The Deputy has 55 minutes.
Private Member's Business. - Vote 49: 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 period commencing on the 1st day of April, 1974, and ending on the 31st day of December, 1974, for the salaries and expenses of the Office of the Minister for Health (including Oifig an Ard-Chláraitheora), and certain services administered by that Office, including grants to Health Boards and miscellaneous grants, and for payment of a grant-in-aid. —(Minister for Health.)
I shall not take all 55 minutes. Before the debate adjourned I was speaking about the parlous hospital position in Cavan town. I pointed out that the Fitzgerald Report had recommended Cavan town some years ago as the proper centre for a regional hospital. That recommendation was considered by the North Eastern Health Board, representatives from Monaghan, Louth, Meath and Cavan, and democratically that health board decided the hospital should be sited in Cavan town. I understand that Comhairle na nOspidéal considered the position and approved of Cavan town as the site for the regional hospital. Visitors from the North Eastern Health Board who visited Cavan and were painfully conscious of the poor quality hospital service available recommended that the regional hospital should be erected in Cavan as a matter of priority.
There is at the moment considerable anxiety in Cavan about the position. There is a feeling that the seriousness of the situation is underestimated by the Minister and his Department and I understand that the urban council have asked for a meeting with the Minister, a meeting which will take place this week. The chamber of commerce is also exercising itself in this matter. The very fine team of doctors in Cavan town are perturbed and are working on the situation to try to improve it. The people in general feel that the time for a decision by the Minister has come.
In his opening statement the Minister said that £4.5 million were being spent on improving the hospitals. I cannot understand why a position which was researched so thoroughly and a recommendation which met with such general democratic approval could not have been taken into account in this context. In my opinion the Minister should have decided to start building the hospital this year.
The Minister also said that he wished to have a national network of efficient, first-class general hospitals. I suppose one should really start with the general and move from that to the particular. At the moment I am dealing with the particular and relating it to the Minister's general remarks. I cannot understand why this capital project has not got under way. I cannot understand why the Minister, having considered the expert evidence and the democratic decisions taken, cannot clear the way. The situation is urgent. This is not, as I said on the last occasion, an ex parte pleading; it is a genuinely urgent case.
I agree that improving health generally so that pressure is thereby taken off the hospitals is the right approach. It is a sound approach. When the Minister talks about improving the health services so that we do not have to continue to rely exclusively on hospital services, in the context in which I am speaking, this is no better than a sick joke. The hospital services are totally inadequate. They are a danger to the community. The Minister says he will continue his work on the development of a general hospital plan for the future. Considering the decisions that have been taken at democratic level and the recommendations that have been made, the Minister could find no better place to start with a general hospital plan than Cavan town.
Later the Minister said:
It is recognised that a hospital system which met the needs of the past will not necessarily meet the needs of the future because of the changing pattern of medicine and hospital care.
The surgical hospital in Cavan has been condemned for a long time. It may have met the needs of the dim and distant past. It is certainly not meeting the needs of the present. We need a decision from the Minister to go ahead with the building of the regional hospital in Cavan town. I say this in the context of the Minister's remarks about high-quality hospital care and reasonable accessibility. Both these factors were taken into consideration by the Fitzgerald Committee and by the North Eastern Health Board when they came down firmly and democratically on the side of building this regional hospital in Cavan town, giving it, in the words of the visitors from the North Eastern Health Board, priority.
I shall not underestimate what the Minister refers to as the socio-economic importance of a general hospital in the town. It is of importance but, at the moment what is exercising all the bodies and all the people I have mentioned is the provision of an adequate hospital service for the town.
If I wanted to, I could be cynical about a paragraph in the Minister's speech. The Minister said he is not prepared to rush his decision on this matter. Seeing that the FitzGerald Committee, the North Eastern Health Board and Comhairle na nOspidéal considered the situation and all came up with the same opinion, I do not think anyone could accuse the Minister of rushing a decision on this matter. The Minister also referred to consultations in areas in which disputes have arisen about the future of the hospital service. I have outlined for the House what has happened in this area. I have pointed out that democratic decisions were reached in the area. I do not think there is any necessity to go beyond those to pick out spheres of minor disagreements in this area.
I am sure the Minister is not talking about the North Eastern Health Board region when he talks about disputes which may impede or retard his decision making in a particular case. I want to talk, not merely about the structure of the hospital, but about other problems which would be comic were they not tragic. There is the radiology situation. There is now no radiologist in Cavan town. A radiologist has to come down from Dublin each Friday to do the X-rays. The X-ray plant itself is outdated and has been outdated for a long time.
For how long? I am sorry for interrupting the Deputy.
I was trying to think. As the Minister knows, there has been a sophisticated development in the X-ray world and the hospital has not been kept in touch with that development. I am appealing to the Minister to attend to this when he is making the decision, which I hope he will make soon, on the regional hospital in Cavan. Taxis have to be sent with films to Dublin in cases of emergency. Every day in the week either a bus service, or a taxi service, or an ambulance service, has to be used for taking X-rays to Dublin. In a moment I will refer to the situation in regard to the laboratory and the House will see that it is absolutely ridiculous. A time and motion man who had to consider the situation with regard to X-rays and specimens for the laboratory would get an ulcer within a week of studying the situation and, if he did, there would not be a bed in the hospital for him to get treatment.
The specimens are taken to Dublin from the surgical hospital and from Lisdarn every day by ambulance or by special taxi. The hospital staff spend a lot of time ringing up hospital services to get people to call to Busaras to collect specimens when the ordinary bus service is used. Twice a day mini-buses are too-ing and froing from Lisdarn and the surgical hospital to the bus station. Telephone calls have to be made to messenger services in Dublin to collect specimens at Busaras. Telephone calls have to be made to find out the results of the tests. You would not need to be a time and motion expert to see how chaotic the situation is in regard to the X-ray and the laboratory service. Any person with ordinary common sense could see that it is deplorable and ridiculous.
I am asking for a rationalisation of the whole system. This will all follow upon the Minister's decision with regard to the regional hospital. The laboratory service can be set up. The X-ray equipment can be modernised and the whole system nationalised as soon as the basic decision is made on the regional hospital. The pressure on beds is high. I understand that sometimes people have to be sent out after three days in the hospital and asked to come back to have their stitches taken out. Of course, the surgeon decides this and I am sure he will not decide it unless it is safe to do so.
When medical personnel are required it is very difficult to entice a man to come to a place like that to work. Consequently there is a danger of a running down of the personnel numerically and even qualitatively. For this reason the urgency of the need for a decision by the Minister is apparent. I am asking the Minister to make the decision at once. One hundred surgical beds at Lisdarn as an initial step are absolutely essential. I am sure the Minister as a reasonable man, and as a man concerned with the improvement of the health services in the area, will see when he examines the brief carefully, that my demand is a moderate one. I am not making a case simply for the sake of making a case. The groups I have mentioned are really concerned about this issue.
I should like to make a few general remarks on the Estimate before I sit down. My main point was to deal with a particular case in the light of the general principles which the Minister enunciated in his Estimate speech. I notice in the statistics, which are very valuable, that in the North-Eastern Health Board area the percentage of people over 65 years is 11.3. This is the lowest percentage in the country apart from the eastern region. I should like to speak briefly on a serious problem with regard to old people who are kept in their own homes and who fall to the care of in-laws, sons and daughters-in-law or vice versa. There is a serious problem here. The prescribed relative allowance paid by the Department of Social Welfare should be extended.
At the moment if there is anybody other than the prescribed relative and the aged person in the house, this allowance is not paid. It should be. The pressure that this should be liberalised should come more from Health than perhaps Social Welfare. When the person is very old, and consequently perhaps rather difficult, there is a serious social problem. This is not something which occurs on a minor scale. I am convinced from contacts with my own constituents and discussions with people in other constituencies that this is a major social and health problem. If the in-laws find the burden too great these people have to be taken into hospital. Then the cost to the community is much greater than if there was a liberalisation of the prescribed relative allowance or some such allowance. I am talking about a social ill which should be examined and dealt with, preferably by the Department of Health.
