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

Debate resumed on the following motion:
That a supplementary sum not exceeding £10 be granted to defray the charge which will come in course of payment during the year ending on 31st day of March, 1972, for the Salaries and Expenses for Health (including of the Minister for Health (including Oifig an Árd-Chlaraitheora) and certain Services administered by that Office, including Grants to Health Boards, miscellaneous Grants and certain Grants-in-Aid.
—(Minister for Health.)

I regret that time did not permit me to complete reading the statement on the 1971-72 Health Estimate. I did deal with a large number of subjects last week including the Estimate itself, the Supplementary Estimate, health contributions, programme budgeting, the pursuance of the Health Act and establishment of health boards, establishment of the family doctor service, vital statistics, infectious diseases, staff relations, general hospital development, the appointment of consultants, capital made available for building projects, psychiatric services, drug abuse policy, accommodation for the aged, community care for the aged, the public health nursing service, mental handicap and the child health service. Those matters were all dealt with last week and I now come to dental services.

Dental services will continue to be provided in the main by wholetime dental officers employed by the health boards. In recent years, due to better salaries and conditions of employment, recruitment of these officers has shown a marked improvement. There are now 141 dental officers, including senior dental officers, employed in the public dental service. This represents a 44 per cent increase as compared with four years ago when revised conditions of appointment were introduced. Most health boards have a number of senior dental officers whose duty it is to organise and supervise the operation of the public dental services in local areas; it is the policy of the Department to encourage health boards to create such posts where they are needed and thereby, to ensure that the services are organised and operated as efficiently as possible. It is recognised that the development of dental services for the eligible classes, in particular for school children, has been uneven throughout the country and the service is one which a number of health boards have, since their establishment, been critically reviewing.

Prevention is better than cure in the case of most human ailments but in no other case, perhaps, does this principle apply more than in relation to tooth decay. It is, therefore, important that children should be instructed, even from a very early age, to acquire good habits of dental care and oral hygiene. The dental health campaign conducted by the dental health education committee of the Irish Dental Association and the dental health programmes operated in some areas by public dental officers have made a valuable contribution in this field. Health boards will, in future, be expected to include dental health education as a regular part of their programme.

The programme for adding fluoride to public water supplies as a proven means of preventing much dental decay continues to make steady progress. So far 78 supplies have been fluoridated serving a total of 1.4 million persons or 47 per cent of the total population. All the major cities—Dublin, Cork, Limerick and Waterford—and almost all towns with a population of 10,000 or more are now on fluoridated water; 70 per cent of all the population using piped water supplies are now receiving the benefits of fluoridation and only the smaller supplies remain to be treated.

Preliminary research in Cork city has shown a marked reduction in caries in both the first and permanent teeth of the children who from birth were provided with fluoridated water. Also, the dental staff of the Eastern Health Board have made a survey of the dental condition of school children in the Dublin area who have been on fluoridated water for about six years. The preliminary findings of this survey, while awaiting full statistical assessment, show a significant reduction in caries among these children compared with the results of the similar survey made by the Medical Research Council in the area in 1961. For example, in the temporary teeth of the five and six year olds the reduction was 64 per cent and 52 per cent respectively and in the permanent teeth of the ten and 12 year olds there were reductions of 34 per cent and 32 per cent respectively.

In the more sparsely populated parts of the country which have not public water supplies suitable for fluoridation, a number of schemes have been initiated for applying fluoride by means of regular mouth rinsing by children under supervision with a suitable fluoride solution.

Generally it is accepted that about 3 per cent of primary school children suffer from speech defects and that about one half of these children would benefit from attention by a trained speech therapist. For adults suffering from speech defects due to brain injury or other conditions the provision of speech therapy is also desirable. The Dublin College of Speech Therapy was established in 1969 under the auspices of the National Rehabilitation Board to train speech therapists for the health services. The first three-year course at the college will conclude in June, 1972, and it is to be hoped that the students, who will then qualify, will take employment here.

Deputies will note that this year's Estimate includes a sum of £70,000 for health information. This is by far the largest amount devoted to this purpose in any one year and reflects the importance I attach to health education. Quite a number of our health problems are avoidable, but due to human ignorance or weakness —perhaps sheer indifference in some cases—many of us find ourselves in need of medical treatment of one kind or another, due, for instance, to cigarette smoking, excessive drinking, drug taking, lack of exercise, overeating or eating the wrong foodstuffs, and so on. This is where health educational measures can do much good.

Health education is approached in two complementary ways, firstly, by inculcating a proper and deepening understanding of life and health from childhood, through adolescence, into maturity and, secondly, by advising and warning groups at risk of the dangers associated with particular habits or practices. I think there is much room for improvement in both methods of approach in so far as concerns our existing arrangements for health education and I hope to introduce improved measures to educate the public more effectively in matters of health. Television can do much good in this field and we have made considerable use of this medium, with the co-operation of Telefís Éireann. I hope to see greater use being made of television in the field of health education.

Health education in schools needs development, in view of the young age at which children nowadays become aware of the problems of living and behaviour. Here I am thinking mainly of the need to inculcate in children a healthy regimen—starting with simple hygienic practices and taking account, at appropriate ages, of education about the ill-effects of cigarette smoking, excessive drinking, drug taking and such like problems.

As Deputies are aware, I have already embarked on a widespread publicity campaign aimed primarily at discouraging young people from smoking cigarettes, using television, radio, magazines, newspapers, posters and school film shows. Anti-smoking publicity on television and in the Sunday papers during the past year has featured some well-known sporting personalities —the footballers, Tom Prendergast and Steve Heighway, the Cork hurler Charlie McCarthy, the swimmer Vicki Smith and the boxer Mick Dowling. Further anti-smoking filmlets are currently appearing on television featuring some well-known parents in different walks of life—Charles Mitchel of Telefís Éireann, Tom Kiernan, the international rugby footballer, and Frank O'Farrell, manager of Manchester United football team. I feel sure that the influence of these well-known personalities against cigarette smoking will be persuasive and counteract the false image of cigarette smoking as an essential ingredient of modern sophisticated living.

I have thus dealt with the special anti-cigarette smoking campaign of my Department which is aimed primarily at the younger generation. This campaign has been given real impact by the fact that Radio Telefís Éireann have ceased to accept cigarette advertising on television with effect from the 1st April last.

There has been one other significant development which I feel I should report to the House. At my request the Irish Tobacco Manufacturers Advisory Committee have agreed voluntarily to put a warning notice on all packets of cigarettes which are sold in this country. The warning notice will read: "Government Warning— Smoking can damage your health." All advertisements in newspapers and magazines and on posters will carry a reminder that there is a warning on the packets. I am most grateful to the tobacco manufacturers for their public spirited co-operation in this matter.

I intend to continue and intensify the anti-smoking campaign aimed at our young people in view of the serious health hazards to cigarette smokers.

These hazards have been publicised time and again, and I have on several occasions quoted from reports of such reputable bodies as the British Royal College of Physicians about them. In a leaflet published by the US Public Health Service today's knowledge about the health consequences of smoking cigarettes is summarised in the following major conclusions:

1. Cigarette smokers tend to die at earlier ages and experience more days of disability than do comparable non-smokers in the population.

2. If it were not for cigarette smoking, practically none of the earlier deaths from lung cancer would have occurred; a substantial portion of the earlier deaths from chronic bronchitis and emphysema would not have occurred; and a portion of the earlier deaths of cardiovascular origin would not have occurred.

3. If it were not for cigarette smoking, excess disability from chronic respiratory and cardiovascular diseases would be reduced.

4. By quitting or significantly reducing their smoking, people could delay or avert a substantial portion of the deaths which occur from lung cancer, a substantial portion of the earlier deaths and excess disability from chronic respiratory diseases, and some portion of the earlier deaths and disability from diseases of cardiovascular origin.

