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Dáil Éireann debate -
Tuesday, 30 Mar 1971

Vol. 252 No. 10

Committee on Finance. - Vote 48: Health (Resumed).

Debate resumed on the following motion:
That a supplementary sum not exceeding £6,575,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1971, for the salaries and expenses of the Office of the Minister for Health (including Oifig an ArdChláraitheora), and certain services administered by that Office, including grants to Local Authorities, miscellaneous grants and certain grants-in-aid.
—(Minister for Health).

On Thursday last I referred to the problem in relation to the ambulance service in rural areas. I asked the Minister to institute an ambulance service which would ensure that a qualified doctor would travel with each ambulance to the scene of an accident.

On a point of order —perhaps it is not a point of order— I am trying to see that the standard of debate in this House would conform with some of the recommendations made by the two Opposition parties. However, the Deputy is repeating himself because he made this statement the other day. Are Deputies entitled to repeat their statements?

That is not a point of order.

If the Deputy has already dealt with the point, it would not be in order for him to go over it again.

I agree that I have dealt in some depth with the question of the ambulance service and with the possibility of a doctor travelling with each ambulance to the scene of an accident but I should like to qualify that and to expand a little on it. What I am proposing is that a doctor travel with an ambulance to the scene of an accident if the extent of the accident should warrant immediate medical attention. The doctor would then be able to commence vital anti-shock therapy on the way to the hospital as well as any first aid treatment that might be necessary. That is all I wanted to say in that regard.

The other point I wish to make is that articles 28 and 36 of the Road Traffic Regulations of 1963 forbid a doctor to have any implement on his car which would enable him to travel through dense traffic to the scene of an accident. Unless a doctor is permitted to have such a device on his car whereby he could proceed independently to the scene of an accident, it would be necessary to have a doctor on call at the ambulance station so that he could travel with the ambulance.

I have not very much more to add to this debate except to say that I would like the Minister to publish the report of the commission he set up to inquire into the subject of drug abuse in Ireland. I did not mention this the last day because I was speaking on the drug situation in a detailed way, but I am sure that the people the Minister has appointed to this commission have compiled some very interesting facts and made some suggestions for tackling this problem.

A previous speaker compared cigarette smoking with smoking marijuana. I do not think it is right—and I am sure the Minister will agree with me—to compare the known with the unknown. We know that cigarette smoking is injurious to health. We know that many beds in our hospitals are taken up by people suffering from the effects of cigarette smoking. These are not limited to sufferers from lung cancer but from many other illnesses. To compare cigarettes with a drug about which very little is known is not completely accurate.

Very little is known about marijuana and conflicting reports come in. One of the latest reports is from Oxford. No doubt the Minister has it. According to that, marijuana can be a dangerous substance which could endanger health and it can be stored up in the body. Their investigations were made possible because of a grant of £10,500 by the Medical Research Council in England. We have no such research into our drug abuse problem in this country. We have a terrible problem among younger people here the vast majority of whom are suffering under-lying personality disorders. There is also an overriding sociological factor in that either one or other of the parents is missing, dead or suffering from alcoholism.

Following appeals by Deputy L'Estrange in 1966 and by Deputy Clinton in 1968 an effort was made to nip the problem in the bud. Appeals also are still being made to do something about drug abuse. In the city of Dublin some effort is being made to deal with this problem but something should be done for the country as a whole because the problem is not confined to Dublin. It is a problem which recognises neither social status nor creed. The problem was not fully appreciated in the United States until it emerged from the Negro and Puerto Rican ghettoes into the upper and middle class areas. In that country there were 1,050 deaths from drug abuse last year.

We know the efforts made in St. Dympna's Home on the North Circular Road were fruitless. Out of the total number of patients treated there only one could be described as having been cured. I do not know if the cure is permanent. I should like to criticise the efforts which have been made to set up an outpatient treatment centre in this city. I am speaking of the centre in Jervis Street Hospital. Here we are repeating what has happened in Piccadilly Circus in England. This is a central meeting point for drug addicts on a purely voluntary basis. It is a meeting place at which they can discuss the latest sources of drugs. The service is inadequately staffed and no adequate treatment is available. Verbal advice is available there but no concrete medical treatment. It is an information centre and it is a centre for passing drugs, similar to Piccadilly Circus. Numerous people who attended there stated that and are not impressed by it.

Would the Deputy give the source of his information? He seems quite certain of it all.

We know that in this city there are many minor sub-culture migrant groups which form the major part of the drug taking section in the population. We also have information, or there are indications from drug abusers, to the effect that LSD is being manufactured in this city. I should like the Minister to tell me in his reply whether there is any law against the manufacture of LSD in this country or whether there is any law against the growing of marijuana in this country. It is only a short time ago since the only law which prevented one person from selling drugs to another was the lack of a 5s hawker's licence.

The majority of teenagers who were treated in St. Dympna's clinic were between the ages of 14 and 19. These minor sub-cultural migrant groups could in a way, as has been mentioned to me, be compared with an organisation similar to the resistance movement. They will travel from country to country and help people of their own sub-cultures who have got into trouble with the law, who have gone into hospital and who are in some way affected by our social standards.

The hippies of this country, which the gardaí recently confirmed exist, use two main types of drugs—marijuana and LSD. Both of these drugs are readily available in this country. Recently it was reported to me that a certain individual walked into a public-house with over £100 worth of LSD tablets in a matchbox. The reason he had gone over to peddling LSD instead of marijuana was that he could carry £100 worth of LSD in a matchbox but for the equivalent amount of marijuana he would have to carry a big brown parcel under his arm. It is not for me to say what the dangers of LSD are They are well known.

