Health Contributions (Amendment) Bill, 1974: Second Stage (Resumed).

Question again proposed: "That the Bill be now read a Second Time."

Mr. Moore

On the last occasion on which we were discussing this measure I referred to the general cost of hospital and health services. We were told that this Bill has been brought in for the purpose of increasing the contribution in order to combat inflation. I endorse the remarks of the Leader of the Opposition, Deputy Lynch, in regard to the sloppiness in the presentation or, rather, lack of presentation, of this measure. If the purpose is to combat inflation then we will have further amending legislation bringing in further increases. The Minister said he was going to examine the whole financial structure of the health services. He should, of course, carry out the examination first to see what changes are necessary and then bring in whatever amending legislation may be necessary. Here, he is putting the cart before the horse; he is amending first of all and promises the examination following on the legislation. Less time would be wasted if we were to have the examination first and then the legislation. Mounting costs of illness are a contributory factor in prolonging illness. They certainly do not help to heal.

Health services have improved tremendously but they will not go on improving unless we accept certain basic needs and requirements. I mentioned before the case of an old lady living alone in this city who has to wait until next March for a cataract operation. She is the holder of a medical card. She will have to spend the next few months worrying about whether the operation will be a success. Though the services have improved we must not be complacent about them. This old lady is just one case. I am sure all Deputies and the Minister know of other cases.

We need a comprehensive review of our health services. Most of the money now goes on hospital services, specialist services, maternity and drugs and very little is left for the general health services. I cannot understand how anyone can talk about a free-for-all health service or worry about top socio-economic groups which can look after themselves when we are unable to provide a bed for the old lady to whom I referred. Before we start talking about a free-for-all health service, which would include the affluent sector of our society, we should get down to examining our services to make sure that the weaker sections are given every possible help.

Being in public life enables one to agitate for the removal of gross injustices. People will willingly pay for a good health service. I do not anticipate that costs will decrease or that inflation will disappear, but the person who is sick and awaiting treatment is not an economist or a financier; he does not understand inflation. Very few people do understand it. He does understand that he has a serious illness and needs hospitalisation, but no hospital will take him because there are not enough beds.

We have built new hospitals but we failed to estimate accurately the demand. There must be an examination to ensure that those who really need our medical services get those services. We must also ensure that the services are administered without waste. When women come to me looking for a house or something else they often produce from their handbags several bottles of tablets which, they say, the doctor has given them for their nerves. These nerves are caused by the conditions in which they are living. I often wonder is there no other way in which people could be treated.

We should have more social workers who could talk to women especially and try to relieve the mental strain of the domestic scene on women with families. Nowadays we are all inclined to look to the magic tablet to cure our ills, but we should look at medicine on a much broader basis. If we had more social workers to help mothers of families to overcome the strains of modern day living this would pay a dividend in reducing the frightful cost of drugs.

The Minister has told us how much the Exchequer is contributing to these services. He said that the cost falls back on the Exchequer. The Exchequer depends on the taxpayer. There are sections of our society, widows and others with over £1,600 a year, who get very little help from the State services. I am sure this will engage the attention of the Minister when he is carrying out the promised review of the financial structure of our health services.

I want to see an all-embracing health service, but it must be a graded service. Those most in need of help must get most help. If we tackle it in that way, we will remove the gross injustices from the health services. Over the years it has been the ambition of successive Ministers for Health to improve the health services, but we are racing against time. There are many people who, because of their ailments and because they cannot get proper treatment, as in the case of the old lady I mentioned, may have to endure many weeks and months of suffering. Who knows but that in some cases irreparable damage may be done to some organ of the body during that period of waiting. I am sure most Deputies have had people come to them to say: "I want to go into such-and-such a hospital. Can you get me in?" You tackle the job with rather mixed feelings. You know in your heart and soul that, if you are successful in getting a person admitted, somebody else on the waiting list who has nobody to speak for him will be put back.