This is a serious, sober statement on a widespread habit that is, without equivocation, a matter of life and death. Many cigarette smokers tend to ignore this warning, but, if they do, I am afraid they do so at their peril.

The Working Party on Drug Abuse, which reported to me earlier this year, devoted a chapter of their report to education and publicity on drugs. They recommended, among other things, that "information and advice in connection with drug abuse should be provided as a matter of urgency for parents, teachers and others who come in contact with young persons". I have accepted this recommendation, and I am happy to tell the House that my Department, in co-operation with the Department of Education, will hold seminars for post-primary teachers. These seminars will discuss the problems of drug abuse and alcoholism in a way that will, we hope, equip the teachers to give advice and guidance, in a balanced and helpful way, to teenage children. The first two of the series have been held already.

The working party considered the difficulties of communicating information on drugs to young persons and concluded that, as this point in time, there should not be any "crash" programme for schools or youth clubs and that there should not be any general use of the mass media in an educational campaign. I think this is a wise viewpoint as the wrong type of publicity about drug abuse could do more harm than good, in promoting curiosity rather than understanding among the young. The working party did, however, make some specific recommendations in regard to young people who had been identified as having abused drugs in regard to the identification of children at risk, et cetera. They recommended also that a group representing the Departments of Health and Education, the schools, the university departments and professional bodies should investigate the general question of communicating information on the dangers to young persons. These recommendations are being pursued in the Department.

With regard to the problem of alcoholism, I have mentioned already that arrangements are in hand for distributing the Department's new leaflet "What Sort of Drinker Are You?" widely throughout the community. Press advertising of the problem of alcoholism has also been undertaken.

Alcoholic drinks are widely advertised, as Deputies know, and recently the Institute of Advertising Practitioners adopted a code of standards governing advertisements for alcoholic beverages. It seemed to me that this code could be improved in some respects, without being in any way unfair to the brewing and distilling interests, and some suggestions for improving the code have been put to the institute.

A publicity campaign to draw attention to the dangers of accidents in the home was undertaken during the past year, including a new illustrated leaflet on the subject. This leaflet was widely distributed at the Department's stand at the Ideal Homes Exhibition in the Mansion House a few months ago.

Food hygiene was another health topic on which the Department produced a new leaflet during the year, to coincide with a "clean food" campaign organised by the Irish Housewives' Association.

I should tell the House that I have been examining the possibility, indeed the inevitability, of promoting a health education centre. This will occupy my attention in the coming year.

The standard of food hygiene in the food trade is controlled under the Food Hygiene Regulations. Experience gained in the working of the regulations showed that certain amendments were desirable.

Under the regulations a person who is carrying on, or proposes to commence, a food business such as a restaurant, hotel or butcher's shop is required to obtain registration of his premises from the health board for this area. Up to this a premises had to be registered in full or not at all. This presented certain practical difficulties, for example, a licensed premises providing snacks or precooked meals for customers could not be expected to have full kitchen and cooking facilities. In practice, regard must be had in the reasonable operation of a registration system of this kind to the nature and extent of the business involved and, in order to provide an appropriate basis for this, an amendment has been made of the Food Hygiene Regulations.

Under the revised regulations health boards will have power to grant registration where the nature and extent of the food business carried on is appropriately limited to take account of the facilities and size of premises available. Should a proprietor exceed the limitations on the nature and extent of the food business after the registration has been granted or should a change occur in the extent of the facilities available. the chief executive officer of the health board has power to cancel the registration. The proprietor has a right to appeal to the Minister for Health against any such cancellation.

The regulations also require proprietors to provide sanitary conveniences for customers in restaurants and other registrable catering premises where such a requirement is reasonable and practicable. They also contain provision aimed at securing the establishment of more hygienic conditions in food stalls.

In October, 1967, a committee was appointed to consider and make recommendations on the measures which should be taken, in the interests of public health, to further and maintain a programme of education and training in food hygiene and in other related aspects of hygiene and for ensuring the education of school children in the basic principles of hygiene.

The membership included persons concerned with the catering and food manufacturing industries, the trade unions, the Irish Countrywomen's Association, the Irish Housewives' Association, a chief medical officer of health, a health inspector and officers of the Departments of Education, Health and Agriculture and Fisheries.

The report of this committee, which was published recently, covers a wide field. It points out that as a result of the implementation of the Food Hygiene Regulations, 1950, there had been a general upgrading of hygiene standards but that a great deal of further progress is necessary. It defines the object of a food hygiene programme as the ensuring of clean, safe and hygienic food premises in which food is prepared for human consumption and enumerates the hazards that need to be guarded against.

The committee refers especially to the great importance of education in bringing about an appreciation of the fundamentals of hygiene and recommended the setting up of a health education centre.

The committee's report represents a careful and thorough assessment of the many aspects of the field assigned to it for study and will be of great assistance to all concerned with the problem.

The report of the committee has been widely circulated and comments on its recommendations from interested bodies have been invited.

Our participation in the activities of international health organisations continues to increase. In the Council of Europe we are represented on the two principal health committees—the European Public Health Committee and the Partial Agreement Public Health Committee. We are also actively concerned with the sub-committees and working parties attached to these committees. This enables this country not only to benefit from the pooled expertise of the participating countries but also to contribute usefully from Irish experience, as in the case of the Working Party on the Problems of Implementation of Drinking Water Fluoridation, the report of which was recently published by the Council of Europe. We have joined as full members the Partial Agreement Public Health Committee and this has resulted in a considerable expansion of our commitments, particularly in the continuous and valuable exchange of information between member states which is a feature of that committee's work. The 23rd session of the Partial Agreement Public Health Committee was held in Dublin in April last.

We also continue active co-operation with the World Health Organisation. On the occasion of the 1970-71 Estimates I referred to a pilot scheme of registration of ischaemic heart disease which we were carrying out in co-operation with the World Health Organisation. That scheme is continuing and it has recently been the subject of very favourable comment by WHO. Our association with these and other international organisations in the field of health brings this country the considerable benefits which derive from the exchange of information, the co-operative control of diseases and the opportunities for Irish doctors and paramedical medical officers to attend international seminars and to study abroad with the aid of fellowships. It also brings international recognition of the contribution which we are making towards the raising of the standard of health services in the world at large. This is seen in the increasing number of fellowship holders and others who visit this country to study Irish procedures.

The negotiations on Ireland's application for membership of EEC have not indicated any insuperable difficulties for us in the health sector. The steps necessary for effecting freedom of movement and freedom to practice in relation to medical and paramedical personnel have not been completed. This is essentially a matter of co-ordination of training and rules of practice and provision for the mutual recognition of qualifications. From now on we will be consulted regarding further proposed developments in these matters as in other matters and, of course, we will be in a position to influence directly the final form of the particular controls. We have kept in close touch with the professional and other interests involved in these matters and will continue to do so. In regard to directives already enacted by the EEC in matters which are the concern of my Department, officers of my Department have participated in the negotiations to ensure that the interests of this country are taken into account in the adjustments which the enlargement of the Communities will require. These principally relate to food additives, et cetera, proprietary medicines and social benefits for migrant workers.

Deputies will be aware that I recently established a National Social Service Council which held its inaugural meeting on the 1st October last. The council includes persons active in voluntary organisations and officers of local authorities and Government Departments. The majority of the members are people who have over the years participated in a prominent and positive way in voluntary activity and they represent a good cross-section of those in the community who have indicated their willingness to devote themselves to the service of others.