I think it is a tragedy the Minister has not given a grant to a team of responsible people composed of a psychiatrist, a psychologist and some lay person, duly qualified, to do some reserch into the drug addiction problem here instead of tackling it in the amateurish way in which they are forced to do it because they have not got the funds to launch any good investigation.

There are a reported 2,700 addicts in the North of Ireland. Down here, where we have over twice the population, the reported number is something in the region of 300 to 400. I would like the Minister to set up a register of drug addicts not that it will give us any true statistics but at least it will keep us in line with other countries and we will not have people going around saying there is no drug problem here. I hope we will never adopt the indifferent attitude which the British adopted some time ago when they reported that they had only about 400 drug addicts and now they have reported that almost 40,000 people in England are habitual smokers of marijuana.

There are only two countries which have come to grips with the problem of drug addiction. Russia introduced the death penalty and inside of two months they had completely reduced their drug problem as an undermining factor of their society. Japan introduced compulsory imprisonment for drug pushers and drug users. Inside a year the admission to hospital of drug abusers dropped from 200,000 people in one year to only 300 the following year. In South Africa they are taking steps in their Department of Justice to deal with this problem. But here we have little or no legislation and what we have is totally unsuitable to deal with the ruthless drug pusher who initially came here as a draft dodger from the US or from England and has begun to push these mind polluters and hallucinogenic drugs amongst our teenagers.

What evidence has the Deputy for all this?

The Minister has time and again said that the Deputy has grossly overstated the position. It is about time he gave some hard evidance to the House. I am prepared to take the Minister's word any day before the Deputy's.

I hope the Deputy does not go on the record as saying that there is no drug problem in Ireland.

I said no such thing. Last week according to the Deputy they were growing drugs in Ireland, in the Dingle Peninsula.

I should like to come to something which has been occuring over the past two years in the Ballymun area. The incidence of admissions to casualty departments of women suffering from overdosage of everyday tranquillising drugs has increased fourfold. I believe we are not far away from having a new, defined syndrome in our medical textbooks, the Ballymun syndrome, when these women are unable to cope with conditions prevailing in their society. Perhaps it is only a gesture when they take these over-doses but it has resulted in increased admissions to north city hospitals and also resulted in an increase in emotional diseases in families.

I am sure the Minister will agree that it is tragic that we have more gardaí involved in tracking down poteen distillers than in attempting to track down drug pushers. I quote from the Irish Independent of 13th January, 1971 that the gardaí are helpless in the drugs crisis and that Ireland is in the throes of an alarming new outbreak of drug smuggling and peddling on a big scale. Evidence has been compiled showing that there are five drug pushers in the city of Dublin, located in Dalkey, Ballyfermot, Crumlin, Whitehall, Finglas East-Cabra. Their names are readily available to the gardaí but in many cases they are powerless to act. In many cases it is fruitless to act because apart from the new compulsory unit opened in association with Dundrum Mental Hospital in the old residence of the medical superintendent, there are no facilities. This is the only suitable clinic we have after practically a five-year campaign. Apart from being urgently needed this clinic is totally inadequate if the drug abuse crisis continues. There is one way of stopping it and that is to impose a life sentence or a death sentence on a person who is completely normal, physically and mentally, and who has no defects and is not addicted himself to drugs but is doing this solely for cash.

And the Deputy professes to be a medical practitioner.

A report in the Independent newspapers in the last few days reported a hippie as stating that the drug marijuana was being grown all over Ireland. He said they were not foolish enough to grow it where they lived. He said if "they"—meaning us —want to come to the root of the problem it is easy enough to do so but it is unfair to make scapegoats of a few people, obviously referring to his own hippie colony on the island where they live.

Would the Deputy please give the reference?

Sunday Independent of March 28th.

The Deputy is again repeating himself, contrary to the rules of the House.

I cannot repeat what was printed on 28th while this is only the 30th.

No, but repeating the statements that marijuana is grown here. It is not grown in this country. The gardaí have issued a statement.

I am quoting a hippie who would know and he says it is being grown. They are getting it from somewhere in this country.

Why not give us the sites and the areas where it is grown?

The Deputy should first inform the National Drugs Advisory Council.

The Deputy has a vivid imagination.

I hope the Minister is not stating that it is not possible to grow it here. Does the Minister agree that it is possible to grow it here?

I am told the climate is too mild. Perhaps it could be grown.

Are there any areas in the country where it could be grown? Is the Minister aware that it was grown openly in the Botanic Gardens?

Yes, it is grown in the Botanic Gardens. All but one plant has been removed.

Who removed the others?

The Deputy can proceed with his novelette.

They were stolen two years ago. The police know that.

I am not going to answer the Deputy's novelette talk about drugs or anything else.

There is a definite association between the deterioration in the behaviour of our youth, the increase in vandalism noted in the Dublin area, the phenomenal growth of venereal disease among the male population in Dublin city two years ago and the increase in tuberculosis and drug abuse. These are related in some way to drug abuse.

In what way? Is there such a thing as lack of housing, lack of community facilities, lack of educational facilities——

I cannot speak about these now because they would not be relevant.

Put them in the proper context.

They are not relevant to the debate.

The Deputy has the most vivid imagination of any Deputy I ever met.

I should like to see greater restriction on the sale of such readily available drugs as aspirin in supermarkets and grocers and public houses. The Minister knows these drugs can be abused—I do not want to explain how. I am sorry that certain Deputies do not seem to think that there is a drug problem in this country.

