In discussing this Supplementary Estimate covering last year's affairs in the Department of Health I should first like to refer to my disappointment at the fact that the Minister has not been successful in bringing into effect the free choice of doctor scheme. I know there were prolonged negotiations with the medical profession extending over years and I have seen dilly-dallying by the Government, by the Ministers, since the late Deputy O'Malley introduced the White Paper on health services. To give the present Minister due credit he has tried in every possible way to meet the doctors and discuss the matter. He has not been anxious for a breakdown or an impasse and I commend him on his decision to reopen negotiations as a result of the questionnaire prepared by the Medical Union. I am not certain a solution will be found as a result of these negotiations but the great pity is that the scheme was not introduced before now.
We know that the dispensary system is obsolete. It has carried with it humiliation and degradation for patients who had to avail of it. It was a startling revelation in this House to find that patients attending dispensaries had no record cards of their ailments or illnesses or dispensary visits for the information of the dispensary doctors. This is a disgraceful state of affairs. There was no record of patients attending dispensaries and no means of ascertaining the numbers of patients attending any one session at a dispensary. The fact that this has gone on for years is deplorable. It is no wonder information is not available to the Department or to the House on visits by patients to dispensary doctors. Neither do we know the prescribing habits of the dispensary doctors. In the near future when the Minister reaches agreement with the doctors I hope he will ensure that a proper clinical record card is produced for use by doctors so that we can have up-to-date information on patients' illnesses.
The deficit on the voluntary hospitals is considerable. I am not surprised. I have long been an advocate of the short stay for patients in hospitals since I first wrote from my practice to Deputy MacEntee, former Minister for Health. I saw patients being detained unnecessarily in hospitals because no effort was made at streamlining the system or the consultant was unavailable when cases should have been discharged. When it is realised that the cost of maintaining a patient in hospital is £30 to £32 per week it is disgraceful to have patients detained unnecessarily. Many factors play a part in this. It is dreadful that X-ray departments should close at 4 p.m. or 4.30 p.m. when, with no great effort, we could have them operating on a 24-hours basis so that patients could be admitted, say, on Friday and not left until the following Monday before investigation begins. This is the cause of the tremendous rise in the deficit for voluntary hospitals.
I have asked time and again that a committee be set up to investigate the length of stay of patients in hospital. I have seen patients admitted on Friday afternoon and hospitals commenced tests on the following Monday. With the demands made on X-ray and other ancillary services, it is quite wrong to find that these laboratory and X-ray services close at 5 p.m. or 5.30 p.m. It is sad to think that expensive and useful equipment is not fully utilised. This is what is wrong with the system and it is now the cause of the high deficit for voluntary hospitals.
Now is the time to talk about this. I should like to see X-ray departments asked to change their whole system of working so that they can work on a shift basis. The same applies to laboratories. This matter is too important and too expensive and the change should be made if we are to cut down the cost of hospitalisating patients. We must tackle this immediately. It is constructive work towards lowering hospitalisation charges. What I am complaining of represents the major part of the £32 per week cost of maintaining a patient in hospital. This is the built-in factor. It results in patients being detained unnecessarily, especially when they are in for investigation.
Also because of the short hours which X-ray and other hospital departments are working patients are being admitted, who should not be admitted to hospital for investigation. Doctors who would be glad to have patients investigated in the out-patients' departments find that the delay is too long and that it is quicker and simpler to have the patients admitted to hospital. This is unnecessary admission of patients to hospital and is the cause of the high cost of hospitalisation. It is a very important factor and I would ask the Minister to look seriously into this. Recently I made a survey among doctors in regard to this problems and I found that doctors were dissatisfied with the hospital appointments system because patients had to wait so long. They found it easier to admit the patients to hospital. This confession by doctors shows something radically wrong with the system. It should be possible to streamline out-patient departments so that patients could have the fullest intensive investigation on an out-patient basis and need not be admitted to take up beds which cost so much.
We have another big problem on our hands, the problem of the terminal patient, say, with cancer who is in the last stages of his life and needs nursing care and, perhaps, narcotics or pain relievers in the final stages of his life. It is an unchristian attitude we adopt in not accepting these patients. We look upon them as if they must be forgotten about and allowed to die without any care or attention. Families are left with this terrible burden because no hospital is prepared to give facilities for them. We can have sophisticated, elaborate hospitals like St. Luke's to treat cancer patients. Personally, I do not agree with calling any hospital a cancer hospital and the sooner we get rid of that idea the better. These cancer hospitals should be units attached to general hospitals. Let us get rid of these cancer hospitals immediately because there is a terrible fear in everybody's mind when cancer is mentioned.
It seems ridiculous that we should be talking about this when these units could very readily be provided as part of a general hospital. I seriously ask the Minister to consider this aspect. This cancer hospital and the other hospitals which provide treatment for cancer provide acute treatment but when they say further treatment is of no avail the patient is sent home. There should be provision for some unit to be attached to general hospitals for terminal cases. Many doctors have had to lie over and over again to bend the regulations to get those patients into hospital for treatment. This affects every one of us in our families one way or another. None of us is completely immune from this. It can affect our fathers, mothers, brothers, sisters or ourselves. It is nice to think there are facilities for those patients to get this care and attention in their final stages.