I want to pay tribute to the hospitals for their concern that they should admit every patient referred to them. They just cannot do that. I serve on a voluntary hospital board and I know the gross overcrowding in some hospitals. St. Vincent's hospital is a magnificent new hospital only two miles from here. It was finished a few years ago. We were all proud of it. Now we are told that because of overcrowding some patients are being referred to the old military hospital at Leopardstown. That is no reflection on the Leopardstown hospital. Surely it shows that we went wrong somewhere. When this new hospital was being built it was not made big enough. It has extensive grounds. Now we have to use a hospital which was built some time before the first world war. Indeed, casualties from that war may have been treated there.

This makes one a bit uneasy about the progress we are making. Progress is being made and there have been improvements in the service, but when one sees such a basic mistake in the planning of the hospital I mentioned, one realises that somebody must have underestimated the demand that would be made on it. It may be a tribute to the hospital that so many people want to go there. I can testify that it is a fine hospital. The situation may be the same all over the country but there is an incentive to people to come to the city where they feel the best service is available.

We are preparing to close six hospitals in the city. We are preparing to close most of the federated hospitals. Sir Patrick Dun's, on which I serve, is down for demolition. It gives a great service to people from around the dock areas mostly and indeed, from all parts of the country. We may well have to look at the report which sets out what hospitals we should build and what hospitals we should get rid of, and revise our whole thinking on it. It would be rather ironical to see one of the federated hospitals closed down while another hospital has to send patients to a non-teaching hospital for treatment.

Perhaps it is a cliché to say we should be striving to keep people out of hospital. I am sure we should be using preventive medicine much more than we are using it. This is the solution suggested by the experts. The general hospitals could well take an example from the maternity hospitals who have mobile units going around the city. The standard of housing has improved so much that the vast majority of houses in the urban areas have hot and cold running water. Mobile teams could move out from the big hospitals in the city and perform small operations in the patient's home. The maternity hospitals have been doing this for many years. In that way we would reduce the cost of hospitalisation without lowering the standard of attention given to the patients.

Unless we can check costs we may well see the day when people will not be able to afford whatever they are asked to pay. In our neighbouring island at one time they had a free-for-all service but they had to introduce certain charges. We must look at the whole cost of the hospital services. The Minister should have this examination carried out immediately. I am sure the House will give him every possible help with regard to any legislation which we are sure will improve the health services.

Because of the excellence of medicines and drugs the scientists have given us the span of life in the next few years will increase and we are going to have a massive problem catering for old people. It will not be just a matter of putting old people away in some home to wait until their call comes because with improved geriatric services these men and women will want to be part of our society.

We have to change the outlook on old people's homes. A few years ago people were glad to see an old person going into a home where he would be fed and cared for but there is a greater awareness now that we owe a lot more to our old people and we are not satisfied to put them away in homes. For this reason we have to spend vast sums of money providing proper accommodation and services for these people. I feel sure that our people would not begrudge paying money for such a service.

When the Minister is carrying out his examination he should do so on a broad basis and not just think of the teaching hospitals though they must be to the forefront in the fight against disease. The Minister should also think of the non-teaching hospitals and the homes for old people. We owe it to our old people to give them the best accommodation and services possible. I marvel at what voluntary bodies in our city are able to do in providing up-to-date homes, with the help of liberal Government grants, for old people.

On this question of caring for the aged I accept that the Minister has a great problem but, compared with a Minister for Health of 30 years ago, he has greater resources to fight this battle. The Minister should get his priorities right and stop talking about a free-for-all scheme and about accommodating the top socio-economic group who can generally look after themselves. People in the middle income and lower paid groups want that little extra. A scheme based on ensuring the greatest help to the ones in greatest need is one that should be contemplated. If the Minister introduced such a scheme he would have no regrets.

