Dáil Éireann debate -
Wednesday, 3 Dec 1969

Vol. 243 No. 2

Private Members' Business (Resumed). - Health Bill, 1969: Committee Stage (Resumed).

Question again proposed: "That section 59 stand part of the Bill".

Dr. Browne

I was talking about domiciliary care for sick and infirm persons and, where there are dependants, the amendment Deputy Ryan proposes, and which I support on behalf of the Labour Party, to include widows or widowers. I was making the point that the lack of care given to old people in our society, which is a very big problem for various reasons, is probably the most shocking manifestation of our indifference to human suffering which is to be seen in the country. In a country in which there are many manifestations of indifference to human suffering to be seen, whether it is in relation to the health services, housing, emigration, unemployment, I think the lack of care of our old people is likely to be the greatest single indictment of our appalling callousness as a nation professing Christian virtues. This provision is, as I have suggested to Deputy Andrews, long overdue, from 1932 until 1969, 37 years. The fact that we are now getting to the stage where we are saying in a Health Bill that a health board may make arrangements to do these things is its own eloquent evidence of the indifference of the Government to this problem over the years.

Putting it at its lowest—because we have got to the stage in Ireland, as a strictly materialistic and hedonist society, in which all that matters is money and what you can buy for it— it would save the Government money if we were to provide this type of domiciliary care service. Putting it at its highest level, we would be caring for people who are unable to help themselves, people who have given everything they could give to the creation of the society we have here, for better or for ill, but who can now give little or no return for whatever we can do for them. Therefore, this makes great demands on our idealism, and it is possible that, because there has been so little of that in our society over the last half century, so little has been done in that regard. As I say, I was concerned with this years ago in the tuberculosis question, and I feel that at least one worthwhile job would be done in encouraging the religious orders to take on this work.

I am thinking in particular of the widower referred to in Deputy Ryan's amendment. Quite often one finds that a man is left with four or five young children on the death of the mother and he is in an utterly helpless situation. I know of families in which there are children of one, two, five, six, seven years of age, and so on, each one practically completely dependent on the unfortunate widower. Leaving aside the appalling emotional problems which are created by the loss of the mother at an early age, when the children are young, the physical problems which the widower has to face are enormous. It would be a most valuable provision in the Bill if some service could be provided to help this person to keep the family together. Most men in such circumstances are helped by relations, but frequently the relations have their own worries and after the first few months the effort dies and the person is left on his own. If this service were available it would avoid sending the children to an institution which creates even greater emotional problems for the children. The same applies to the widow. I am one of those people who do not believe that a married woman with a family should go out to work.

An Leas-Cheann Comhairle

At this stage——

Dr. Browne

I am not pursuing that point. I am simply saying that it does arise in this case that the woman with a family should not be forced to go out to work, as she is frequently forced to do in our community. It is very cruel and heartless to force the average widow to make a choice between going out to work to try to keep her family in the home and sending them to an institution, which again results in serious emotional disturbance for the children. Anything that can help the widow in those circumstances——

An Leas-Cheann Comhairle

This section is concerned with home service. Deputy Ryan's amendment to include the widower or widow was ruled out of order.

Dr. Browne

I am so sorry.

Mr. Ryan

It might constitute a charge on State funds.

An Leas-Cheann Comhairle

This section deals with sick and infirm persons.

Dr. Browne

I accept your ruling, but it was an excellent amendment and I am astonished it was ruled out. I hope the Minister will take it into consideration on the Report Stage. However, I welcome the proposals that are being made in relation to the sick and the infirm. Would the Minister, in relation to the health board, feel it necessary to say that a health board shall make arrangements? He should be very much more directive in his approach to this problem in order to make many more of the local authorities provide these essential services which should have been provided a long time ago.

Mr. Childers

I understand that section 54 (2) of the Health Act, 1953, is not being repealed and that section 59 (1) and (2) can be applied to it, and that home help can be given to persons who, although they might not be sick themselves, would have to have institutional care unless they could not otherwise be provided for. Therefore, we do not need that amendment in order to cover such case.

Dr. Browne

Maintenance at home as well?

Mr. Childers

Yes. Between now and the Report Stage I shall ask the officers of the Department to look at this again to make quite sure we have got this correct. We do intend to have home help available for such cases.

I would like to make it clear to the House that even Great Britain, which has twice the income per head of ourselves, has not come near a solution for solving the home help problem. They are only able to take care of about half of the people who need this kind of help. It is estimated that there is demand in Britain for a home help service for 8.5 per cent of the aged living in private households. This is partly due to the difficulty of getting staff and it is partly due to other reasons that I need not go into. We are going to go ahead with this. Not only for statistical cold-blooded financial reasons, as suggested by Deputy Dr. Browne, but for entirely human reasons—irrespective of the savings that can be made—we believe in keeping people out of homes as much as possible. We believe these homes will be required in the future as the number of people over the age of 65 who continue to live longer increases because of the discoveries of new drugs and even possibly because of the effect of chemotherapy on a long-term basis on the dreadful disease of cancer. We do therefore intend to develop these kind of services.

I should also say that, although I agree with Deputy Dr. Browne that some elements of our society are affluently selfish, the Report on the Aged Poor revealed that a tremendous amount is being done by voluntary organisations all over the country. Such organisations provide outings for old people, chiropody and similar services as well as the service provided by the meals on wheels organisation. A great many old people's organisations are growing up, such as these in Cork, and collaboration between the various voluntary organisations, the local authorities and the State is needed. This could be done by the setting up of a national council for consideration of the aged poor, which would act as coordinator in the exchange of ideas. Many problems have to be solved such as whether or not home helps should be full-time or part-time; should they all be paid and should we have highly trained home helps; and should we have people willing to give their services freely to help find people to do this work. Not everyone can or wants to do this type of work and not everyone has the ability or time to do so. There is also the question of avoiding unnecessary overlapping and excessive expense through all the various services operating for people who are psychiatrically ill but who can be kept at home by these social workers. There is also the question of whether home help officers should be directly appointed and paid for by the regional health boards or whether they should be paid for by voluntary organisations. This is a very complex business and we are going to go ahead with it as fast as we can afford to do so.

I can assure the House that my own priorities in regard to the health services are in keeping young children healthy by the development of the child health service and in looking after the old people and mentally handicapped people, particularly the mentally-handicapped people. We have not yet sufficient places for the mentally-handicapped but we are beginning to reach the end of that problem. The number of places completed and the number in course of completion amount to 1,400 and this almost fills the requirement of the mentally-handicapped.

I feel most sympathetic about this matter and I would assure the House that section 59 will be used in the best way possible. The matters referred to by Deputy Dr. Browne and Deputy Ryan relating to an amendment which was considered out of order will be examined and if we feel there is not sufficient and not definite commitment to be able to give aid of this kind to the class of people they have mentioned we will put in an amendment on the Report Stage.

Dr. Byrne

This is a very good section. Unfortunately, the amendments on it have been ruled out of order at this stage. The present situation with regard to home helps is far from satisfactory. There are a few voluntary and religious organisations providing home helps. The Minister has already said that these voluntary groups are doing tremendous work in this field but the work which they are doing is not getting to the root of the problem.

One of the main causes for having to introduce this section into the Bill is because of the malnutrition of the aged. Elderly people are not getting sufficient nourishment in their diet and as a result of this some of them have been deprived of vitamins essential for brain function. This has resulted in their premature admission to mental hospitals which is one of the reasons why this country has the highest percentage of its population in mental homes and mental hospitals.

Subsection (1) of this section provides for the assistance and maintenance at home of a sick or infirm person. The infirm will, of course, relate to the number of mentally defective cases which we have. Many of these cases have resulted from improvements in our medical skills, the saving of premature infants with a high rate of mental deficiencies and a low IQ rate and the psychiatric treatment, which has been so successfully applied in health authority areas, resulting in the open door method of treatment. However, this has added to the number of people who are at home sick and infirm.

As the Minister will appreciate, this section of our population will always increase regardless of the facilities provided. We have got to be prepared for a gradual increase in the number of sick and infirm persons in our society. The meals on wheels organisation, which the Minister has stated he would include in a home help service, does excellent work. At the moment we have public health nurses engaging themselves in jobs such as lighting fires, cooking meals, washing clothes and washing patients which has nothing to do with their nursing duties at all. All this work can be done by a home help. It is very time-absorbing for a public health nurse to have to cook a meal or make a pot of tea for these people. It is not in the best interests of the efficient execution of her duties. It is one of the problems we have in our area. Very often nurses who are doing the home help service are sent on messages. In charity, they cannot refuse but it is a great waste of skill and time.

A very noted doctor in this country has said that it was not a good day when antibiotics were discovered because they prolonged the life of so many infirm, old people who had suffered strokes and who normally would have passed on but who are now being kept alive for many years oblivious to their circumstances and surroundings. It is an excellent thing to provide a home help service for these people.

I note the wording in the section is: "... may make arrangements to assist in the maintenance at home of sick and infirm persons or their dependants". It does not say "maintenance of dependants at home".

Mr. Childers

Either—the people or their dependants or the people and their dependants.

Dr. Byrne

My reading of this is that it is to maintain at home the dependants of the infirm people.

Mr. Childers

Yes.

Dr. Byrne

In other words, that they will not have to go to work in order to increase their income so as to provide for a maid or a char as they have had to do up to now.

Mr. Childers

Each case will be examined on its merits.

Dr. Byrne

My reading of this is that it is to assist in the maintenance at home of sick and infirm persons first and, secondly, "or their dependants". This would mean that dependants of handicapped people who otherwise would have to be taken to institutions, can be looked after at home. Am I reading this correctly?

Mr. Childers

Yes.

Dr. Byrne

The section says "without charge or at such charge as he considers appropriate". This, of course, can work two ways. It can mean that they can have it completely free of charge for three days a week or for six days a week. There are many interpretations. The easiest one is that one would have to make a contribution if required to the wages of the home help but I would prefer to see here that any home help which it is necessary to provide for sick or infirm persons or their dependants should be provided completely free of charge.

Mr. McLaughlin

It is of vital importance to the nation that the health of the people should be carefully guarded. I have frequently referred in this House to the question of mentally handicapped children. I live near a very fine hospital outside Sligo which is doing marvellous work but which, unfortunately, is unable to admit all the cases that seek admission. I have on many occasions been asked to make representations to have a person admitted but, of course, there is no need to make representations to the matron who is anxious to deal fairly with everybody on the long waiting list. It is only when a vacancy arises that she can accept another patient.