The primary function of the council is to promote the establishment of social service councils, to encourage and co-ordinate voluntary activity, and to help in its co-ordination with the activity of statutory bodies. The council will, I hope, be a focal point of voluntary social work activity in this country and will be a source of encouragement, assistance and advice to existing agencies. That the council will have a challenge is evidenced by the fact that in the whole of the Republic there are 37 social service councils operating reasonably full services and 32 councils mainly caring for the aged. The lists are in the notes circulated to Deputies.

The council will also provide a means through which the Government may be constantly aware of the views of those most concerned with social work problems and create a channel of communications through which the Government might seek the advice of those concerned with these problems.

To co-ordinate the work of Government Departments concerned with social work activity, a permanent inter-departmental liaison committee has also been established comprising representatives of the Departments of Finance, Social Welfare, Local Government, Education, Justice and Labour as well as my own Department. This committee will work in close association with the National Social Service Council.

It will be clear from recent pronouncements which I have made that I am deeply concerned about the extent of and the role of voluntary activity in our society. There have in recent years been many marked improvements in conditions in this country. The population, for the first time in many years, is rising; new industries have been established to replace those becoming obsolete and to provide for the many who are leaving agriculture and seeking alternative employment. There has been, despite rising prices and despite temporary setbacks in our plans, an increase in the general standard of living of the majority of our people. While we have not attained to the level of affluence which has developed in many other countries it is true to say that our progress in recent years is leading us in that general direction.

While this is so we cannot overlook that there are also in our society many who have failed to participate in full in this growth in living standards. One thinks, in particular, of those who are disadvantaged by age, those handicapped in one way or another through physical or mental ailment and those suffering from deprivation proceeding from economic or social causes.

Throughout our society in general there has been a growing awareness in recent years of the problems of such persons and groups of such persons and an increasing urge to take some practical steps towards meeting their needs. Some have found it possible to provide such services through the traditional voluntary agencies such as the St. Vincent de Paul Society or organisations which have a history of helping specific groups of people to live a better life. Others, particularly the young, have found outlets for their idealism in newly founded organisations providing specific services for groups whose needs have hitherto been unidentified or for whom no practical activity has in the past been undertaken. One thinks in this connection of such organisations as the Samaritans and the Simon Community which have been doing most valuable work for the dropouts from our society. There are many also who have found that their contribution can best be made in a general purpose such as a social service council or a community association whose primary function is to co-ordinate the activities of voluntary agencies in a particular area and to ensure that, by avoiding duplicating or parallel developments of similar activities, available voluntary resources are used to the best advantage, for the good of the under-privileged in our community.

In all of these organisations there are those concerned who try to see the whole picture, the most desirable pattern into which to weave the many differing strands of voluntary work. The National Social Service Council will, I hope, be of great assistance in local areas in which there develops, among those engaged in voluntary activity, an awareness of the need to make their activity more effective through co-operation and co-ordination. It will be able, when it has settled down and recruited some staff, to provide specialised advice and assistance in an area in which, without such assistance, much time and effort could be wasted. The council will also be able to provide for voluntary organisation in the social service field an information service which will keep them abreast of developments in the statutory services and inform the voluntary agencies of the schemes and assistance and the help which can be made available by central and local statutory bodies.

It should also help in the important function of promoting sensitivity to social need and a desire to meet it. These are practical short-term steps which must be taken during the next year to improve the impact of voluntary endeavour on the problems of our society. There is also the broader, more general question of the total role of voluntary activity in the solution of social problems with which society is faced. We must try to develop a clear view of the respective roles of the State and other organisations; we must harmonise them and see that each component of the global effort to help the disadvantaged plays its part. We must develop an accepted attitude towards the extent to which the State should subsidise and financially assist voluntary organisations in discharging their activities. We must try to be clear on how best to encourage people to become involved in social activity in their communities and on the steps which can most appropriately be taken to achieve the defined aims.

All of these are matters which can legitimately be considered by the National Social Service Council but this is not, of course, the only body concerned with the evolution of a philosophy in this field. One such body recently established, for instance, is the Council for Social Welfare, appointed by the Catholic Hierarchy, which is considering broad general questions in this field in order to advise the Catholic Hierarchy of the steps which the church might appropriately take. Incidentally, I am glad to tell the House that, at my invitation, three members of that council are also serving on the National Council. I may also mention that I have been glad to note that the council recently held a conference on poverty which was attended by a widely representative body of people and at which there was a most useful dialogue on the subject of poverty.

A number of other national bodies are also actively concerned in the field of community social service and there is, of course, the pending reorganisation of the local government structure under which proposals have been made which would result in greater participation by communities in the evolution of local government policy.

All this shows a welcome apppreciation of the need for involvement of individuals and the general body of the public in the direction of our society and in the solution of its social problems. I think that the next two or three years will be a time of great development in this field and one during which, I hope, it will be possible to achieve advances, if not solutions, to many outstanding social problems which will find a general acceptance among all those, whether at central government, local government, church or voluntary level, who are involving themselves in the attempt to push forward towards the completion of what is, to my mind, a most pressing task.

I have frequently, in this House and outside, expressed my sincere thanks to the very great numbers involved in providing unpaid service to the community through membership of bodies set up under the aegis of my Department. It may come as a surprise to many Deputies to learn that there are some 30 such bodies with membership of from 30 plus down to ten. I have in the course of this speech mentioned some of them, the National Social Service Council for instance. My failure to mention others does not arise from any lack of appreciation of the tremendous service which they render to the community, a service which, if it were to be paid for, would cost the taxpayers and the ratepayers a vast sum of money annually. And here I can say also that since I became Minister for Health I have had occasion to invite large numbers of persons to serve, unpaid, I should stress, on such bodies and I could count on the fingers of one hand the number who declined my invitation. Further, in no case that I can remember was an invitation declined without a very good reason. To all of them I again offer my thanks.

Apart from those who are serving on the various bodies established under my Department's aegis, I must also pay warm tribute to the religious orders who faithfully continue the age-old practice of charitable service for their fellow citizens. There is no area of the country in which members of these orders are not to be found, working in our general hospitals, in homes for the mentally handicapped—perhaps the most exacting but equally the most spiritually valuable form of personal service one could give—in geriatric hospitals and in social service. And in mentioning social service I also express sincere appreciation of the work of the hundreds of good lay folk who are doing noble and most useful work for people in social need through the channel of community social service organisations, whether as members of voluntary charitable organisations, as public officers, or as simple lay men and women without formal affiliations. All these are making a most worthwhile contribution towards the health and well-being of the less fortunately circumstanced. We are very much in their debt.

As Minister for Health, I would naturally like to advance at twice the pace actually accomplished. At the same time, I offer to the House this year a report indicating real and substantial progress in all branches of the service and specific sanctioned plans for progress in the coming year.

If I were asked to give my No. 1 priority I would answer—the development of social service councils throughout the country.

I move:

"That the Estimate be referred back for reconsideration."

First of all, I wish to thank the Minister and the officials of his Department for the very useful notes circulated to us over the past few months and for the wealth of information the Minister has given us in the speech he has just concluded. I am quite sure that the Deputies of every party will join with me in saying a sincere word of thanks to him and his officials for their invaluable assistance to us.

The figure we are now debating here is quite a sizeable one, and that is an understatement. The Minister's Estimate for this year is for £83 million, and it is strange but true that over 80 per cent of the people who are paying for the service are dissatisfied with it. The amount of money provided for health services by way of taxation and rates has gone beyond the stage of being described as staggering and frightening. It behoves all of us here to examine this figure critically to see if it needs to be pruned, to see if good value is being obtained for it and, if not, to correct that.

