortunate, so also I am sure, as the Government's White Paper accepts, and as the various committee inquiries into the rating system have suggested, there are many people at present paying rates on an average of £2 per £ of valuation per year for health services and because they are required to pay these rates, which we know they are required to do without any regard to their ability to pay, they fall into ill-health from undernourishment and inadequate heating and clothing. The Government's inadequate measures to try to provide some relief at the expense of other ratepayers will not clear up many pools of hidden poverty which exist in our community because people are required to pay for health services in relation to the rateable valuation of the property which they occupy.

We find it intolerable that this Health Bill should continue to operate the present system of limiting the State's statutory liability to only half the cost of the health services at a time when, in the Bill, the Government are seeking to get more and more power for the central authority. If the Minister were coming before the House with a specific proposal to give a certain increase in reliefs in the cost of providing health services by providing help from central funds, the State might be justified in getting the additional control they are seeking so that the person who pays the piper could call the tune. What is proposed is that the person who pays the piper will not be allowed to call the tune and such opportunity as people have at the moment is being taken away because under subsection (3) or section 31 we find that the future bill is to be determined not by the health board and not by the local health committees but by the Minister for Local Government who will determine what the expenditure should be. The position in the future will be that the rates will be struck not by any health authority, not by any health board and not by any local authority but by the Minister for Local Government who will determine the bill and notwithstanding that position the Government will strike the total cost of the health services and say that half of it must be paid for by somebody other than the Government of the day.

The effect of this section is to continue an inhuman and inapplicable system under which people with an income of more than £1,200 a year are regarded as being persons in the middle income group who must, because of that, pay for at least portion of their hospitalisation and must pay for all the medical attention required for themselves and their families. It is clear from figures that I received in reply to a Dáil Question within the past month that if the figure of £1,200 was applicable three years ago it should now be £1,600 for the insurable limit because one-third of the people who were within the limit of £1,200 three years ago are now known to be outside the limit and the State has done nothing to bring these people within the insurable category.

Surely this is a time when this sort of thing should be put right, a time when we are determining the percentage responsibility of the ratepayer and the whole community to pay for the health services. At a time of putting through legislation of this kind we should rectify what is known to be wrong. At present we operate 14 different forms of public health service and in these 14 different forms we have 14 different means tests requiring, in most cases, that applicants for the individual services must submit themselves to a new assessment of means. New norms must be applied and new inhuman investigations must be carried out.

Mr. P.J. Lenihan

Which section are we discussing?

An Leas-Cheann Comhairle

Section 31.

Mr. P.J. Lenihan

It is a very comprehensive section.

Mr. Ryan

It is the most comprehensive and I think the most objectionable section in the whole Bill. It retains what we should be anxious to get rid of—means tests of all kinds, which are inappropriate at a time when people are seeking medical aid. That is not the time to be applying tests as to whether they should be paying for it then. Our community should be as capable as any other community in Europe—has proved itself capable— of having a health service without a means test. That can only be organised if the State accepts the responsibility for payment of all health costs. The expenditure of the State is expenditure of money collected by the State from all the people according to their means. Tax should always be paid according to means. Services should not be with-held because of means or presumed means. Any modern, progressive society will always tax people according to means.

This Bill proposes that half of the cost of the health services will be imposed on people without regard to their means. Because they are required to pay that cost, they will in many cases automatically be excluded from benefit. That is wrong. That is contrary to every tenet of what I thought Christians would regard as natural justice. At the same time as the State is proposing to continue this injustice, the State is saying that not only will the people be unfairly taxed, without regard to their capacity to pay, but they will not in future have the close personal local representation they hitherto enjoyed in relation to the health services because the new tax on a local level on rates will be fixed not by the local authority, not by the local public representatives who are living in the community, but it will be imposed by the Minister for Local Government sitting in Dublin in the Custom House, far removed from the local problems to which he presumes to attend.

If the Fianna Fáil Government had honoured the promise which was made in the White Paper in 1966, which was re-echoed in this House by successive Ministers for Health since then, and, which I heard re-echoed by several Fianna Fáil members of the Dublin Corporation and Dublin Health Authority, to keep the rates at the figure at which they were in the year 1965-66, rates in every county and city in Ireland would be from £1 to 26s less than they are at present or than they will be in the coming year. The only redeeming feature of the proposal in this Bill is that apparently it is more honest than the long series of broken promises made by Fianna Fáil Ministers and various members of the Fianna Fáil Government and their supporters over the past three years. However, it does make us very concerned that any Minister in an Irish Government or that any Irish Government should publish a White Paper with solemn promises, and that their agents should continue to repeat those solemn promises, and not honour them. How can people have any respect for Government, how can people have any regard for the assurances of public men when Governments publish White Papers with promises which they do not honour?

