Last night I was referring to the measures taken to bring benefit medicine on to a better basis, to broaden the scope of our health schemes, to review and strengthen the school health service, to provide better health education in general, to regenerate the district nursing service, to extend the general medical service and the auxiliary services such as the dental side of the scheme, and to provide better care and accommodation for the aged. The care of the aged is a new scheme with which all Deputies in the House will agree. It is one we should like to see working well from the start. I think the action of the Minister in trying to promote it on a unit basis whereby it will attract voluntary health subscribers is a very good decision.
I suggest that all these extensions mark a milestone of our progress on the road to the better health of the community. I also suggest that our progress in the hospital side of the scheme, the setting up of the Comhairle na nOspidéal and the regional hospital boards, is welcomed by those in the country who have a genuine interest in the patient, who is the most important person in medicine and who is always conscious of the need for good hospitals.
We subscribe to these views and there are thousands of people in the community who also subscribe to them. We can only have a high class hospital system if it is founded on a basis where all information needed on the various aspects of hospital management is available. If we are to build up better medicine we must subscribe to the suggestion that there should be better management of hospitals and I am glad to know that on the administration side the Minister deemed management to be worthy of immediate attention. Nowhere is management more important than in a good hospital system if we are to move towards better and larger hospital units. Therefore, I was impressed to learn from the Minister's statement on the Estimate that the recruitment of management teams is proceeding and that by the end of the financial year the Minister hopes to have this work completed. This is a distinctive move forward on our part.
Many speakers at various times criticise in a scorching way our hospital services. Of late we have heard some comments in relation to some hospital charges. This is only natural. The recent announcement of an increase in the scale of charges for treatment in voluntary hospitals brought forth that sort of comment. When we hear of such increases we must realise that hospitals call for large well equipped staffs with a high degree of skill in medical science. That covers top-class surgery and top-class medical therapy from the head surgeon and physician right down to the junior doctors, the matron and the nursing staff. It is very hard to place a value on the work of a good surgeon or a good physician. It is equally hard to place a value on good nursing care. If one considers the number of trained personnel required to look after one patient it is very hard, if not impossible, to evaluate the services of such a team.
Teamwork is called for in industry, in the services, in agriculture and in business generally. How much more is it called for in hospitals? In an intensive care unit at any given time from three to six nurses and, perhaps, three or four doctors, may be engaged in looking after one patient. This illustrates the effort involved. The effort is truly enormous. This is where the greatest expenditure is bound to occur. This is the heart of the matter. This is what good hospitalisation is all about and those who are critical must look at the naked facts. As I said, we aim to provide the best service possible for the patient and, if we baulk at paying for it, then the patient will not get it.
The Minister stressed the increased cost. We all know that the staff of a hospital must be paid, must have time off, must have decent living quarters, must keep up certain standards and so forth. No one disagrees with these aims. If anyone does disagree then I should like to hear the arguments against. I am advised that another side of the hospital system has also to keep up good standards. I refer to the housekeeping side of hospital care, providing the patient with meals, supplying a laundry and other services. These compare very favourably with similar services rendered elsewhere. Indeed, some of our hospitals could teach some catering establishments a lesson.
The conditions of employment of the staff must be as good, if not better, than the conditions of employment of staff engaged in other enterprises. When we take everything into account there is no difficulty in seeing that a case can be made for increased charges in this sphere. I am not here to make a case for hospitals. I am here solely for the purpose of having regard to the facts.
Health services of their very nature are different from other services. They have nothing in common with commercialism. There is no profit motive. Unlike a business venture a hospital is not interested in making a profit qua profit. The aim and the ambition is to provide the best surgery, the best medical therapy, the best nursing and the best maintenance possible. This is a laudable aim. This aim can be accomplished only by a truly dedicated team using the most up-to-date methods.
In my own local authority area costs have been increasing all the time. In 1958-59 the health grant in County Longford amounted to £101,365. In the last financial year, 1970-71, it amounted to £372,000. This brings us up immediately against increasing costs. If we expect more money from Government sources, then we must, as members of local authorities or of health authorities, also recognise that our share of the cost must also increase. It is not possible for costs to be met altogether on the one side. The Minister said that the cost of running the health system is roughly £86½ million and that this represents an increase of £13 million on previous years. This in itself points to the direction in which we are going: the direction of raising the standard of the health of the community.