I am glad to see from the statistics that the North-Eastern Health Board area has the highest birth rate apart from the eastern area, which leads in everything and gets the greatest attention of course. The marriage rate has improved. People are marrying at a younger age. These statistics are very useful to the practising politician because they help him to identify both health and social problems in his area.
They will probably get a good football team out of that.
We are trying hard enough. We got them before when the marriage rate was not so good and when the marrying age was later. There may be a moral in that, I do not know.
In Cavan town there is one physiotherapist employed to deal with 450 beds. He is working in the Surgical Hospital, St. Felim's and Lisdarn. I also recommend that the Minister encourage his health board to improve the physiotherapy service, not to mention the orthopaedic service and the ear, nose and throat services for the area.
All these improvements, rationalisation, and dovetailing of services can take place only when a decision has been made on the regional hospital. Again, I appeal to the Minister to make a decision to build a regional hospital in Cavan with all possible haste. We will not be persecuting him about medical questions if he gets this under way. All the people of the area this hospital will serve, not merely those of my constituency, will be eternally grateful to him for this.
I compliment the Minister and the Government on their ever-increasing commitment to the care of our people, as the figure of £166 million in the budget proves. The Minister is anxious to provide facilities to cater for our sick, young and old people. This figure represents 60 per cent of an increase on the budget of two years ago.
This is a very difficult Ministry. The Minister's comprehensive report indicated his genuine concern for these people. The fact that in this difficult year there is an increase of 7 per cent in expenditure speaks for itself. In my own town great strides have been made in the care of the aged. Recently a home for these people was opened and the atmosphere is conducive to their contentment. They are now able to enjoy their remaining years among their own people.
I should like to refer briefly to two aspects of the care of these people. The first is the home care allowance. If there was more flexibility in the regulations to enable relatives to qualify for these allowances there would be fewer old people going to these homes. This is worth investigating. I appeal to the Minister to look into this. The second is the question of home help. There is a very urgent need to develop this service, especially in rural Ireland. In isolated areas, where many old people live alone, far from any person or settlement, they are left and not cared for.
I now come to one of the most important items, the general hospital services programme. With an expenditure of £73 million this qualifies as an item of great importance. I commend the Minister on his priorities. His objective is to have first class units backed up by a viable community-based welfare system. The question of outpatients clinics should be gone into urgently. This will result in a better and more decisive treatment for the sick and will reduce considerably the number of beds used in our hospitals.
I was delighted to note that the Minister disagrees with the terms of the Fitzgerald Report. Since this report was published, I have opposed it at all levels because I consider it a city-orientated document prepared by urbanised specialists. Dublin is not Ireland. The Minister agrees with this statement when he says that there is a need for these hospitals in many parts of the country. He has been attacked by members of the Opposition for his delay in resolving this problem and in coming to a decision on the recommendation. They forget that his predecessor also had this on his desk for five years. I appreciate his detailed examination, because on his decision rests the future of the care and hospitalisation of our people.
However I must take him to task on his suggestion that every town is looking for a hospital. I speak as one who was vigorously opposed to the Fitzgerald recommendations from the outset. Our main concern is to ensure that our country hospital system is retained so that each unit can continue to serve the people of four or five large towns and the adjoining rural areas. These 100-bed units cater for surgical, maternity and ordinary medical cases. They serve in most instances between 50,000 and 65,000 people within a radius of a maximum distance of 40 miles.
Rural Ireland has suffered too much and too long, with the central authority designed destruction and closures of such essential services as Garda barracks, railway stations and national schools. We in rural Ireland are determined to save our county hospitals which, with some additional senior staff, will serve the future needs of our people.
Prior to the health boards being foisted on us by the previous Government, the county councils, knowing the needs of their people, had built up these institutions. We will not accept any interference from the central authority which will deprive rural Ireland of these services. It is amazing how easy it has been, since the inception of the health boards, to have numerous senior executive posts on the administrative staff filled but then one witnesses tremendous opposition to the appointment of the necessary additional staff required to make our county hospitals viable, independent and sufficient to serve our people.
I accept that there is, and always will be, a need for specialised services in the nearest regional hospital but the normal surgical cases should continue to be dealt with at county hospital level. I appreciate the Minister's concern to meet and consult with every group interested in the future of our county hospital system. It is a decided improvement on the attitude of the former Government to consultation. Naturally I am concerned about the future of the county hospital in my home town, Nenagh. I have resisted at every opportunity the terms of the Fitzgerald Report relative to this institution and even though I am a Government back-bencher I will continue to ensure that the 55,000 in my constituency enjoy the facilities of a first-class county hospital in Nenagh.
It is ludicrous to suggest, let alone to recommend, that the facilities now available, or even those envisaged for the regional hospitals in Limerick city, will satisfy my constituents in the years ahead. One must remember that Limerick city is expanding and that it will require these additional services to cater for its own people and the people of county Limerick. I find it difficult to obtain a bed in any city hospital for any case, specialised or otherwise, from my area.
There are approximately 270,000 people in our region which consists of north Tipperary, Clare, Limerick city and Limerick county and with the expected population expansion, as predicted by the McCarthy Report, by 1986 this figure will have reached 350,000. We must plan our hospital services for the future and that is what development is about. In view of these facts no one has the right to interfere with the county hospital system in our region which consists of a county hospital in each county.
There is an obvious case for the immediate upgrading of these hospitals. Feeling is running high in my constituency and I can assure the House that there will be the maximum resistance to any effort made to interfere with a hospital of which we are rightly proud. I will be in the front line, as I have been for a number of years past in the fight to retain this hospital. I give this pledge to my constituents.
My final remarks concern the Fitzgerald Report. Rural Ireland must fight, and will fight, for the retention of the county hospital system. Too much money has been spent and too much work and endeavour put into it by the staff of these hospitals to have them taken away by the health boards, through their executives, or by some senior executive in the Custom House.
I should now like to deal with the child health services. A tremendous amount of work has been done in this regard under difficult conditions and I should like to compliment those involved. However, I believe that to achieve the full and final objective of this service the scheme should be extended to cover children up to the age of 14 years, the most vital year in the proper and healthy development of a child. This extension should also apply to the school dental service.
On the community care programme I should like to congratulate the Minister on his efforts to improve this essential service. I can see that every effort is being made to increase the number of social workers. This is an urgent necessity because there is a serious shortage of trained personnel. I know that the need is greatest in the isolated areas of rural constituencies where there are old people living alone miles away from settlements and dependent on the odd visit from a nurse or doctor or a friend. This should be gone into urgently. I urge the Minister to press ahead with his plans to ensure that these people are catered for and not forgotten after years of service to the community. I believe better results could be achieved if the community care team worked in conjunction with the county health advisory committee who are conscious of the needs of the people of the area.
On the question of health education I should like to compliment the Minister on introducing the worthwhile project of educating our youth on the dangers of excessive smoking and of drinking, which has increased alarmingly. I suggest that this programme be extended and worked in conjunction with the Department of Education so that young people will be encouraged to spend their leisure hours at sporting pastimes and healthy outdoor exercises rather than excessive drinking and smoking.
I should like to refer to the recommendation issued by the Department of Health to the effect that the mass X-ray units should be withdrawn from rural Ireland. I appreciate that TB is on the decline but it is still prevalent and active. Until such time as it is completely eradicated an X-ray unit should be stationed in rural Ireland. At health board level I expressed the desire that in order to cater for the south a unit should be stationed in Cork city.
I should like to refer to an important issue the Minister has on his hands, resolving his difficulties with the consultants. There is a grave need for straight talk on this issue. These 300 people, so vital to the well-being of our nation, have adopted a stubborn and selfish attitude, in the prolonged discussions with the Minister. It is apparent that they do not wish to co-operate or reach a settlement. I have my own views on their reasons for not doing so. Often in the past we have heard criticism by the general public of small groups of craftsmen in essential services holding the country to ransom by withdrawing their services. Here we have an educated professional body, comparatively small in number, who are prepared to deprive our people of a service that means so much to them.