Mr. Toal

This is a small amendment Bill which will have the effect of increasing the contributions by £3½ million, bringing the figure to £8½ million. This figure represents about 10 per cent of the total cost of financing the health service. The figure of £3½ million is a sizeable one but, when spread over the people who are contributing or who will contribute to the health service, it represents something like the price of a packet of cigarettes in the week or the price of a bottle of lemonade. This is a very small imposition.

The Bill is necessary and Members should support it. In relation to eligibility I feel that the ceiling should be raised substantially. When this scheme was introduced the income limit was something like £15 per week and this has since been raised to £20 per week. In these inflationary days it should be raised to about £30 per week. As a result the free health service would become available to those in most need. In another area of the health service an unfortunate yardstick was used. I am referring to the poor law valuation system where farmers of £60 poor law valuation are entitled to free health service on payment of £7 per year or 15p per week. If a farmer has a valuation of £61 he is excluded. In my view this is an unfortunate limit. To use the poor law valuation system as the criteria for any health service is bad.

I should like to remind the House that the poor law valuation system was introduced in the late 1840s. The inspectors started their investigations in the southern part of the country and it took them two years to work from the south, through the midlands, to the northern counties. Unfortunately, in those two years there was a very good flax crop and, as a result, the rateable valuation per acre in the northern counties was grossly in excess of that assessed for the southern counties. This was done in spite of the fact that the land in the southern counties was, and still is, much superior in quality to that in the northern counties. However, the rateable valuation is much less in the south than it is in counties Cavan, Leitrim or Monaghan. Farmers in these counties with small holdings and poor quality land have a much higher valuation than their southern counterparts who have the most fertile land in the country. The £60 valuation limit is unfortunate and I should like to see it raised to £100.

I should like to see the Minister making progress in the provision of dental treatment for our people. In my view the dental service is the poor relation of the health service. If a child has a toothache that child, even though he is entitled to free dental treatment, must wait until the dentist visits the local hospital. I would like to see a proper choice of dentist scheme introduced and more time and money devoted to the improvement of this service.

The most welcome part of the Minister's statement was that signifying his intention to set up a committee to look into the financing of the health service. There are so many guidelines, so many regulations, that I get the impression that the scheme is being done piecemeal, by patchwork. I would like to see Members who are also members of health boards represented on this investigation committee. They have a good working knowledge of the administration of the health service. They could offer some advice and put forward concrete proposals to the committee which I should like to see set up early in the new year. Further, I should like to see a report forthcoming shortly afterwards and the Minister acting on it as soon as possible.

Needless to say, no matter how much money was spent on health services in a country there would still be room for improvement. 1975 is forecast as a gloomy year in economic terms. This is particularly unfortunate with regard to the provision of health services. It is the proper duty of any Government to provide adequate health services and, in this respect, the Minister has a momentous task before him. At present he is dealing with the structural system of the hospitals. I should like to see him dealing with the day-to-day services. Despite the limited resources available to him, progress should be made in this field above all or in any other Department.

This is a small amending Bill. It merely amends the provision in regard to health contributions introduced in 1971. After 1974 I feel confident we will see a more equitable system of health contributions ensuring that those who can best afford to pay for them will do so and those most in need will be able to avail of proper health services.

There are so many areas comprised in the health services. But I think the Minister should give more direction to the health boards in relation to their day-to-day administration in the various regions. In this respect, I notice a gap or lack of liaison between the health boards and the Department. I should like to see greater synchronisation resulting in people in need of medical services having them available when they need them.

Mr. Calleary

I should like to apologise in advance for any remarks I may make that may appear to the Chair to be outside the scope of this Bill. I welcome the opportunity the Bill provides to set on the record of the House some facts concerning the services provided by the Western Health Board and by the Department in Mayo, especially in the Ballina region. This opportunity was denied us on previous occasions through lack of time for debate on the Health Estimates.