Government Ministers repeatedly make promises which they do not honour. The finances of local authorities can become wellnigh impossible because local authorities, very properly, proceed on the basis that the promises will be honoured and then they find that they are broken. I remember well the terrible embarrassment suffered by Deputy P.J. Burke in the Dublin Health Authority when he found that the clear promises which had been made to the Irish nation in the White Paper were not being honoured: nobody was more distressed than Deputy P.J. Burke. Furthermore, when we went on a deputation to the Minister asking him to fulfil his promises, nobody was more anxious that the Minister should fulfil them than Deputy P.J. Burke. But, despite all the efforts we made over the past few years to get the Government to honour the promise in the White Paper—and, in case there was any doubt about what was meant in the White Paper, it was repeated several times after that—it was never fulfilled. We have now reached the utterly degrading and contemptible position in which a Government which issues a White Paper in which it promises to do one thing produces, three years later, a Bill to do something entirely different. How can people have any faith in a Government, how can people have any faith in the administration of a country, which publishes White Papers promising one thing and then brings in a Bill and accepts responsibility for a great deal less?

I am aware that, under subsection (2) (b), the Minister may make some supplementary grants—but it is purely permissive. It is entirely at the discretion of the Minister, with the consent of the Minister for Finance. But that is simply not good enough. When clear promises are made in White Papers, when they are made in this House, when they are made in Seanad Éireann, when they are made in local authority meeting places throughout the country, to undertake responsibility for a greater share of health costs, it is not good enough to bring in a Bill saying that the Minister may make an increased contribution. If the Minister claims, as I suspect he may claim, that the State is paying 56 per cent of health costs, why does he not ensure that the State will never pay anything less by providing, in subsection (2) (a), that the State will make grants of not less than 56 per cent of the total cost of the health board? The only reason we can assume he has not done it is because he wants to leave himself the scope to cut the contribution being made by the State to health expenditure, to reduce it by this six per cent——

Mr. P.J. Lenihan

On a point of order. This is not a Second Reading debate. We are on section 31. I fail to see what relevance the remarks of Deputy Ryan have to section 31. I am prepared to deal with section 31 when he is finished.

Mr. Ryan

The Deputy will have to be patient. If I have to repeat what I have said, in order to get the Deputy to understand it, I am prepared to do it.

Mr. P.J. Lenihan

I understand it thoroughly.

Mr. Ryan

If Deputy Lenihan will allow his indignation to subside for a moment and will turn on his receptive capacities, he will find that I am explaining to him that if the Minister wanted to hold the present contribution by the State at its present level, then he should accept in the Bill a statutory obligation to contribute what the State is now contributing but what he has done is to provide that his obligation is to contribute less than what the State is now contributing. Therefore, it is fair to assume, in fact we must assume, that he wants to have scope to reduce the contribution made by the State to health services. We consider that is a retrograde step.

If the Minister is prepared to give an assurance that there will be no reduction, then we believe that he should crystallise that assurance by writing it into the Bill. If he is not prepared to write it into the Bill I am sure he will forgive me when I say that, much as I respect him as a gentleman and as a worthy parliamentarian, I am, in view of the conduct of his predecessors in committing such serious breaches of solemn undertakings, unable to accept any assurance which he or his party might give that they will not reduce the contributions made by the State to the health services.

It seems to me that the whole purpose of section 31 is to allow the axe to fall to cut the contribution by the State which at the moment is anything from 20s to 25s in the £ less than it ought to be on the basis of promises of three years ago. That is not enough; they want to make it even worse and reduce it by a further six per cent so that the unfortunate ratepayers may well find themselves next year or the year after paying, in respect of health services from which they are to be excluded, as much as £3 in the £.

Mr. P.J. Burke

On the 46 per cent mentioned by Deputy Ryan, of course, we have not got an allowance for the social welfare benefit. Is that not so?

Mr. Ryan

Exactly.

Mr. P.J. Burke

We, in the regional health authority, gave out about £½ million last year. We got over 50 per cent of the usual gratuity but in respect of the social welfare benefits which we appreciate and value so much we got nothing. That is being transferred in this Bill to the local authorities. I should like the Minister to have another look at that section because I do not like to see these two divide. We in the regional health authority in Dublin have been working very well over the past nine years and we have only built up that understanding regarding a person leaving hospital. I wonder could the Minister bring that into this section here and not give it to another authority because I feel that would be doing the individual a great injustice.

Mr. Childers

On a point of order, perhaps Deputy Burke would raise this on section 43?

Mr. P.J. Burke

I know, I only wanted to say that I differ from Deputy Ryan on that point. I shall raise it on section 43.

Dr. Browne

I used to embarrass one of the Minister's predecessors, Mr. MacEntee, by reminding him of the magnificent piece of health legislation introduced by him as Fianna Fáil Minister for Health in 1947.

One of the grand provisions of that piece of legislation was the one in which we in the central authority paid the total cost of the expansion of the health services agreed upon by the local authority at the time. Of course, it was an invaluable provision because it gave the local authorities during those three years the wonderful feeling that they could expand their health services and that we in the central authority would foot the bill. Whether or not one is worried about a provision of that kind from the point of view of the Exchequer there is no doubt that from the functional point of view it was excellent because it meant that we got a very remarkable improvement in our health services during that period primarily because of the provision in the 1947 Health Act that we would pay all additional expenditure over a certain datum year. They were the great old days of the Fianna Fáil Party when they were seriously concerned with the health services and with the health of the general community and did not worry, as some Deputies seem to worry today, about who would pay.