I extend thanks and congratulations to the staff of our hospitals, the doctors, the nurses and the wards maids. They have done wonderful work over the years.
I am not at all satisfied with the operation of the general medical services scheme. I am not satisfied mainly because there are so many people who I think are entitled to this service and who are not getting it. The eligibility limit for health cards should be raised at least once a quarter. There is a guide scale laid down by the Minister for Health for health cards and this is operated fairly rigidly by the health boards. This scale applies in respect of persons in receipt of wages or salaries but it does not apply to small farmers. Each application from a small farmer is judged on its merits. The limit of £20 per week for a married man is unrealistic and should be raised immediately. At one time the eligibility limit was related to the income of a county council road worker or labourer. I am glad to say that his income is now in the region of £28 to £30 per week. I believe that the income limit should be increased immediately from £20 per week to £28 per week, when more people could qualify for medical cards. We know that persons in receipt of non-contributory old age pensions are automatically entitled to medical cards by the majority of health boards. I would go further. I would feel that persons in receipt of contributory pensions, particularly old age pensions and contributory widows' pensions, should be automatically entitled to medical cards also. I base my case mainly on the fact that those people paid for their pensions. In the case of a widow, probably the husband paid during his life-time and, in the case of the contributory old age pensioner, he had paid into the pension fund himself.
I believe also that a certain allowance should be made in the case of a wife who has to take up part-time employment in order to supplement the income of the household. I know of a number of cases in which, immediately the wife took up part-time employment, the medical card was taken from the family and the result of her employment was nil in so far as the family then had to pay for drugs and medicines in addition to the fees of the local doctor.
Every person in receipt of unemployment assistance, again, should automatically qualify for a medical card. In this respect, I am thinking particularly of small farmers in receipt of unemployment assistance. I believe that each small farmer receiving such assistance should qualify for a medical card because in most cases there is a fairly rigid means test carried out by the local social welfare officer. I have come across a number of people who have suffered a lot because they were incapable of purchasing drugs and medicines for themselves.
There is another aspect of the general medical services scheme about which I am concerned. This relates to persons holding health cards who receive a prescription from a specialist or, in an emergency, a doctor other than their own under the choice of doctor scheme. That person cannot go to the chemist of his choice for the drugs and medicines prescribed. Even though he holds a medical card, he must pay for those drugs and medicines himself despite the fact that had he got the prescription from the doctor of his choice he would have been entitled to have them prescribed free of charge. The regulations should be amended to provide for such an eventuality.
The time has come too, when persons who hold medical cards should also have a choice of ophthalmic optician. There are quite a number of such opticians throughout the country and I see no reason why such a scheme could not be implemented initially, on a trial basis within the confines of some health boards. I would advocate that such persons would have a choice of frames as well which would help in no small way to clear the huge waiting list at present in health boards in respect of persons seeking ophthalmic services.
Of the total Supplementary Estimate amounting to something in the region of £4,600,000 £2½ millions relate to price increases. There is no doubt that inflation has had a terrible impact on the health services generally. Certainly the cost of drugs and medicines to health boards has created financial problems for those boards. There appears to be no real price control so far as drugs and medicines are concerned. The high cost involved cannot be understood by many people who believe that neither the Minister for Health nor any other Minister has any control over those prices. I am informed that some manufacturers may be making exorbitant profit. The time has come when a full inquiry should be conducted into the cost of production of drugs and medicines which cost the patient so much, wherever a prescription is prepared, whether it be in a chemist's shop, hospital or institution. I believe that if the income scale to be used by health boards in considering eligibility for medical cards is increased, if more people qualify, ultimately there will be fewer people seeking treatment. I know of at least half-a-dozen people who have come to me in the past three or four months and told me they could take only half the quantity of drugs prescribed by their doctor because they could not afford to pay for them, and in one case a woman told me she could take only a quarter of the quantity.
I have come across a number of medical card holders who were sent to private nursing homes for various reasons. But the case I shall take now is one of emergency, or of a person being sent to a private nursing home for investigation or treatment of what may appear to the local doctor to be a minor ailment and which might ultimately involve a very serious operation. A few years ago when a case like that arose, provided the health board was satisfied that the case was genuine, as far as I know, a proposal was made to the Department of Health for ministerial sanction to enable the council, or health board, to pay either a percentage or the total cost of maintaining and treating that person in a private nursing home.
I know of a few cases where sanction was issued. Could this policy, which appeared to me at the time to be a very good one, not be carried on? It would certainly mean a lot to families where one member who appears to have a minor ailment, is sent into a private nursing home for investigation but later the patient may require major surgery and prolonged medical and hospital treatment. The family, because that person is not in a general hospital, have to pay the full cost to the private nursing home. I know of a case where a family were forced to put up their house for sale to pay for maintenance in a private nursing home.
I would like the Minister to give some priority to the proposed new hospital for Tralee. There has been undue delay in regard to the provision of this hospital. In reply to a Dáil question recently no reasonable answer was given and no promise was made in regard to when this hospital would be erected. This must not be put on the long finger, particularly when a badly needed new laboratory was completed recently in Tralee.
I believe health boards should not trade in old ambulances when they are purchasing new ones. They should give the old ambulances to voluntary organisations, such as mountain rescue teams, or local branches of the Order of Malta.
Those discarded ambulances would not be very good. I would not like to take them.
I refer to ambulances being traded in. Even though they are not in good condition many of these voluntary organisations would be prepared to spend a little money on them and bring them up to a standard which would make them very useful for short runs. They would provide an emergency service in many districts when the county ambulance might be 50 or 60 miles away.
Extensions to district hospitals in many parts of the country should be provided to cater for geriatrics. I refer particularly to Kenmare and Cahirciveen, where by reason of the lay out of the existing hospitals and the staffing structure, it would not cost very much to provide extensions to cater for geriatrics in the area. This would be beneficial to elderly people who could be hospitalised locally. Their relatives could call to see them frequently and they would live in their own environment with people they know around them. The cost of providing such extensions would not be very great.
I agree with the Minister that the organisation of community care in the near future, with particular reference to the role of voluntary organisations, requires close study. This should certainly keep people out of institutions and hospitals. I am not satisfied with the level of orthopaedic services operated by the Southern Health Board. Quite a number of people are on the waiting list for admission to the orthopaedic units of hospitals. The bed turnover is very low in these cases and if it were not for the few orthopaedic surgeons who work very hard over long hours this service would be in a very bad state.
There is great delay on the part of the Southern Health Board in providing surgical appliances to people. Some must wait for months after they have been measured. By the time such appliances are supplied and fitted whatever treatment the patients received in hospital is of no use, particularly if a few months have elapsed.
I regret that the Minister stated that he must cut back in the expansion of health services in 1975 because of lack of funds. It will be very hard in future years to make up for this cut-back. We all know that with ever-increasing costs it will cost far more in a few year's time to do what we could do next year.
I am sure it is obvious to everybody in the House that there is an appalling lack of training facilities for girls who wish to train as nurses. The vast majority of them must emigrate to England. Extra places should be provided in the training hospitals. The Minister should ensure that a training school is attached to the new county hospital in Tralee I hope such provision is being made in the plans for this hospital.
There are also many complaints with regard to delays in waiting for X-rays and in getting the results. This causes worry to the people concerned and it means more visits to local doctors and probably having to take certain drugs in the meantime. Every effort should be made to improve the service from the point of view of taking X-rays as soon as requested and also of sending back the results to the local doctors as fast as possible.
The Minister will need a good deal of luck to reach the targets that he has set himself and I wish him every success in this regard.