Paragraph 2 of the explanatory memorandum circulated with the Bill explains the services to which people covered by this Bill are entitled, that is, hospital in-patient and out-patient, maternity and infant care services, and so on. In the context of the hospital in-patient and out-patient services, I should like to refer to the situation in Ballina District Hospital which has greatly agitated people in the Ballina area and about which there is frustration, anger and considerable concern. I refer to the fact that the post of medical officer at Ballina Hospital has been filled on a part-time temporary basis only since April 1973, coincidentally, since the Coalition came into office. At this juncture I should like to pay tribute to the man now carrying out the task involved there. He accepted that task because of his friendship with the staff of the hospital. He carries out this task with dedication, energy, selflessness and, of necessity, with complete disregard for his family life. He carries out the task because of his commitment to the area, at considerable personal inconvenience and, only then, with the help he receives from his brother, who is a doctor also, and from some of the other doctors in the area. In addition to that task, this man has an extensive and widespread practice. I do not think that any man should be placed in the position of serving two masters.

Under the present conditions a man so appointed will be placed in that position. He will be required to serve the 101 bed hospital and also some 500 patients under the general medical services programme. This cannot be done. At some stage in the future that man will be placed in the position of making Hobson's choice. And, no matter what choice he may make, a life may be at stake because a man cannot be in two places simultaneously. Further, the dedicated, efficient and very courteous matron and staff of that hospital will have to accept any claims or consequences that may arise. A public meeting was held in Ballina attended by approximately 500 people —many of whom represented organisations and associations—endorsing the demands that two deputations had made to the Minister already. They asked for the appointment of a man of consultant status, a man who would have the service and experience of a houseman. It is estimated that that would cost approximately £5,000 extra annually. I would put it to the Minister that this is a very small price to pay for proper services and very little compared with the cost of a life. I would ask the Minister to concede to the wishes of the people in that region and allow the extra salary involved. I would ask him also to treat this hospital—the largest district hospital in the country—as a special case; treat it as a pilot scheme because, in view of industrial expansion, the population of the town is envisaged to increase threefold in the next ten to 15 years and the services for which we ask now will be required at that juncture.

I should like to mention just a few of the other services referred to by various Deputies and to say that if the Minister could guarantee that the extra money forthcoming when this Bill is passed—because none of us would be so naive as to say it will not be passed—would be spent solely for the purpose of enlarging and expanding the existing school services and for inaugurating others, I would have no qualms whatever in regard to it because I am convinced that a proper school service would, in the long term, result in a saving of many millions of pounds. Prevention is always better than cure and in this case is a lot less expensive.

Much more encouragement should be given towards the establishment of mobile dental clinics especially in areas such as the one I represent. An extension of this service would help to eliminate the unfavourable delays that occur in dental services. These delays are due mainly to lack of staff. The Minister should endeavour, too, to encourage greater participation of private dentists in this scheme. I am sure the Minister would have their co-operation if he were prepared to offer them better rates of remuneration. Again, this would result in saving in the long term because experience shows that delayed dental treatment leads later to hospitalisation and it appears that it is on hospitalisation that most of the moneys being provided for the Department are spent.

I should like to see a considerable expansion also in the home care service, a service that is proving of tremendous value especially in areas such as mine. The existence of this service is responsible for a considerable number of old and infirm people being kept at home rather than having to be hospitalised. Consequently, there is a resulting saving to the State because instead of the £20 or £30 per week that it would cost to keep a person in hospital, the cost of this service is only about £2.50 per week.

A worthwhile innovation would be a system whereby everyone would be compelled to subject himself each year to a thorough medical examination by his family doctor. In this way we would have a warning system, as it were, in respect of many diseases. Another aspect of this would be that, by preventative measures being taken, the demand for hospital beds would be reduced considerably. I know that it would not be an easy matter to introduce such a system because while we Irish can be led almost anywhere, we cannot be driven. At the same time, it might be well worthwhile to try this idea, at least in a pilot area in the first place.