I am trying to deal with Deputy Ryan's suggestion that the services should be paid from central taxation to a greater degree than they are at present. Of course, the general community should pay for the services. They should pay in the form of taxation but in the form of direct taxation and not as at present in the many forms of indirect taxation of which rates is only one. For that reason I believe that this is a very important section because it is the one which will determine the rate at which our health services will expand. I believe that the retention of the rate content of financing the health services will be a very powerful inhibitory factor. It does not matter whether it will be 20, 30 or 50 per cent. Lest the Minister should raise it with me I know that one of the provisions of the 1947 Health Act was a later reversion to 50-50 in the expenditure but certainly when they wanted a serious expansion of the health services the Fianna Fáil Party did introduce that provision and got the results. Even though I was the person who reaped the harvest they sowed the seed. I did not reap the harvest, the community reaped the harvest, by improved health services. For that reason this is a retrograde provision and it will mean that the health services will not expand at the rate at which the Minister would probably like to see them expanding.

There is a great difference between the taxation that we used to have under Fianna Fáil in its radical days in the early 30s and taxation now. The party's general attitude was: "Let the rich pay for the poor" and they did not mind making the very wealthy pay for the poor, for the aged, for the sick. Now there has been a very perceptible, considered and conscious reversal of that policy towards a policy in which moneys for health or social services are now being taken from the less wealthy and from the poor in order to ease the burden on the very wealthy. That, of course, has been the great departure from the radical outlook which the party had in their early days. Of course, it suits the present Minister for Health who is an extremely doctrinaire conservative politician.

Deputy P.J. Lenihan is probably right in saying that there is a section on which we can deal with the essentially humiliating provisions of this Bill involved in the eligibility clauses, the many means tests which are included under that section. However, in regard to this section there is all the difference in the world between taxes on a very wealthy person—surtax, supertax, excess profits tax, corporation profits tax—and taxes like purchase tax, sales tax, ordinary pay-as-you-earn tax which bears very heavily on the ordinary earner. I am not concerned particularly about him. I am sure he is prepared to accept the need to pay something for his services in accordance with his income but the many indirect taxes, particularly purchase tax, are grossly unfair because they lead to the old age pensioner paying as much in indirect taxation as the wealthy person. He eats the same amount of bread, butter, if he can afford it, tea, sugar, pays the same rents and so on.

An Leas-Cheann Comhairle

The Chair does not want to interrupt the Deputy's train of thought but it would appear that this section is concerned with the grants which the Minister would make to health boards and is not concerned with——

Dr. Browne

I accept your ruling but Deputy Ryan went into the general problem of fund raising for health services. I was simply following him, but I presume I can take the matter up on another occasion. It seems to me in relation to the payment to health authorities the amount of money available to a health authority or to the Minister is dependent on how he raises that money. He can raise it in one of many ways. My case is that the Government are raising it in a grossly unfair way. Even if one takes the amount of money which would be needed by the different health authorities in the form of rates in order to subsidise whatever they would get from the Minister, it is quite clear that most local authorities have found that the need for funds raised from the rates has become completely out of proportion to that which most local health authorities can afford. For that reason it seems to me that this is a very bad provision in the Health Bill.

As Deputy Ryan pointed out, we were given many undertakings by successive Ministers for Health that the whole question of the funding of the health authorities would be considered very carefully by the Government and that a much greater proportion would be given from the Central Fund. In fact, most elections it seems to me have been fought on the assumption that the whole payment for health services would be taken away from the rates altogether and that the total sums needed for the funding of health services by local authorities would be met from the Central Fund by the Minister. I agree with many things which Deputy Ryan said and I would ask the Minister to reconsider this section and the implications of the unpredictable varying contributions which he says will be made available from the central authority to the various health boards.

Mr. P.J. Lenihan

Section 31 is the main financing section of the health services and is a very important section. I want to refer to the previous Minister's Second Reading speech. It is well worth reading because it shows the intention of the Government. In 1947 there was as Deputy Dr. Browne said a very great improvement in the health services. That was because so many had so much leeway to make up. In 1966 in the late Deputy O'Malley's White Paper the freeze was promised for one year. Again, the Government's story was they agreed in principle the rates were not the best method of financing the health services but they had not come up with any other solution so the amount was frozen for one year. During the Second Reading of the Health Bill the previous Minister said:

The effect of these provisions, of course, is that there will be no such thing as a statutory "freeze" on the amount of the local contributions, but I should point out that the section is framed so that, should the Government of the day decide in future that such a freeze was desirable, it could be provided for. I would personally not think it appropriate that future Governments should be firmly committed by the Bill in any way in this respect. The decision on this is something which has to be taken from time to time in the light of the general financial circumstances—central and local. Accordingly, section 31 in its present form seems to me to be more appropriate than one setting out a more rigid financial basis for the services.