At the outset I would refer to the problem of the provision of accommodation for mentally retarded children. In the area from which I come we are fortunate in that a monastery has been purchased at Clooneymahon, convenient to Sligo, which will be used for accommodating mentally retarded children. However I understand that it is the intention of the Department to bring to this establishment people from the constituency who are being accommodated at present in various other hospitals in Dublin and elsewhere. If that happens the accommodation for mentally retarded children will become a problem again. As far back as I can remember this problem has been a burning one in the area. I appeal to the Minister to ensure that the accommodation at this institution will be reserved for those people who are anxiously awaiting accommodation. I compliment the Department on having acquired this fine building in such a convenient and suitable area and I trust it will not be long until it is put into service.
I congratulate the Department, too, on the provision of a very fine home at Manorhamilton which will accommodate between 40 and 50 aged people. There has been a great need for such an institution in that area for a number of years. Up to now old people were sent to Carrick-on-Shannon which, for some of them, was as many as 50 miles from their own homes. Very often relatives were not in a position financially to visit the aged there regularly with the result that as time went on there was a tendency to forget, and consequently the old people were deprived of the comfort of these visits. The provision of the new home will also relieve pressure on the county hospital.
In the various hospitals I have visited I have noted that the staffs have been increased. This step is to be welcomed. In other days there might have been only one porter to do the heavy work in a hospital with the result that a considerable amount of heavy work had to be carried out by nurses and other staff. Staffs today are well paid and they enjoy the work they are doing. They receive the highest praise from the patients of the various hospitals. However anything the Minister might do by way of increasing the salaries of nurses would be very welcome.
Other Deputies have referred to the question of medical cards. My experience has been that in recent times the means test in this respect has been eased considerably so that it is not so difficult any more to acquire a medical card. Nowadays, too, all old age pensioners qualify automatically for this benefit. This is of great help to all those people who have reached the age of 68 and we hope that this age will be reduced further. Many of these people would not be in a position to pay doctors' fees.
I notice, too, that disabled persons' allowances are paid regardless of means to those who are in poor health. I have been successful in arranging to have those allowances paid to necessitous persons. This allowance means a lot in a home where previously there was great difficulty in making ends meet.
A few years ago I happened to be a member of the committee of St. Columba's Hospital. That was before the change to the health board system. At that time there was a great need for major extension works and repairs to be carried out in the hospital. I am informed that very little of that work has been done in the meantime. In those circumstances I appeal to the Minister to act as soon as possible in this matter. The building is old but it is one that has given tremendous service as well as giving a fair deal of employment. It has been known for its good doctors and other staff.
Only last year the Parliamentary Secretary to the Minister, Deputy Barry, officiated at the opening of a new hospital for old people at Manorhamilton, St. John's Hospital. This replaces a very old and outdated hospital that had existed longer than I care to mention. That is good progress. Previously it was sad to go through that hospital and see the old people in the old wards and dormitories with cold floors and whitewashed walls. That is all changed and we now have a bright and lively hospital that gives satisfaction to everybody. The patients are very comfortable with modern heating, lighting, cooking and transport. It is a hospital of which any county could be proud. With a bit of good luck and better times I trust the Minister will again go ahead with the good work which he has been carrying out.
Another step in the right direction is community care, which is very welcome and essential. Recently many people are being appointed to care for the aged in rural areas. I remember not so very long ago when the aged lived in isolation and very few cared for them or bothered to see them. Occasionally they might visit the local shop. Sometimes they were found— perhaps after a few days—to have passed away and nobody knew anything about it. That is not the case now. There are people to look after them. I should like the Minister to ensure if possible that a local person be appointed in each area. It is important that a local person work among the old people because he or she knows them, where they live and exactly the care and attention they need. It is very important that such appointments be made on a local basis. I know from experience that from among those interviewed it is always possible to get one or more people quite capable of doing this job well.
There should always be good follow-up treatment and attention for mental patients leaving hospital. A mental patient may go out in good shape after three or four weeks—it does not take very long now—but without follow-up treatment there is always the danger that that patient may become depressed, go down-hill and, perhaps, be back in hospital again. It is vitally important that a close watch be kept on discharged patients by the mental hospital staff.
There was a very serious scare a few months ago throughout the county about the possibility that Manorhamilton hospital would close. A very largely-attended meeting was held because everybody was worried in case the hospital would close, from the point of view of the loss to patients and loss of employment. The health board members arrived when the meeting was in progress and gave a very clear assurance that there was no danger of the hospital being downgraded or closed and that everything was being done to up-date it and make it more modern. The money involved is very substantial and I must congratulate the health board and the Minister for having removed that worry from the community. It was made clear that the hospital would be retained, that money was no object and that the hospital would not be interfered with on the grounds of finance.
When the £7 charge came into operation we had a number of complaints and it was very hard for people to see why they should pay this sum. They now realise that it is the best insurance money they could pay. If for any reason they have to go to hospital they are free there under £60 for an indefinite period. That is a great consolation to many people, particularly in the western counties where valuations are not high and where there are many smallholders. Fear and worry regarding hospital bills are almost written off as a result. Some people may find themselves in difficulties due to a change of hospital or a change of doctor. However, as a rule the health boards take a very lenient view and are very co-operative and, if at all possible, try to meet the wishes of a patient or a public representative to relieve worry and strain.
My experience is that dental care is still a big problem throughout the country, although I must say that our dental surgeon in Leitrim is making good progress. He is satisfied that he has sufficient staff for the present. At least that was the position at our last meeting. But changes take place very quickly and many dentists come and go quickly. The necessity for orthodontic treatment also causes much worry. I think there is only one hospital for this treatment and that is in Dublin. I strongly recommend that something be done in that connection. Many parents are worried about the attention their children need from that type of hospital. Sometimes treatment must take place within a limited time and I again emphasise to the Minister the necessity to have this treatment available for children who require it.
Recently I had people calling on me about allowances while their husbands were in hospital. A man who has been receiving insurance or some sort of allowance may go to hospital, perhaps a mental hospital, and be there for a long time. The allowance is discontinued while the husband is in hospital. I have one particular case which I intend to bring to the Minister's notice before I go home. The situation can be very serious for a wife and family with the cost of living as high as it is today.
In my constituency the hospitals are doing an excellent job. We have hard working doctors and surgeons. People can be critical of doctors when they hear of a mistake being made but we are slow to compliment them on the many cases they put through their hands successfully.
The Minister's Department are doing a very good job. If one goes into a hospital in the morning the place is over-run with mothers and children. The children are being vaccinated against various serious diseases. I must compliment the Minister on the amount of work that is being dealt with by his Department.
I should like to compliment the Minister on his very fine brief. It was so comprehensive that it would take a long time to read and study all of it. I believe he is carrying on the good work of his late predecessor. I believe he has the interests of the people in the lower and middle income groups at heart.
The emphasis in the Minister's brief was on trying to keep as many people as possible out of hospital and rightly so. Community care is most important in that regard. I hope the Minister will not take too long to make up his mind about the rationalisation of the health services. This is something that has been going on for a long time. I agree that it is something on which one cannot reach a decision overnight. It will be a very important decision and no matter what it is it will be an unpopular decision.
I come from an area in which there is great concern about this question. In my town we have a private hospital which caters for many health board patients. It has 204 beds and the number of patients treated in one year is 5,178. It is the most modern private hospital in the country. It has an excellent training school for nurses. I refer to the Portiuncula Hospital in Ballinasloe. It has a very large catchment area. Until a decision is made the sisters there do not know where they stand. I know everybody interested in health has recommended that this should be a general hospital. I do not know what the health board have in mind. The hospital is prepared to work anything within reason. The people of my area are worried in case anything happens to this fine hospital. I would ask the Minister to make a decision as soon as possible. We are leaving the matter to the good sense of the Department of Health. We are not calling on the Minister every second day, bringing up delegations and talking loudly. I hope we will not lose out because we are not making enough noise. We believe common sense will prevail.