The Minister rightly drew attention to the escalating costs of medical services. Despite this situation, however, it is saddening to note that the Minister proposes going ahead with his free hospitalisation for all policy. In this way, he would be diverting money that is needed badly for underfinanced services to help those who do not need help and who have not asked for free hospitalisation services. I am talking of the people who can afford to pay their own costs. There is no guarantee that in the event of the Minister's policy being implemented, there will be a better service for all. The State would even be paying for those 5 per cent that we hear mentioned so often in this House.

The money proposed to be spent in this way could be spent, for instance, on providing jobs for newly-qualified doctors who, now more than ever, find themselves like pieces of flotsam cast out to seek employment wherever they can find it. Their skills and expertise are going to help other people in other lands. It has always seemed ludicrous to me that before a doctor can be registered he must, on completing his six years course, find a job for another year. This year should be a part of the doctor's education and the onus for finding the job should be either on the colleges or on the Department of Health. In this way a student's education can continue from the time of his pre-med to the time of registration.

Some time ago I attended a wedding of two young doctors at which many of the guests were newly-qualified doctors. I was very saddened to hear from about 80 per cent of those present that they had no option but to go away to seek employment. This situation is due to a number of reasons, not the least of which was the very good agreement which the Minister reached in respect of junior doctors some time ago. This has meant that a number of those who might otherwise have gone away are now here. It has meant also that some of those who were away have been able to come back. However, the Minister might try to persuade the universities to assume the task of finding jobs for these doctors until such time, at least, that they are registered.

In this context there should be more incentives to doctors to work in what are referred to as isolated regions. I come from an area in which there is great difficulty in filling some posts. The Western Health Board have had a lot of difficulty in finding people who are prepared to take up the various posts offered. I am aware that there are factors other than remuneration involved especially where married men are concerned because they will be influenced by such factors as educational facilities and other services. However, if more money were offered for these posts, I am of the opinion that a lot of the posts which are still vacant would have been filled long ago.

A lot more help could be given by all of us to the many voluntary bodies whose members are doing very dedicated and difficult work. I include in this the various community centres. Any help given by the State in this area would be repaid many fold. I take this opportunity of recording my appreciation of the tremendous work being carried on by the various voluntary bodies in County Mayo. There are far too many to refer to individually but we owe a deep debt to all of them. Every help possible should be given to them.

There are many other matters that I would like to discuss but time does not allow for that. Perhaps, though, I might be permitted to refer to a few local matters and to ask the Minister what is the position regarding the psychiatric unit that was to have been attached to Ballina District Hospital. Also, what is the present condition regarding the planning of the group practice building to be built there and the Minister might let me know, too, when it is envisaged that the community home, in respect of which outline planning permission was granted 15 months ago, will be established at Ballina?

Another matter that has been the cause of some concern and agitation in Mayo for some time is the establishment of a school of nursing at Castlebar hospital. Some days ago I was approached in connection with a post for a student nurse and I was horrified to hear that 1,400 applications had been received for the 80 posts available.

I ask that these matters be looked into and the money made available. Finally, I ask the Minister to heed the cry of the people of Ballina and arrange for a full-time doctor of consultant status with a houseman to provide back-up service. I should like to thank the Minister for his courtesy and kindness to me personally and to the deputation he met. He follows a line of very dedicated Ministers and it is a pity that his talents are frustrated and confined by ideological traces. I wish him well in his task of reformation.

Mr. B. Desmond

One of our wearing responsibilities on the Government side is that we have to attend most debates and I was present last Wednesday when this debate began and through Thursday afternoon and evening when the debate was talked out. What struck me about that experience was the incredible irrelevance and the abysmally low level of many of the contributions. This is a relatively simple Bill. The Government are asking the Dáil for another £3.5 million in addition to the £5 million currently contributed by persons of limited eligibility. It is a Bill that does not warrant the amazing series of irrelevancies—no disrespect to the Chair— put forward on all matters of health which had nothing to do with the Bill, and a great deal of the tendentious arguments from local personal experiences of Deputies and the bringing in of what Fianna Fáil have described as ideological nuances in regard to the Bill. We might be excited if it was ideological but, in fact, this Bill, as we know, is a simple measure.