Mr. Ryan

The Deputy has not quoted the reference.

Mr. P.J. Lenihan

I am sorry I have not got it. I have only a copy of the speech the Minister read in the House.

Mr. Ryan

It is volume 239, No. 10, column 1651 of the 16th April, 1969.

Mr. P.J. Lenihan

Thank you very much. I will take note of your kindly intervention. In any event, that puts section 31 in its proper light. The Government have never committed themselves to a freeze. They preferred that this should be less rigid. They are committed to the fact that the rates are not the best method of financing the health services. The supplementary grant is so framed that that could reach 75 per cent, which is what Deputy Ryan wants to write in. It may come to that and I am sure the Minister in his reply on this section will indicate that the contributions the State make are much higher than 50 per cent.

Minister for Health (Mr. Childers)

As the House knows it is desperately important that this Bill should be passed by the Dáil before Christmas even in respect of those sections which are agreed to by the whole of the House even if some people may object to certain sections of the Bill because we cannot split the accountancy as between regional boards and county health authorities within a financial year. It would create chaos and would make it very difficult to apportion the cost of the health services. I do not want to perpetuate a debate of the kind which took place at very great length not so many months ago when there was a special resolution in which the Opposition admitted they very ably presented their case for a change in the method of providing finance for the health services. My predecessor answered them even more ably so I do not want to perpetuate an argument which has already taken place.

Section 31, as Deputy Lenihan said, is flexible. It enables the Government to provide supplementary grants and, if necessary, to go beyond the present 55 per cent odd of the cost of health services paid for by Exchequer grants. There is nothing to prevent the Government doing that. This Bill only comes into operation on April 1st, 1971. This House will have the opportunity of discussing the Health Estimate for 1970-71 and repeating their views on this matter. They will have the opportunity of discussing the Health Estimate when the regional boards are formed so there will be ample opportunity between now and then to discuss this question of whether or not the proportion of money raised by rates or taxation should be changed and how it should be changed.

I have also indicated to the House that we are examining the possibility of providing some of the cost of the hospital services and the health services to the middle income group by way of contributions. We have found great difficulty in the administration of such a scheme. One of the difficulties relates to an obvious problem which was referred to even in connection with the Fine Gael policy for health in which they pointed out that certain classes of persons would not be asked for contributions and others would be asked for contributions. The division of the community into those who are asked to pay contributions and those who would continue to get the services on the present basis is very difficult to determine. The collection agencies are difficult to determine. It is an immensely complex matter. I am perfectly certain that if there was any Government but my own in office they would find this was difficult under our circumstances. Under our circumstances it is the attitude of people towards taxation and the conditions which have been created in relation to taxation. We are still examining the possibility of a contributory scheme.

I should like to repeat again that the salaries, wages and costs of material have doubled since 1958 and up to 1968 the actual volume of the services has doubled after eliminating all inflationary influences. The actual cost of the health services has roughly trebled. In the interval of ten years the volume of production of the country has gone up by 50 per cent so we have gone away beyond the rule of trying to relate in a general way whatever we can do socially with the increase in the volume of production. We have done so quite rightly. All parties in the House have, in fact, agreed to that procedure. Therefore, there is no doubt the health services have improved, but we want further improvement.

Next, Deputy Browne referred to the State bearing 100 per cent of the increase in the cost of health services after 1947. From a purely sentimental point of view, I wish we were back in these halcyon days. The basis was that the State would have borne the additional cost of the services until it was 50 per cent of the total, the State contribution in 1947 being only 16 per cent of the total cost of the health services. Therefore, what Deputy Browne said was only part of the truth. Since then we have made a very clear statement, in paragraph 116 of the White Paper which states:

They proposed therefore that the cost of further extension of the health services should not be met in any proportion by the local rates.

That is a pledge that has been honoured since the White Paper was published and one which will be honoured in the future.

As the House knows, a number of proposals await the passing of this Bill for their implementation. Among them is the choice of doctor which has been approved by everybody and it will cost us money. There are the arrangements for the improvement of the drug services and services for the middle-income group in respect of inpatient facilities, child health services. There are other proposals of the same kind all of which will help to improve the health services.

There is nothing in the Bill to prevent the Minister for Local Government, under an entirely separate measure, from altering the rate structure if he chooses to do so with the consent of the House. A committee have been set up to consider the whole rating system and there is a Bill which makes it possible for local authorities to raise amounts over and above the total cost of their services in order to effect rate remissions for those who are hard pressed thereby, and also arrangements to pay rates by instalments. This Bill does not have to be amended if the Minister for Local Government should amend the rating system in any way through equalisation of rate levies throughout the country, but he has not even decided that.

There is nothing in this Bill which prevents an alteration in the rating system or prevents the Minister for Health from adding further percentages to the total cost of the health services if he so chooses. The Minister for Health is pledged to provide a full course of extensions to the services. I do not think I should get into an argument with Deputy Browne about different forms of taxation. It might however, be in order to say that there are countries with left-wing Governments——

Dr. Browne

Is this in order? If it is, I intend to pursue it.