The charges on the rates for health services have gone so high that a change is urgently demanded. It is not so long ago that the Minister said here in this House that it was his belief that if the charges for health services continued to increase as they were increasing, by 1980 the cost of the health services would be doubled. If that is so, we must tackle this problem now to see how those charges can be met. Every ratepayer knows that the largest single item on his rates bill relates to health charges. In practically all local authorities the health charges represent something between one-third and one-half of the total rates bill.

It cannot be denied that great strides have been made in recent years in the development and improvement of the health services. It is the enormous cost of that expansion which is giving rise to concern. The most worrying aspect of the whole thing is that 70 per cent of the population pay 50 per cent of the cost for the 30 per cent who possess medical cards. We all know that local authorities have, for some years, been pointing out to the Minister that they were unable to accept the increases for health charges on the rates. There was nothing the local authorities could do about it because it is a statutory imposition on them. Some years ago the Minister made an attempt to stabilise health charges on the rates but this was a failure. I am glad to see that the Minister, this year, has done something better. He has fixed the health charges on the rates to be not more than 30p in the £.

I read in one of the daily papers that in County Leitrim the rates are increasing by something like 94p in the £. It is not any consolation to those people to know that the health charges on the rates are being fixed at 30p in the £ because there are other elements on rates which materially affect the pockets of those people. The rates in North Cork for 1971-72, which is the area in which I pay my rates, were £5.69. Health charges accounted for £2.23 of that figure. Many people who will be called to pay big increases in rates this year will not be able to do so. Families who are already hard-pressed to manage their budgets are quite unprepared to meet those new charges. The cost of living is rising daily and an increase of £1 in the £ on the rates means for a person who lives in a house with £12 valuation that he will have to pay an extra 50p in the week. We should seriously consider removing health charges from the rates.

A white paper on local government was issued recently and it appeared to me that the reorganisation of the local government services deliberately dodged the question of rates. We are now promised another white paper from the Minister for Local Government on the financing of local authorities and I hope before it sees the light of day that the Minister for Local Government, the Minister for Finance and the Minister for Health will come together on it and take into account the comments I have just made.

In Fine Gael we regard the health charges on the rates so seriously that there is on the Order Paper at the present moment a motion in my name and that of some other Deputies of my Party which states:

That, in view of the recent increase in rates (20 per cent in the past year) of which health service costs are becoming such an oppressive feature and the fact that the administration of these services has now passed from county council control, Dáil Éireann is of opinion that the cost of these services should now be met from central government sources.

When this motion is being discussed in the House, if the Minister has not already made up his mind on it, he will then see the justice of the case we make and our plea that the health charge should be removed from the rates.

I have previously appealed to the Minister that home assistance officers who spend most of their time working for health boards on health matters and who are being paid by local authorities should be put on the payroll of the health boards where 50 per cent recoupment could be got on their salaries. I hope the Minister will have another look at what I regard as an injustice to the ratepayers.

The Minister said that many people do not realise the extent to which the Exchequer meets the health services. He quoted figures and said that in most cases 75 per cent of the charges were recouped by the Exchequer. He admitted—this is where the exception comes in—that in certain towns and cities the health rates form a higher proportion than that figure. I have already pointed out the percentage that obtains in Cork County and the town of Fermoy, from which I come.

We are told by the Minister that health services are costing this year £28 per head of the population. I was interested to note in something I read over the weekend that the figure in England per head of the population is £36. While we are much lower than Britain in that regard we still have per head of the population to carry a very heavy burden.

Last year the Minister introduced a Bill into this House known as the Health (Contributions) Act, 1971. The contributions that were imposed on 1st October on insured workers were 15p per week and there was a levy of £7 put on farmers whose valuation was under £60, those people and others who are known as the limited eligibility group. I remember saying in the House then that I believed that to be the first of the mini-budgets of 1971. It is true to say that that description was reasonably accurate. The Minister says that he hopes to collect £5 million by this exercise. It is true that he is losing something between £750,000 and £850,000 in not collecting the 10s per day from people in hospital who come into that category. What has become of the £5 million? Has the Minister taken that figure to ease the £7,390,000 in the second Supplementary Estimate we are discussing? The Minister should tell us exactly where the £4,250,000 he has gained by the introduction of the Health (Contributions) Act, which came into force on 1st October last, will be spent. I am speaking about the cost of the health services and I hope I have made the case, in my own simple way, for changing the financing of the health services from rates to general taxation.

I have already said in this House that I was not altogether happy with the functioning of the health boards. Now that they have been working for practically one year we may have a better opportunity of judging them. Perhaps I judged them prematurely here some months ago. Though I am a member of a local authority, I am not a member of a health board and anything I say is not intended as a criticism of the personnel of any of them. I shall comment on what I have read of them.

Since the first day the health boards were set up there has been pulling, dragging and tearing going on in one direction or another. I saw it in the case of the Southern Health Board. I read about it in regard to the other health boards. In the first instance there was dragging, pulling and tearing as to where the headquarters of the boards should be located. That argument went on between the members of the local authorities who comprised the different health boards. We were told then, and I said it in this House, that some methods were being used to get people to make their decisions as to where the health boards should be, methods that were not what we would like and which certainly were not parliamentary.

When the headquarters were finally decided there was pulling and tearing as to who was who with regard to staff. Naturally when there was a health board comprising County Kerry, County Cork and Cork city, human nature being what it is and with the healthy rivalry that has always existed between Cork and Kerry, there was bound to be some pulling, dragging and tearing as to who was to be staff officer, who was to be chief officer, who was to be programme manager and now they are talking about something that I cannot understand—evolution managers.

All this having been settled, the health boards now appear to be in worse trouble than ever because when it comes to the striking of the rate the Kerry people do not accept the Cork people's proposals; the Cork county people do not accept Cork city's proportion of it; the Cork city people naturally do not understand people like Mr. Martin Corry and myself. The dragging and tearing is still going on with regard to who will pay and for what and how much.

I forecast here six or seven months ago that all this would happen and while that is going on the Minister has not yet decided on the apportionment of rates to be paid by any of those local authorities within the health board area. Now an arbitrator is to decide on them. All this does not add up to good administration. For that and other reasons, which I shall mention later, I think the Minister should have another look at the organisation of health boards. I read in today's Cork Examiner, when coming up on the train, that at a meeting of the Southern Health Board held in the Cork County Hall yesterday the programme manager, giving an account of the set-up of the board for community care, a very desirable and admirable thing I accept, went to great lengths to point out that Kerry, for community care, should be taken as one region and that Cork city and Cork county should be taken as a second region. That is bringing us back to the stage we were at before the health boards were set up on 1st April, 1971. I wonder is this an indication of things to come. Do coming events cast their shadows before them?

I read that the Minister said recently that the extra cost involved in the setting up and running of those health boards would be in the region of £200,000. He also represented that as something like a halfpenny in the £ on the rates. I find it difficult to believe, from what I observe going on with regard to those health boards, that their cost will be limited to anything like the figure the Minister suggests, not that I am doubting the figure, but they are appointing programme managers and evolution managers and as a member of a local authority for the past 22 years I know that when you set up any new department within a local authority, even with the best intention of any manager, it will snowball into more and more offices and more and more expensive personnel. That is why I am sceptical about the future and the cost and when we speak in terms of £83 million we should stop and take note. I accept the Minister's statement that administration and staff charges are responsible for practically 50 per cent of the entire cost. Is that not another reason why we should be more careful to reduce staff costs, if anything, rather than recruit more people? We should call a halt now before it is too late.

I read in the newspaper last week, on the day on which the Minister was paying such nice compliments to the health boards here, that a member of the Southern Health Board whose name was given as Mr. James Courtney, a Kerry representative, was calling for the dissolution of the Southern Health Board. I shall tell later how another member of the board called for the same thing at a meeting of that board in the County Hall in Cork yesterday.