It is rather astonishing that there should be so much talk about the building of luxury hotels while we fail to provide adequate accommodation for mentally handicapped children. The family that cannot find a place for such a child suffers severely as a result.

Mr. Childers

I do not want to interrupt the Deputy but we have already dealt with this matter on section 50. We can talk about keeping mentally handicapped persons out of homes on this section but we have already dealt with the institutional care side on section 50. If we are ever going to finish this Bill we should get on with the section.

Mr. McLaughlin

I hope the Minister does not mind but this is of vital importance. In our rounds we find very tragic cases. Even though I may be out of order I would remind the Minister of the necessity to provide for these children.

An Leas-Cheann Comhairle

The Chair would hope that the Deputy would not continue on this line.

Mr. McLaughlin

I shall not, but I would emphasise the need. All over the country there are county homes——

An Leas-Cheann Comhairle

The section with which we are dealing at present concerns home service.

Mr. McLaughlin

There are county homes overflowing with aged persons as the result of the fact that home service is not available. We have frequently emphasised the fact that if an allowance were given for the maintenance and care of these people at home the old people would be happier. As Deputy Dr. Browne has said, when these people are put into a county home they are remembered for about six months and after that it is only if some person sees them in the county home that one knows whether they are dead or alive. Home help should be given to aged persons. There is a general feeling that nobody cares about the aged. Taxation has become so heavy that even very good families have been forced to agree to a father or mother being sent to a home simply because home help is not available. At estimates meetings members of local authorities are told of the expense involved in maintaining a patient in an institution and have often pointed out that these persons could be maintained at home at much less cost. That is the kernel of the problem. If an allowance were made the aged could be maintained in their own homes.

The question of meals on wheels has been referred to. That service is required in rural areas, villages and towns just as much as in big cities.

Dr. Browne

Why is it that in this part of the Bill the permissive "may" is used instead of the mandatory "shall"?

Mr. Childers

The word "may" is generally used in health Bills.

Dr. Browne

If the Minister looks at this he will find "shall" mostly, but in this case it is "may".

Mr. Childers

We are encouraging regional health boards to undertake this kind of work.

Dr. Browne

Why does the Minister not tell them?

Mr. Childers

In actual fact, they would not be able to find the staffs to do this if we told them to do it. This must develop gradually. The Deputy will appreciate that this process is likely to make considerable progress over the next five years because of the work of voluntary associations and because of the continuous growth of local community feeling. The Deputy need not worry about the use of the word "may". He may be certain that in the next five years this concept will expand greatly and, because the communities themselves have been and are doing a great deal of work themselves, they will be only too glad to have the necessary assistance from the local authority subsidised by the State.

Mr. Ryan

The Minister, I think, referred me to the wrong section of the 1953 Act or else he misunderstood the purport of my remarks and my intended amendment. I am concerned, as are others here, with the provision of assistance to enable a widow or a widower, as the case may be, to keep the children in their own home. That is perfectly feasible if someone comes in for two or three hours, cooks the main meal and does the cleaning; the widow or widower can come home from work at the end of the day and put the children to bed. The section of the 1953 Act to which the Minister referred me provides that where a person is unable to provide shelter or maintenance for himself and his dependants he will be eligible for institutional assistance and that means shelter and maintenance in the county home. That is not what we want. That breaks up the home.

Mr. Childers

The Deputy has not understood. Under section 59 of this Bill home help can be given.

Mr. Ryan

But they must be either sick or inform before the home help will be given.

Mr. Childers

I am advised that is not the case. However, I shall have another look at this before Report Stage.

Mr. Ryan

I am grateful to the Minister.

Mr. P.J. Burke

This has been the practice so far as the Dublin Health Authority is concerned and the last speaker was chairman of that authority while this practice was in operation.

Mr. Bruton

I welcome the section. It is a very laudable thing to have a home help service and, in providing this service, the Minister is reflecting the policies we have been advocating for a very long time indeed. As my colleague, Deputy Dr. Byrne, said earlier a great deal of the work which will be carried out by the home help service is at present being carried out by public health nurses. They are asked to prepare meals and clean homes, and so on. This will be a great relief to them, the more so as not enough public health nurses have been appointed. In one area in which, according to circular No. 27, there should be three nurses, in actual fact, there is only one. In arranging this home help service I sincerely hope the Minister will not allow the kind of understaffing which has happened in the case of public health nurses to occur in this service. There are so few nurses in some areas that there is no one to relieve them and they cannot get any proper holidays. I also hope there will be no difference in conditions. In the case of the public health nurses some have much better leave than others. Some areas lag behind. I hope this will not happen in the case of the home help service.

Question put and agreed to.

Section 60 agreed to.

SECTION 61.

An Leas-Cheann Comhairle

Amendment No. 86 in the name of Deputy Ryan has been ruled out of order.

Question proposed: "That section 61 stand part of the Bill".

Mr. Ryan

This is something on which medical colleagues could advise us, but it seems to me that the provision of medical, surgical and nursing services for infants up to the age of six weeks is inadequate and the period should be extended. My proposal of six months might impose a charge on State funds and is, therefore, not in order and the Chair had no option but to rule it out. Nevertheless, I press the point that six weeks is inadequate. There are expenses following on the birth of a baby. Some capital outlay has invariably to be incurred, not so much, perhaps, in the case of the second and subsequent children as in the case of a first baby. There are expenses which impose a certain hardship, one people gladly shoulder, but the State could go a little further than six weeks and I would urge the Minister to extend the period.

Dr. Gibbons

There are two points I should like to make. First, the position is at the moment that the mother and her baby are discharged from hospital within seven days and the family doctor with whom the mother is registered sees the mother during that period. At the end of the seven days he is paid for his post-natal visit. On the other hand, if he sees the mother outside a certain date, after the birth, he is not paid for the visit. There is something wrong about this. There has been a certain amount of cheeseparing and in the past I have suggested that this post-natal visit should be defined as one occurring within seven days of the mother being discharged. In other words, she would spend roughly a week in the hospital, then she would return home and would then be visited by her medical practitioner. Some practitioners do this, not in every case, but at a time of convenience, perhaps, when they are passing the house, while at other times they may be called in and they are not paid for this visit. By altering the regulations to stipulate within seven days of being discharged from the hospital would encourage the practitioners to visit both the mother and the baby and there would be this extra care for the infant.

If a doctor sees a baby who is five weeks old and he finds that the baby has some defect will that baby be treated by the health authority even though it may be eight weeks before the baby gets to hospital? If the defect is found before the six weeks' period arrangements may not be made for the baby to be hospitalised until after that and will the health authority accept the responsibility in this case?

Dr. Byrne

The six weeks limitation here on mothers and children is purely one by definition referring to perinatal death, and is in entirely for classification reasons. This is the only logical reason why this should be put in here. Those of us who are in general practice have had the experience of trying to get a five weeks old baby back into hospital. You may have to wait for a week. The maternity hospital will not take the child back because when they do it will be six weeks and one day old. In the case of my own son, which I shall never forget, he took ill approximately four hours before he was six weeks old and there was consternation about whether they would get him into hospital before he was six weeks. We come up against this arbitrary age limit on numerous occasions in the field of medicine. This limit could be extended without any necessary charge on the health services because the child, if he is fully eligible for maternity services, is almost certainly entitled to full eligibility under section 57 for free drugs, etc., and hospitalisation. I do not think that the free treatment under section 61 should be limited to six weeks. I do not think we should limit this at any stage because, as Deputy Dr. Gibbons pointed out, there are many occasions when you refer a child under six weeks to hospital by the time a cot or a bed is available the child is over six weeks. It is introducing bureaucracy into a very important section of medicine, namely, the perinatal stage.

Dr. Browne

I should like to support both previous speakers in the suggestion that the Minister should have another look at this. This matter should not be determined by a bureaucratic decision of this kind. Six weeks, six months, six years—who knows when the child will be fit for discharge? Surely, it should be a medical decision when the mother is ready for discharge, at the discretion of the practitioner or the hospital? At least that should be allowed to the people concerned. Hospitals are not going to keep patients in hospital unnecessarily. This should not be restricted to a six weeks' period.

The Minister may not fully appreciate it but a decision of this kind can condition decisions affecting people's health and can condition things like bed usage and facilities in quite a remarkable way. Fees paid, say, for domiciliary midwifery care could quite radically change the incidence of domiciliary midwifery. For instance, the voluntary health insurance system is institutionally orientated and tends to increase the number going to hospital although they may not need to do so but simply because it will enable them to benefit from the scheme. The Minister should be careful before fixing a period of this kind and he should try to leave it as open as he can.

Mr. Childers

I will look into this matter to see if there is something which restricts a child who comes to the notice of the maternity doctor that from a maternity point of view the child requires to be kept in hospital for a period of over six weeks. I gather that the section is based on the fact that in the ordinary way a maternity doctor considers that, form the point of view of immediate post-natal service, he is finished with the child of six weeks. This may be out of date. We will look at it and see if it should be made slightly more flexible.

In reply to Deputy Dr. Gibbons I will look into this question, about which I am afraid I know nothing, of encouraging the practitioner to visit the child within a certain period. I was not aware that there was this difficulty. The House is aware that children of the middle income group and in the medical card group if they have real disabilities discovered either after birth at any time, or at birth, can get free treatment in hospital and the payment of drugs. That would cover a number of cases of this kind. I do not feel completely bound by the six weeks and so I will look into the matter. To tell the truth I have not had any complaints of children suffering from this cutting off at the six weeks, partly because those with medical cards continue to have free service.

We intend to set up child health services and to have a special examination of all children at six months of age. Section 64 (1) will provide for this. There should be at least one other examination. Some Deputies have mentioned the rather grim facts about defects discovered in schoolchildren which should have been discovered at an earlier age. We intend to have these two examinations before the child is six years of age. I shall have a look at it.

Question put and agreed to.

SECTION 62.

An Leas-Cheann Comhairle

Amendment No. 87 has been ruled out of order.

Question proposed: "That section 62 stand part of the Bill".