I am one of those who did not agree with the Fitzgerald Report. I know there must be very few well-equipped hospitals in the country but I do not believe in closing down too many county hospitals and making them county homes. There are always emergency cases and people die on the way to hospital. I would like to see as many hospitals as possible kept open and fully staffed and equipped.
With regard to the means test for medical cards, I think the Minister has in mind full coverage for everybody. If I were the Minister I would not go that far all of a sudden. I would be more inclined to bring up the limit to something like what Deputy O'Leary mentioned. The means test for medical cards at present is unrealistic. County Council workers were always eligible for medical cards until recently. They earn around £30 now. It is not realistic in this day and age to have a limit of £20 for a man and wife. The State would save money by issuing medical cards to people with a higher income. In this way people would be kept out of hospital. When one has a medical card one gets free service at home, at the dispensary, at hospitals and clinics. If a person is not very seriously ill and is not the holder of a medical card his people say hospital is the place for him because once he goes into hospital he does not have to pay. That puts people who should be treated outside into hospital.
As a member of the advisory committee of the Western Health Board, I recall the limit being £15 not so long ago. We had it increased to £17.50 and then to £20. I have been fighting for £25 but it has been refused by the CMO. I do not know whether it is on his own initiative or on directions from the Department. The present guideline of £20 is completely out of line with inflation, salaries and so on. That confines the health card to a very low income group, which is very bad policy.
This also has a bearing on community care. When community care was first introduced, the few pounds that were given for home help was meant for voluntary organisations with a nursing staff who would go around and take care of old people. Take the case of a married woman with three or four children. If there is an old person there and if someone comes in from outside she will be paid a few pounds for looking after that person. However, if the mother of the children happens to have a husband working and he is supposed to be supporting her, unless the patient is bedridden, she gets nothing at all. A person who is not bedridden can be much harder to mind. At least a person with a house full of children knows that a bedridden person cannot go around the house and perhaps fall into the fire or hurt one of the children. While the nurses who look after these people do a good job, when they have examined the patient and see how she is kept, they leave her there and it is the woman of the house who has to look after the patient. As I say, if the woman has a husband supporting her she will get no home help. Anyway £2 is no use. It should be at least £4.
What happens at the moment, if the woman of the house is getting nothing, is that when the doctor comes, if the patient has a cold he is asked "Is there any chance of getting her into hospital? I have three or four children. I think she would be better off out of here." The doctor, quite naturally, tries to get the patient into hospital. If the woman could get the £4, instead of being debarred because of the clause relating to support by her husband, it would keep people out of hospital. I have seen some of these homes for the aged. They are beautifully kept—we have one in Clifden— but there is a lonesomeness in these people for the environment in which they have lived all their lives. Furthermore if people who are not too ill were kept at home, there would be more accommodation in hospitals for people who are genuinely ill.
A free for all scheme may come eventually but, in the meantime, an improvement could be made. More people should be taken into the middle income group. I agree with every word Deputy O'Malley said about the voluntary health scheme, and this should be gone into. However, take a farmer of £60 valuation. While I am against valuations this is the way things are done at the moment. A person of £60 valuation can have very poor land. If the middle income group was expanded, eventually we might arrive at an overall scheme. Of course, the Minister would want to give serious consideration to the question of whether there is accommodation to take everybody in. I think it would be better to move gradually towards that goal.
There is nothing in the Minister's brief about mentally retarded children, for whom there is not sufficient accommodation. I have visited houses where there have been children of that kind and I know what a burden it is. People have to wait a long time for accommodation and something should be done about it.
Dental treatment is also very poor in some areas. The excuse I hear is that there is a shortage of dentists. I had a letter the other day from a qualified dentist who had an interview with the Western Health Board and was not called. I cannot understand that, because I know people who are waiting for months and months for dental treatment.
I do not like repeating what other people have said about the health services. At the moment they are reasonably good. I was opposed to regional health boards initially because I was afraid of what I describe as "remote control". I am always willing to admit that I have made a mistake. In this instance I was mistaken because, as far as the Western Health Board is concerned, everybody is very sympathetic. In the old days one could approach the county manager in cases of hardship and the hardship clause would be implemented. I must admit that the Western Health Board is working very well. I was opposed to it and to the recommendations in the Fitzgerald Report because I believed that, if things became too big through amalgamation and so on, the ordinary Joe Soap would be nowhere. That has not been my experience. The board have been most agreeable to me and to everyone discussing problems with them.
It would be a tragedy if the hardship clause were not in existence. I know people who would be in a desperate position because of ridiculously unjust valuations were it not for this hardship clause. I know the Minister is concerned for those who do not have too much of this world's goods and I would urge him to remind people that this clause is there to be implemented. There are people who, if they had to meet hospital bills, would be in a really desperate state mentally. I have been told that there are some who are not inclined to implement this hardship clause and I would urge the Minister to insist on its implementation.
I do not believe that the present system of home help will keep people out of hospital. It looks grand on paper; it does not work in practice. If, for some technical reason, a relative is disqualified that relative will not be anxious to keep the infirm or aged person at home. The whole trend of the Minister's thinking is to keep people in their normal environment. I suppose there is a certain materialism everywhere, though I do not think all are affected by it. If a daughter-in-law is looking after an aged or infirm relative and the nurse comes in and makes rules and regulations, that daughter-in-law will not be encouraged to look after the relative if he or she becomes ill. The patient will be put into hospital, occupying a bed that may be needed for someone seriously ill.
With regard to the question of rationalisation, a decision about Ballinasloe Hospital is awaited in my county. People are worried. We expect our hospital will be classified as a general hospital, but we are still awaiting a decision. We have a catchment area. There are 204 beds and the average daily occupation is 168. We have a training school for nurses. It is one of the best in the country. It would be a tragedy if this hospital were not classified under the proposed scheme of rationalisation.
I congratulate the Minister. He is carrying on the good work initiated by the late President Childers when he was Minister for Health. I know he is concerned about the kind of people to whom I am referring. I can assure him that every speaker on this side, including Deputy O'Malley, is not criticising for the sake of criticising. He is trying to be constructive. He is trying to ensure that the best service is provided. Health is not a political football. All we want to do is to make certain that the services are improved.
I have pointed out the snags in home help. It is a bit selective. The £2 is absolutely useless. If the snags are removed the aged and infirm will be able to live out their lives in their normal environments. Homes are excellent but, if one chats to these old people, they will be the first to admit that the homes are very good; they will tell you that it is grand but what would they not give to be at home.
I compliment the Minister on his work and I appeal to him once more to make a decision with regard to rationalisation as soon as possible. The country and particularly the area I represent are eagerly awaiting it.
I find myself in agreement with much of what the previous speaker said regarding geriatric patients. It is very hard on unfortunate people from West Galway who, having given good service to the nation, have to "live till they die" in a home 25 miles away from Galway city or maybe another 40 miles away. I am referring to patients who have to be kept in the County Home in Loughrea, County Galway. The home is excellent but, in many cases, their children cannot afford to visit them. It is terrible that old people in their dying days cannot see their children. The Minister should consider the reopening of the Merlin Park section of the hospital. At one time it was called "the Mayo Clinic" because patients were brought there from Mayo while city patients were sent to Loughrea. I would ask the Minister to do something to meet the needs and wishes of these people.
The Minister mentioned the drug problem and its effects. He made a very brief reference to the greatest drug problem we have today, alcoholism. This is the "in" thing now. Television tells us it is the "in" thing to drink and, if you do not, you are a square. It is costing £4 million a week. What could the Minister not do with that to improve the health services? Are we sweeping the problem under the carpet? Are we ashamed of ourselves? If we are, what are we doing about it?
This is a greater problem than the drug problem we hear about and we are closing our eyes to it. We do not want to recognise it because so many of us are involved in it. Many homes have been wrecked by it. I hope the Minister for Finance will have a look at these tasty little drinks. I often shook more holy water on my forehead than there would be alcohol in a glass, but it seems to be deadly. The Minister should consider what he might do in this respect in the coming budget. They are grand tasty little glasses but they are dynamite. They put people in great humour while they are in the pub but, when they go home, the home is wrecked. We have accepted this for too long. We would need about ten Father Matthews to come back and make us have a look at ourselves.