We made no such statement.

It comes as a great revelation to me that two Members of the House should feel that there is no drug problem. They certainly give me that impression.

The Deputy is distorting our words in the same way as he distorts the problem.

We submit the Deputy is dealing irresponsibly with the problem.

With respect to the Chair, I am not the authority to legislate and administer for these unfortunate people.

Thanks be to God.

This is the responsibility of the Minister for Justice and the Minister for Health. My constribution is directed towards the responsibility of the Minister for Health. I will have further to say when the report of the commission on drugs is put before this House. Perhaps the Deputy will then learn something of the problem. It is unfortunate to see elected representatives who do not appreciate that we have a very severe problem in this country in regard to drug abuse and that no effort is being made to tackle it. We have more gardaí involved in the detection of poteen than we have in tackling the drug problem. Poteen itself is not nearly as harmful as some of the drugs which have been peddled around this city, particularly among the workingclass people, whom I am particularly concerned about. The rich people can buy themselves out of trouble but those other people cannot.

I would like to refer to the other end of the scale, namely the aged people in our society for whom there is inadequate accommodation and facilities. I would like to see an increase in the number of geriatric hospital beds which would give those people an opportunity of living out their lives in some peace and contentment and not in the bitter frustration in which many of them are now forced to live. In the rural areas many of those people are forced to end their lives in country homes and in Dublin they have to end their lives in psychiatric homes. They are becoming bitter with us and with the world. It is not right that those elderly people should have to form queues for this, that and the other. I hope the Minister will release the report which the drug commission have brought in as soon as possible.

I would like to say, first of all, that I was shocked and amazed when I saw the report of last week's Dáil Debates in the papers where Deputy Dr. Hugh Byrne referred to the drug problem and exaggerated it out of the imagination which he undoubtedly has got. He said there was widespread drug abuse in the Dingle Peninsula. I want to refute in the strongest possible way what the Deputy said. I want to put on the record of this House that there is not such a problem in the Dingle Peninsula. It is very wrong of a Deputy to come into this House and make unwarranted and unfounded allegations against harmless people in the Dingle Peninsula. Those allegations have already done untold harm to that area.

I may be moving away from the Supplementary Estimate but I want to tell the people of this country, and particularly the people who send their children to the four Irish colleges in my area, that we have no drug problem in that area and there are no drugs grown there. The gardaí have already confirmed this. When people are elected to responsible positions they should not come into this House and abuse people. It is about time that Deputy Byrne stopped hounding people. He should not have mentioned that there were two hippies living in Annascaul who were growing this drug. Those are innocent people who have come in to the Dingle Peninsula and are not doing harm to anybody. They live their own way of life and have been accepted by the neighbours there. It is wrong for anybody to point a finger to them and say they are suspicious people, that they are undesirable, when they are more or less integrated into the community. We should live and let live.

I hope the papers will give this short speech of mine the same publicity as they gave when they highlighted the speech of Deputy Hugh Byrne last Friday. If people have a weakness for drugs it is sympathy they should get not death penalties or anything else. It is a sad state of affairs in an Irish Parliament when we hear the death sentence being suggested for people who for some reason of their own have strayed off the straight and narrow.

Deputy Byrne said that when the film "Ryan's Daughter" was being made in the Dingle Peninsula this drug abuse started. It is a well-known fact that Deputy Byrne visited the people engaged in the filming of "Ryan's Daughter". He mixed with those people and if he saw drug abuse going on at that particular time, two years ago, that was the time to go to the gardaí and tell them that this drug abuse was going on. It is very easy to say two years after, when all those actors and actresses, who were so happy in our Peninsula and who gave so much employment, have gone away, that the drug abuse began when they were here. I hope we will never again witness such an unwarranted attack on people who have no chance of defending themselves.

We are discussing here today a Supplementary Estimate for £6,575,000. I want to say that this is due to the inflationary policy of the present Government through the years. As far as the health charges and the rates are concerned the Government seem to be standing idly by. I was on a deputation to Dr. Ryan some years ago and he told us that the new health services would put only a few shillings in the £ on the rates. We know now that in many counties the health services have put more than £2 in the £ on the rates. I also remember in 1965 when we were told by the then Minister for Health, when the White Paper was introduced, that the charge on the rates for health services was being stabilised. The blame for all this, as I said, lies in the inflationary policy of the Government. They were standing idly by taking no action. If this is allowed to continue, the health service may collapse. The Minister and his officials have pointed this out in the past.

I remember when Mr. Lemass was Taoiseach he stated that if in the future the charges increased the Government would cut taxation and they would try to live within their means. Are Fianna Fáil prepared to make any promise at times in order to get votes? They made promises in the past but immediately they got back to power they completely forgot the promises they made to the people to get them into power. In his Budget speech in 1969, the then Minister for Finance, Deputy Haughey, at column 125 of Volume 240 of the Official Report of 29th April, 1969, said:

The cost of the health services is rising so rapidly that it is necessary to consider alternative methods of finance in order to reduce the amounts now charged on the taxpayer and the ratepayer. A detailed examination in being undertaken of the feasibility of introducing an insurance or contributory scheme to finance at least part of the costs of the services available to the middle income group.

This Budget speech was made before the general election and we know it was made to get votes at the election. Have Fianna Fáil sunk so low that they are prepared to make any type of speech before a general election in order to get people's votes? The moment they get back into power they conveniently forget all the promises they made. We should ask if those promises fell when the Minister fell off his horse. A promise was made and I quote, "to consider alternative methods of finance in order to reduce the amounts now charged on the taxpayer and the ratepayer".