I am somewhat disappointed in relation to the question of medical cards. The Minister said in the Dáil in October or November last, and we were all very pleased to hear it, that he proposed to have the whole matter reviewed with the intention of setting up new standards. He was talking about the Draft Health Services (Limited Eligibility) Regulations. He said:

I hope also to include in these regulations a provision fixing income standards for full eligibility, that is, for the category who are entitled to medical cards. After detailed and careful study of the matter, I have come to the conclusion that as circumstances other than the purely financial vary so much between country and town and between one family and another, I should not at this stage make regulations on such standards but rather to leave to it the chief executive officers of the eight health boards to try to achieve the greatest practical uniformity in their decisions on eligibility. I am arranging for my Department to bring the chief executive officers together with a view to working out a formula for achieving maximum unity of approach. The reduction from 27 to eight in the number of bodies responsible for the operation of the health services should facilitate a reasonable degree of consensus in this matter.

He went on to describe the information the CEOs had at their disposal. At that time I commented that I did not think it would work and that the Minister was failing in his responsibility by not making a decision on common standards that would be applicable to all the health boards.

Since then, the CEOs of the eight boards met and my information is that they did not express any common opinion as to who should and should not have medical cards. The Minister himself should make those regulations and in that way lay down guidelines for a common standard in respect of all health authorities.

Talking about medical cards, by design or otherwise it looks to me as if an attempt is being made to take cards from people who had them heretofore. This is being done on the ground of income. It is interesting to see the percentage of people in the different areas who possessed medical cards on 30th November, 1971. In Cork, 26.8 per cent of the population had medical cards; in Kerry the figure was 44 per cent; in Galway, 50.9 per cent; Roscommon, 50.6; Dublin, 12.5; Limerick, 28.9; Donegal, 42.9; the average for the country being 29 per cent. Do those figures not suggest to the Minister that there is a glaring case for him and the Department to lay down guidelines instead of leaving it to the CEOs to decide who should and should not have medical cards?

One case in respect of which I am sure is the Southern Health Board. The earnings of a person who can still qualify there have been raised since 11th January last. I wonder whether other Members of the House would be interested in what is happening in this respect in the Southern Health Board area. I have here a document headed Southern Health Board, Bord Sláinte an Deisceart. It refers to guidelines on standards of eligibility for medical cards. In paragraph (a) it states that persons in the following classes and dependants of such persons may be regarded as eligible for health cards: persons in receipt of the following pensions or allowances under the Social Welfare Acts and Health Acts, that is, old age care allowances, old age non-contributory pensions, widows' non-contributory pensions, orphans' non-contributory pensions, deserted wives' allowances, blind pensions, infectious diseases maintenance allowances and disabled persons' maintenance allowances. The last one is understandable and to be commended.

In paragraph (b), the circular relates to other persons whose incomes do not exceed the following limits: a single person living alone, £13 per week; a single person living with his family, £10 per week; a man and wife, £16.50 per week. There are allowances of 75p per week for each dependent child. Allowance is also given in respect of outgoings in excess of £1.25 per week. In Cork city an allowance of £1 per week is made for married persons. In paragraph (c) it states that hardship cases are to be dealt with on individual merit. All medical cards in future are to be for a fixed term not exceeding one year.

That document is signed W. MacEvilly, Chief Executive Officer. The same Mr. MacEvilly was one of those who appealed to the Minister and expressed publicly his opinion that the Minister is the person who should give the guidelines. In fairness to him, I regard Mr. Walter MacEvilly as a first-class official and a most conscientious man who has done a reasonably good job. However, since that formula was published a number of people who had medical cards have had them taken away. We seen to be forgetting that although wages are high they have to be increased to meet the spiralling cost of living and that persons on fixed wages are less well off now than they were two years ago. Therefore, I suggest that, though the figures I have quoted were meant to be reasonable, they will make things very difficult for several people. Accordingly I appeal again to the Minister to have another look at this. It will require some courage on his part because it may be an unpopular decision but I know the Minister is not afraid to make unpopular decisions and I have always admired him for that.

I am glad that the Minister referred to his intention to introduce legislation with regard to drug addiction and control. A few weeks ago a First Reading to a Bill introduced by Deputy Byrne and myself was refused. Our Bill referred to this very important matter. I am glad to note from what the Minister said that his Bill contains practically all the points which were written into the Bill to which Deputy Byrne and I penned our names.

I am not at all satisfied that the Minister fully appreciates the nature of the drug problem. If he does, he is certainly taking his time in dealing with it. Last week when the Taoiseach was asked about the Bills which he thought would come before the Dáil before the Easter recess he did not mention the Bill which the Minister referred to in his speech. I hope that the Minister, when replying, will tell us whether that is so.

A few weeks ago I said that the problem of drug-taking in this country is increasing. It has assumed frightening proportions. The Report of the Working Party on Drug Abuse is now 12 months old. It contained a serious warning. Some of the suggestions of improvements and cautions mentioned in that report have been considered by the Minister. There is no doubt that much remains to be done about this problem. This problem was mentioned in the House a fortnight ago and the following Sunday I came across The Sunday Press which contained a heading right across the top of the page: “Heroin spreading in Dublin. Smuggled from London, says Drug Squad.” The article goes on to describe what is happening here and the attempts being made by the Garda drug squad to cope with the situation. We all see from the papers what is happening in other countries in regard to the use, abuse, sale and distribution of drugs. A young boy of 14 was sentenced to jail for many years. I do not approve of his sentence, but this gives some idea of the magnitude of the problem outside this country. In these days of sophisticated and easy travel, what happens in Europe or America today could well happen in Ireland tomorrow. There is a real element of urgency in regard to this problem. I read recently that 90 persons per month are attending special drug clinics in Dublin. We are told that the drug problem now embraces several provincial centres and that the use of cannabis is now spreading to Cork, Galway and Kilkenny.

Deputy P. Barry from Cork raised this problem when we were discussing the Estimate for the Department of Education. The Deputy showed me a letter which he had got from 15 students attending a secondary school in Cork city who asked him to raise the matter in the Dáil. These young people were aware of what was going on around them. This is frightening. It is alarming that youngsters of 15 years are themselves writing to their Dáil Deputy about such a matter. They are the people who know what is going on. They see what is happening all around them. Their action must serve as a serious warning that time is running out and that we should take the problem in hand forthwith.

I hope that the Minister when introducing legislation will include in his Bill penalties similar to those which were referred to in the Bill which Deputy Byrne and myself attempted to bring before the House. At the Fianna Fáil Árd-Fheis a few weeks ago the Minister, according to a report which I read in the Cork Examiner, described drug-taking as a sub-culture and said that he could not stop it. He felt that all he could do was try to contain it and that he was drafting new legislation. The drug squad do their best and are hard-pressed in coping with the increasing drug circulation. The increase in the drug squad is still being considered by the Minister for Justice. The Minister for Health and the Minister for Justice should have a serious discussion about this matter. An early decision should be arrived at as to how the problem should be tackled. There are many parents throughout the country who are deeply disturbed about drug-taking and its problems. They are inclined to lose patience with the Minister who is taking too long to introduce legislation dealing with the control and distribution of drugs. Before the Minister gets an opportunity to reply to this debate I hope that he will introduce legislation to control the use, abuse, pushing and distribution of drugs.

The Minister described at length the hospital building and the hospital improvement programmes. The figures he has given us are quite impressive. They refer to the improvement and extension of hospitals throughout the country. We all accept that a real attempt is being made to provide more and improved accommodation for our people who must go to hospital. The Minister should be assured of the willingness of the public to provide this money. At some stage most families have the experience of seeing one member of their household going to hospital. They see for themselves the hard work and dedication of the hospital's staff. They see the conditions under which the nurses work. We should press on strenuously with the completion of the hospital building and improvement programmes.