I am delighted to see that nurses at long last are being treated as ordinary human beings. We have too often heard the saying: "It is a vocation; it is a dedicated life and they must be prepared for it". I have seen nurses in hospitals doing the worst possible tasks although they were doing them very gladly. When I was working in hospital on a 12-hour shift the nurses were expected to be on their feet all day at the ridiculously low salary they were getting. They were living in the Victorian era up to quite recently, until the time the late Donogh O'Malley saw fit to recognise the fact that they must be treated normally. Nursing is a vocation. I would not like to see the stage being reached where nurses were far removed from the nursing care of their patients. I would like to see a proper national college of nursing. I would like to see them receiving university training and I would like to see them brought completely up to date on every aspect of medical care and medical treatment. I would not like to see them, as I have seen them in America, so far removed from the patients that the patients represent numbers on a chart.
We will have to face the problem that we will have a more severe shortage of nurses in this country. There are too many opportunities for girls in other professions and they will not be attracted to the dull, menial tasks which some of our nurses are asked to perform, which are not necessarily associated with the care of the patients. A few years ago I was in the Mater Hospital in Dublin and I saw a nurse on a tall stool washing the wall. I asked the sister if this was part of the nursing care of the patient, and she said that this was proper training for nurses. It is intolerable that nurses should be asked to do such things. They should be asked to perform nursing duties alone.
I would like to see the establishment of the assistant nurse who could help with basic nursing chores which would help the trained nurse in every way. The Minister should not completely discard the idea of assistant nurses. When we get fewer and fewer nurses we will have to think seriously of assistant nurses, who would be trained in basic nursing care but who would not have the skill nor the knowledge that the generally well-trained nurse would have. We should talk about this now instead of waiting until we face the acute shortage of nurses, which is likely to arise in the near future.
I was disappointed recently to find that some hospitals still charge fees for nurses during their training. This is not right. There are many girls with a special flair for nursing, with the ability and with the talent, who are deprived of the opportunity of taking up nursing in this country because they have not got the requisite fee. The sooner we get rid of this fee the better because a girl more than pays her way in her training as a nurse. In a teaching hospital in Dublin the wards are staffed by student nurses. They are performing daily nursing jobs and it is disgraceful that they have to pay a fee.
I saw recently that a doctor was involved in a case of not attending at the scene of a road accident. This raises the question as to whether or not the Department of Health should seriously look into this problem because this regularly happens. Admittedly doctors have no legal obligation to attend those cases. Many of them feel that they cannot do much at that time and this is quite true. They may find themselves depriving their own patients of the care and attention which they need by attending road accidents. Their absence may involve many hours, especially in rural areas. Doctors realise when they attend the scene of an accident and render whatever medical care they can, they have to attend in Dublin at a later stage for insurance purposes. This is something doctors are loth to do.
I can readily understand a doctor's point of view but the public have a point of view as well. They say that it is unchristian for a doctor not to attend a road accident. I feel strongly that we must have a proper road accident emergency service with properly equipped ambulances somewhat on the lines of the cardiac ambulances that provide full care for patients from the time they are brought into the ambulance. Attached to those ambulances must be properly trained casualty officers so that from the time the patient is put into the ambulance immediate anti-shock therapy can be applied.
There were over 532 deaths last year and I maintain many of these deaths could have been avoided had emergency care been provided by properly trained men at the time the patient was put in the ambulance, such as therapy by way of infusions against the shock which kills the patient on the way to hospital. How often have we read: "He was dead on admission to hospital"? In many cases this need not have happened. We are going to face the problem of more and more road accidents and we have got to have a properly equipped road accident service to deal with this problem. I am making these suggestions because I do not think it is good enough for a Deputy to criticise without making constructive suggestions as to what can be done. Something must be done if we are ever going to reduce the holocaust on the roads. If a properly equipped ambulance with trained casualty officers can be available on 24 hour call this would help. What does the cost matter if we can reduce the number of deaths?
The financing of the health service gives every Deputy food for thought as it must the general public who have to pay for it. While I have made some suggestions as to how costs could be reduced we must seriously consider how to reduce the tremendous burden on the rates, which is the cause of so much concern. We all realise that health charges are increasing. The health service must be financed from the Central Exchequer. The Minister must realise this and if he is going to realise it next year or the year after why does he not face up to it now? Health insurance must be paid by the general public including farmers, civil servants and all those who do not pay insurance at the moment, so that we can have a proper health service. The only way we can properly finance the health service is by graded insurance so that the man on the small income would pay less than the man earning £30, £40 or £50 a week. Besides extending contributions to a larger section of the community we can spread the load more evenly by graded insurance.
The burden of the health service is becoming worse every year and we must try to solve the problem. Dublin ratepayers were shocked to hear the latest increase. They have no way of protesting against these increases. No one seems to think about what it will be next year or the year after. In two or three years time we might be paying £7, £8 or £9 in the £. It is already over £5 in the £. It is terrible to think that no one is doing anything to stop this; no one is suggesting that we can finance it from the Central Exchequer and thereby spread the load more evenly.
With the aid of the Civil Service it should be possible to devise a scheme that will spread the net over a larger section of the population so that the burden will be less on those who are needy. The rate increase is a worry beyond words to people living alone. They do not know how they will face this extra burden. I know people with small houses and the rates on them are crippling them. I know of people who would be glad to dispose of their houses but they cannot do so because they know they will never get a flat from Dublin Corporation. It is terrible that we are faced with this problem again this year.