Mr. Ryan

My amendment was ruled out of order as it might impose a charge on State funds which is clear when one seeks to increase the maternity grant from £8 to £20. The increase from £4 to £8 after a long interval of years would not seem to indicate a genuine effort to make the maternity grant of any worthwhile value in this day and age. We are supposed to be legislating for the years ahead. In fixing this sum of £8 by statute there is not much expectation that it will be amended for very many years to come.

When the figure of £4 was fixed for the maternity grant, the pint of stout cost 1s 2d. It is now 3s 2d—up or down one penny depending on the location of one's drink. The grant has not kept pace with the price of celebrating a birth and it has little real value in relation to the maintenance of the infant, much less the mother. As the grant is deemed to be for the purpose of assisting the great event of bringing a new being into the world, I believe it should be made something worthwhile: even £20 is not a great deal but it is certainly a great deal better than £8. What is the actual amount paid under this head?

Mr. Childers

If we raise the grant to £20, it would cost nearly £250,000 over and above the cost of the increase from £4 to £8. Again, this is a question of priorities. I could spend the money better at the moment on other more needed services, such as child health services. I understand the convivial spirit in which Deputy Ryan related the grant to pints of stout. I am told that one can get 50 pints of stout for £8. The Deputy will agree that a great many hard-pressed mothers would probably spend this grant not only on a little stout, perhaps, but on more essential things.

Mr. Ryan

It is a recommended therapy.

Mr. Childers

The £4 given in 1953 is worth about £7 now. We have kept grimly in line with the increase in the cost of living plus £1. In view of the many other services we want to provide, it would be as well to leave the grant at £8. Perhaps we can increase it later when circumstances are more favourable.

Dr. Byrne

The maternity grant is for the purpose of offsetting some of the incidental expenses attaching to childbirth. Would it be possible for section 59 to be taken with section 62 so that, when the mother is taken into hospital to have the baby, provision would be made whereby home help would be available if required? In some of the lower income groups, there is a large number of children. At the moment, the local dispensary doctor is asked to have these children removed to institutions while the mother is in hospital.

Mr. Childers

I have already said I shall look into that matter.

Dr. Byrne

I thought that was in relation to widows and widowers.

Mr. Childers

No, it relates to mothers defined as sick or infirm.

Dr. Byrne

Is a woman in confinement sick and infirm? It is a normal process in the life of a woman to have a baby.

Mr. Childers

I shall look into that matter.

Mr. Ryan

Into whether it is a normal condition for a woman to have a baby?

Dr. Byrne

In the case of a family in the lower income group where there may be as many as ten children and where the mother is going into hospital for a further confinement, there can be a lot of disturbance in the family and very often the dispensary doctor has to put some of these children into an institution while the mother is having a baby. Home help might possibly overcome this problem. The grant of £8 in respect of each child born is supposed to offset some of the expenses attaching to childbirth but it is utterly inadequate. I should prefer to see the really hard-pressed members of our community receive a higher maternity grant and its withdrawal from those who do not really need it. Think of the cost of clothing the child, of a cot, a pram and the other incidentals. A grant of £8 would not go very far towards meeting the expenses. It would buy less than 32 packets of cigarettes. It is not an awful lot to welcome a new child. Perhaps the number of people to be entitled to the grant could be limited so as to enable more money to be given to those who would benefit?

Mr. Childers

This applies only to people with full eligibility. It does not apply to the middle income group.

Dr. Byrne

Many people do not need the £4 grant which is given at the moment and yet they will now be eligible for the £8 grant. Could we apply it only to the lower section of the lower income group or even to those in most needy circumstances?

Mr. P.J. Burke

It is for the lower income group.

Mr. J. Lenehan

Deputy Byrne would not know anything about that.

Mr. Ryan

Deputy Byrne is pleading for the lowest level of the lower income group.

Mr. Tunney

Does he suggest taking it from others in that income group?

Dr. Byrne

In other words, the most needy.

Mr. Tunney

They are all in needy circumstances.

Dr. Byrne

I agree, but I did not write the Bill.

Dr. Browne

What is the meaning of subsection (3) that the justice shall not take into consideration the fact that the mother and child are entitled to a grant under this section? Is the grant still given to the unmarried mother?

Mr. Childers

That is the idea. We include the unmarried mother in these grants.

Question put and agreed to.

SECTION 63.

An Leas-Cheann Comhairle

Amendment No. 88 has been ruled out of order as it involves a potential charge on State funds.

Question proposed: "That section 63 stand part of the Bill".

Mr. Ryan

We view with considerable disappointment the introduction of the Victorian assessment of need in relation to the provision of milk. We have just spoken about people with full eligibility, people in the lower-income group and people who it is understood are destitute or nearly destitute. Section 63, however, requires a new means test to apply to the provision of milk for children under five years of age. They will not receive free milk unless it can be established that their parents "are unable from their own resources to provide the children with an adequate supply of milk". This is very close, indeed, to the poor law test of "a person who is unable by his own industry or other lawful means to provide the necessities of life". Milk and milk products are essential for children under five years of age.

Mr. P.J. Lenihan

Full eligibility.

Mr. Ryan

No. A health board can make available——

Mr. P.J. Lenihan

Line 29—full eligibility.

Mr. Ryan

The section provides:

A health board may make arrangements for the supply of milk to expectant mothers with full eligibility, nursing mothers with full eligibility, and children under five years of age whose parents are unable from their own resources to provide the children with an adequate supply of milk.

Does the Deputy see my point? Full eligibility gives free milk to expectant mothers and nursing mothers but not to the children of people who are entirely eligible for other services unless it can be established that they "are unable from their own resources to provide the children with an adequate supply of milk".

Milk is a very costly item today. Milk products are provided for in subsection (2). They can also give the benefits which can be obtained from the direct consumption of milk. The point is that the larger proportion of families in the Dublin region who have medical cards do not eat butter, because they cannot afford butter. They spread margarine very thinly, but they do not eat butter. It might, in fact, be a great benefit to the farming community if people who are entitled to full eligibility and their children were to get free milk. It is something that should be done. It is done in a very large number of European countries. I do not know of anywhere it is not done, and I know several where it is. A dairying country like Ireland which has a surplus of milk ought to be glad to provide it in this way.

We are concerned here with a Health Bill and with health matters. Building up the bone structure and the health of our children is an investment in the future, and it will save medical costs later. We should not have undernourished children in our community. I believe that this requirement that they must prove inability to provide milk from their own resources is too severe a test, and an unnecessary test which we ought to do away with. If people have medical cards they should get free milk as well.

Dr. Browne

I support Deputy Ryan on this, but does the Minister seriously intend to restrict the provision of milk to people who cannot provide milk from their own resources? The first five years of a child's life are most important years. The finest food of all is milk. Therefore, if the Government are seriously concerned for the welfare of young children it seems to me that every effort should be made to see that young children up to the age of five years have free access to milk and other vitamin-producing substances such as orange juice. Both the warring countries of Germany and Britain during the war years gave priority to nursing mothers of course and, in particular, to young children in regard to all those essential supplies and high food content supplies, particularly milk and the vitamin foods of one kind or another. This was a wonderful thing. The Minister should look at the section again to see if there is this qualification suggested by Deputy Ryan.

Mr. Childers

I will look into it again. In the short time I have been Minister for Health it was not possible for me to examine everything in the vast panoply of services provided. I honestly have not looked into the milk service yet. I am told by the Department that if we say "children under five years of age whose parents are unable from their own resources to provide the children with an adequate supply of milk", we are more likely to get the really necessitous people provided with milk. The way it works out in relation to budgeting for food in comparison with full eligibility status is that you may find people who are outside the full eligibility class but who still cannot afford to provide milk. It is actually in the interests of the families to leave it this way. Perhaps in view of the increase in the cost of milk and the general changes in the patterns of consumption, we ought to have another look at this. I absolutely agree with the Deputies who have spoken on this matter. We must do the utmost we can to make quite sure that no family suffers through a lack of the provision of milk, which is one of the essential and excellent foods. I will look into it again but I am told at the moment that it would be better to leave it this way and that more children would get milk if we leave the section in its present form.

Dr. Byrne

In my short time in this field I feel that there is not a sufficient number of people coming forward for this service. The needy people do not always present themselves to go through red-tape and, in some cases, unavoidable humiliation, subjective as it may be in certain cases, to enable them to obtain free milk and other free things which are going. I feel personally from my own experience that, were this milk made free to every child under five years of age, the Minister might find that not everybody would be claiming it and in this way we would be assured that all the needy children got milk and there would be no need for the Minister to worry in this regard. Otherwise, I feel that only the needy children whose parents are aggressive enough to come forward for milk will get it. Once again, the section of people to whom I have referred previously on other sections, the shy and retiring individual, and the proud person who does not want to be subjected to a means test, will not benefit from this Health Act. These people will be neglected in this Bill and I feel that the provision of free milk for all children under five years of age would be a good thing. I am glad the Minister is to look into it.

Question put and agreed to.

SECTION 64.

Mr. Childers

I move amendment No. 89:

In subsection (5), page 29, line 50, before "or" to insert ", 54".

This is a drafting amendment. Section 54 gives the authority for the provision of out-patient services and it is desired to make it clear that similar power is not given under section 64. It is purely a drafting amendment.

Amendment put and agreed to.

Question proposed: "That section 64, as amended, stand part of the Bill".

Mr. Ryan

There is a significant change between the 1953 provisions and the present ones. I would be grateful if the Minister would say why the change has been made. Under the 1953 Act it is provided that, where a health authority are not satisfied that an adequate health examination is available for the pupils attending a school in their functional area, which provides elementary education and is not a national school, the health authority may, by order, direct that this section shall apply to the school. That is the section providing for school health examination and treatment, but the test under the 1953 Act is the satisfaction of the health authority as to the adequacy of health examination in a school which is not a national school. Now we are proposing in this Bill to provide that the health examination shall not take place unless the governing body of the school so requests. This seems to me to be a retrograde act which could arise where the health authority is not satisfied in regard to the health condition of children or the adequacy of examination. It would appear we are proposing to divest health authorities of the power to direct such examinations. I am a person who is entirely on the side of the freedom and the rights of the individual, even where the individual is acting contrary to his own interests, but the right of a parent or guardian not to undergo the examination still exists and would still exist even if the health authority could direct the holding of an examination in a school. The Minister may have good reason for the change, but I should be glad if he would explain why.

