The Minister will appreciate that the protracted debate on the health regulations indicated the feeling of Deputies in regard to the abolition or partial abolition of our democratic system of selecting public boards. We are moving from that system. The Minister may say that the main reason for doing so is that you can get a better qualified person on the board who could not gain the confidence of the electorate. If that argument were sound it could apply to the Minister or the Government also and it could be said that you could get a better body of men to fill the Government seats who could not and would not get the confidence of the public. So that argument fails.
For the record, it is now generally accepted that although the health boards have been in operation since April, 1970, little or no worthwhile improvements have taken place under the new system. I know of none. There are more dissatisfied people now in regard to health services—one meets them in one's constituency and I am sure this applies in all constituencies—than when the Health Estimate was £5.7 million as it was in 1948. That may seem peculiar but it is correct.
The Minister has heard a number of contributions on the procedures and regulations governing eligibility for medical card services. This is possibly one of the greatest questions for the Minister, the health boards, public representatives and those engaged in health administration generally. The main reason, of course, is that money values are steadily declining and health costs are increasing rapidly, and families who are stricken with illness and whose incomes are moderate find it very difficult to measure up to the costs involved in getting proper care and medicines for the members of their family who are afflicted with illness of one kind or another. The guideline set down of £16.50 for a married couple, with £1 per week in respect of each child—it was 75p and I understand it has been increased by 25p— gross figures, of course—would exclude a man with a wife and four children whose gross income was more than £20.50 weekly and that is an exceptionally moderate sum, having regard to present-day money values. How is such a person to buy medicines at an average cost in many instances of £2 or £3 per item, equating an item to a prescription? The average prescription, I would say, would cost in or about an average of £2.
I am joining with the other members who expressed dissatisfaction with the figure set down and the rigid manner in which the administration deals with applications at present. It seems to me that so far as wage earners are concerned, if you are above the income limit, irrespective of how small the figure in excess of that limit may be, you get a letter telling you that you are excluded from benefit. I did refer to families who in the old days were getting some special consideration, some of the members of which had poor health and had occasion to have medical attention regularly. Surely in such cases that kind of attention should be provided at public expense? I am stressing that again tonight. It has been stressed already, but I think that with the amount of money which we are paying to doctors now and the new terms made available to them, this kind of service could be provided at little additional cost. The men are there already paid for and I assume that we buy medicines— when I say we, I mean the public— at a cost some 40 per cent below what it would cost the private individual to buy them.
The Ceann Comhairle may think my margin of profit rather too high and maybe it is, but in any case it is probably better to say that a body like a health authority purchasing substantial amounts of medicines will get terms much more favourable than those given to the private individual, and I hope something will be done to rectify the present unsatisfactory position and that some directives will be issued to the chief executive officers of health boards on the matter. If that is not done, there is no purpose in having discussions in this House. It serves no purpose to take up time here, time which is costly on public funds, to discuss such matters or for elected representatives to bring them to the notice of the Minister if some action is not taken, and definitely this medical card field is a field which cries out for action at present.
Leaving the question of cards—my sequence may not be too good—I move to another section, that is, the section who do not qualify for medical cards and who have to avail of the services of the voluntary health insurance scheme in order to provide against illness arising in their families. I am not satisfied that some families are getting a fair deal. Possibly it would be better to say that I am not satisfied with the voluntary health insurance system as it applies at present. It is difficult to get over what I have in mind but it relates to families above the £1,600 income limit or the valuation limit in the case of farmers, one or more of whose members is stricken with illness which needs continuous or regular attention. The Voluntary Health Insurance Board will exclude that member when an application is made. He may be mentally handicapped and his parents are keeping him at home. He may be a person moving on to manhood and may be suffering from several other ailments, and with the exception of a few ailments such as diabetes and two or three others, there is no cover for him at all. I know some in my constituency who find themselves in this position and they are not very well-off financially. I have one person in mind whose income would be around the £2,000 mark. One member of his family needs regular attention. He must provide medical services for that member. The board excluded him. They could not cater for someone who obviously would be a liability. They excluded him when representations were made because his parents' income was deemed to be well over the set standard. It would be about £300 or £400 over the limit. In such cases some means must be devised whereby, say, the voluntary health insurance would carry the liability even if that meant an overall increase in their charges. This and all such families would be joining such a scheme anyway and paying their contributions, but they are in this unfortunate position that one member is suffering from this ailment of a continuous nature and they have been told that institutional treatment would not be any great advantage so far as the possibility of a cure is concerned. Many families are anxious to keep such a handicapped relative at home and this is desirable. I am putting this forward here. I am not offering any suggestion as to how it could be overcome. I know the health board's view that if they take such a person and accept responsibility for him, he is bound to be a liability on their funds over many years. I am making a sincere plea for such people. The Minister and his Department should devise some method of helping those who are outside the limit but who, by virtue of the illness of members of their family, find it difficult to provide the care and attention required.