This brings me to a subject about which I shall have some harsh criticisms to make, namely, the position with regard to Mallow Hospital in my constituency. I am glad that the Minister is present and if I say anything incorrect I would ask him to let me know. The proposal to downgrade Mallow Hospital and to close its major surgical unit was defeated by a majority vote of the Southern Health Board in the County Hall, Cork, on 6th December, 1971. The proposal was defeated by 19 votes to eight votes.

That was the result of a long and strenuous campaign conducted by a committee which was known as the Retention of the Mallow Hospital Committee. That committee had worked for the previous 12 months in consultation and co-operation with the different public bodies and voluntary organisations throughout north Cork. On the committee there were people of all political persuasions, of different organisations, and of different religious creeds, and they were from an area which contains some 70,000 people in north and north-east Cork. When it transpired that there was a suggestion in the FitzGerald Report that the Mallow County Hospital, like others, might lose its major surgical unit they commenced their campaign.

They were convinced of the severe and unnecessary hardship which would be caused to people in that large area. The campaign took the form of meetings and parades; there was a petition signed by some 12,000 people and practically every organisation and association in the area sent representatives to the many public meetings held during 1971.

The Institutional Care Committee of the Southern Health Board, one of three Committees in the board, considered the proposals for downgrading Mallow Hospital at a meeting which was held in committee. It aroused great interest in the locality, especially among those who had fought strenuously to upgrade the hospital. Although the decision of the Institutional Care Committee could only be a recommendation to the Southern Health Board there was tremendous interest in the outcome.

It is only right to say that the general view in the area was that the Minister would not interfere. On at least two occasions, Deputy Tom Meaney, who is close to the Minister, said in public that the final decision rested with the health board and he was so quoted in the public Press. He said the Minister could not reject the decision of the health board because such rejection would be tantamount to a vote of no confidence in the board and the Minister would have no option but to dissolve it. Subsequently Deputy Meaney was joined at a meeting of the Northern Committee of Cork County Council, at which I was present, by a Fianna Fáil county councillor, Mr. Jerry Fitzpatrick who expressed the same view and said the Minister would save the day. It is only fair to say that at a meeting of the same committee held in the same county council office on Friday, 25th February, 1972, both Deputy Meaney and Councillor Fitzpatrick admitted that they had made these statements at the December meeting.

A few days before the important meeting to which I have referred was held in the Cork County Hall on 6th December, the Minister for Defence— who represents north-east Cork with other Deputies and myself—who resides in Mallow, and Senator O'Callaghan, a Fianna Fáil Senator who resides outside Mallow town, spoke in favour of the upgrading of Mallow Hospital and the retention of the major surgical unit for the hospital. They wrote a well-worded letter to the Cork Examiner and to the Corkman an I shall quote an extract from that letter. I hope I can find the newspaper because it makes interesting reading——

I can save the Deputy a lot of trouble by giving him the explanation.

I have the letter here; I shall not read it in its entirely because it may not be relevant to the debate. The letter appeared in the Cork Examiner on 3rd December, 1971, and in the Corkman on 4th December, 1971. It reads as follows:

In view of the great public concern and disquiet caused by the proposal to close the surgical unit at Mallow County Hospital, we feel it necessary to state our views clearly in regard to this proposal. The surgical unit at Mallow has given an entirely satisfactory service to the needs of the area it serves. Since it was first set up as a surgical hospital, it has catered for as many as 2,500 cases of major and minor surgery in one 12 month period. The service it gives to the public of this area will not easily be replaced. Up to the present time the surgical units at Mallow County Hospital and at Mount Alvernia Hospital catered for the county area north of Cork city. Together these hospitals are capable of accommodating approximately 150 patients and have done so adequately up to this time.

It is the experience of many who have sought admission to Cork hospitals that frustrating and dangerous delays are very often experienced in gaining admission to them due to the already overtaxed bed situation in city hospitals. Severe stress would be imposed on the already heavily burdened bed situation by the closing of both surgical units at Mallow. We are adamant that these surgical units must be maintained to provide a full surgical and medical service both now and in the future for those who are presently serviced by these hospitals.

The implementation of the plan for the provision of surgical services for the Cork/Kerry area entails the provision of a comprehensive regional hospital in Cork and an equally elaborate hospital in Tralee. The building of the Cork hospital is about to start but, because of the size of the project, it must be a considerable period before it is ready for use. Considerable extensions have to take place at the Tralee hospital and these are not scheduled for completion for many years.

I am coming to the concluding and most important part of the letter:

Mallow is a point centre to Cork and Tralee. It has many obvious advantages for the extension and co-ordinated development of surgical and medical services for the very big area it serves. If both hospitals in Mallow are fully integrated, two surgeons, two physicians and a full complementary staff could be maintained here, thus giving a full-time service to all those in the area who need it. Any attempt to close both of the surgical units at Mallow and to transfer the surgical patients to other hospitals already heavily taxed for bed space, must be opposed by everyone who is concerned about the administration of an adequate health service in this area.

This letter was signed by Jerry Cronin, T.D., Minister for Defence, Main Street, Mallow, and Kevin O'Callaghan, Senator, Eden Hill, Mallow. That letter more than any words of mine gives the true position with regard to the needs of the 70,000 persons involved here for the retention and upgrading of the surgical unit at Mallow.

Does the Deputy not want an explanation now or will he wait for the reply?

When I have finished. I have just one other matter to deal with. Will the Minister give it to me when I have finished? I do not mind if the Minister intervenes now.

The Deputy is taking an awful lot of time over one simple issue.

The Deputy can take all the time he likes.

Certainly, the description "simple" is an oversimplification. I want to explain what happened subsequent to the publication of this letter, within the last week or ten days. The majority and democratic decision of the Southern Health Board was made and the recommendation sent to the Minister for Health, that Mount Alvernia should be purchased and integrated with the Mallow County Hospital—Mount Alvernia is a hospital about three miles from Mallow—and that the two hospitals should be upgraded. After some few weeks, when there was no reply, Deputy Phil Burton from Mid-Cork and I tabled a question to the Minister in the House asking him if he had yet made a decision with regard to integrating Mount Alvernia and Mallow and upgrading them. The extent of the Minister's reply was that he had caused a letter to be sent to the Southern Health Board and that he would not like to discuss it further until the health board had seen and discussed the letter.

The health board discussed the letter only yesterday but when I pressed the Minister on that occasion in the Dáil for the gist of the reply he had sent he said that there was nothing sensational in it. I can assure him that the people of North Cork and North-East Cork did not look at it in the same tame way as the Minister did. They thought and still think that there is something really sensational in it and they intend to make that known to the Minister and his Department.

I have no intention of reading in full the letter the Minister wrote back and which has been published in the various papers but the gist of it is that, in any case, the Minister does not believe that the Mallow hospital should be upgraded and integrated with Mount Alvernia. In fact, he suggests that the Southern Health Board should possibly acquire Mount Alvernia Hospital and use it as a psychiatric unit. Like him I have no doubt, and neither has Deputy Healy who is sitting behind the Minister any doubt, of the need for more room for the treatment of psychiatric cases but to bring that need into this issue was just a damp squib.

It was not.

That is my belief. The Minister says in his letter that it may not be easy to integrate the two hospitals because of the distance of three miles from Mallow County Hospital, out the road as I would call it, to Mount Alvernia. Does the Minister not agree that the people who live in Ballydesmond, 40 miles from Mallow and 60 miles from Cork city, would be much more satisfied to have a surgical unit available to them in Mallow than to have to travel from Ballydesmond through Mallow to Cork city and have to pass through all the traffic in Cork city in order to get to the new regional hospital to be built at Wilton? Does he think that that would be fair to them? The Minister says that the Southern Health Board should have another look at this whole proposal, he, having completely turned down the recommendation that they made.