Mr. J. Lenehan

Subsection (4) is a most extraordinary sentence:

The school manager may be required, when notice has been given to him by a health board, to provide reasonable facilities for an examination.

Normally the manager is either a parish priest or a parson. Who will serve this notice? This provision makes no sense to me and I should like an explanation from the Minister.

Dr. Gibbons

I should like to ask the Minister if it has been decided yet whether the services under subsection (1) will be made available through the family doctor. I take it that children under six years of age will not be examined in the school but at dispensaries or clinics?

Mr. Childers

General practitioners' surgeries and dispensaries.

Dr. Gibbons

Will the family doctor make the initial examination?

Mr. Childers

Yes, the family doctor in rural areas.

Dr. Browne

The child health committee made a number of specific recommendations. Is that what the Minister has in mind when he talks about services up to six years? Will they be in accordance with those recommendations?

Mr. Childers

As far as possible we will follow the recommendations of the child health committee. That is one of the most important improvements in the service.

Dr. Browne

Section 64 (4) provides: "The school manager will be required..." a point was made in that report about the very bad conditions, the great pressure—I think that was the phrase — experienced very frequently by doctors. To what extent— again we have this old question of "may" and "shall"—will they be required to provide satisfactory accommodation? If services are provided at all surely they should be provided under satisfactory conditions from the point of view of the child and the doctor.

Mr. Childers

As the Deputy probably knows, in some of the newer schools in the country there is a proper room where these examinations can take place. In other cases the conditions for examination of the children are not satisfactory, and the doctor does his best, aided by the public nurse who is appointed to the area. Later on we intend to make more provisions for the training of teachers to watch out more closely for certain neurotic conditions which they will not attempt to analyse but they will know something about the children who might be selected by the doctor and the nurse for prior examination. In fact, some kind of selective examination is essential because the burden placed on the medical fraternity by the school examinations is tremendous.

As I stated, the pre-school examination will take place at other prescribed places which could include general practitioners' surgeries or dispensary surgeries as distinct from child health clinics which have been the only places where children under six could be examined up to now. That will be a change for the better. Subsection (4), I understand, is hardly ever likely to be used in that no school manager of an ordinary national school refuses to give examination facilities, at the present time in any event. In regard to the elementary school which is not a national school and is, therefore, privately owned, there was a section in the 1953 Act under which you could compel a private school to have a school medical inspection of the children. Apparently it was not considered possible to make use of this and we feel we shall get along much better if we ask for their consent and encourage them to permit examination. I have not the slightest doubt they will do this, so gradually the school examination system will begin to apply to elementary schools that are not national schools. In fact, there are already examinations in a great many private schools, as the Deputy knows, and this is merely extending the facility.

Dr. Browne

A number of Deputies have raised this problem of the child of six weeks in section 61. Is it correct that there will be a comprehensive general medical service for children up to the age of six years? If so, why restrict it in section 61 to six weeks and then give it up to six years in section 64, if it is to be a comprehensive general medical service?

Mr. Childers

We shall have to work it out. We are examining the child health service report. It would be impossible for me at the present time to prescribe the new policy. I have not had an opportunity of examining the list of priorities taken out of the child health services, with the exception of those where the public nurses services are involved, where the pre-school examination is involved. We will take the best advice we can get from the child health service committee, but I have not had the time fully to examine all these proposals.

Dr. Browne

In regard to Deputy Dr. Gibbons's point, under subsection (1) examination will take place at clinics, health centres and at doctors' private surgeries?

Mr. Childers

Or "other prescribed places," which could include general practitioners' surgeries.

Dr. Byrne

In what circumstances would the Minister envisage this taking place?

Mr. Childers

This is recommended by the child health services committee, as I have already indicated.

Dr. Byrne

Do I take it that all children under six years of age will have full eligibility or will it be only children under six years who had full eligibility under the old health Act?

Mr. Childers

No. All children will have full eligibility for the under six-year-old examination.

Dr. Byrne

I understand this quite well. We now have the words "and treatment service" which is a very big step forward. Could we be assured that all children under the age of six could be provided with a treatment service completely free regardless of whether this treatment service necessitated in-hospital therapy?

Mr. Childers

This is a rather complex business to describe. We have been through some of this before.

Dr. Byrne

Is this treatment to be confined to a health centre, a private practitioner's surgery or a clinic?

Mr. Childers

It does not cover hospital service, except for medical cardholders and those in the middle income group and those with prescribed long-term disability.

Dr. Byrne

In other words, the subsection does not deal with all costs up to the age of six years because everyone up to the age of six will not be entitled to full treatment following examination under the scheme?

Mr. Childers

The middle income group can get out-patient examination without paying any costs for X-rays.

Dr. Byrne

Even the out-patient treatment may not be sufficient for what has been discovered at the examination. There is a lot of distress at the moment regarding the present system whereby children of six years of age are examined and fairly expensive therapies are prescribed for them. I should like to see all children under the age of six getting completely free treatment for any disease which has been discovered as the result of a health examination under this Act.

Dr. Browne

If the Minister is going to carry out the recommendations of the child health committee, he would in effect get such a service. It would be a significant advance if the middle income group and the lower income group could get free treatment service in hospitals, clinics and dispensaries.

Mr. Tunney

I am concerned with subsections (2) and (3). All our people are enjoying the medical examination at national school level, it is not confined to any particular group, but I am wondering whether or not the Department of Health are aware of the fact that in national schools today the tendency is for a child to leave at an earlier age than he did before. Formerly we thought of a child leaving a national school at the age of 14 and as a result a child enjoys these services. Most children are now leaving national school at the age of 12 plus and in some cases we find children who are educationally entitled to leave at less than 12. It would appear to me that we are taking away from the parents of those children a very commendable service which they have enjoyed to date. It may be said that the ideal situation would be that those children at the age of 12 should have the service of their own doctor; but the middle income group, who are contributing heavily in their rates to the health fund, will be deprived of these services when the child reaches the age of 12. I do not think it should be confined to national school or elementary education. I think a case can be made for making this service available to children until they reach the age of 14.

Mr. Ryan

It will be 15 next year for elementary education.

Dr. Byrne

With regard to subsection (1) and the treatment service mentioned therein I would like to point out that it is easy to discover a defect in a child in a routine examination. I should like to know if there is any provision in the Bill for the assurance that the treatment prescribed will be carried out. I have in mind such things as speech defects, hearing defects, early indications of autism and possibly symptoms of epilepsy. Very often the child will be prescribed a certain treatment but the mother will not bother to go ahead with it. We are giving a completely free service to the fully eligible section, but the fully eligible section has the highest incidence of diseases such as epilepsy and diabetes. The fully eligible section is not the most stable section. For reasons best known to themselves they do not even bring their children down for vaccination. What I should like to know is, if I, as a practising doctor, discover a child has a certain hearing defect, is there any way in which the parents can be compelled to ensure that these defects will be remedied by the treatments available?

Mr. Childers

No, there is no compulsion whatever. In fact, there is provision to this effect in the 1953 Bill.

Dr. Byrne

I do not think it is socially desirable to bring compulsion into it but we should bear in mind the other extreme. Let us take the itinerant section of the community. We have voluntary organisations dealing with these people who have been neglected up to this time. They are travelling people. On examination it may be discovered that they have numerous physical defects but there is no system whereby this treatment can be instigated.

Mr. Childers

No, I am afraid not. I do not propose to enter into a controversy of the greatest possible magnitude. I can see there are two sides to this, but I have to get this Health Bill through by 1971 and I do not intend to start an explosive controversy of what constitutes liberty of the person.

Dr. Byrne

I see the point the Minister is trying to make.

Mr. Childers

I would not dream of starting such a controversy.

Dr. Byrne

The other point I wanted to make was that very often treatment can be prescribed which parents are not able to afford and, as a result, the children do not get the treatment. I think all children should be made eligible.

Dr. Loughnane

I do not wish to be considered a spokesman for the Irish Medical Union or Association but I think the word "treatment" should be deleted in subsection (1) of section 64 and the word "advisory" put in its place.

Mr. Childers

I have taken note of what the Deputy has said.

Mr. J. Lenehan

Subsection (4) of this section states:

A school manager may be required, when notice has been given to him by a health board, to provide reasonable facilities for an examination under this section.

but I do not think anyone in this House understands what it means. I would certainly like the Minister to clarify this. It is typical Civil Service-ese. It could mean anything. You could have a manager who would be sick for five or six months and would not even answer a letter and some child could be in trouble in the meantime. The Minister should make clear to us what exactly the section means.

Mr. Childers

It means exactly and precisely what it says and no more and in the civilised world of 1969-70 it is unlikely that it will ever have to be used.

Mr. Ryan

May I say that I agree entirely with the Minister that this is one of the clearest sections of the Bill? The purpose of it is to prevent situations which have arisen in the past in which the health authority have sought to conduct medical examinations in schools and have not been provided with proper facilities for doing it and have had to do it in corridors or classrooms that have not been cleared of desks and other things. I agree with the Minister that the number of occasions on which it might need to be used are few and far between. It is to provide an authority for the health board to carry out a medical examination efficiently in the event of their coming up against an unreasonable manager or headmaster and it is better left there.

I would ask the Minister to have a look at subsection (3). I would much prefer to see a marriage of subsection (3) of section 19 of the 1953 Act and subsection (3) here. The decision as to whether or not an examination is conducted in a private elementary school should not rest solely with the governing body of this school. Perhaps it would be better also not to provide as we did in the 1953 Act that a health authority had to be satisfied that the examination and treatment in school was inadequate before it even sought the right to go in but simply to provide in the Bill that a health authority may apply the section to an elementary school which is not a national school and to provide for consultation and for the kind of agreement which the Minister anticipates would be given in most cases. I do not know why it is necessary to make an order as the subsection suggests but there may be some administrative reason for that but if it is proposed to carry out the examination in an elementary school why not carry it out without the formality of an order being made by the board?

Mr. Childers

I will look into it. I have been told that by this provision we are most likely to get an extension of the medical examinations in private schools which already exist on a considerable voluntary basis. I shall look into it.

Question put and agreed to.

SECTION 65.

An Ceann Comhairle

Amendment No. 90 is in the name of the Minister. Perhaps, as amendment No. 91 in the name of Deputy Ryan is an alternative amendment, the two amendments could be discussed together.