Mr. Childers

I do not think we want to discuss whether certain types of taxation are progressive or retrogressive.

Dr. Browne

I have no reluctance to discuss it but I was prevented from doing so in those terms and I am wondering why the Minister is permitted to do so.

Mr. Childers

The Deputy referred to the difference between sales tax and income tax and I imagine the Ceann Comhairle will give me the right to reply to these matters. Socialist administrations disagree about this, although indirect taxation plays a very large part in their tax structures, the indirect taxes being linked with social welfare payments so as to ensure that a tax based on spending will not affect adversely those with large families or those otherwise in necessitous circumstances. I have gone into it as much as I can at the present time. There will be opportunities for discussing the relative courses of rates on at least two occasions before this Bill finally comes into operation.

If it were possible to establish a contributory scheme under this Bill it would be so complex, linked as it would be inevitably with a number of Departments, that there would have to be a separate Bill in any event. I could not possibly have included a contributory scheme in this Bill. If the Government ever adopt a conciliatory scheme for the middle income group, there will have to be a separate Bill because such a scheme would have so many complications.

Mr. H.P. Dockrell

I welcome the Minister's statement that he is still looking into the Fine Gael policy on health but I am sorry because his predecessor three years ago promised me, at a meeting in the Custom House, that he would do that within a year and that the matter would be brought before the House. Since then nothing has been done by the Government and this Bill does not alter the situation in any way. While discussing this section, I should like to remind the Minister that I proposed an amendment which unfortunately was late, and ruled out of order accordingly. The proposed amendment was as follows:

To delete section 31 (3) and to substitute: Each local authority required under this Act to appoint members to a health board shall each year make to the board at the time specified by the Minister such contributions as may be specified by regulations made by the Minister for Local Government, calculated in relation to each health board according to such proportions as the relevant local authority of the health board area may agree on with the consent of the Minister: or, failing such agreement within a period of six months, or such longer period as may be approved by the Minister, from the establishment of health boards, according to such proportions as may be determined by a person appointed by the Minister for the purpose, a person in making a determination under this section in relation to health boards shall have regard to

(a) the cost in respect of each area concerned during the five local financial years next preceding ...

An Leas-Cheann Comhairle

At this stage the Chair wishes that the Deputy would clarify what exactly he is dealing with.

Mr. H.P. Dockrell

I want to alter section 31.

An Leas-Cheann Comhairle

Did I understand the Deputy to say this is the text of an amendment which was ruled out of order because it was late? In that case, of course, the Deputy will understand it cannot be discussed in the House at the moment.

Mr. H.P. Dockrell

I wish to bring it to the notice of the Minister so that he will have it on record and possibly might agree to it at a later stage.

An Leas-Cheann Comhairle

As far as the Chair is concerned, in allowing the Deputy to discuss an amendment which was ruled out of order we would be widening the scope of the debate.

Mr. H.P. Dockrell

I submit that on the section I have a right——

An Leas-Cheann Comhairle

The Deputy has a right to speak on the section but what the Chair is concerned with is that there is not introduced at this stage a matter which is not before the House.

Mr. Clinton

What Deputy Dockrell is trying to do is to propose, in discussing the section, that subsection (3) would be better if it were amended in that way. He is regretting that the Minister has not in fact done this. That is really what he is saying.

Mr. H.P. Dockrell

Yes, that is my argument. I think I am entitled to read this and to argue in that fashion that the section would be better if the amendment had been accepted.

An Leas-Cheann Comhairle

If the Deputy wishes to argue that the Minister should do certain things under the subsection of the section, there is no objection. The Chair is trying to prevent amendments which are not before the House from being discussed.

Mr. H.P. Dockrell

I am only endeavouring to have on record the manner in which I want the Minister to improve this section.

An Leas-Cheann Comhairle

The Deputy might paraphrase it.

Mr. H.P. Dockrell

It is rather difficult.

(Interruptions.)

Mr. H.P. Dockrell

Have I the Chair's permission to continue?

Mr. Ryan

Surely Deputy Andrews understands the need to——

Mr. Andrews

No, I am only trying to assist.

Mr. H.P. Dockrell

I know Deputy Andrews; he is always trying to assist in the same way as Deputy Burke. It reads:

(a) The cost in respect of each area concerned during the five local financial years next preceeding that in which the Health Board became established, of the operation of services which have become transferred to the Health Board.

(b) the principles which have previously governed the allocation of the expenses of joint bodies operating any of these services.

On another subject it says:

An agreement under this section varied (1) by agreement between the boards concerned made with the consent of the Minister or (2) by a person whom the Minister, acting at the request of one of the boards concerned, has appointed to review the agreement.

Mr. P.J. Lenihan

Did the Deputy say: "...with the consent of the Minister"?

Mr. H.P. Dockrell

Yes. I am being very good to him. It continues:

A determination under this section may be varied (1) by agreement between the relevant authorities with the consent of the Minister or (2) by a person whom the Minister, acting either at the request of one of the relevant authorities or on his own initiatives, appoints to review the determination.

I think the section would be better with that amendment and I urge the Minister to accept it.