That brings me back to the point I made some minutes ago as to the usefulness or otherwise of the health boards. Have we now reached the stage when their decisions may be so easily changed by the Minister for Health and his Department?

When the Southern Health Board met yesterday they had something to say about this problem. I have before me today's issue of the Irish Independent. A banner headline in regard to a discussion the Southern Health Board had on this problem in Cork County Hall yesterday says: “Rubber Stamp Status Angers Board.” Why would it not? Is it a fact now that any decision the health board makes can be rubber-stamped by the Minister and his Department?

I was a member of a deputation that attended at the Cork County Hall on 6th December, when this majority decision was taken. I have been a member of a local authority since September, 1960, and I have never yet seen a more representative or larger deputation than that which attended that meeting. It was representative of all classes and creeds. The Southern Health Board heard three members of that deputation. They put their case in a sensible, plain and clear manner and they impressed the board, if they were not impressed previously, to the extent that they voted 19 to eight in favour of upgrading Mallow Hospital. Everyone was pleased and people in the town of Mallow and in the hospital were particularly pleased. We saw photographs in the following day's paper of the nurses and staff dancing around a bonfire on their return home, but their celebrations have turned into misery because they are still in doubt about their future and the people who depended on the hospital for so many years are still very much in doubt.

I want to suggest that since the eminent surgeon we had in Mallow for years, Mr. Henley, left some months ago and went to Tralee County Hospital, Mallow Hospital as a surgical unit has been floundering. The belief down there, and it is my belief also, is that this is the way the Minister and the Department want it. Temporary surgeons are coming and going and eventually it will work out all right for the Minister and the Department because if that situation continues, the number of people looking for beds there will be diminishing and then their case will be, possibly in a few years time, that the bed population in Mallow Hospital does not warrant the appointment of a surgeon there in any case.

Perhaps the Deputy would allow me to intervene because he has cast doubt on the veracity of the Minister for Defence and Deputy Meaney in regard to the point they made, that it was a decision for the health board. I told them that the position in Mallow Hospital was a decision of the health board at a time when I assumed that either the health board would adopt the principles of the FitzGerald Report in regard to Mallow or the status quo would remain, pending the building of the Cork Regional Hospital and an examination of all the proposals in the FitzGerald Report in detail by the regional health board, by the hospital boards yet to be set up, the health boards and the county advisory committees. I did not conceive at the time, and I said to Deputy Meaney and the Minister for Defence that it was a decision for the health board, that there would be a proposal for the upgrading of Mallow hospital.

I simply cannot accept as national policy the upgrading of a hospital in the area where Mallow is. I can accept it remaining for surgical purposes for a future period; I can accept it being integrated according to the FitzGerald proposals and changed into being a hospital run by medical doctors, obstetricians and gynaecologists, but I cannot accept in any area a deliberate reversal of the proposals in the FitzGerald Report. Therefore, when I spoke to the Minister for Defence and to Deputy Meaney, I was speaking correctly because I just did not conceive that the final proposal would be an upgrading and not either the status quo or else proposals on the lines of the FitzGerald Report, so that they were not deceiving anybody and I was not deceiving them. I hope the Deputy appreciates that. At the conclusion of my letter I say that if the health board are not willing to consider again the proposals of the chief executive officer they can consider the preservation of Mallow Hospital for surgical purposes in its present form. The Deputy will realise that that is in the letter.

(Cavan): May we take it that the Minister has accepted the FitzGerald Report?

(Cavan): And proposes to implement it?

In principle—with a great deal of consultation by everybody.

(Cavan): I am glad to hear that.

I want to assure the Minister that not for a moment do I doubt his veracity, or the veracity of the Minister for Defence or Deputy Meaney. I was simply repeating what they said and I would like that to be accepted. The Minister says that he cannot accept that Mallow Hospital should retain its status or should be what the people of North Cork wanted it to be, a surgical unit where, between itself and Mount Alvernia, two surgeons would be employed.

I cannot accept the upgrading of any hospital within 23 miles of where a great city hospital is being constructed.

If the Minister cannot accept that, I want to assure him that the people representing the 70,000 people in north and north-east Cork cannot accept his view of it either.

It is quite legitimate for them to feel that way.

That is exactly the position. It is no wonder they were incensed when they read the Minister's letter because they really had legitimately believed and accepted that all their troubles were over, after years of hard work and agitation and protest meetings in the town hall and in private. They believed that everything for them was right and that they had attained what they believed to be their civil rights.

I learned a very valuable lesson from it because I have learned that in connection with these controversies, I must now advise health boards where there are hospitals in this position, that whatever they do, I simply will not accept an enlargement of a hospital in an area where there is a general reconsideration of the service. I can accept a hospital retaining its status but I simply could not accept going into FitzGerald in reverse, in the opposite direction, and I learned a valuable lesson from this because I did not really believe that a proposal would emerge, not for the status quo but for an enlargement of the surgical facilities. I was innocent enough to believe this was not possible and if I had believed it was possible, I would have perhaps prevented misunderstanding by clarifying the position.

Will the Minister be replying on this Estimate?

I do not think there will be any need.

If the Minister has learned a valuable lesson from all this, I assure him that the 70,000 people in north and north-east Cork have had a real stinging from the Department of Health.

There is another thing which annoyed these people, and the retention committee members in particular, who have taken such a keen interest in this matter—the letter, dated 24th February, 1972, addressed to the secretary of the retention committee. That letter reads:

With reference to your letter of 1st February, 1972, regarding the representations of the north Cork committee for the retention of Mallow County Hospital, in respect of the proposed competition for the above-mentioned post, I am to state that the Commissioners are unable to proceed with the competition due to circumstances outside their control.

This, by the way, was the plea that was made for the appointment of a permanent surgeon to Mallow Hospital, but the Civil Service Commissioners wrote this letter on 24th February, to the town clerk, who was the secretary of the retention committee, so it does mean, in effect— and this has brought it out more clearly than anything else—that even the proposal or expectation of a permanent surgeon being appointed there is now stymied through something outside the control of the Local Appointment Commissioners. It is true to say that the Minister last week —I saw a report of this in some paper, and we can only learn from reports because we can get nothing direct from the Minister—met Deputy Meaney and others and said that he was prepared to sanction a permanent appointment there.

That is correct—when the health board finally make up their mind on this.

How then did it happen that the Local Appointment Commissioners could write this letter?

Because there were a number of different positions before the health board, the one the Deputy has been referring to.

Does it not appear that it was only when Deputy Meaney and someone else called on the Minister and pointed out to him the serious way in which this was being received that this was changed.

They made me realise I should do something about it quickly.

They made the Minister realise something last week. I hope that what I am saying here will make him realise that these people are not going to accept a downgrading of the hospital. I believe, and I am not saying this in any threatening way but in the full sense of my responsibility, that I know exactly the way those people feel. The matter is so serious and important to them that in all churches from Ballydesmond on the Cork/Kerry border to Ballynoe at the end of Cork county, a radius of some 60 miles, notices were read out last Sunday saying that a public meeting would be held in Mallow next Saturday night at 8 o'clock to air views and see what the people feel and what they are prepared to do to retain what they believe are their rights and privileges. This is a public meeting and its size and nature will, I have no doubt, be conveyed to the Minister next week by the Minister from the constituency and the other Fianna Fáil Deputies for the area.