Mr. Childers

I move amendment No. 90:

In subsection (2), page 30, line 8, to delete "discovered" and substitute "noticed".

We discussed this on amendments Nos. 73 and 74 and I assure Deputy Ryan that "noticed" is as good a way of describing it as any other.

Mr. Ryan

It is as good a way of observing, I agree.

Amendment agreed to.

Amendment No. 91 not moved.

An Ceann Comhairle

Amendment No. 92 in the name of Deputy Ryan is out of order for the reason that it would impose a charge on State funds.

Question proposed: "That section 65, as amended, stand part of the Bill".

Mr. Ryan

We are again proposing in this Bill, as we did in the 1953 Act, to provide dental, ophthalmic and aural treatment and dental, optical and aural appliances for persons with full eligibility and persons with limited eligibility. I notice that the word used here is "shall" and not "may", which does appear to impose an obligation on a health board. I am surprised that the word "may" has not been used although the Minister has said that that is supposed to mean "shall".

We are in the rather Gilbertain situation at the moment that we are aware that we have failed to provide the dental, ophthalmic and aural services to which people were entitled under the 1953 Act and, being so aware, we proceed to write solemnly into this Bill that which we know we are not already doing. This seems wrong. I would much prefer that the Minister would take his courage in his hand and acknowledge that we would not provide dental, ophthalmic and aural treatment and instead provide that we would very definitely provide these services for certain sections of the community and provide stepping stones to enable us to cross to the position in which we would provide them for larger sections of the community. The present position in which we detect dental, ophthalmic and aural defects and, having detected them, have a waiting list of up to two years and more for treatment is deplorable in the extreme and I think it is wrong morally that Oireachtas Éireann should be purporting to confer an entitlement to services at a time when it knows it is not in a position to provide these services at all. The 1953 Act has never been any more than partially implemented so far as these services are concerned. We appreciate the need to provide these services all right but we have to do something really drastic if health boards are to be in a position to provide the services which we say here they shall provide.

We have, for instance, at the moment national school children who are entitled to get free dental treatment and in order for those children to receive free dental treatment we should have 500 dentists looking after them. The fact is that we have only 120 public authority dentists, so that we have only about one-quarter, or less, of the number of dentists necessary to provide the health services which the 1953 Act said were to be provided and that is 16 years ago.

Again, a similar position applies in relation to ophthalmic and aural services and the Minister has acknowledged that we have had waiting lists of up to two years for hospitalisation where surgical attention was necessary. An effort is being made to cut down on this but such a situation should never have been allowed to develop. We must anxiously apply all the energies of the new health boards and regional hospital authorities to ensure that the present backlog of work is attended to with the minimum of delay and that similar situations are not permitted to arise again.

I mentioned earlier that we should be trying to programme our rate of advance towards providing these services and I would instance the example of Norway where it is incumbent on a health authority to attain certain predefined stages of development within certain periods of time. There are measures available to make health authorities account for their failure if they do not provide them. But health authorities as such are not to blame. It is our whole national approach to the provision of these very essential services which has been so very defective. Dental defects, ophthalmic defects or aural defects are all very serious. We were talking earlier today about the need to declare an emergency in relation to another public service. Perhaps, we should realise the need to regard these as emergencies as well.

I would recall the fact that TB, diphtheria, polio, would never have been eradicated if approached with the same seeming indifference that we now apply to defects of a dental, ophthalmic and aural nature and, therefore, with all the sincerity that we can command we urge upon the Minister to ensure that we provide full care for teeth, full eye care and full ear care for everybody in the community who needs it and is not in a position to pay for it so that we can prevent situations arising, such as now arise and must be known to many people, where people have teeth extracted, have an impression taken for the false teeth and have to wait two years before they get them. At that stage the teeth do not fit the mouth which has been left without any kind of teeth for two years. This is a very urgent service and, because we are conferring entitlement here, we must not think that we are also conferring the means of achieving the object aimed at. We must ensure that the means of achieving these rights are attained within the least possible time.

Dr. Byrne

One of the difficulties in prescribing optical apparatus or optical treatment for elderly people is their inability to make their way around the city. Would the Minister consider providing some form of transport? There is transport available in the health authority at the moment. Will that be included under subsection (1) of section 65? Elderly people are unable very often to make their way to the specialist hospitals and subsequently to the opticians.

Mr. Childers

This is a technical matter mainly. I do not think there is anything to prevent visits to the elderly in their own homes. I would encourage such visits. I am told that there is difficulty in some cases because one cannot transport the equipment required to the home.

We intend to improve the dental services. I am absolutely frank with the House: the dental service is far from perfect. There are not enough dentists. In some areas there are not enough private dentists even though they could earn a very good living. The number of dentists in the public service has increased by 20 per cent in the last two years and the amount spent has increased by 40 per cent. But that is still not sufficient. We should go on expanding the service as quickly as we can. Deputies will have seen proposals for improving the ophthalmic and aural services. These will be introduced according as the finance is made available. The ophthalmic service is not bad. The aural service is reasonably satisfactory, though there is room for improvement.

Question put and agreed to.

SECTION 66.

Mr. Ryan

I move amendment No. 93:

In subsection (2), page 30, line 25, before "premises" to insert "or assist others in providing or maintaining".

The purpose of my amendment is to make it quite clear that not only may a health authority provide, under this section, this specific service itself but it may assist others in providing or maintaining such a service. Health authorities are, in fact, assisting many voluntary bodies in the provision of this service but the section, as drafted, would appear to limit this activity to the health authority itself and that, I think, would be most undesirable. Not only should a health board provide and maintain premises, workshops, farms, gardens, materials and equipment for the purpose of rehabilitation but it should also be able to assist others in providing these facilities. Perhaps "maintain" includes assistance to others to do this but, in case there is any doubt, I should like to see it written in clearly because, if it is not, we may be in some difficulty later on.

The assistance of many voluntary organisations in this most commendable work is something which no public authority will ever be able to replace. Because of that every encouragement should be given to organisations doing this invaluable work. I think the effect of the section is that the provision of assistance is for the purpose of training disabled persons. There is no provision for sheltered employment subsequent to training. Not only should the health authority train the handicapped but they should make the training meaningful by providing employment opportunities after training. If that is not done the handicapped may find themselves trained but unwanted, trained without any opportunity of using that training. From an economic point of view that would be complete waste. Worse still, people would have had their hopes built up and, deprived of worthwhile employment, their distress would be great because their hope would be dashed to the ground.

Mr. Carter

There is the point that the rehabilitation service is more or less tied by reason of the fact that there is no extended provision in the shape of grants for these, shall we say, school leavers to continue in training and it would be a pity, in the light of this progressive legislation with regard to rehabilitation, if we did not have a scheme to enable those discharged to become fully rounded and trained for whatever calling they may wish to follow.

Dr. Byrne

Subsection (1) is excellent. The word "shall" is used instead of "may". That is most encouraging. I interpret this to mean that a health board will make available the service necessary for the training of the disabled and not that they may make it available. This is really an excellent section. It is tackling the problem at its roots. We have numerous voluntary organisations attempting to rehabilitate people and they are doing an excellent job within the resources available to them. We must bear in mind what I have already stressed, that the percentage of our population which is disabled is going to increase and continue to increase. The epileptics, diabetics, people suffering from spina bifida, congenital heart diseases, the mental defectives and the psychiatric cases which we are keeping alive are all going to increase and, therefore, I am delighted to see this section, that each health board will provide a rehabilitation service. I should like to see provision also that any disabled person who is entitled to social welfare benefits should be allowed retain them after being placed in suitable employment. We must bear in mind that the time these people would spend in employment is not generally as long as that which a normal human being would spend.

An Ceann Comhairle

I wonder if we could dispose of Deputy Ryan's amendment, No. 93?

Mr. Childers

We are not talking about social welfare benefits.

Dr. Byrne

I am talking about subsection (1).

An Ceann Comhairle

We are discussing an amendment by Deputy Ryan, to insert certain words.

Dr. Byrne

It is most important to provide premises for these people after they have been suitably trained and provide an outlet for their products, to see they are gainfully employed and protected. Under this section the mother of an epileptic will have home help and free medical treatment.

An Ceann Comhairle

That does not arise. We are dealing strictly with amendment No. 93. Is the amendment withdrawn?

Mr. Ryan

I should like to hear the Minister on it.

Mr. Childers

I can assure the Deputy that section 25 of the Bill combined with section 65 of the 1953 Act will give the health boards adequate power to achieve what is envisaged by the Deputy's amendment We intend voluntary bodies to continue and to be aided by health grants from the various local authorities, supported equally be State grants. In regard to sheltered employment where the person has to continue employment in a workshop under abnormal circumstances, as distinct from being in an outside factory, if help is required because the person cannot earn enough by his own industry, then there are powers to provide aid in that connection.

I can assure the House that we intend to develop this kind of activity as fast as possible. I should say it is heartbreaking work and, naturally, there are often failures and certain people cannot be put into any form of employment. I have had the privilege of going over some of these wonderful institutions which are doing splendid work. During the international rehabilitation congress I was very glad to hear some people from abroad who visited these institutions saying how impressed they were. However, we have still a great deal of progress to make with an extension of the system.

Mr. Ryan

Could the Minister say to which section of the 1953 Act he referred?

Mr. Childers

Section 65 of the Health Act of 1953. This combined with section 25 means that there will be no question but that the health boards will have adequate power to do what is envisaged in the Deputy's amendment.

Mr. J. Lenehan

The only point troubling me is that at the beginning of section 66 the word "shall" is used. I agree that even grammarians have doubts about when to use "shall" and "will" and——

An Ceann Comhairle

That does not arise.

Mr. J. Lenehan

It does. I am dealing with——

An Ceann Comhairle

Would the Deputy please listen? We are discussing an amendment in the name of Deputy Ryan.

Mr. J. Lenehan

I know that.

Mr. Childers

In any event, I am not going to start a debate on the difference between "shall" and "may".

An Ceann Comhairle

It does not arise on the amendment.

Mr. Childers

In legislation going back over the years I have been quite incapable of telling the difference between "shall" and "may".