I began by mentioning the question of the Minister looking into the Fine Gael policy on health services and I want to say now that the Government have had before them the report of one of the inter-departmental committees on rates in which it is stated that rating was an outmoded method of taxation 100 years ago. Yet, here we are with this modern go-ahead Government still retaining this outmoded method of taxation. I am sure the Minister has been reminded of his predecessor who went before Seanad Éireann in 1965 and said he, as Minister for Health, would hold the health rate at the 1965-66 level. That promise has never been fulfilled by the Government and at present the Government contribution to the Dublin Health Authority is only 46 per cent. The Government should at least increase their contribution to the health estimate by up to 75 per cent.

We have read in the newspapers that in the present estimate which would come into force in the coming financial year there is an increase of 4s 1d for health alone on the Dún Laoghaire Borough Corporation. I understand that figure is not quite correct and that it will be 3s 10.6d. That represents another large increase to be met by the ratepayers of County Dublin for health alone. Both authorities will also have to meet a considerable increase in employees' remuneration granted during the year.

From time to time we have noted that the Minister for Health, as soon as he has seen the estimate of the Dublin Health Authority, proceeds to grant an increase to the private hospitals or does something of that kind where we have no control. That completely nullifies the estimate of the health authority. Therefore, I urge the Minister that any increase he proposes to give to voluntary hospitals, or in respect of other matters over which he has control, should be given beforehand so that they can be included in the health estimate so that the estimate, as considered and paid for by the local authority, would be a proper one and so that we would not, year after year, have to meet some such increase for two years at one time. The Ministers should consider that very carefully.

Mr. Tunney

Ba mhaith liom roinnt eolais d'fháil ní amháin ón Aire ach ó na daoine a labhair i dtreo go mbéadh ar mo chumas mo chuid tuairimí a neartú agus breithiúnas a thúirt.

I wish to comment on one or two aspects of this section—one in particular. In this regard I share the concern which Deputy Ryan and other speakers have for our ratepayers. I visualise a situation where a person in the middle income group is purchasing his house. Up to this he has not been a liability on the local authority as regards housing. He now finds himself in an area like Ballymun, Finglas or Churchtown, paying for his house on a valuation of, say, £25. I visualise a man with a wife and four children. On a valuation of £25 at the moment he pays approximately £37 to a health fund. The extraordinary thing is that in quite a number of cases neither he nor his wife may benefit from that fund. Having paid that money which would give full coverage to himself, his wife and children in voluntary health insurance, he is not entitled to an aspro from the health authority. He sees people who are not making the contribution he is making benefiting from his sacrifice and his labours. Obviously, in those circumstances one could not condone the financing of such a health fund.

I hope Deputy Dr. Browne will help me to understand the nature of his concern for that man. He suggests that the finances to finance existing services should now come from the central authority, the Central Fund. He suggests that the system should not be of robbing Peter to pay Paul. He is overlooking the fact that in suggesting that certain finances should not come from the rates he is automatically releasing the wealthy people about whom he would speak, the commercial concerns, the big farmers and the wealthy ratepayers from making a contribution from which other people might benefit.

I was a member of a rates committee which sat in the Dublin Corporation. On that committee we had representatives from the Deputy's Party. When we suggested that money should not come so much from the rates but from some other source, when we suggested that people who use the amenities of the city might be asked to pay for them, when we suggested that young people who seem to have a little extra money at the moment might be asked to pay, when we suggested an amenity tax, when we suggested that it would be better to ask people who are spending money to contribute something in taxation rather than asking people who by virtue of the fact of their having a piece of property were being asked to pay, the representatives of the Deputy's party objected. They said they did not want any additional taxation.

The vice-chairman of the Deputy's party is on the Dublin Corporation. I know that the party are an entire bloc with complete unanimity of thought and I hope that the Deputy will indicate to me how he wants to maintain the present services. He does not want the big ratepayer who is contributing at the moment to continue contributing and his party do not want any additional taxation. The only conclusion we can come to is that they are not in earnest in what they say, or else they want a reduction in the service—a service which could be provided for less money.

As regards these moneys being collected elsewhere, Deputy Ryan and his party joined with us in appreciating the situation where an injustice is being done to the middle income ratepayer. The Minister for Local Government has introduced a Bill which is a first step towards removing from the rate-paying group those who may not be capable of paying. Already recipients of social welfare benefit and old age pensioners are being considered in this category. I hope that the middle income man about whom I speak will be included in that category and that we will continue to have the service we have, paid for by those who can afford to pay, assisted by the contributions which we are getting at the moment from industry and from well-to-do ratepayers and that we will be able to exclude from it those people in the category for whom Deputy Ryan and I are concerned but who apparently are not included in the concern of the Labour Party.

Dr. Browne

Is mór an trua go bhfuil daoine anseo nach bhfuil Gaeilge acu nó bhéimis in ndán dul ar aghaidh leis an díospóireacht ar fad i nGaeilge ach tá mé ag iarraidh cúrsaí sláinte a phlé agus, dá bhrí sin, caithfidh mé labhairt leis an Aire. D'fhéadfainn é sin a dhéanamh i mBéarla da mbeadh gá leis.