Numerous memoranda and books have been issued telling us of the many advances in our health services. There is one from Mr. Brendan Hennessy painting a rather bright picture of how smoothly our health services are moving. I do not think that is so. There have been statements issued from the Department telling us about all the services that are provided and all the schemes that operate for the benefit of our community.
The Minister for Social Welfare in his speech this evening on the Social Welfare Bill re-echoed the views of Members of this House on the desirability of keeping old people in their own homes as far as it is humanly possible to do so. He said it was a matter more for the Department of Health but one would think that the two Departments would put their heads together and try to devise some helpful scheme for our old people. I have made suggestions from time to time which I think would go a long way towards relieving the congestion in our district hospitals and our county homes. I do not like using the term "county home". We have, with our relatively small population, more hospital beds per head of population than any country in the world. In Cork County we have almost 10,000 hospital beds and that is an exceptionally big figure in proportion to the population of the county. How is it then that it is almost impossible to get hospital accommodation, especially for old people, at present? It strikes me that even if we were to increase hospital accommodation sharply the same position would obtain. I tried, when on the former health authority in Cork, to go a part of the way towards relieving that position. I tried to get approval, unsuccessfully of course, for the payment of disablement allowances to incapacitated persons of more than 70 years of age. My reason for so doing is that such supplementary allowances would help families to care for these old persons at home. I know that many people would like to keep their aged parents at home and they should be obliged to do so, but having regard to the small incomes of some households that is exceptionally difficult. Then there are cases of relatives outside the first degree, uncles, aunts, cousins. It must be distressing for some of these people when they are advancing in years to realise that it is possible that they will end their days in some institution, if a bed can be obtained there. The most distressing feature of all and one which amazes me is that in order to get admission to what used to be described as a county home, representations must be made. That is a peculiar situation. In the past, people tried to avoid having to go into such places. In west Cork we renovated and reconstructed the county home and brought it up to the standard, possibly beyond the standard, of the average district hospital.
There must be something wrong in regard to hospitalisation. Are our people more prone to illness than people in other countries? How is it that, apart from district hospitals and homes for elderly persons, the acute care hospitals—and there are a number in County Cork, Dublin and Galway—have long waiting lists for admission? I do not understand the reason for that. The only conclusion I can come to is that the Irish are not a healthy race, that they need more hospital care and are more prone to hospitalisation than other races.
There may be another reason. I do not know whether the Department try to probe these questions in order to find answers to them. In the past, people were not inclined to go to hospital except where hospitalisation was urgently needed. The system seems to have changed, in my view unnecessarily, especially in the case of aged persons. If they were to receive an additional allowance, where circumstances warranted it, to remain at home and be cared for there, there would not be so great a need for institutionalisation. I refer to an additional allowance over and above the prescribed relative allowance of £2.75 applicable in certain cases and which is helpful. As I mentioned earlier today on the Social Welfare Bill, even for two persons, the allowance would amount to only about £8 a week.
I ventured to assert that the per capita charge in district hospitals should be more than £30 a week. The Minister for Social Welfare gave the figure at something less than £20. I think that figure is incorrect. In my view, having regard to the increase in costs that has taken place in the last few years, it costs more than £30 to maintain an aged person in a district hospital. Five or six years ago, in Cork, the cost was, on average, about £18 and I have no doubt that the cost has increased by 70 or 80 per cent since then. I appeal, therefore, to the Minister to give more consideration than is given at present to the provision of financial help, where circumstances warrant it.
In the departmental circular of 20th April, 1972, on home help services, which is a rather lengthy document with several subheads, there is very little reference to financial aid to individual families. If financial aid were given to the families or to the aged persons, most of whom are social rather than medical cases, that would suffice. Many of these old persons do not need medical attention in hospitals. An extra payment in these cases, where circumstances warrant it, would be the best way to provide for them and would have the effect of keeping them in their own homes.
It was emphasised on the Social Welfare Bill today, and it had the approval of the Minister for Social Welfare, that it is desirable to keep as many old persons as possible in their own homes, first, because old people like to remain in their own homes and like to live out their lives in familiar surroundings. We do not like institutional life and avail of it only when there is no alternative. As I said when the Minister was absent from the House, he should consult with the Minister for Social Welfare and try to get his priorities right in regard to the alleviation of the overcrowding in district hospitals and homes. The best way to do that is to give financial help to families and individual old persons. The authorities are very niggardly towards applicants for this kind of help. I know a number of cases. I might mention at this stage the non-implementation of section 69. This would relieve the position to a considerable extent, particularly for those under the age of 70. The Minister indicated that so far as these disabled people are concerned, the additional cost would be more than £1 million. I realise that this money must come from the people but he should provide that £1.25 million and pay the allowances on a means system similar to that operating with regard to old age pensioners.