Very seriously I say I have warned the Minister of the feelings of the people there and I, as one of their representatives, want to make the case for them that they are making outside. I think that is my duty and I feel so strongly on it that I think it only right to have devoted the time I have given here in the House telling the Minister the nature of their intentions. Having said that, I appeal to him now in the name of commonsense before the matter escalates into any kind of nasty situation—God knows we have enough of those without having them in Mallow on our own doorstep, but it is building up in that way—to have another look at the matter in the interests of the people and in the interests of harmony between the Southern Health Board and the Department.

I want to make it clear to the Deputy that under no circumstances shall I go in the opposite direction to the recommendations of the FitzGerald report, recommended by consultants over the length and breadth of Europe. In no circumstances shall I go in the opposite direction to FitzGerald. I am willing to live with the status quo until time and examination of these problems can show what is necessary but not to go in the opposite direction. The Deputy had better get that absolutely clear in his mind.

I could say a great deal about the FitzGerald report but I do not intend to say it now. We know only too well the composition of that board, where most of them came from, of their little experience— without casting any aspersions on them—of rural Ireland and rural life and the hardship people suffer in regard to doctors, sickness and hospitals. They made a decision to which I understand the Minister is going to adhere rigidly.

Not rigidly to the report but rigidly to not going in the opposite direction. Does the Deputy understand?

I do indeed. It makes it all the more clear that if the Minister holds office for very long as Minister for Health the people of Mallow and district will know exactly how they stand as regards the retention of Mallow Hospital.

I did not say that Mallow Hospital would not be retained. I never said that.

Why quibble with words? Is it not the same thing? What the Minister is saying is exactly what the people feel you are saying and thinking.

Will the Minister say to me now in regard to the appointment of surgeons to Mallow Hospital and in regard to the floundering position in which it now stands since the permanent surgeon, Mr. Henley, who had made a great name for the hospital before he left for Tralee—the best of luck to him there; the people should be very glad to have him—that he will leave the hospital now floundering along indefinitely until it comes to the stage in five or six years time when he says that the Regional Hospital in Cork will be available, that it has become so bad that we cannot have it there anyway? Is that the intention?

No, I have not said that. I have not said what would happen in five years time.

Deputy O'Connell asked the Minister to deal with this in replying to the debate and I do not want to draw the Minister any further.

Surgery as it exists at the moment, if the health board wish to retain it, can be retained. That is what I said. The Deputy knows exactly what I mean.

I do indeed. I do not want to be accused by anybody afterwards of not having warned the Minister. As the representative of the people of north Cork and north-east Cork and recognising their plight I know the taking away of the privileges that they had over the years is not something that will be taken lightly and I appeal again to the Minister to have another talk with his colleagues who represent the area as well as I do and who know as well as, if not better than I do, the feelings of the people of that area.

I want to refer to the training of nurses. From time to time we hear there is a shortage of nurses in the country and no doubt it exists. That is a pity when so many young girls go to England to be trained. Unfortunately, it is very hard to get them back again. Are we right in this? This is something I want to bring to the Minister's notice. To be accepted as a trainee nurse a girl must now have her leaving certificate. I think this loses the profession many girls. I know many excellent nurses whose education did not go beyond the primary certificate but because they were suitable nursing material they made very good nurses. To be a good nurse does not necessarily require an extra high standard of education; it involves something much more important, having a way with people, having a good sense of humour and having a good bedside manner. In view of the shortage of nurses here I think the Minister and the Department should reconsider the conditions imposed on girls who wish to train as nurses, especially the obligation to have the leaving certificate. I think most Members of the House will agree in that.

I am not clear on this—I am sure the Minister is—but I hope that in regard to the new regional hospital being built in Cork there will be good accommodation and facilities for the training of nurses there.

There will be.

At present St. Finbarr's is one of the best training hospitals not only in the country but in the British Isles but, unfortunately, as it stands, only 40 trainees can be taken on each year. I am glad to hear from the Minister that added accommodation and improved facilities will be available if and when Cork Regional Hospital is completed.

I was glad the Minister referred to the choice of doctor scheme and pleased to know that this will shortly come into operation in the Eastern Health Board area. It is only fitting at the commencement of this phase in our health services that we should pay tribute to the dispensary doctors in that area and throughout the country who did such remarkable work over the years and who were always at the disposal of their patients. They served the community well in the past and at times when conditions for them, as for the rest of us, were not as good as they are now. It is only right that we should put on record our appreciation of the services they rendered to the public.

The Minister referred also in his speech to the strike of psychiatric nurses which took place some time ago and of which the Minister appeared to have been rather critical. Like him, I hope that there will not be a strike by this body of people in the future. However, on my way home on Thursday evening I noticed a report in the Cork Examiner for that day, March 2nd, headed “Mental hospital nurses' dispute”. It read and I quote:

Psychiatric nurses of Our Lady's Hospital, Cork, are in dispute with the management of the hospital because they have not yet received their 13th round wage increase—of £2 per week which was due on January 1.

They are further incensed by the management's attitude in asking for increased meal contributions before they pay the 13th Round.

A spokesman for the nurses told the "Examiner" yesterday that they had no objection to paying increased meal contributions. "At present we pay 35p per day and are asked to pay a further 5p or 10p. We have no objection to this and we appreciate that rising costs generally have affected food prices.

"It is the management's attitude in demanding that we pay this increase before they agree to pay us our 13th Round increase that we object to."

From yesterday the psychiatric nurses were refusing to eat at the hospital until the whole issue is settled.

A spokesman for the management said that settlement depended on the nurses paying increased meal contributions. He declined to comment when asked why the management had looked for increased meal contributions before paying the £2 per week the nurses are entitled to.

Have those people not a just cause for complaint if that report is true? I only mention the matter in passing but it will be seen that in this case, as in any other, there are always two sides to be considered.

I was glad to note also that the Minister referred at length to the psychiatric services. I am sure every Member of this House would join with the Minister in expressing hope for the improvement of these services. Much work remains to be done in this area of health services. I understand that the problem of overcrowding in the Cork Mental Hospital manifests itself in other hospitals also. There is a need for a considerable expansion of the diagnostic services, and a greater attempt must be made to provide sheltered workshops and suitable hostel accommodation for the mentally handicapped. There is a need also for greater domiciliary attention. A greater effort in this regard could result in fewer people having to be hospitalised. More short-stay accommodation should be provided and also more out-patient clinics. Although I have only one particular case in mind I am wondering whether the follow-up visits by social workers or doctors or others is adequate. Such follow-up is necessary to ensure that when patients leave hospital they continue to take whatever drugs are prescribed for them. Social workers should be in a position to discuss the progress of a patient with his or her relatives.

Regarding health education, I compliment the Minister for the attention he has given to this matter. Health education plays an important role in regard both to mental and all other illnesses. Regarding mental illness, people must be assured that there is effective treatment for the mentally ill in the same way as there is treatment for all other illnesses. Also, there must be no stigma attached to this illness as there was in the past.

During the year I asked the Minister a question regarding occupational therapy and in his reply he assured me that he was considering the possibility of improving conditions of pay and promotion of occupational therapists and also that this field was being developed. However, I see no reference to that in his speech and I mention it now for the purpose of bringing that promise to his mind.

I have said here that some effort must be made towards cutting the cost of the health service. I have said that health charges should be met in full by the Exchequer. I have said also that more than 80 per cent of our people are dissatisfied with the costly health services we are providing. Of course, it is easy for one to say such things and I might be asked what I would do if I had responsibility in this matter. In anticipation of somebody making such a remark I have jotted down a few suggestions that might be useful to the Minister and his officials. The Republic of Ireland has more beds per thousand of the population than has any other country in Europe and hospital beds are costing between £30 and £80 per week. That is a startling figure. We must do everything possible to effect a reduction in the numbers of people going to hospital. In 1971-72 the total expenditure on hospital services was 70 per cent of the total expenditure of the capital amount for health services.

Progress reported; Committee to sit again.