Since that speech was made instead of reducing the tax on the taxpayer and the ratepayer there has been an increase of over 60 per cent. Is that how Fianna Fáil keep their promises to the ratepayers and the taxpayers? The Minister went on "A detailed examination is being undertaken of the feasibility of introducing an insurance or a contributory scheme to finance at least part of the costs of the services". What has happened to the detailed examination that was being undertaken then? We are entitled to ask that question and I think the Minister should answer it. We have been fooled so often in the past with White Papers and statements like the statement made in 1965 about stabilising the rates and a similar statement by the Minister for Health in 1969, but so far nothing has been done. The burden on the ratepayers is becoming very unfair. They are being crushed with increasing rates, much of which are due to increases in the health service and the inflationary policy of the Government. If, for example, a doctor gets an increase of £6, the ratepayers pay £3 of that and £3 comes from the Department of Health, but in a month or two the Department of Finance get back 42s in income tax so in reality the State is only contributing 18s and the full burden of £3 falls on the ratepayers.

We are also entitled to criticise the minimal amount of help given recently to the ratepayers despite the hopes held out by the Minister and other members of the Fianna Fáil Party. There are grants to help the new health authorities which are known as regional health boards. Even though I am a member of the local authority I am sorry to have to say that I think the regional health boards a disaster. As far as the health of our people was concerned, whether it be mental hospitals, pay for nurses, pay for doctors, or anything like that, in the local authority politics were immediately forgotten; all worked as one and, in their own small way, did the best they could for the afflicted section of our community. But what have we now in the regional health boards?

Regional health boards do not arise.

This grant is for the health authorities, the present health authorities and the future regional health boards, and they have been discussed.

The Deputy may not, at this stage, criticise the new health legislation.

I shall not criticise the new health legislation, but what are we giving these people money for?

The money in this Vote is money expended in the year which ends 31st March this year.

It is a Supplementary Estimate of £100,000 and other speakers have spoken at length on it. I am entitled to say that instead of there being a homogeneous unit they are divided. In my area we held a function at which the Minister and the boards were brought together. They have met on numerous occasions and we in our region were assured that there were excellent headquarters in Offaly. After voting us down we find that they had no headquarters, but they had to pay £30,000 to erect new headquarters. They will have to purchase land, service it and fit the building out and I would say this would cost at least £70,000. I want to appeal to the Minister to override the decision that has been taken because we in Mullingar can provide them with excellent accommodation at St. Loman's Hospital. It is ridiculous, with ever-increasing rates and taxation, for an extra £70,000 to be spent in this region.

That is not the sum in the Supplementary Estimate; nothing is included in it for building.

It is the policy of the Department and, next year, they will be looking for even more. If the aim is to deal with the afflicted people in our community we are entitled to find out if that is the aim because on 12th February, 1969, the Minister for Health sent a circular to all local authorities asking that each health authority should examine critically their forecasts of expenditure for the coming year and endeavour to achieve substantial reductions in their projected expenditure. With the present state of health finances and the demands made on them it would be ridiculous for the Minister to allow expenditure of £70,000 in a region where the facilities are already available.

I am not allowing the expenditure. If there have to be new premises they will have to be rented.

I am delighted to hear that. We should move them to Mullingar or some other place where facilities are available.

I did not say they would be moved to Mullingar, I said they would have to rent a premises because I am not going to give money for capital for the centres of health boards.

I agree entirely with the Minister on that, and I think he is to be congratulated on his decision. Deputy Dr. O'Connell raised the question last week of whether a doctor is legally or morally bound to attend an accident. Within the last fortnight in my own county an accident occurred and of the three doctors who were called two were not available and the third refused to go out and said he was not legally or morally bound to attend. His wife mentioned that they were seldom paid for accident cases. Apparently there is a snag in the law, and if any person is unfortunate enough to meet with an accident either today or tomorrow no doctor is legally bound to attend to that patient. I claim they are morally and ethically bound and it is time some arrangement was made by the Minister such as the arrangement whereby doctors are paid a free and in return can be called on by the Garda. This is something which should be attended to immediately. In the accident I have mentioned a young English chap was killed and when his friend came to the inquest he was insulted and ordered out. We are supposed to be a great Catholic country. Some, unfortunately, seem to be more concerned with filthy lucre. There seems to be little Christianity or charity. I am sorry to have to say that here. From 60 to 80 per cent of the medical profession do their work diligently and conscientiously; it is the minority 20 to 30 per cent who err. Four or five years ago I came on the scene of an accident; a girl had been knocked down by a car. I called on the doctor and he said he would not go to the accident because he would not be paid. I had hot words with him and he did come out and attend to the girl. She was taken to hospital and her life was saved.

I would not interfere unless this were a very common occurrence. Happily it is a very rare occurrence.

Unfortunately it is not. I should love to agree with the Minister, but I have known three or four cases in my own county in the last few years in which doctors refused to come out. The wife answers the phone and says the doctor is not in. If you ask those involved in accidents how many times they had to phone before they could get a doctor you will find that this kind of thing is happening all over the country, a country that prides itself on its Christianity. It is happening far too often. I do not like saying these things here, but they must be said.