At present we spend £166 million on health services. About £120 million represents the cost of hospital and specialist services, the cost of maternity and infant care, drug subsidy schemes and so on. Of the £120 million, £72 million represents the cost of services for persons of limited eligibility and at the moment they contribute towards that £72 million health contributions of about £5 million. For Deputy O'Malley to come here and have the sheer effrontery to attack this measure—which is not ideological because he is ideological and almost apolitical in his attitude to this Bill—is totally unjustified. I regard his attitude as no more than adolescent in party political terms. At present we propose to increase a miserable £5 million in health contributions by a mere 6 or 7 per cent from those of limited eligibility towards the cost of the service they receive. We propose to increase the current figure by £3½ million to bring it up to £8½ million in a full year. That £8½ million will cover only 10 per cent of the total cost being borne by the State.

Mr. Hussey

Why not abolish it entirely?

Mr. B. Desmond

I shall come to that. We propose to add to the existing 15p per week a miserable 11p per week. I submit that not only are the people getting very good value for 15p per week but they are getting extraordinary value. This 11p goes on to a service which has not been increased in any way from 1971 in terms of cost to the electorate. Let us put this in its proper perspective; it represents less than a half-pint of stout. Yet, Deputy O'Malley weeps beautiful crocodile tears about how no farmer, large or small, could possibly afford an extra 11p per week and how every industrial worker will have to stay at home every night of the week if he has to find another 11p a week for the health contribution—the cost of half a dozen fags.

That is what Fianna Fáil are voting against. I regard this as hypocrisy. There has been no increase in the health contribution since the Bill was introduced in 1971 by the late, esteemed Deputy Childers at that time. Fianna Fáil voted for it then and now they are voting against an adjustment of that Bill. This smacks to me of narrow, stupid, political expediency and if it were not for the effrontery of it I should not have bothered to speak about it because I found the debate incredibly poor and the Fianna Fáil arguments incredibly stupid and narrow.

Deputy O'Malley is a very well briefed Deputy. As a Minister, his personal attitude could be very pathetic but, by and large, I found him to be on top of his job, exceptionally competent in dealing with the issues in his portfolio, and he exercised great care. He was very industrious, but I am more interested in the personal policies of people than their abrasive personalities. As regards his attitude on health matters, I suggest he has become the Mrs. Thatcher of the Fianna Fáil Party. On health matters, Enoch Powell is to the left of Deputy O'Malley. This applies with relation to the extension of the health services, who is going to pay for them, to matters of industrial relations and to disputes that have arisen between the Department and the doctors. For a person so young, one who comes from a family that has made such a distinguished contribution with regard to a national educational system and the introduction of free post-primary education, it is extraordinary that the spokesman for Fianna Fáil on health matters is the most notoriously conservative spokesman on health since the former Minister, Deputy MacEntee and, goodness knows, he was a conservative on such matters.

Mr. Calleary

Is this relevant?

Mr. B. Desmond

It is entirely relevant because it has coloured the attitude of Deputy O'Malley to this Bill. I shall quote to the House one example of Deputy O'Malley's opposition to the Bill. At column 1506 of the Official Report, dated 11th December, the Deputy stated:

... in his doctrinaire efforts to give the better off people the benefits of limited eligibility he is giving them something which for the most part they do not want and he is proposing to do it, as I pointed out before, at the expense of the less well off who will be shoved further back in the queue, the queue for the limited facilities which are available in our hospitals, hospitals which are grossly overcrowded and unable to cope with those entitled to institutional services at present.