We are very concerned about mentally handicapped people. We have the greatest of sympathy for them but the burden rests on the State to provide for them. We are spending a great deal of money on the modernisation of institutions for these people but this is a necessary expenditure in order to help them. Our ratio of mentally ill people per head of the population is higher than in neighbouring countries. The building of smaller units would be an effective way of providing accommodation for these people. The old-type hospitals, such as the old Cork Mental Hospital which was a huge building housing some 2,000 people, is not the best type of accommodation. The type of unit built in Cork, known as St. Anne's, is the ideal accommodation for these people. It is not fair to apply the term "mentally handicapped" to many of the patients. Some of them may be in the institution for a short period only but they may have to spend some time in a hospital to receive corrective treatment.
Therapy work in our institutions is something we should encourage. It is desirable to build up the confidence of people during their stay in mental homes; to teach them skills or to advance the skills they have is praiseworthy. Every effort should be made by social welfare working groups to provide suitable employment for those people when they have finished their treatment. This will give them a sense of independence and will help them in their rehabilitation efforts.
The problem with regard to mentally handicapped children is sizeable. In this case, also, we have a higher ratio per head of population who are suffering in this regard than other countries. I know that the Cork group of the Polio Association, in conjunction with the Department and the health board, have made quite an impact in Cork. Although other institutions have done the same in other parts of the country, despite this there is demand for accommodation which is not available.
This is a matter of extreme urgency. The provision of suitable accommodation with training for mentally handicapped children should be given top priority. In Cork we get many representations from parents but despite the efforts of all concerned the accommodation is not available. Let us hope that this problem will diminish in the years to come. If the additional accommodation is provided it can be used for other purposes if it is not required for the mentally handicapped children. Therefore, it is not a case of pouring money down the drain.
I shall not take up the time of the House by going into details on the administration of health boards. I have made my views clear regarding the constitution of these and other boards so far as other aspects of local government administration is concerned. I believe in the democratic system but I know that there are moves afoot to abolish that system. For instance, there are plans for removing as many powers as possible from public representatives at local level.
Fianna Fáil are not the only culprits in this respect because there are some people in both the Fine Gael and Labour Parties who advocate this step also. This ailment, as I shall call it, arises because many people in our society who are deemed to be professional do not like the idea of giving their time on such bodies as county councils. They consider it a waste of time to attend meetings of these bodies and to have to deal with correspondence from the people they represent. While some of them may like to be members of these bodies they would prefer to be selected for membership of them without having to be elected. Knowing that they will not have to answer to anybody they would consider themselves free to say what they wished. I shall not go any deeper into that question for the moment.
There is another matter that I would like to raise for the purpose of geting a comment on it. I refer to people in this country who, without qualifications of any kind, set themselves up as healers of one kind or another. I know that there are such people as bone setters who are successful and who are capable and efficient but there are many others whose activities are questionable. These people advertise in the newspapers to the effect that they are capable of healing certain ailments. They usually request that a certain amount of money be forwarded to them in the first instance for which they will, in turn, forward medication of some kind. Unfortunate people suffering from the ailment for which a remedy is advertised will very often take a chance and buy the medication offered.
It is my contention that such public advertisements should be subject to scrutiny for the purpose of ascertaining whether there is any merit in the commodities advertised. No one knows how much one of these people might earn from his activity. In recent times there has been one particular group of people moving around the country and attracting huge crowds. Many people spend a lot of money when they attend the clinics at which these people operate. Sufferers are told, after these alleged healers lay their hands on them, that they may be cured. I am doubtful as to the authenticity of these operations. I am wondering whether the Department should investigate the activities of these people. Many people in Cork have availed of these services in the belief that they will be cured. I do not share their faith in that respect and I do not like to see money being extracted from them in such circumstances. In some instances people travel many miles to visit these alleged healers. In fact, three or four people whom I have known personally in west Cork have moved from there to the province of Ulster in the hope of being cured. The cost involved for these people was formidable. They are entitled to do as they wish but the State has some obligation to see that they are not being fooled. Perhaps an inquiry by an independent party would be the answer. This would ascertain whether these people have the powers they claim and whether cures are effected.
To sum up briefly, the matters I have raised here today and on the last occasion: I drew the Minister's attention to the desirability of changing the regulations governing eligibility for medical cards, changing the regulations so far as they apply at present to married women who are never deemed to be engaged in gainful employment and are consequently precluded from qualifying for disabled person's allowances. I mention these matters to the Minister and I suggest that he should not wait until the debate concludes to do away with this system. I read to the House a letter from the Cork Health Board relating to a particular case to illustrate what is happening. I suggest that the Minister should not let that happen again because it is a most outrageous feature of our health services.
The next item I have in mind is the desirability of providing additional accommodation for mentally handicapped children and the other very important item, the desirability of recasting the rules and the conditions of the Voluntary Health Insurance Board to cater for members of families——