Deputy Dr. O'Connell nearly a year ago raised the question of pillboxes. I also raised it. I myself had the experience of seeing a wife put the wrong lids on boxes. Her husband was suffering from heart disease and, in my presence, she took the lids off the sleeping tablets and the other tablets and replaced them on the wrong boxes. I took them from her and corrected her mistake. That man was admitted to hospital the next day and was dead within the week.

I made a proposal about that and I am awaiting the result of my proposal.

That is a good thing. The instructions or the distinguishing marks should be on the container, not on the lid.

I think we could do this without any increased expense if pharmacists would draw a coloured pencil across the lid and the bottom of the box so that red would go with red and green with green.

That would be a solution. It was stated recently that 50 per cent of deaths are due to heart disease. That is a very high mortality rate. This disease is becoming a scourge. It is said that we are too lazy, that we do not take enough exercise, that we do not eat the proper food and that we drink too much. It should be brought home to the people that it is essential to take sufficient exercise and eat the correct foods.

Over the years, under successive Ministers, our hospitals have undergone a steady transformation. Instead of the grim survivals of Victorian days we now have bright new hospitals, fitted with up-to-date equipment. The Ministers and the Department are to be complimented on the transformation. The only criticism is that waiting-rooms—this is true of dispensaries also —are drab and dreary.

Deputy Dr. Byrne dealt with the drug problem. This problem is worldwide. I was the first to raise it here away back in 1966 and the Minister at the time, Deputy Brian Lenihan, said that he had no responsibility for hysterical newspaper reports or hysterical Deputies. Had something been done then the problem might never have reached its present proportions. Drug addiction and drug abuse are on the increase. It was suggested here a year or so ago that there should be a register of drug addicts and that the register should contain photographs. That could be of tremendous help to both doctors and pharmacists. Drug addicts are very clever people and they have been known to forge prescriptions.

Great precautions were taken a few years ago to deal with foot and mouth disease and all credit is due to those responsible for the steps they took to keep our country free of this scourge. We are faced with a crisis again now but it relates to the destruction of people and not the destruction of cattle. This is a problem which should be tackled by everyone, parents, priests, teachers and all who are interested in the welfare of our society. Every effort should be made to apprehend the drug pushers and bring them to justice. I do not recommend the death penalty, but I certainly recommend a salutary prison sentence. I doubt if enough is being done. A committee was set up round 14th January, 1969, and on 13th February, 1969, the Minister for Health informed me that, in setting up this working party, he had to ensure that it was of optimum size to enable it to carry out its task efficiently and quickly. I think the committee is unduly long in arriving at recommendations. Other countries have dealt with this, America and England. If they went over to England they could learn from what happened there. Remember that in 1962 it was stated in the British Parliament that there was no problem there, just as it was stated in this House in 1966. Unfortunately, this problem is with us and the Minister will get all the help of each and every one of us on this side of the House in trying to adjust these maladjusted people. The Minister is aware that there are drug parties being held in this city. People know of them and it should be the duty of anybody who hears about them to give this information immediately to the proper authorities.

I adopted virtually all the recommendations made in the interim report of the drug abuse committee and I have now got the final report.

I am sorry. I did not know the Minister had the final report. When did he get it?

In February.

What can be done through legislation to punish the pushers? That is what I am more interested in than anything else. Are the Garda powerless in this regard? Are district justices powerless, as they claim in court, to deal with these people? I can only go by the reports I see in the newspapers. In any case the Minister will have full support from us on this side of the House in whatever effort he makes to eliminate this scourge.

This debate started to be a full-scale debate on the Department of Health, and if every Deputy who had something to say were to speak in the House we would have been here for days and days. I do not propose to answer all the questions that have been put to me in cases where full answers have come through questions in the Dáil. Many questions were asked of me and have been answered in the course of the last six months through Dáil questions. I see no point in taking up the time of the House when there are many other important Estimates to be considered, matters that are just as vital to the future of the country as are the health and hospital services. I am trying to keep some kind of consistency in the use of time by representatives of this House in confining my speech to some essentials.

First of all, I want to speak on the financial position that relates to the Supplementary Estimate. I should like to point out that, for the first time, in the year 1970-71, the Supplementary Estimate included all the increases of remuneration that occurred during the year and that, whereas in former years, that portion that would be paid by the health authorities was transmitted to them and notified to them and formed a debit balance carried over in the ensuring year, on the present occasion the Government have undertaken to pay the whole of the huge increase in remuneration, part of which was due to the twelfth round. One particular element of it which is non-recurring in the sense that it will not repeat itself on the same scale, was the increased status pay for nurses which I think was well merited and the reduction of hours of work from an 85 to an 80-hour fortnight, which cost £1,150,000. I might add this forms part of any balance in the accounts for the whole financial year. If the Government had not taken that action the rates would have gone up another 3s in the £ on average, so the Government did save to the country an increase of 3s in the £ consequent on making this unusual arrangement of taking on itself to pay for the whole of the increased cost of the remuneration. That is one of the reasons why this Supplementary Estimate is so large.

In the passing year the Government have contributed about three-quarters of the total cost of the health and hospital services, that is, after making allowance for the grant towards the voluntary hospital deficits. These payments relate to the taking care of people in voluntary hospitals where the costs are not met through capitation grants from local authorities; the contribution made by the Minister for Finance for the relief of agricultural rates in respect of the agricultural rates relief required to meet the health portion of the local authority expenditure. Along with the State grant towards the health services we are paying for three-quarters of the total hospital expenditure.