Certainly, that is not a progressive statement. It is the statement of a man in his early 30s, about to get to grips with the serious structural problems of our health services. Because there are difficulties in the hospital services with regard to facilities, Deputy O'Malley does not think extended limited eligibility should be introduced. That is negative thinking, it is regressive and introverted and it does not contain any policy. If there are queues for limited facilities, it is the function of the State to get rid of the queues and this is what the Government are proposing to do. If there are limited facilities, it is our policy to make the facilities extensive and to abolish any disadvantages that exist. If our hospitals are overcrowded, it is our intention to make them less crowded and to extend the hospital services. The multitude of deputations the Tánaiste is meeting and the number of consultative meetings he is attending are a substantial step in that direction.

We have positive policies on matters like this but Deputy O'Malley merely puts forward the introverted argument because our health services are not entirely what we would wish them to be under no circumstances should we contemplate extending them. That is the argument of defeatism; from a man so young it is the argument of a rank, status quo conservative. With regard to the health services, Deputy O'Malley is a raving conservative and I want to pin that on him.

I am worried about the future role of Deputy O'Malley. Many prominent Fianna Fáil Deputies and Senators have said to me that now that Deputy Haughey is no longer going to be on the front bench Deputy Lynch has long term plans for Deputy O'Malley. All I can say is "Carry on, Deputy Lynch". God forbid that Deputy O'Malley would become Minister for Health——

An Leas-Cheann Comhairle

The Deputy should come back to the Bill.

Mr. B. Desmond

I refute completely the arguments of Deputy O'Malley as to why we should reject the Bill. His first argument was that some of those people currently of limited eligibility should have the GMS services extended. I have to deal with arguments put forward by Deputy O'Malley and many of them are entirely irrelevant so far as opposition to the Bill is concerned. Indeed, as the debate developed, it became most irrelevant.

A further argument put forward by Deputy O'Malley was that it would be impossible to collect the sum of £7 per year from the farmers. I will quote Deputy O'Malley on this matter when he stated:

We know the tremendous difficulties experienced by the health boards in trying to collect contributions of £7 a year from farmers and others. The smaller farmers find it impossible this year to make their payments.

They find it impossible to pay £7 per year for this service?

Mr. Hussey

That is quite true. Some of them have not paid it for the last three years.

Mr. B. Desmond

A small farmer in rural Ireland would pay that amount per annum for attending the Connacht Senior Football Final.

Mr. Hussey

It is quite true. They cannot pay it.

Mr. B. Desmond

If a small farmer finds it impossible to pay £7 a year for limited eligibility, then I submit that possibly his children are suffering from malnutrition and the poor man should be in the local county hospital getting vitamin treatment. To suggest that people cannot pay £7 a year for limited eligibility contributions is rank hypocrisy and everyone knows it.

Mr. Hussey

That is not so.

Mr. B. Desmond

The Deputy and I have often discussed matters relating to health. He knows that 15p per week, or three-quarters of the price of a pint of stout, will not break anyone. Much more money is being spent on cigarettes, as the Deputy well knows. To suggest as Deputy O'Malley has done, that the country will be driven into complete impoverishment because of the increase in this case is, to say the least, stretching one's political imagination beyond the bounds of credibility. The arguments put forward by Deputy O'Malley are so stupid and ridiculous that one must assume that Deputy O'Malley and Fianna Fáil are the counterparts of Mrs. Thatcher and the Tory Party in England. Indeed, for all his conservatism, Sir Keith Joseph would not dare to put forward the line of argument of Deputy O'Malley.

Another argument put forward was that it would not be possible to collect the money. I know there are serious difficulties in the health boards collecting £7 per year from many people who are self-employed or who are farmers. I know, for example, that I, as an insured person, and there are probably only about a half dozen in the House, am very pleased that my family will have available to them limited eligibility for hospital and specialist services, maternity and infant care services, drug subsidy schemes. I am quite pleased to be paying 26p per week. I would not get that cover from any insurance company in the country. I am grateful to have it. Fianna Fáil know perfectly well that that is the position.