I am disappointed that there is nothing in the Minister's speech about the treatment of alcoholics. Are we leaving it all to Alcoholics Anonymous, who are doing great work? The State should play its part. Some hospitals in Dublin are geared to treat alcoholics, but have we got them throughout the country? I am afraid we are just fiddling while Rome burns, fiddling with the whole problem. During the Oxford debate the other day a Northern delegate said that he would not want to join the alcoholic South. I must admit there is a lot of truth in that. Shame on us. The merry-go-round continues and we will not face up to it.
The Department will have to take a stand. Alcohol is a depressant. It depresses not only the victim but also his family and all around him. Give me the man who will take his pint and know when to stop. I am not a pussy-foot. This is the type of man who should take a drink. I should like to know what we intend to do to come to grips with this problem. There is hardly a home in the country which is not affected in one way or another by it. Are we to encourage it by doing nothing? That is what it amounts to. We see it glorified on television.
Young women are drinking. I remember a time in my town when there was only one pub that women would go into. All they took was a bottle of stout and they were the better for it. They had their shawls over them and you could barely see the glass because they had a certain shame in it. Now we have the lounge bar, the "in" thing with the high stool and the music.
We know of the carnage on our roads. What is causing a lot of it? I am not saying all of it. If the carr bán, as we say in the west, the Garda white car, came out again at night it might sober up some people as it did before. People went home sober at 10.30 who might not have gone home until 4 a.m. when they would be "nicely" and would take the two sides of the road.
I have referred to the hospitals in Dublin. There is one in Kildare doing excellent work, but treatment is expensive. People cannot afford to go into these hospitals. Some patients should be put in and "put in" are the right words, because the vast majority will not admit they need treatment. I should like the Minister to announce what he intends to do to solve this problem. This week is dedicated to temperance. I did not come in here to preach temperance. I have been in bars with men at 2 o'clock in the morning—perhaps shame on me. I did not take a drink and these men know how to take it. Perhaps they should have been at home at that hour but they went home sober. They were there for the "crack", as we would say, and they knew how to drink. I feel very strongly about this.
When I was coming up today there was an accident in the street. The Garda were called to the scene. There was more damage done to the car than to anything else. A lady had a gash in her shin. An ambulance arrived and because she was not going into hospital her shin was not even properly disinfected. I thought it strange that the ambulance should come when she was not going to hospital. Something should have been done in that case. First aid does not cost a lot.
The effects of these loud, blaring, sounds described as music in dancehalls, are very dangerous. Doctors have said that they are bound to mentally affect children. They have been described as a drug. By using amplifiers this music is heard all over the neighbourhood——
Does the Deputy hold the Minister for Health responsible for that?
I say that he is responsible for the children's health if it breaks down. If he takes steps now this will not happen.
The Minister should do something about the serious problem of alcoholism. We are not ashamed of this problem although we ought to be. We will have to pay a very dear price if steps are not taken very soon to deal with it. It can affect industry, the health of the children and the mental health of children to come. The Minister should come out strongly on this subject on television. I compliment him on bringing home some points, but he could not do it often enough. Five minutes later we will hear a song on television blaring at us. One gets so much of this that it could drive one to drink.
Much has been said about the Estimate for the Health Services. There are few, if any, motions which come before the House that create so much anxiety and interest. The immediate reaction for many people to this Estimate is the alarming increase in the cost of the services year after year, notwithstanding the fact that people have evidence of inflation in many other walks of life. When one sees millions of pounds being spent, one thinks of all the things which need to be done rather than the things which are being done.
I want to add my voice to those which have gone before in acknowledging the improvements which have been made possible in the health services during the last 20 years. Maybe if I reduced the number to 15 or 16 years, that would be nearer the mark. To those of us in public life who have from time to time felt frustrated at the slow pace at which things are done, it is some consolation when we can look back and ask ourselves if anything worthwhile has happened in the last ten or 15 years. Looking at the health services one cannot but feel that a good deal has been achieved with the resources at our command.
It has been said here by the Minister's predecessor that there is no country in the world that can meet the health demands of its people. Those demands are insatiable. There are so many facets of ailments and illnesses which need attention that one could not possibly supply all the money necessary. As a small country we must spend wisely by allocating money properly and supervising its spending. For that we must plan. We must think not only of the present but also of future trends.
No matter how much money we have to spend we cannot do all that needs to be done unless we can enlist a tremendous response from voluntary efforts and workers. I have had much experience of asking for that help. Because I know the result one gets from such a response, I feel confident that if it is sought in the right way there is practically nothing one cannot get from our voluntary workers. We are blessed in that way. Not enough is made of them. They do not get as much publicity as others less worthy of recognition.
We have the problems of restructuring the hospital services and system. The position in Cork is a very delicate one. A good public relations service is needed there as well as the knowledge that one is doing something worthwhile. We are dealing with institutions, some of which have been serving the community for more than 200 years. They have given an unselfish and, to the best of their ability, a very adequate service. This was at a time when the country was poor and few people thought of the health of those who could not afford to pay for those services. Some of those institutions are now expected to welcome with open arms the changes felt to be necessary to ensure the advancement of the services in modern times. That is not easy to achieve. These institutions and their staffs, down through the years, have given a marvellous service. Nobody could speak too highly of voluntary hospitals and institutions. Nowadays, change has come and the State, central or local government, are paying 95 per cent of all the expenses of these institutions. Some of the buildings are so old that they are fire hazards. Some of them have not enough beds to be viable propositions.
I am not here to defend the Fitzgerald or any other report. In my view, the time has come when the specialist and the consultant—posts which are now regarded as imperative —will not apply for a position in a small hospital unless he is assured of a back-up service and ancillary staff. That means a bigger building and a more expensive outfit. Eventually, it all comes down to a question of finance.
I am sure any Minister for Health would like to see a super hospital, general or regional, in each county if it was warranted and if the country could afford it. That is not even a pipe dream because the population governs what we can afford and where we can have such institutions. It should not be done harshly or ruthlessly. It should be explained to the people who are in the old institutions that there is still work for them to do, that their buildings are still required and that they can still contribute to the well-being of the community as they have been doing for up to 100 years.
In Cork city there is one convalescent home, with about 20 beds, for women but no convalescent home for men. The six hospitals in the city must keep those convalescing in beds that are required for acute operations and illnesses. The ultimate aim of everybody engaged in the health services is to get the best possible results from the services at our disposal.
In my view not enough emphasis is being placed on the need for children to care for their teeth. It is understandable that if a child's teeth are bad every morsel of food that goes into the child is poisoned. I wish somebody better qualified that I would explain to parents the effects decayed teeth have on the ears, eyes and other parts of the body. It is imperative that of all parts of the body the mouth should be clean and healthy from the beginning. The service we provide is only scratching the surface and that is all it can do. If we examined the school service we would find that we have not a proper follow-up service with the result that children are not given proper treatment. The treatment and examination of children ceases too early in the child's life. It should be maintained as long as the children are at school and until they know the importance of looking after their teeth. Children should be made aware that washing their teeth is as important as washing their faces.
When this case was put forward the reply given was that we do not have enough dentists. The Higher Education Authority, in the course of their report about the health of children, devoted only one paragraph to dental education. They said the country was too small for more than one dental school. This is absurd to anybody who knows anything about the position. It is obvious that there was nobody available who cared to talk to this authority about the problem. Of course, I am plugging for the retention of the dental school in Cork. This school has turned out a number of dentists annually for the last 50 years. However, because there is inadequate physical provision in the city the staff are uncertain as to their future. The professors at that school are worried and there is an air of uncertainty. The result is that it is not possible to replace staff who leave.