That is no comfort to the people who have to pay very high rates. I am merely mentioning it as a fact, and it really is an illustration of the enormous cost of the health and hospital services in this and every other country. In the passing year the health services will be costing the community something round about £22 per head of the population or, shall we say, for a married man with a family of three children, £110; and although this sum is collected by taxation which bears obviously more heavily on those who are wealthy than on those who have no income, it, nevertheless, presents an enormous burden to the community. No matter how it is paid for whether by rates or by taxes, whether by a 50 per cent contribution from the State, a 55 per cent, a 60 per cent or a 63 per cent contribution from the State, it is an enormous cost. One of the reasons is the very rapidly growing cost of the hospital services that total between 70 and 75 per cent of the total cost of the health and hospital services combined. We in common with some other modern European countries are now taking one out of every ten of the population into an acute care hospital other than a mental hospital for some period of the year, long or short, and the numbers of persons going into hospitals are increasing at the rate of 4 per cent per annum. We do not know when the ceiling will be reached. I wanted to mention those facts because the position, naturally, is very serious.

As Deputy L'Estrange pointed out, one of the major reasons for the huge increase in the cost of health and hospital services is just sheer national inflation, and the staffs of the hospitals and the health service cannot be expected not to receive the same increase in remuneration as other sections of the community. Nevertheless, the situation in regard to this service is highly inflationary because the labour content is about 71 per cent. A good deal has been said about inflation in the last four years. I myself have made many speeches about it, and although all the leading economists and people of all reasonable viewpoints have pointed out over and over again that incomes should increase only at the same rate as productivity, we and other countries have disobeyed the rules.

In reply to Deputy L'Estrange I do not know of any democratic country that has been able permanently to control inflation save by agreement of the people and by the consent of the employer and trade union section to moderation in the growth of incomes. There was a compulsory Bill enacted in Great Britain with the provision that salaries and wages should rise by only 3½ per cent and they rose 7 per cent. When this compulsion ceased there was an enormous out-burst of demands for increases in wages and salaries that have gone on ever since, and the British and ourselves share the melancholy privilege of having, of all European countries, the highest increase in wage costs per unit of output. We are at the very top of the table. It is a pity we copy the British in respect of one of their worst habits of life. It would be good if we could become at least independent of them in that respect. If the rate of inflation which we have experienced here and which has been experienced in Great Britain and, spasmodically, in other countries, continues for the next eight years, the cost of health and hospital services will double in that time without any increase in the volume of service and without any better services being provided for the people.

Therefore, I would ask the trade unions and employers that when they come together in 1972 to negotiate a new agreement they would examine the indirect effects of grossly excessive increases in wages and salaries on all services. My Department or the Department of Finance will be quite willing to inform the ICTU and the Federation of Employers at the beginning of 1972 of what are to be the likely effects on the taxes and rates that will be levied on everybody, very much less on the people at the lower end of the medical card group and very much more on the rich, as a result of any particular specific increase in salaries and wages, having regard to the growth of the economy.

As I have said, the cost of hospital services will double in eight years if the present rate of inflation continues but we would be in line with respectable countries in Europe if, at the same time, we had completely normal conditions but we could not expect a greater growth in gross national product than something between 4 and 5 per cent per annum. It is obvious that we simply cannot continue to have huge increases in remuneration that bear no relation to the growth or the cost of production.

May I add also that the Government are now considering legislation for a contributory insurance scheme. When this legislation comes before the House, it will not solve the problem of inflation. No matter what we do to replace the form of collection of taxes and rates for the health services to a partial extent by some form of contributory insurance, there will be no difference whatever in the burden that will be placed on the community if inflation continues.

A number of questions were raised in relation to the health boards. Now that we have eight regional health boards instead of 27 health authorities, it will be the duty of my Department to ensure that there is sound budgeting procedure. If we have a smaller number of health boards, it will be possible that budgets be prepared properly and it will be possible for the health boards themselves to control expenditure because, covering a larger area, they can have more specialised officials concerned with finance at the head of the health boards.

What has been said by a number of Deputies is absolutely correct in so far as that, having faced this enormous inflation, while wanting to provide the best possible service to the community, it will be essential for the health boards to consider how they can avoid unnecessary extravagance and unnecessary cost and how, over a period of time, they can ensure that the beds available for all classes of patients are used to the best advantage without, in any way, diminishing the human attitude to patients and without diminishing the character of the services offered. This will be the duty of the regional hospital boards, for which regulations will come before the House later, working in conjunction with the health boards.

I am setting up, in my Department, a work study unit to enable the regional hospital boards to give assistance to hospitals with a view to their keeping their costs as low as possible by reducing, if possible, the amount of movements required of nurses around the hospitals, improving the facilities for nurses and improving the facilities for ancillary staff and, if possible, in order to see whether we can possibly control the cost of hospital services by introducing productivity pay schemes. These have now been introduced in Great Britain for the ancillary staff of hospitals.

I was asked a question about expenses in connection with the health boards. The supplementary provision of £100,000 relates to the fees and expenses of McKinsey and Company, the management consultants, which amounted to £63,500. It also relates to the salaries and expenses of the chief executive officers and the other staff who are being recruited for the new boards and who had to begin their work before the beginning of the new financial year and before the boards come into operation legally on the 1st April. This amount was £25,000. The rest of the expenditure is of a minor and unimportant character.