Mr. Tunney

An fhíinne atá ag teastáil uainn.

Mr. P.J. Lenihan

Is cuma linn.

Dr. Browne

First, I should like to comment on the extraordinary and breathtaking arrogance of the Minister in coming in to us here and telling us in Parliamentary jargon to get on with this Bill and give it to him. This is a Minister in a party which have been in office intermittently since 1951, and he comes in here now and tells us to get on with this piece of legislation and that he wants it as a Christmas present. He will have to wait for his Christmas present until we decide to give it to him. He has had the opportunity of getting on with this legislation but, instead of doing so, his party went to the country and had their absurd referendum. There was this business of producing a White Paper in 1966, and then they could wait until 1969 to get on with this piece of legislation.

An Leas-Cheann Comhairle

The Deputy will appreciate that we cannot have a Second Stage speech. We are on section 31.

Dr. Browne

We have been asked by this man to hurry up, and I am explaining to him why it is that we believe it is his party who should have done some hurrying up in the past 20 years during which they have been in office.

An Leas-Cheann Comhairle

I am sure the Deputy will appreciate that he should refer to the Minister.

Dr. Browne

I do not agree with Deputy Ryan's contributory scheme as a matter of principle because, as I said earlier, I believe the finance for the health service should come from direct taxation, from central funds. I am not sufficiently doctrinaire not to accept that a totally contributory scheme would be a great improvement on the proposition put forward here. I would accept it as an interim proposal towards the creation of a proper health service funded entirely from general taxation.

The Minister is extremely well-read. In fact, that is one of his problems. He works so hard at examining both sides of a problem that he very rarely comes to the third side of any problem and that is the conclusion to do something about it. He knows as well as I do that there is nothing original or greatly radical in the proposition put forward by Deputy Ryan that some form of a contributory scheme should be introduced covering all or any sectors of the community. In fact, the Fine Gael Party did something of that kind in relation to their voluntary health insurance scheme. There is that type of contributory principle involved in that scheme. It is absurd for the Minister to say that a Government Department could not devise a scheme of that kind if he seriously wanted to help the people in the middle income group.

On the question of taxation and rates, Deputy Tunney asks me to reconcile my suggestion that the ratepayer has found it very difficult to go on paying the rates which are attributed to the health services in any local authority with a suggestion for the improvement of these services. This general catch-cry that has gone up. about the burden of rates due to the increase in our health services has been a pretty deliberate campaign by people who try to discredit the idea that we should try to improve our health services. If anybody looks for such an improvement he is told it will mean more money on the rates, and there must be a limitation on the spending of the local health authority in order to calm the feelings of the general ratepayer.

I accept the fact that there is a great feeling, created deliberately, accidentally or in any way you like, among ratepayers that a great proportion of their payments go out in health services. That is one of the reasons why I believe that the rating system for the funding of health services is a bad one. There is also the obvious factor that there are poor counties like Leitrim, Mayo and some parts of Donegal—some Deputies may have seen the BBC television programme last night on the present state of the west of Ireland; whether you believe it was prejudiced or not, there appeared to be a fair amount of fact in it in regard to the decay there— and to ask these counties to pay rates at the same level as the wealthier counties like Cork, Limerick or Dublin is unreasonable, and the only people who get hurt in that type of situation are the people in those counties, and they should not be penalised. It is bad enough to have to live in a poor county like Leitrim or to be a small farmer trying to earn a living in Connemara or wherever it may be, without having to suffer because the health authority cannot raise sufficient funds for health services.

As to the question of general taxation, Deputy Tunny asked me whether I thought the wealthy ratepayers ought to be relieved. I think funding through rates is a bad system. I do not think there is any reason why the wealthy industrialist, the wealthy shopkeeper, the wealthy businessman, the wealthy individual, self-employed, or wealthy unemployed drawing dividends, should get such relief. We are not blazing a new trail in taking money from the wealthy and giving it to the poor. That was started a very long time ago.

Mr. Tunney

We have a system at the moment which allows us to do that via the rates. To get that money, and if we want to retain that money we must set up another system whereby we shall get it.

Dr. Browne

I accept that point. I am saying that we should set up another system and the system we have at the present time distributes the burden of rates unevenly. The people mentioned by Deputy Tunney, after the first five years rates remission, will have to pay rates. These people frequently have to pay rates at a level at which they cannot afford to pay. I believe the really retrograde departure from the early redicalism of the Fianna Fáil Government has been the shifting across of fund raising from the wealthy through the direct tax device, that is, from each according to his means, to each according to his needs, by these different devices such as purchase tax, sales tax, national health insurance contributions, voluntary health contributions: all these social service contributions, indeed even the scheme suggested by Deputy Ryan is simply a device to save us getting at firms like Guinness, Jacobs, Rowntrees or other people like that who have a lot of money and who could easily pay a lot more money than they are paying in order to ease the burden on the old age pensioner, the man with the big family, the widow or the disabled person, who are paying relatively high taxes because they are taxed on the commodities they must buy if they are to live.