I want to refer for a moment to points made by previous speakers. Some Deputies were inclined to dwell on the management end of the scheme. Earlier I made the point that if we were to move towards better hospital units we could only do so with better management. We are told that management represents what about ½p in the £ would produce, say, on the local rates. The Minister did fairly well during the year in this regard. When we came to strike a rate the argument was raised that we were in an area of increasing costs. We are all aware of the fact that down through the years 50 per cent of the cost was allocated from the resources of the Department of Health. We used to receive a supplementary grant over and above that figure. This year the Minister stepped in and arranged that the rate in any health area would not be deemed to be raised above 30p in the £. This was a distinct relief to members of local authorities. Otherwise costs would have worked out at roughly twice this figure. Instead of a moderate increase of 30p in the £ we would have had an increase of double that amount. I heard no comment on this from any previous speaker. I am not saying it was not recognised by some speakers.
When we talk about rising costs in the health services we must realise that we are trying to spread those costs all around as evenly as possible. There are those who would advocate an outright comprehensive health system. Unfortunately, in our circumstances, and having regard to the scope of the costs, people who advocate a comprehensive health system without referring to what it would cost are talking like people on a champagne income when, in fact, our income is more akin to a soda water income. In the whole context of providing better health services we will have to move in steps.
We also know that money had to be provided to cover the increased cost of drugs and medicines. When members of local authorities or members of health boards criticise rising costs, and criticise the increased costs in the voluntary hospitals, I would suggest that we have to take account of the advantages to health authorities of being able to send their patients to the voluntary hospitals. There is a distinct advantage in this.
This year health boards were voted 50 per cent on health expenditure, plus 9 per cent in supplementary grants, plus a sum which was made available from the general capitation fund to cover deficits in voluntary hospitals. All these measures make a difference to health boards. A health board who send a patient to a voluntary hospital are never called upon to pay the full cost of the services in respect of that patient. If we take all these elements into account, the amount the patient pays and the actual cost of keeping that patient, we see that the elements I mentioned give a distinct advantage to the health authority. I am referring to the patient sent by the health authority to a voluntary hospital outside their own area.
At this point in time we must pay tribute to the Irish Hospitals Trust Fund. Down through the years this fund was in the background providing large sums of money in aid of voluntary hospitals, adding up to a total of roughly £90 million. I suggest that this has made a vast difference in the standards of hospitals here. If we had to find this sort of money on a yearly basis for the Exchequer, we would be in a much more lowly position. A word of thanks is merited by the Irish Hospitals Sweepstakes. No community and no Government could raise the volume of money raised by that body. The point I am trying to make is that one is inclined to forget the extent to which a patient from a health board area is subsidised in a voluntary hospital. It is sometimes thought that the payments which patients were called on to make up to the introduction of the contributory scheme, made some difference. It was only a very nominal sum. Even the proceeds of the contribution of £7 a year for the middle income group is a very small sum in the context of hospitalisation. People are not sufficiently alive to the hazards today in the field of health. If they were they would take more advantage of the voluntary health insurance scheme. Everybody not covered by the middle income group scheme should be a contributor to the voluntary health insurance scheme because the more people covered by the scheme the stronger the fund and the stronger the fund the better the terms for the patient. I am a little surprised that now that we have reached a reasonable level of affluence in certain directions we have not a greater number covered by voluntary health insurance. I think it is incumbent on every person whose income is above the maximum for the middle income group scheme to become a contributor to voluntary health.
The Minister said that some degree of balance had to be maintained in the running of hospitals and that this was a factor to be taken into account when talking about increased costs, balance in the sense that capitation grants had to be adjusted upwards this year and that a certain sum of money had to be devoted by the Minister to meeting the deficits in voluntary hospitals. We all know it is incumbent on the community to see to it that voluntary hospitals do not go too far into debt. If they do, they run down like a worn out clock not worth winding. We cannot have that today in our health system.