Dr. Browne raised the question of our attitude towards cigarette smoking. As this matter relates to an item in the Estimate to the extent of £25,000, I wish to say a few words about it. We are studying all the implications of the report prepared by the Royal College of Physicians and we are examining all the recommendations of that report. Personally, I am pessimistic as to the effect of any large-scale advertising for adults in trying to reduce the incidence of cigarette smoking. When advertising ceased in the United States, a report came through to the effect that the cessation of advertising did not seem to have had any measurable effect on the consumption of cigarettes. In a number of the more advanced civilised countries, the consumption of cigarettes is levelling off. There has been an increase in their consumption by young women but there has been a decrease among other sections of the population.

I still believe it to be essentially a problem concerning the young. We must see what can be done to prevent people from smoking in the earlier years of their lives. I did note from the report of the Royal College of Physicians that some 83 per cent of men who are now smokers began smoking between the ages of 15 and 20, whereas only 40 per cent of the women smokers of today began while they were still within that age group. The report shows that women began smoking at a later age. I do not know what the reason for that was. Nevertheless, we intend studying the report.

The House, and in particular Deputy Dr. Browne, will be aware of the recent statement by the British Minister for Health in relation to examining the possibility of making a formal declaration as to the comparative tar and nicotine content of the various brands of cigarettes being purchased in Great Britain, this having been done already in the United States. We would be unable to do this until somebody had evaluated the research that has been carried out by the Tobacco Council and until some respectable body validates the research on the same brands being smoked here. Obviously, we would have to consider action of a similar nature, drawing the attention of the public to the brands in which tar content is high, but that would be a matter for examination. I mention this as one of the further decisions on the part of the British Government. It would be impossible for us to do anything about it until such time as we could be certain that the tar and nicotine content of each cigarette relates, in some way, to the danger of smoking. This will be examined along with all the other proposals of the Royal College of Physicians' Report.

I should say, too, in connection with what Dr. Browne said, that compared with alcohol or the dangerous drugs, nicotine is not a dangerous drug in itself but people die from physical diseases arising from excessive consumption of cigarettes. That is the challenge that we must meet in so far as we are able. In addition, it is intended to draw the attention of parents to the example they are setting by smoking, when we are asking their children not to start smoking. I hope the House approves of the latest campaign to induce young people not to smoke. Deputies no doubt have seen the first examples of it on television. We have asked people who are famous in the sporting world and who do not smoke to point out the value of not smoking as a contribution to better health and better athletic ability. The £25,000 is being spent on propaganda largely appealing to young people. There is quite a problem among young people. In one county, which I shall not name, one in every 12 boys of the age of 12 is a confirmed smoker and one in every three boys of the age of 16 is a confirmed smoker. I am quite sure this is simply a prestige business. It is just smart to smoke. I do not believe they are smoking because they are addicted to nicotine. I do not believe it reaches that level until much later on. This indicates the importance of getting at young people in the first instance.

Somebody suggested that the allowance for disabled persons which is paid by county councils is totally inadequate. The increase in the amount for allowances for disabled persons, £400,000, was decided at the last Budget and it represents an increase of about 11 per cent in one year. Of course we would all like to raise the social services as rapidly as possible but an 11 per cent increase in one year in this disablement allowance at least is a help. At a later stage, whenever it is financially possible, I hope to introduce into the Dáil a measure to exclude the income of anyone but the husband and spouse in a household in assessing the means for allowances to disabled persons. That will have to be done when the financial position is more satisfactory but at least the total vote was increased by 11 per cent.

Deputy Dr. Browne also raised the question of alcoholism as did other Deputies. We have shoved this under the carpet for far too long. We have the second highest record of alcoholism in Europe. There again it is very difficult to know what we can do about it. I have asked the Department to ask the National Council for Alcoholism to collaborate with the new health boards and to appoint for every health board a very highly trained social worker whose sole responsibility will be to give lectures on the subject of alcoholism, to bring Alcoholics Anonymous branches, the doctors, the existing social workers, the public health nurses and the whole community into closer contact with each other and to give lectures to any association that asks for them, to get them to speak to industries, with the consent of the trade unions to speak to the workers and to point out the enormous sum lost in wages and productivity apart from the misery occasioned in homes. I hope these social workers will be able to do good work aided by all the existing associations that can be found in every part of the country that are preaching temperance or preaching teetotalism of one kind or another, that the social workers will act as a liaison between all those who want to consider this subject.

Quite obviously we must take this question from under the carpet. I hope all the Deputies of this House when they meet somebody who will say to them: "So-and-so is not looking after himself too well" will say that this is a very human way of putting the truth but that it is time we stopped talking like this about people who are alcoholics and will immediately draw attention to the appalling social evil that alcoholism constitutes in this and in every other country. It is a very serious problem and this easy attitude, exemplified in that simple phrase, which no doubt carries a very human association with it, means that people are not looking at the realities.

Deputy Browne asked about the Professor of Forensic Psychiatry. I am doing my best. I hope the Local Appointments Commission will report on what they intend to do about the appointment of the Professor of Forensic Psychiatry as soon as possible.

I do not intend to start a State ambulance service and I do not intend at the moment to ensure that a doctor travels with every ambulance to the scene of an accident. I do not think it is a practical scheme.

Would the 532 deaths in the last year not worry the Minister?

They would worry me naturally but I do not think it is a practical scheme.

If we could do something about that would it not be good?

I will not reply to any of Deputy Dr. Byrne's questions to me. Deputy Dr. Byrne has been speaking in the manner of a cheap novelette and I hate to criticise people in the House. His exaggerations, his innuendoes, his inaccuracies are just to me utterly woeful. A great deal of what Deputy Byrne said should be immediately communicated in the form of facts to the Garda Síochána or in the form of facts to the local health authority and he should get his facts properly examined before he comes to this House with his ghastly nonsense. I will not reply to any of his questions.