There would be no problem at all if one were to change the taxation system so that there would be the type of taxation which is used in other countries, mostly socialist countries, but not necessarily socialist countries. The Minister's generalisation about socialist administrations was, consciously or otherwise, a dishonest one because, as he knows, there are many variations in this type of administration, and to lump them all together and to say they are good, bad or indifferent is an attempt to score a cheap debating point. For instance, Sweden in which there is a predominantly capitalist set up has been and is ruled by socialist governments.

Mr. P.J. Burke

One of the most Christian socialist Governments is Fianna Fáil.

Dr. Browne

We could have a long debate upon what the Deputy means by Christianity.

An Leas-Cheann Comhairle

That is what the Chair fears.

Dr. Browne

There was a most enlightening cri de coeur from the Minister when he said: “if we could only get back to the halcyon days of 1947”. After the best part of 20 years of Fianna Fáil Government is it not a wonderful tribute to their socialist and economic policies that we want to go back to 1947 in order to be able to afford better health services? Is it not a wonderful tribute to them that we have here a piece of legislation containing provisions which are those first introduced by Lloyd George in 1913, or something like that, in the British House of Commons?

We are up against this very important question—and I do not know whether the Minister would care to enlighten us on it—of giving a choice of doctor and how the doctor is to be paid for the service.

Mr. Childers

It comes under another section.

Dr. Browne

The Minister mentioned this matter and I wonder if he would care to enlighten us as to whether he intends to adopt the proposal put to him of a fee per service type of scheme. I think it comes up under another section and possibly it would be better for me to go into it in greater detail then. The Minister did say that it is going to be a very expensive proposition, but for reasons I shall explain later I am inclined to support it.

Mr. Crotty

Section 31 is one of the most important sections in the Bill because it deals with the financing of it. We all know that everything has to be paid for and our concern here should be to find equitable means of paying for this service. The Minister has recently visited county councillors and I wonder if he got their opinions on it. The whole problem of rates as a tax is being questioned; all sides agree that it is a wrong system of taxation.

The problem of rates as a tax has arisen in the last few years because of the very large increases put on to the rates year by year. Previous to that, when the rates went up by 4d, 5d and 6d, local councillors tried their best to cut a halfpenny or a penny off just for the sake of doing it, but now we have increases of 5s, 6s, 7s and 8s and these increases are so severe that people do not even bother to see if they can economise. These large increases have been brought about because the health charges are paid out of local rates. The proper expansion of the health service is going to be inhibited by this charge which is put on the rates.

Deputy Ryan mentioned earlier that one-seventh of the people have to bear the rates charge. We are not getting support from the people who have the real spending power today and because of this I think we should get 75 per cent of the health charge from the Exchequer. The people with property and fixed incomes who had a large income ten, 15 or 20 years ago are now holding on to their property by a hair's breadth and yet they have to pay rates on their properties while six-sevenths of the population make no contribution to the rates at all. We should get the payment for the health services by taxing the big companies and large business concerns instead of hitting the property owners.

I agree that some financing of the health service should come from the rates because if local authorities get a free hand and get all their finance from the central authority there is no doubt that they will run riot with the health charges. A 25 per cent charge on the local authority would be a very fair charge. I would ask the Minister to adopt Deputy Ryan's amendment.

Mr. Andrews

Subsection (2) (b) states that:

supplementary grants, as determined by the Minister with the consent of the Minister for Finance, towards the reduction of the amount of expenditure to be met by contributions under subsection (3).

I fail to see what the bruhaha is over this particular section. Deputy Browne said that the Health Act introduced here in 1947 was a radical approach to the health service. He said he was very happy about the outcome of the application of a particular section of that Act. It must be remembered that at that time only 16 per cent of the Central Exchequer was being made available for local health authority contributions. The figure has been considerably increased, and if 16 per cent in 1947 could be termed radical what can the increased amount in this day and age be termed as? I do not think there is an adequate term for it.

I totally agree with the views expressed by Deputy Tunney that rates as now constituted are a penal tax and are, in their application, penal. I have said this before and I shall continue to say it until we get an equitable application of rates. The people who are hurt most by the application of rates are the middle income group, particularly those living in city and suburban areas. These people are being picked on year in year out as a result of the iniquitous rates system under which we operate at the present time. What is the alternative to it? If we were to go to the other extreme and abolish rates in a blanket form then the wealthy people would get away with not paying any rates.

I believe a scheme of selective local taxation should be examined because there are many people apparently well off who cannot pay rates. The Minister made observations in relation to a contributory health scheme for the middle and lower income groups, and I would strongly urge him to examine the proposition which would allow these people to enjoy a reasonable standard of living without having to worry about this type of taxation, namely rates.

The Minister has been accused of arrogance because he asked for this measure to be let through with a certain amount of urgency. I think this was a very fair request and if Deputy Browne did not want to take the Minister's advice there was no need for him to call the Minister arrogant.

Progress reported; Committee to sit again.