Mr. Ryan

It seems to me that the combination of the sections to which the Minister referred would not enable a health authority to give assistance to a voluntary organisation for the provision or acquisition of premises. Section 65 of the 1953 Act enables a health authority to provide premises for use by another body but sometimes the best assistance that can be given is to provide a contribution towards the cost of premises to be acquired by one of these other organisations. It might sometimes slow up things if it was said "the premises must be provided by us and the service cannot be provided until we provide the premises". Perhaps, the Minister will have another look at this matter to ensure that a contribution could be given by way of cost rather than the actual provision of the premises, which might not meet all cases.

Mr. Childers

I will look into the matter.

Amendment, by leave, withdrawn.

Amendment No. 94 not moved.

Question proposed: "That section 66 stand part of the Bill".

Dr. Loughnane

I should like to see provision in the Bill for the following: the contribution of capital for voluntary bodies for buildings, machinery et cetera; capitation and training fees to be increased from £72 per annuam; the maintenance allowance while patients are undergoing training and have accommodation in hostels or digs or residential centres to be increased to a maximum of £6; grants towards the repair and renovation of premises and the renewal of machinery. There should also be provision in regard to sheltered workshops for the moderately mentally retarded and others who are too severely handicapped to come within the scope of rehabilitation facilities. I should also like to see provision in the Bill for the commencement of this type of training on a larger scale than at present. There should also be provision for capital expenditure on workshops, hostels and machinery, full re-imbursement of salaries and wages of all necessary staff and the provision of free transport for all attending on a day basis and a mid-day meal allowance.

Mr. Childers

Every effort will be made to provide as much aid as possible for these services but there will have to be voluntary effort and that effort is splendid at present.

Dr. Byrne

Could the Minister say if insurance is required where firms are taking in such people as epileptics who are more accident prone than others? Would it be possible to give some financial assistance in this regard?

Mr. Childers

I will look into that matter. I have not had any complaints about that and firms have been very good about taking people in either in sheltered workshops or providing employment in factories. The trade unions have also been extremely helpful.

Dr. Byrne

Many disabled people are in sheltered workshops.

Mr. Childers

I have made some prolonged visits to these institutions and discussed their problems. If the Deputy will give me particulars of anybody who has failed to get employment because of insurance difficulties, I shall be glad to take up the matter.

Mr. J. Lenehan

I welcome this very important section. We are told that a health board may provide equipment. Unless we make some change, there is no real responsibility to provide anything. As county councillors, we shall soon be losing control of them. Could the word "may" be substituted by "will" or even "shall"?

Dr. Browne

The discussion is largely academic. There are about 60,000 able-bodied persons who cannot get work.

Mr. J. Lenehan

No Labour man works.

Dr. Byrne

Certain jobs can be done just as well by disabled people as by able-bodied people. In some cases, disabled people are more willing to do them. They should be considered on their merits.

Question put and agreed to.

Section 67 agreed to.

SECTION 68.

Mr. Ryan

I move amendment No. 95:

To add to the section a new subsection as follows:—

"(2) No test shall be carried out under arrangements made by a health board without the prior consent of the person or parent concerned."

Section 68 very properly provides that the health authority will make tests to ascertain a disease, defect, condition, and so on. It is proposed that these tests will be carried out without charge, irrespective of a person's income. This is good. It is in accord with the very best in public health. The important point is to ascertain the presence of a disease, defect, condition, and so on, and to take corrective action. I want to provide that no test will be carried out except with the prior consent of the person or parent or guardian, where applicable. It is very important that the rights of the individual be protected in the future as in the past.

Mr. Childers

Section 4 of the 1953 Act is not being repealed. It provides that a parent must be consulted in the case of a child or person——

Mr. Ryan

I am satisfied.

Amendment, by leave, withdrawn.

Question proposed: "That section 68 stand part of the Bill."

Dr. Gibbons

I want to speak on behalf of those of us who are not convenient to a pathology laboratory. Some attention might be given to the question of containers for the despatch of these tests: they could be more convenient and more reliable. If this is not done the test will not be done. The biggest trouble with the test is the packaging and posting.

Mr. J. Lenehan

How could a health board know that there was anything wrong with anyone? Why is it not provided that the local practitioner will carry out the test?

Mr. Childers

The health board makes the arrangements.

Mr. J. Lenehan

How in the name of God can the health board know that there is anything wrong with anybody? We might as well be honest about it. Why not get that re-worded?

Mr. Childers

There might be an epidemic which might come to the attention of the board.

Question put and agreed to.

SECTION 69.

Dr. Browne

I move amendment No. 95a which stands in the name of Deputy O'Connell:

Before subsection (2) to insert a new subsection as follows:—

"( ) Any regulation made by the Minister under this section affecting members of the medical profession shall be made only after consultation with the representatives of that profession."

I presume the Minister accepts that no regulations will be made by him affecting the medical profession without prior consultation with members of the profession?

Mr. Childers

I do not think this amendment is necessary. The National Health Council, on which the medical profession is very strongly represented, must, by statute, be consulted in the making of regulations under the Health Act. A requirement for consultation is of little use in a statute unless there is good will between the body affected and the consulting authority. We have innumerable consultations with the medical profession. If the members of the National Health Council felt that they themselves were not entirely adequate to deal with what they regarded as some very serious proposal in relation to the operation of this Bill they would very quickly get the associations particularly involved to ask to see the Minister for Health.

Dr. Byrne

I think the reason for the amendment is that the two representative organisations of the medical profession might possibly be overlooked before any regulations are drawn up by the Minister in regard to this section. Everyone would be a lot happier if they were consulted prior to the drawing-up of ministerial regulations.

Sir Anthony Esmonde

Am I to take it that all the regulations the Minister introduces go before the National Health Council for consideration?

Mr. Childers

Regulations made under the Health Act all have to go to the National Health Council.

Amendment, by leave, withdrawn.

Dr. Browne

I move amendment No. 95b:

Before subsection (2) to insert a new subsection as follows:—

"(2) Regulations made by the Minister under this section shall make provision for the employment of medical officers in psychiatric services on a sessional basis and the designation as consultant psychiatrists of properly qualified medical officers engaged in such services."

This contains two components. The Minister is probably long enough in office—I realise he has been a short time in his present office—to know that in relation to the psychiatric service he is dealing with a very difficult problem. It is not uniform in any way, in its qualities or defects. He will probably have to apply himself to it with an enormous amount of dedication over the years during which he hopes to be in office.

I think the Minister knows that the designation of consultant is really in line with the recommendation of the Commission on Mental Handicap, in their report at page 131, recommendation 190. The whole pattern of the officers in the mental hospitals has changed. The old days are gone when the medical superintendent was appointed primarily as a farmer, and, secondly, as a clinical psychiatrist. We now have more emphasis on the clinical side, and less emphasis on the administrative side and certainly less emphasis on the ability of the medical superintendent to look after the farm. I doubt that the Minister will have any great objection to this proposal.

In the psychiatric service there is, of course, much greater cross-fertilisation clinically with the voluntary hospitals and the status and standing of the individuals in the voluntary hospitals, and the nomenclature of the individuals in the voluntary hospitals should be applied appropriately to the local authority hospitals. I am not a great defender of the local authority health services. I have in many ways criticised the voluntary services. I do not think anyone will deny—and I certainly will not deny—that the prestige of the voluntary services has been higher than in many aspects of the local authority services. I should like to go on hurriedly and say that the quality of service provided in many parts of the local authority service, in the county hospitals, the regional hospitals, the clinics, and so on, is of the highest possible standard. Wonderful work has been done also in relation to infectious diseases, and so on. There is equally no doubt that the quality of service in the voluntary hospitals is particularly high.

What we want to do is to take the best from the local authority service and the best from the voluntary hospital service and merge the two, and try in that way to get the best possible joint service for the community as a whole. Working as they do side by side with the voluntary hospital service, I think it is only rational to accept that consultant status will be accepted for the psychiatric service run by the local authority as it already is accepted for the psychiatric service run by the voluntary hospitals. As I say, it is also in line with the recommendation in the report of the Commission on Mental Handicap. I think the Minister is sympathetically disposed towards many of its recommendations.

There are other points which I will not raise at this stage. It is possible that the Minister is already in agreement with me and, for that reason, there is no point in my introducing other supporting points in substantiation of this proposal. I want to go back to the other component of this amendment, that is, the sessional basis. May I make haste to say that, as an individual, I do not agree with the idea of the sessional basis. I have always believed in the full-time medical officer. I do not believe in private practice or this kind of thing, but I am simply an individual in the service and I would not dream of trying to impose my own personal views on a group of individuals.

I put it forward for this reason. The Minister is finding it very very difficult, indeed, to staff the psychiatric hospitals. I think there are something like 140 vacancies, about 60 of those are occupied by temporary staff, and about 18 of those have the basic DPM qualification. The Minister is finding it particularly hard to staff the peripheral hospitals, the hospitals out in the provinces, with high quality and good level personnel. There are plenty of good level people in them but they are grossly overworked and are carrying an unfair burden.

One of the ways in which the Minister's predecessors got around this—and I include myself—was by allowing private practice. As I have already said, I believe in the full-time concept but, as Minister for Health, I accepted the realistic situation that a generation of doctors had been put out by the medical schools who believed in this type of practice, whether on a sessional basis or private practice. Therefore, it would have been absurd and futile to ignore that reality, and I accepted the principle of private beds and private practice in certain instances for the local authority doctor, in order to attract into the local authority service the quality of man I wanted for the community. I knew he would not come in as a full-time salaried officer. I knew he would come in—and many of them did come in and are giving excellent service in the local authority service—if they had either private beds or private practice. As a by-product of this I got the service which I wanted for the community from high-level and high-quality practitioners, surgeons, physicians, anaesthetists and gynaecologists.

I would put it to the Minister that of the two, sessional as opposed to private, there is a greater danger in giving permission for private practice in so far as you can give a basic salary to an officer and he can then carry on a private practice. We have the old dichotomy of interests which we find in general practice and, again—I made the case for this earlier and I do not want to repeat it—the need for a one-level service which can be established only by a fee for service, or direct payment, or whatever it may be.

Where there are two types, private patients and public patients, there are two qualities of service. The better the doctor is the more likely he is to be drawn away by his private practice from his local authority practice. It is very difficult to curb this. There may be a genuine need for him. He may be of a quality that is badly needed by the people who can afford to pay him. There is this division of interest which eventually will lead to the officer in the local authority service probably spending much too much time in his private practice and much too little time in his public practice.