I replied to Deputy Dr. O'Connell on the thalidomide question. If there is any change in the situation he can ask me a question again. I also replied in the Dáil on the subject of visiting hours in hospitals.

Deputy Dr. O'Connell referred to hospital development. He perhaps did not recall a speech I have made on a number of occasions in which I said that the regional hospital boards should be responsible for research and evaluation of what requires to be done for the reorganisation of the hospital system and for co-ordination and integration between voluntary hospitals and health board hospitals.

I must say I was a bit puzzled. I am not too sure of the function of the regional hospital boards.

They will also be serviced by the elaborate survey now being prepared by the medical social board, a hospital in-patient survey from which we will learn fairly accurately the numbers of persons suffering from every malady in every hospital in the country, the length of time they stayed there, the length of time before investigation, and other facts that will enable us to see how we can deal with growing specialisation and how we can utilise to the best of our ability the modern techniques and modern paramedical equipment.

The regional hospital boards will naturally have to be in touch with the health boards. The regional hospital boards will also have to report to me on the siting of those general hospitals proposed in the FitzGerald Report where there is some doubt or where there is some element of controversy. Mercifully for myself the location of these general hospitals in the western part of the country is quite evident— Letterkenny, Sligo, Castlebar and Tralee. The development of Galway Regional Hospital was self-evident and the development of Our Lady of Lourdes Hospital in Drogheda was self-evident. Apart from that there is a great deal of controversy about where the rest of hospitals should be and I will have to get advice from these boards in regard to this matter before making the correct decision.

I agree with Deputy Dr. O'Connell that it is absolutely essential to develop out-patient clinics on a more elaborate basis, to increase the out-patient consultant service in the hope of keeping people out of hospital with a consequent saving of cost and far better health for the community. We are also examining in that connection whether the cost benefit analysis involved gives a favourable answer to the question: if you could construct, in connection with hospitals where there is a space around, inexpensive hostel accommodation for out-patients and provide therein a service which would be much less expensive than the elaborate service required in a hospital where people are actually undergoing treatment, whether you could not save a great deal of money for the community and at the same time ensure an even better service for the patients concerned.

I have given full particulars of the child health service and if any Deputy would like to have a fuller statement about it I would be glad if they would ask me a question. I have admitted quite publicly that the dental service in my view is a low priority, that it is slowly improving, that it is still deficient and I have already told the House in reply to parliamentary questions the number of extra sessions that have been provided each year and the number of extra full time dental officers that have been appointed to the health boards. I have informed the House that the salaries paid to the full time dental officers now compare reasonably favourably with those paid in England but that there are vacancies that have not been filled in various parts of the country and we are going slowly ahead with the dental service. I am absolutely frank in saying that it is not a high priority this year either even if I were able to get dental officers to serve in districts where appointments are vacant.

If anyone feels the inspection of food premises is defective in any particular place I should be glad if they would ask a question about it in the Dáil. I am told the health inspection system is reasonably efficient. I have to decide appeals in Dublin and as a result I read a great number of cases in which premises have been found defective. It seems to me that the rules of the Dublin Corporation inspectors are reasonably strict. I am not sure if we could do better; it is partly a question of getting necessary staff. I think there has been a big improvement but if Deputies feel the system is defective in any way they have a duty to question me about it, either privately or in the House.

We are negotiating with the Medical Association and the Irish Medical Union on the choice of doctor. We have examined the analysis of reasons why there was a contrary vote in the ballot on the proposals. We are taking some of the reasons which seem most important, subjecting them to examination and negotiating with the association and the union.

Deputy L'Estrange asked what we were doing about heart disease. The Irish Heart Foundation is doing splendid work, as Deputies know, giving lectures throughout the country which have attracted great interest. I hope to do some publicity out of the token Vote provided for publicity in the next financial year on this subject. We are developing health education and the total amount to be spent on it in the coming year will be a record figure. As the House knows, there is the Mediscan experiment which is extremely valuable and in which volunteers are asked to go before a team of doctors to find if they are prone to coronary thrombosis. I am very interested in this research and if anybody could prove to me that three years later a considerable majority of the people who were warned on their condition were keeping to a regime, I should have to consider if we could find the money to make the screening service a national one. There is still a good deal of controversy about this in research circles but the Mediscan experiment is bringing out the facts about what percentage of the population is prone to coronary thrombosis. Later we shall learn whether people who are warned are physically and morally sufficiently strong to keep to the proposed regime because otherwise the screening would be a ghastly waste of public money.

Because of Dr. Byrne's ludicrous talk about drug abuse in this country and his exaggeration of it, I want to say in conclusion that I have accepted all the proposals of the Working Party on Drug Abuse in the interim report and I shall examine the remaining proposals, the most important of which relate to education and publicity, as rapidly as possible. I think I have answered every question not already answered in the form of answers to parliamentary questions in the past six months.

May I ask the Minister has he given any consideration to the question of a health education council? Instead of this work being undertaken directly by the Department it might be advisable to have it undertaken by a council.

I regard the establishment of a health education council as absolutely inevitable. Deputies are very busy people and it is hard for them to find time but if they were to listen to all the radio talks on health in the current financial year, all the TV spots, and read all the literature distributed by my Department—it was on an increasing scale last year—they would see that the officers of my Department, helped by an advertising agency, are doing pretty good work. I agree we probably shall need a health education council eventually.

Question put and agreed to.
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