According to statistics supplied by the Minister, the death rate per 1,000 of the population has fallen below that for the previous five year period. This is a welcome trend. It is the lowest rate recorded for this country and this is good news. The number of deaths from heart disease also fell and this is an indication that the Minister is making some inroads on the incidence of this disease. Unfortunately, lung cancer tends to maintain an increasing rate. The Minister has made many comments on this during the year. It has been said that he is too squeamish about this matter. I think he is in no way squeamish in urging that we get this under control. Hence the pamphlets issued on the incidence of heavy smoking and so on. They are points we should take into account as members of health authorities and we should do what we can to conform with them and to work as a team in the health system.
The record also shows that the infant mortality rate is being cut down. On former occasions here I commented on this and at one stage a few years ago I said our rate was poor by comparison with other countries. Now we have caught up and this is a sign of the work accomplished in the health field generally. As well, life expectancy has lengthened and stands at a comparatively reasonable level. A few years ago our statistics were not so satisfactory in this respect.
The figures revealed also that the birth rate is going up and that we have more and earlier marriages. This is another encouraging trend. If people are married younger women come to the point of maternity younger and I am sure this is more progress the House welcomes. The Minister referred to the fact that because of earlier marriages the point at which maternity occurs is lower. Hand in hand with this trend is the fact that the family size is tending to limit itself. While people are being married younger, the incidence of first and second births are higher than subsequent births and therefore the anxiety of those Members of the House who postulate national family planning loses its edge.
The Minister also told us that better accommodation is being provided in maternity hospitals and that to bring this about he had some members of his Department in consultation with hospital authorities who cater for the maternity end of the scheme. It is important at this stage that we should move to improve maternity units. It is noticeable in my locality that domiciliary delivery is on the way out. I suppose there are reasons for that but I remember long ago when the late Dr Ryan was piloting the mother and child scheme through the House in the face of criticism, that he said he hoped domiciliary deliveries would predominate. The trend has gone the other way for many reasons. One of the chief reasons is the better accommodation provided in maternity units. I am glad to see the Minister has his own team dealing with this matter and that we can hope that teamwork on the part of the hospital authorities catering for the mother and child scheme will still further improve the system.
I referred a moment ago to voluntary limitation of families and said there are those in the House who would postulate planning from cradle to grave. I ask those people to look around and read reports on what is happening in other countries. I suppose politicians sometimes have a tendency to dabble in all sorts of schemes, sometimes with good intentions, but in my experience well-intentioned people sometimes do more harm than good. Some politicians want to encourage legislation regarding family limitation but if we look at the countries practising national family planning we will see that despite all kinds of liberties, shall we say, in prevention, contraception, advice and all the rest of it, in some of those countries the rate of abortion is higher than the birth rate.
I therefore say to those who are in too big a hurry to rush into schemes calculated to limit the size of families, to hasten slowly and look around and see what is happening where all this alleged liberty obtains. We are getting along all right on the family advice we have, some of it derived from various religious denominations and other bodies and some of it not so derived. We should leave it at that and not move in a direction which might create more problems in the end.
The Minister's replies to a number of queries on this matter during the month seem to indicate that his case is established. I shall not go further on this point but we should use commonsense when we deal with matters concerning the family. If we consider the Minister's summary of his aims, and I think the aims of the House, to bring about a better health system I do not think we can disagree with the points he made. We should do all we can to raise the image of preventive medicine, establish a better image for county clinics, make them reception centres for outpatients and provide the best advice and medicine. We would thus lessen the load on hospitals.
We should move towards earlier detection of disease. The tendency in the past was for the patient to keep away from the doctor. Our aim should be to bring the doctor to the patient and see that close contact is maintained between them. In the past the dispensary system was inclined to lessen the image of the family doctor who is very important. I am glad the Minister is having this matter examined. The aim should be to boost the family doctor's importance and move towards encouraging the grouping of family doctors for consultation to provide at outpatient centres or clinics the best possible accommodation and so reduce the numbers entering hospital. If we can achieve this in a couple of years we shall have made some progress towards better health.