The Minister referred to the regional hospital and informed us that he expects this will be opened in 1978. This hospital will cost about £8 million but on the same site there is provision for a dental hospital. The estimates have been obtained and the schedule of accommodation is ready for this hospital but no decision has been taken. It is only right that a dental hospital should be close to a general hospital. The regional hospital is in the course of construction but when it has been completed and the workers have moved from the site I guarantee the House that some enlightened Minister will decide to erect the dental hospital. The work will have to start all over again and the hospital will cost at least ten times as much as it would if it was started now. It is an absurd situation and I ask the Minister, who has some influence in the Government, to press for a decision on this matter. If the staff are told that a dental hospital will be erected in the not-too-distant future they will feel secure. I am not saying that there should not be a dental hospital in Dublin but there is no site available in that city. Of course, Dublin should have a dental hospital. It is not possible to tackle one of the most important facets of the health service, the caring for teeth, unless there is a sufficient number of dentists.
On the question of caring for handicapped children I should like to state that we are well catered for this in Cork. The people there, like those in the rest of the country, are generous with their services and their money. Voluntary services look after the handicapped child from the cradle to the grave. They are subsidised by the health boards but if the State had to pay it would cost a lot of money. Nobody other than voluntary workers could carry out this work. They are available every day and they do not count the time they put into it. They get nothing but the satisfaction of knowing that the work they are doing is for handicapped children.
Those involved in providing services for handicapped children meet regularly in order to ensure that there is no overlapping. A great danger as far as voluntary organisations are concerned is that there would be overlapping. The organisations in Cork meet twice annually and discuss reports on the operations of the various groups. I should like to mention that these organisations receive the utmost co-operation from the Southern Health Board.
Has the Minister ever given consideration to the amount of money taken by the Revenue Commissioners from the sweepstakes fund? A certain portion of the hospital fund is taken by the Revenue Commissioners and this seems foolish. It is foolish to take the money from the Hospitals' Trust and then give it to the hospitals to help them make up their deficits. If it were allowed to the Hospitals' Trust people for the purposes of something like medical research, it would be invaluable. We are a country that gives less to medical research in proportion to our size than do most other civilised countries. If the miserable amount they get in revenue from each sweep was given to medical research it would make the sweepstake more palatable to the world in general and, certainly, would not do the revenue or the State any injury.
I would appeal to the Minister to examine that aspect. I wish the Minister well. I appreciate fairly well the kind of job he has to undertake. We could speak for days on the subject and there would still remain facets on which we could hear further. I hope the Minister will have patience with us. I would ask him particularly to see if he can do anything to expedite a decision with regard to the dental hospital in Cork.
It has often occurred to me—as I am sure it has to many others—that the Tánaiste, the Minister for Health, is both fortunate and unfortunate in having had as his immediate predecessor a man of the calibre and outstanding talents of the late President Childers. Comparisons are said to be odious but in the context of the recent death of President Childers I am afraid they are unavoidable and inevitable. In that way the Tánaiste is certainly unlucky, particularly viewed in the aftermath of the ceremonies and the eulogies which followed the death of President Childers. Tributes were paid to President Childers by all and sundry, tributes to his dedication, his ability, his vision and to the work which he put into whatever task, Ministry or job was assigned to him. It was unanimously admitted, unreservedly, in fact, by the Tánaiste himself in the tribute which he paid to the late President Childers in this House that it was in the Department of Health he was most successful. There is no doubt at all but that the late President Childers by his work left an indelible mark on the office of Minister for Health. Not alone did he set down the programme, policies and structures for the great work he commenced, and which the present Minister is trying to pursue, but he laid down also the structures, guidelines and patterns for future development, growth and progress.
Unfortunately, I must say that the late President Childers' successor did not avail himself of the magnificent work done and the example given by his predecessor. The original thinking and the groundwork done by President Childers were outstanding, but the present Minister failed to take full advantage of this. Instead of the progress and development which should be forthcoming we now have a certain amount of stagnation on all sides. In particular, we have disillusionment and frustration in many fields. I refer in particular to the doctors and more recently to the chemists. In his brief the Minister deals at length but not satisfactorily with his dispute with the doctors.
It is extraordinary that in the same brief of about 40 pages he makes no mention at all of the dispute with the chemists, a dispute which he, his officials and the Department must have known well was brewing for the past 12 months. One would imagine that the Minister would have learned a lesson from his dispute with the doctors, that at least he would have met the chemists and tried to avoid the pitfalls into which he fell in his dealings with the doctors. There is no doubt that the chemists' dispute is now putting the whole health services in jeopardy. I do not know what happened to the Minister. Was it his inability to negotiate? Was it his inexperience or was it his over-anxiety to please? His colleagues in Government have shown on many occasions that they are incapable of and lacking in capacity to negotiate. This has been demonstrated at many levels and in many fields from Ballydehob to Brussels. I think the Tánaiste was over-anxious and over-ambitious. I think he tried to out-Childers Childers; that he took on too much and that he bit off more than he could chew. In particular, I think his free health services for all was certainly over-ambitious. He cast his net too widely. He tried to do too much without having the structures, trained personnel and, indeed, the goodwill of all those involved. He did not have all those prerequisites before launching into the scheme. I think he would do well even now to study the techniques, approaches, know-how and the flair and capacity for negotiating which his predecessor displayed.
Having so spoken, I should like now to refer to a few more mundane matters. I agree completely with Deputy Coogan when he mentioned the problem of drink and alcoholism. As a person who takes a drink, a public representative for a long number of years and a lawyer, who has experience of the court, it is my opinion that drink is probably the greatest problem which we have at the moment.
Deputy Coogan mentioned the high cost of drink. I would prefer to refer to the cost of drink in relation to the damage it does to every facet of life, social, economic and health. It is certainly responsible for broken bones as well as broken homes. It is a disease and it is also the root cause of many other sicknesses. It is the root cause of practically most crimes, larceny, housebreaking, assaults of various kinds, including sexual assaults and fraud. I have had experience of prosecuting and defending people where drink was very often the only element in the background of the serious crimes committed.
I suppose it is appropriate that drink should be mentioned in this particular week. Excessive drinking and alcoholism are very serious problems. Like Deputy Coogan I am rather surprised that the Minister gave very scant attention to it in his brief. He mentioned it in the context of some advertising campaign but that is not sufficient. It should be treated much more seriously.
The Minister also mentioned that he proposes to extend the list of illnesses for which free drugs will be made available, irrespective of income. I seriously suggest to him that alcoholism should be one of those scheduled diseases. Not alone should drugs be freely available but treatment should also be available. This may be expensive but that would be more than justified by the saving to property and to people by the reduction in crime.
The Minister made very scant reference to drugs, which should be put on a par with drink. I do not know much about the problem but it appears that it is something which needs more serious attention than the cursory attention which the Minister has given to it. He has been very dilatory in introducing any legislation to deal with the matter. He mentioned that he proposes establishing a bureau to deal with it. I hope that next year, if he is in charge of this Estimate, that more attention will be given to the question of drugs and that not alone will the bureau have been set up but that effective legislation will have been introduced.
I would like to refer to the home assistance officers and pay tribute to the work most of them do in spite of the fact that they work under appalling conditions in country areas. Some of the premises they use are completely obsolete, inadequate and in bad repair. They do not afford any privacy whatsoever to the unfortunate people who have to visit them. Privacy is a very important factor in the work home assistance officers do. I know of places in east Cork where people have to queue up and parade themselves and their complaints to all their neighbours in the same queue. The Minister's Parliamentary Secretary can verify that there are a number of such places which are not suitable for dealing with confidential matters. The number of people who have to resort to these places is growing. We now have a category of people receiving benefits who were not in the habit of receiving them before this. I know of a number of people entitled to social welfare benefits who, on account of the conditions under which they would have to make their applications to the social welfare officers, have refused to pursue their claims.