The Minister's predecessor—and I think he is too—was inclined to accept the reality of this situation in his proposal on the fee for service principle in the new general medical service. On the other hand, on the sessional basis the health authority know precisely what they are paying for. The usual thing is to divide the week into 11/ 11ths and a person does 9/11ths or 3/11ths or whatever it may be. It may be two sessions a day or two sessions a week or five or six sessions, whichever he chooses, but the health authority know what they are paying for.

They know they are getting value for money because a person has to be there for a specific period and has to attend full-time at health authority work. For that reason I think it is a safer device for the Minister if he is not going to have a full-time officer. If he must attract high quality personnel into the psychiatric service, it would be wise for him to move over more towards this idea of a sessional basis rather than a private practice basis also as there is this interchange between the voluntary private and the public local authority hospitals. He already has accepted the principle of the sessional basis where he uses a private voluntary psychiatrist in the local authority service. That is already in operation, so he is not creating a precedent; the precedents are already there. For that reason it is not in any way a great break away from what is already accepted by the Minister.

There are certain occasions when a health authority may require limited service from specialists within the service. In this way they could avail not only of the private voluntary type doctor, specialist, or consultant whom it already uses, but also might make use of their own specialists or consultants by being able to employ them on a sessional basis. I recommend this subsection to the Minister as an attempt to help him to deal with what I happen to know is going to be his greatest single problem, the upgrading of the psychiatric services. In some areas they are extremely good. In Dublin they are improving at a very rapid rate, and in areas down the country they are at an extremely high level. However, there are other areas in which they are regarded as being fairly backward.

Dr. Byrne

I agree with Deputy Dr. Browne that this is a quick and a very good way out and, if I may say so, a way in which we can obtain the services of some of the best qualified people in this field to work for the benefit of the community. I have found from my own personal experience that those who were employed on a public capitation basis and had also a private practice, gave no preference to the private patient over the public patient. I might go as far as to say from my short experience of working with consultants employed on a sessional basis in the voluntary hospitals and the local authority hospitals that, if anything, they seem to give service to the public patients way above what they are giving their private patients. I would fully support the employment of doctors on a sessional basis.

Mr. J. Lenehan

I agree with what is provided in this section but there is one flaw in it and it is a major one, that while we are now prepared to provide first-class treatment for the psychiatric patients, we have no method of testing, as far as I can see in this Bill, the psychiatrist, to know who is the bigger lunatic.

An Leas-Cheann Comhairle

The Deputy will have to keep to the amendment.

Mr. Childers

That does not arise on this section at all. We have already dealt with the possibility of local inquiries into the discharge of duties by servants of health boards. Health boards no doubt will arrange for an inquiry into the employment of a psychiatrist who is a lunatic.

I have the greatest sympathy with everything that Deputy Dr. Browne has said. As he probably knows, we have not used a brake on the recruitment of psychiatric staff; in fact we have not turned down any proposals for psychiatric staff for several years. We gave encouragement to the recruitment of extra medical staff and agreed to many proposals for the improvement of the Dublin psychiatric service. We also took the initiative in the encouragement of the establishment of a chair of psychiatry in Cork and Galway. We do not need the amendment to examine everything that has been recommended by Deputy Dr. Browne. I can assure him that under existing provisions we can examine the method of the employment of psychiatric staff and the description of their posts. There is a committee now sitting considering means of improving recruitment of psychiatric staff and it will almost certainly make recommendations in regard to the matters raised in the amendment. The Medical Association and the Medical Union have also submitted a memorandum to us and to this committee and they make recommendations also on the lines that have been suggested in the Deputy's amendment. I quite agree with him about some of the nomenclature of officers employed as psychiatrists. The Deputy will be interested to know that this memorandum will be discussed on 17th December, the memorandum which embraces proposals which relate to everything the Deputy has been saying.

I absolutely agree with him about the psychiatric services being provided on a sessional basis by private psychiatrists when this fits in with the general plan. When the regional hospital boards get going one of the main objectives behind their activity will be trying to integrate the voluntary hospital services and the public health services to a far greater degree than ever before. At the same time we do have to have regard to the fact that there are many full-time posts that ought to be filled. We have given a grant for postgraduate teaching to psychiatrists. All these matters will be discussed some time in January at a general meeting of all resident medical superintendents, officers of my Department and other persons at which all the recommendations of the mental illness report— which I am sure the Deputy agrees with me was an excellent one—will be examined to establish priorities, to see how the improvements in the recommendations of the report that have already been adopted are working, and in order to go over the whole of this problem which has become very urgent. I agree with everything the Deputy says. We still have to realise the importance of mental sickness. I suppose it is true to say that, if you asked six people what they meant by sickness, five out of the six would still think only of physical sickness. There is some change coming over that, but we shall have to do a great deal on the line suggested by the Deputy for the improvement of the psychiatric service. However, I am glad to say no amendment is required in this regard.

Dr. Browne

I appreciate the Minister's undertakings.

Amendment, by leave, withdrawn.

Question proposed: "That section 69 stand part of the Bill".

Mr. Childers

Representations have been made to me to change the present position under which persons injured in road traffic accidents are entitled to avail themselves of the hospital services in the lower or middle income group without any liability to refund either the hospital or the doctor falling on the insurer. The Deputy has mentioned it and other Deputies have drawn my attention to it. We have found that the only way we can deal with this matter is to approach it rather differently from what was first of all suggested. We could include a section which would specifically allow health boards and doctors to recover charges from insurers in respect of eligible persons treated in road accidents. I am told it would be very difficult to draft a positive provision which would not be open to evasion, particularly in cases where compensation was paid without admission of liability. We are going to use the provisions set out in subsection (2) of section 69, which provides that:

Regulations under this section may provide for any service under this Act being made available only to a particular class of the persons who have eligibility for that service.

The primary purpose of this subsection is to allow for a deferment of the general application of the service and it is based on a corresponding section enacted in 1954. I am advised that it can also be used to make a provision in the regulations which would exclude from eligibility to hospital services any person injured in a road traffic accident unless he could establish to the satisfaction of the chief executive officer of the health board that he had not received or would not receive damages or other compensation in the nature of damages from any person in respect of the injuries received. I think the question of liability in the case of road accidents will be more satisfactory and flexible in this way. The person injured in a motor accident will be sent the bill for the hospital services and it should be quite easy for him to prove whether he can furnish evidence that he is insured and that the bill can be paid by the insurer.

Mr. Ryan

I welcome the Minister's announcement. I have been pressing the Minister for some time to do this and I am sure he will forgive me if I express a few reservations and make a few suggestions with regard to the method. Under the old Workmen's Compensation Act if a worker applied for compensation one of the queries on the form was: "Is a civil injuries action contemplated?" and if that was the case it then required the worker to furnish the name and address of his solicitor. The effect of that was that the Department could keep in contact with the solicitor who was formulating the civil claim for compensation and in due course if compensation was made then his compensation was repaid. While I agree that it is proper to present the bill, I think the health authority should, on such presentation, have a note of recommendation to the person affected to refer the bill to his solicitor if he was formally to claim for injuries and, if he was not formally making such a claim, to contact the health authority and explain the circumstances. I think it would be wrong to put the injured person in fear that they would have to meet the full bill. An explanatory note would be in the nature of an encouragement to these people to present accounts to their solicitors in order that the matter could be included in the claim.

Mr. Childers

We shall arrange for an explanatory note.

Question put and agreed to.

Sections 70 and 71, inclusive, agreed to.

SECTION 72.

Question proposed: "That section 72 stand part of the Bill".

Sir Anthony Esmonde

Is the provision in section 72 something new in legislation?

Mr. Childers

Section 72 re-enacts the same sort of provision in the 1953 Act. The fines have been increased from £50 to £100 in order to bring them into line with present-day standards.

Question put and agreed to.

Section 73 agreed to.

SECTION 74.

Question proposed: "That section 74 stand part of the Bill".

Mr. Ryan

Would the Minister say what the present legal doubts are which have been cleared up by this section? I know some alteration has been made, and while I studied it some months ago, it escapes me at the moment?

Mr. Childers

This section aims at clearing up the legal problem with respect to the removal of bodies found in public places. There has been confusion about the legal responsibility in this respect in the past. Sometimes there was a long and undesirable delay in the removal of decomposed bodies to appropriate premises. I do not want to go too far into these tragic circumstances, but this section puts it on the health board to clarify arrangements for removing such bodies to appropriate premises. We do have to get the consent of the Minister for Justice because of the question of registering subsequent criminal or other legal proceedings.

Mr. Ryan

I think the difficulty stems from the fact that the body may be decomposed or in an objectionable condition, but much of the difficulty arises because of the objection to use ambulances. It has been argued that ambulances are for the removal of live people and not dead people. At one time it was obligatory on publicans to receive bodies. One famous place was called "The Morgue" and another was called affectionately "The Dead Man's". These names still obtain. I think that obligation was abolished by a liquor Act.

Dr. Byrne

Can ambulances refuse to take away a body from a private residence?

Mr. Childers

A circular was sent to health authorities some years ago telling them that they should use ambulances for removal of a dead person.

Dr. Byrne

From a private residence?

Mr. Childers

Yes.

Question put and agreed to.

NEW SECTION.

Mr. Childers

I move amendment No. 95c:

In page 32, before section 75, to insert the following new section:

(1) The Minister may make regulations for the control of the possession of a substance to which this section applies.

(2) Regulations under this section may provide for the prohibition of the possession of a substance to which the regulations relate, except by persons or classes of persons specified in the regulations and in circumstances and under conditions specified in the regulations.

(3) A person who contravenes or attempts to contravene a regulation under this section or who solicits or incites another person to contravene such a regulation shall be guilty of an offence.

(4) Every person guilty of an offence under this section shall be liable—

(a) on summary conviction thereof to a fine not exceeding one hundred pounds or to imprisonment for any term not exceeding six months, or to both such fine and such imprisonment; or

(b) on conviction thereof on indictment, to a fine not exceeding five hundred pounds or to imprisonment for any term not exceeding five years, or to both such fine and such imprisonment,

and the court by which the person was convicted may order the forfeiture, and the disposal in such manner as the court thinks fit, of the substance in respect of which the offence was committed.

(5) (a) Section 31 of the Dangerous Drugs Act, 1934 (which empowers a Justice of the District Court to issue a search warrant in certain cases), shall apply to the possession of a substance to which regulations under this section relate as if it were a drug, substance or product referred to in the said section 331 and the regulations were made under that Act.

(b) Section 32 of the said Dangerous Drugs Act, 1934 (which empowers a member of the Garda Síochána to arrest without warrant in certain circumstances), shall apply to an offence under this section as if it were an offence under that Act.

(6) This section applies to any substance which may be used in the prevention, diagnosis or treatment of any human ailment, infirmity, injury or defect, or for the modification of any human physiological function, and which, in the opinion of the Minister, produces or is capable of producing depressant, stimulant or hallucinogenic effects on the human central nervous system.".

The purpose of this section is to enable the unauthorised possession of certain classes of drugs, which are liable to abuse and which do not come within the scope of the Dangerous Drugs Act, 1934, to be made a punishable offence. The Garda have made representations to us from time to time, as have Deputies, that the absence of such powers in relation to drugs such as the amphetamines and LSD has been hampering their efforts to deal with the problem of drug abuse. The Government have already approved of the preparation of legislation to deal with this matter as part of the much wider measure in relation to the control of drugs and poisons generally the drafting of which is at present in hand and which I hope will be introduced into the House as early as possible next year.

I thought we must do something about the drug abuse in the interim period and that some appropriate action should be taken as a matter of urgency with a view to containing the present problem of drug abuse. So we decided to take the opportunity afforded by the present Health Bill to introduce this provision as an interim measure pending the preparation of the more comprehensive legislation to which I have referred.

Under the Dangerous Drugs Act, 1934, already, unauthorised possession of narcotic drugs, such as opium, morphine, heroin, cocaine, hemp, cannabis and a number of synthetic narcotics, pethadine, methadone, et cetera, is an offence. Other drugs which are liable to be abused in the same way as the narcotics and some of which may produce physical or psychological dependence are controlled only to the extent provided for in the Medical Preparations (Control of Sale) Regulations, 1966, which were made under the Health Acts. The drugs covered by the regulations include the amphetamines, barbiturates and tranquillisers. The controls prohibit the retail sale of these substances to the public by persons other than pharmaceutical chemists, dispensing chemists, druggists and registered druggists and then only on the prescription of a doctor, dentist or veterinary surgeon.

We are now about to introduce even more stringent controls over the availability of amphetamines following consultations which I have had with the medical and allied professions and other interests involved. These additional controls will help to reduce still further the opportunities for obtaining supplies of these preparations for illicit use. There must be a provision to enable us to make unauthorised possession a punishable offence. This will enable the Garda to deal with persons who have such substances in their possession for intentional misuse irrespective of the source from which they were obtained. The section will enable me to make regulations prohibiting the possession of specified substances of a kind to which the section applies except by persons or classes of persons in circumstances and under conditions specified in the regulations. The enforcement of these regulations will be a matter for the Garda Síochána but I should make it clear that the powers of the Garda will be the same as their existing powers under the Dangerous Drugs Act in connection with the prosecution of offences under this Act.

In the wider measure we intend to introduce and recommend to the House procedural changes which may simplify the task of the Garda in dealing with any offences and the House will have an opportunity of examining these as soon as the Bill is introduced in the House. This is yet another step in the number that we have to take to reduce the consumption of dangerous addictive drugs. The doctors in the House will know, and others may know, that the amphetamines are in very large degree replaceable by other anti-depressant drugs which are not in the main addictive. Therefore, our decision to control the use of amphetamines, which has been fully agreed to by a very representative group of the medical profession, does not mean that people will be unable to get the beneficial effects of amphetamines in a different form and/or amphetamines if we can arrange for a licensing system which will enable people who need them for special reasons to get them. I hope that I will have the full support of the House in making it illegal to possess these very dangerous drugs unless they have been procured and are being used in a proper way on the basis of a prescription and under regulations which we will provide.

Mr. Ryan

On behalf of Fine Gael, we certainly welcome the inclusion of this section in this measure. It is very necessary, as the Minister has emphasised and it is only, of course, one small part of the steps which must be taken to deal with the terrible menace of drugs.

We have one fear, however, that is, that anxious as the Minister is to have this power and to give the Garda the power, it may be some time before it is brought into operation. Would I be correct in thinking that there is nothing to stop the Minister on the passing of this Bill to apply this long before many other sections which quite clearly cannot be applied until elaborate negotiations are completed and machinery is set up? Once the Minister has made the regulations under this section there would appear to be no reason why the section should not be implemented rightaway. Speed is important. This problem is growing in our community and any community that has had it—and we are one of the last to have it—found that it multiplied and ran ahead far in advance of legislation to control it. We, therefore, should not delay in any way in any of the steps which are desirable for the control of this terrible problem.

Dr. Browne

Naturally, we will support this measure by the Minister to help him to deal with the problem of drug addiction. He tells us that other measures are coming along which will be more comprehensive. Quite honestly, I am sorry to have to tell him that while it is true, as he says, that amphetamines are replaceable as antidepressants, they are also replaceable as addictive forms of drugs. That is the sad truth, that he is going to stop people getting hold of these amphetamines and they will simply switch over to something else. That is one of the patterns of drug-taking which is emerging in Dublin, Cork and Galway, there is such a diversity available.

The Minister is more than welcome to the amendment and we will have further discussion, I presume, on this whole question of drug addiction later on but I wish he would be careful about choice of words in this problem. He should try to look on it as an illness. "Punishable offence"—this, of course, is something about which I have very definite views—the whole approach to criminality and criminology generally, the whole idea that somebody who does something wrong is a criminal and must be punished or that someone who has done something bad should be punished. That is a view that I do not share. The Minister could look at this type of thing as an illness or an emotional disturbance of a mild nature or a serious nature depending on the severity of the addiction and whether it is soft or hard drugs.

The Minister should approach the problem in a more sympathetic way and he will get every help from us in doing whatever he can. He must think of drug addiction from the point of view that it is very like smoking and drinking, which are quite acceptable social habits but which are founded essentially in some mild neurotic illness. The Minister will find that he will have to look at the drug addict with none of the anger and disapproval with which society generally tends to regard him. The Minister will have to have a sympathetic understanding of and a compassion for the drug addict. Drug addicts are very unhappy people. Addiction is due to emotional illness and we must do all we can from a medical and psychiatric point of view to help these hapless addicts. We must remove the causes which create this kind of psychological disturbance in young people. That is our biggest problem really because it arises out of the structure and mores of our society which produces youngsters who can only cope with their emotional problems by indulging in some kind of drug.

On the whole, the press has dealt very sympathetically with these drug addicts. Our communications media in general have dealt with drug addiction in a compassionate way and the result is there is not now so much antagonism. Indeed, there is a good deal of sympathy for these people amongst a significant number of influential people. I have had some dealings with the Garda and I have found them wonderfully understanding in their approach to and their handling of this problem. It is a growing problem and, like some of us on the medical side, they are at a loss to know quite what to do. The problem is a serious one and we are at a loss to know how to deal with it because we are dealing with a product created long before we came on the scene at all; I refer to the behaviour pattern that develops as a result of different factors—alcoholism, broken homes, an institutionalised existence, and so on. These are things over which we have no control, but it is very important that we should have a full understanding of them because the youngsters have no control over them either. They are the innocent victims of a set of circumstances which turn them into drug addicts in order to satisfy their particular emotional needs. I am frequently fascinated by my psychiatric colleagues who lecture these youngsters—we have different views naturally—about the evils of the habit while they themselves are happily smoking. The Minister, I think, smokes a pipe. Most of us take a drink. We should at all times try not to let the punitive element enter into our legislation. There should always be understanding and pity. There should, as I said earlier, be compassion for these unfortunate youngsters who are really very, very unhappy. It is not as if they even get enjoyment out of drugs.

A special unit has now been established and I hope it will do very good work not alone in treating the young people but also in the fields of research and education in order to find out the best way to help these people. No one knows the solution or the answer to this problem—we are all agreed on that—particularly from the point of view of the hard drugs. It will have to be dealt with as a special problem unique to our society; we shall have to find its origins and deal with it as best we can.

The Minister will have to decide on the proper approach. Will it be hospitalisation or imprisonment? No doubt he knows something about the British approach. It is rather permissive. The United States approach, on the other hand, is prohibitive. It is authoritarian. The danger in the American approach is that it drives the drug traffic underground because of the punitive measures adopted to curb it. In Britain they at least know the size of the problem and they deal with it in a more humane way and keep it within bounds.

I would ask the Minister to be very, very careful in this legislation. I do not think it will make a great deal of difference really because the youngsters will simply switch to something else. When, however, he introduces his more comprehensive legislation I hope he will bear in mind the fact that these youngsters must be treated as sick people. It will be quite useless punishing them. Punishment, or the threat of it, will only drive them away and no one will ever get near them to help them.

Mr. Childers

I quite agree.

Sir Anthony Esmonde

I welcome the Minister's statement on the action he proposes to take. I also welcome the fact that this is but the forerunner of further legislation. We have all become aware of the problem of drug addiction. It is not peculiar to this country, but there is a tendency to brush it aside and pretend it does not really exist. The drug traffic is a worldwide racket. There is a great deal of money behind it and a great many people are making fortunes out of it. The way in which these drugs are imported is usually through sailors. The Minister should do his utmost to find out how these drugs get into the country so that they can be stopped at source.

In this, the Minister is endeavouring to control certain drugs in an effort to control the very serious drug taking that exists. The major step would be to try to cut off supply. Other countries were not, perhaps, alert to the situation and suddenly found themselves with an enormous problem.

I support Deputy Dr. Browne's plea for a sympathetic approach to addicts. Anyone who takes drugs is to be pitied. The people I am anxious to get at are those who create the problem in the first instance. It is true, I think, that drug addiction is a malady of seaport towns and cities. We have it in Dublin, Cork and Limerick. In the not too distant future, unless the traffic is checked, it will become a problem of the hinterland too. In fact, it has already extended into the hinterland and that development has not just occurred in the last year or two. I hope the Minister will introduce the necessary legislation as soon as possible and I hope that legislation will deal most effectively with those responsible for this illicit and infamous traffic.

Progress reported; Committee to sit again.

The Dáil adjourned at 10.30 p.m. until 10.30 a.m. on Thursday, 4th December, 1969.