I welcome the Minister's intention of providing training and employment for the handicapped. Deputy Healy dealt at some length with the situation in Cork. I can assure the Minister that there is much goodwill in so far as these people are concerned on the part of industrial management in Cork. Much good work is being done by the voluntary associations who cater for those who are handicapped physically or who are mildly mentally handicapped. For a number of years I was chairman of a committee which was under the aegis of the old Cork health authority. This committee dealt with the rehabilitation and training of some mildly handicapped patients in Our Lady's Hospital. We found that most of those who received any training and who were able to go out among the public were employed in factories and in other establishments in the city.
I wish the Minister well in his work. I appeal to him to consider an application that was made to him recently by the Southern Health Board to reconstitute the health advisory committee of that health board. On a few occasions I was on deputations to the late Mr. Childers when he was Minister for Health and I approached him personally on a number of occasions about this matter. However, he was adamant in his refusal to consider having this body reconstituted. Earlier I made comparisons which, I said, were unavoidable, as between the present Minister and his predecessor. However, I would be inclined to even up the comparisons if the Minister would consider sympathetically my request in relation to the reconstitution of this advisory committee. At present the situation is that there is no advisory health body representing the southern committee of Cork County Council. Therefore, we as members of the southern committee have no say in health matters. Indeed one might say that we are disfranchised where health matters are concerned. In those circumstances I trust that the Minister will grant my request.
At the outset I congratulate the Minister, his Parliamentary Secretary and the Department generally for the magnificent job they have done during the past 20 months. Their performance has been most productive but in all work of a productive nature there must of necessity be some omissions. An example of this has been the failure to make further progress on the lines suggested by the Fitzgerald Report and there has been also the delay in the printing of the Misuse of Drugs Bill. I admire Deputy O'Malley's tenacity in having introduced the First Stage of that Bill on the 21st November but I would not laud him for his efforts because it is not much more than a blueprint of the Bill drafted by the previous Administration and that in turn was nothing more than a synopsis of the Reginald Maudling Misuse of Drugs Bill, 1972. Therefore, little credit is due to Deputy O'Malley for any ingenuity in this direction. There are some sections of the Bill that do not appeal to me.
The Deputy will appreciate that we cannot discuss legislation on an Estimate debate.
I shall comment on it at an appropriate time. Regarding the Minister's speech it is very heartening to know that there is an increase of 40 per cent in the health fund. In the paragraph of his speech dealing with general hospital services, the Minister said that his objective is to set about the long-term reduction in the percentage of total expenditure devoted to hospital services and he went on to detail the ways in which he wished to expand the general medical services and to reduce the proportion spent on hospital care. This is very well framed but it is important to realise that any improvement in medical care will result in earlier diagnosis, prolongevity of treatment and an elongated life spell. This is the aim of a good health service but one of the factors associated with the achievement of that aim is further expenditure on hospital and diagnostic facilities, on treatment facilities and on hospital care. Therefore, as the general care programme improves, the expenditure increases pro rata, if not at a higher rate. There are two schools of thought on this. One is the Minister's and the other is that such as I have outlined. Both have been documented in great detail and both have merits.
The Minister's approach is a sound economic one but whether it is sound medically, in the light of experience in other countries, is something that only time will tell. I admire the Minister for having the courage to take one definite line of approach. It is the line of approach which has the least resistance and which would give the optimum results from the contributions of all concerned in attempting to achieve the aim as expressed by the Minister. In the long run it does not imply a reduction in the proportion of money allocated to hospital services. It can go hand in hand. As I said earlier, if the medical health services improve, people will live longer and then there will be greater need for geriatrics and in-patient treatment and at the other end of the scale, as medical standards improve, a greater number of children will grow to maturity and be kept alive. This will result in an increase in the number of cases of mental deficiency or retardation, spina bifida and so on. In that way there can be greater need to have specialisation on the paediatrics sector. It is a vague general approach and I think the Minister has taken a line which I would wholeheartedly support.
He went on then to mention the detoxification unit at Jervis Street hospital and the increase in facilities in St. Laurence's Hospital. At the same time as he is spending money that must be spent on these hospitals there is a rationalisation programme going on on the north side of the city and on the south side of the city which will involve Jervis Street, St. Laurence's and the Mater Hospital coming together with Beaumont and Blanchardstown and forming the three major hospitals on the north side. I am not sure if they are coming together physically or whether it will be just under one board but if it is intended that they should come together physically perhaps we could look again at the investment of money in specialist equipment in hospitals that may be out-dated in the near future. Personally, I would not like St. Laurence's Hospital to be amalgamated with either Jervis Street or the Mater because neuro-surgery is a very specialised field and with the higher incidence of neuro-surgical accidents becomes of increasing importance.
In or around 1943 land was purchased under the St. Laurence's Hospital Act on the Navan Road, quite a good acreage, and I should like to see the erection of St. Laurence's Hospital proceed with specialised treatment, diagnostic facilities and staff provided there. Otherwise, we shall have to try to put similar units on the south side of the city and spend the same amount of money in Cork and possibly Galway and Limerick to provide this extra service. In London there is a national hospital where all these diseases are dealt with and which provides central specialist treatment.
I should also like to comment on what I consider to be the most important part of the Minister's speech. He referred to the Fitzgerald Committee report in 1968 and the fact that there would be a tendency to concentrate hospital resources in a limited number of large centres. Later on he said it was obviously impractical to suggest that each town in the country should have a general hospital. This was the policy of the previous Fianna Fáil administration since 1930 when for some reason they provided a hospital in each county without regard to any population breakdown or percentage. In retrospect it represented probably nothing more than political expenditure of public funds. Now the Minister must try to rationalise this because the fact that an area is a county does not necessarily mean that it requires a fully equipped hospital. A disservice can be done in providing too many hospitals that cannot be provided with equipment, surgeons, physicians or gynaecologists. When the Minister suggests therefore that a middle ground solution must be found I would be grateful if he would elaborate in his reply and confirm that this means that the Fitzgerald Report of 1968 is being jettisoned. It does not appear that he is going to follow the Fitzgerald Report and he is certainly not going to continue with the old Fianna Fáil method. He must find a harmonious solution in between, I should like the Minister to amplify his ideas on this point because he may not realise the significance that different interpreters like myself would apply to such statements.
The Minister says that Comhairle na nOspidéal have set up a special committee to examine the situation in the large urban areas. This seems to be a duplication of what Dr. Fitzgerald did and could be put on the long finger even though the Cork results have come in. Limerick have not agreed on a report as yet. One must admire the tenacity of the Minister having regard to the amount of consultation in which he has involved himself here with due regard to the amount of work done by the Fitzgerald Committee and with regard to the fact that many members of Comhairle na nOspidéal were also members of the Fitzgerald Committee.
I must congratulate the Minister on including in the list of long-term illnesses Parkinsonism, acute leukaemia, muscular dystrophies and multiple sclerosis and on his observation that this does not include all such illnesses. But I would like him to give consideration to coronary artery disease, including post-cardiac conditions, terminal cancer patients, cardiovascular accidents and to investigate further the possibility in regard to asthmatics and people who suffer from rheumatism and to give consideration to ulcerous colitis which is a chronic type of illness that is now found to be very common in general practice. I think that nearly 75 per cent of the child-bearing females in this country suffer from it to some extent and while they can get treatment while they are pregnant and immediately after childbirth, when it gives them trouble later the expense involved is considerable and they are not covered for it.
In concluding, I should like to mention the need for a maternity hospital to cover the north city. I know that the Rotunda Hospital is taking over the Drumcondra Hospital but we should have a maternity hospital something similar to the Coombe Hospital because the north side of the city is expanding very rapidly. The majority of such hospitals, St. Kevin's, The Coombe, Holles Street, Dún Laoghaire and Mount Carmel are all on the south side and the Rotunda is the only one on the north side.
Debate adjourned.
The Dáil adjourned at 10.30 p.m. until 10.30 a.m. on Wednesday, 4th December, 1974.