There are some people who will pay nothing if they can get away with it. If they could avoid paying £7 a year they would do so even though they could well afford it. Any CEO or programme manager of a health board will tell you he has to send hundreds and thousands of letters to people in his area pointing out that they can well afford to pay £7 a year. They are not prepared to pay it because they are too mean to pay for the health services. In many cases this £7 is about the only thing they are asked to pay for, between subsidies for this, doles for that and the devil knows what. The £7 is not an undue imposition.

The very special pleading of Deputy O'Malley is entirely dishonest and tragic coming from an intelligent politician who should be giving a lead and trying to develop a more comprehensive health system. In the past decade we have witnessed the development of a very important trend in our social services, that is the shift away from very rigid, narrow selectivity or the provision purely of a means tested health service. I would remind the Fianna Fáil Party of Dr. Jim Ryan who was a good Minister for Health in his own way, though not terribly imaginative. In 1947 when he introduced the Mother and Child Bill in the Dáil he said it was proposed to make available to everyone in the country, if they wished to avail of it, a free service for mothers and children up to the age of 16 years. That is the simple answer to Deputy O'Malley. What we propose is to extend free hospitalisation to the whole of the population, if they wish to avail of it. If they want their private nursing homes, if they want to go into, say, St. Michael's Hospital in my constituency and pay £10 a day for a private room before any additional charges are added and if they have the money to pay for it, the best of Irish luck to them. If they want to spend their money on having privacy and exclusion, private doctors and private consultants, that is their privilege but, and this is a socialist "but", that will not give them any special privileged exemption from making a contribution towards the cost of free hospitalisation for the whole community. We say all must contribute, irrespective of means, irrespective of income, to a national minimum health service standard. If they want their exclusive consultants and private rooms let them have them but they pay for them themselves.

Deputy O'Malley wants to do it the other way. His proposition is the old poor law proposition, the proposition of a former Minister, Seán McEntee —you look for the poor, you find the poor, you give charity to the poor, you raise up the poor tier by tier. Witness, for example, the statement of Deputy O'Malley that we should extend the general medical services to a proportion of those on limited eligibility. Of course, this will allow Deputy O'Malley to allow the cream to remain as the cream making its own contribution to itself and making no contribution to the State. The policy of this Government will cost vastly less to implement than an extension of GMS which Deputy O'Malley is proposing without any reference to the cost involved or to who is going to pay for it. Indeed it would be useful if some further research were done, in the light of present costs in relation to these matters.

Deputy O'Malley within a fortnight of his appointment as spokesman on health dived in in relation to the junior doctors' dispute. He dived in in relation to free hospitalisation and he swallowed a lot of spurious propaganda from very select medical circles and he cannot now get out of it. The only answer he has is that we are being doctrinaire. At times I wish we were doctrinaire. Ironically, I think we may be somewhat social democratic. We are certainly not terribly doctrinaire. One should hear, as Deputy Hussey has heard at the Council of Europe when he and I have been in Strasbourg, some of the doctrinaire statements on health and then one is listening to a little bit of continental socialism which, if it were to be uttered by Deputies in this House, might mean they would not even be re-elected.

It ill becomes Deputy O'Malley, on a matter which is not of major importance, to put forward views which are so special in their pleading, so narrow and introverted in their rationalisation. Here we have a party which professes to be a universal party, catering for all groups, classes and creeds in our community, a people's party, a social democratic party. They say: "Let us take another segment of the poor and give them general medical services". If we build it up on that basis and extend it on such a narrow basis we will find ourselves with the same patchwork quilt of health services which was the legacy of Fianna Fáil in the fifties and the sixties.

We want to change that and we will change it. Deputy O'Malley in his opposition to this measure is guilty of rank, juvenile conservatism. Usually well briefed, it was a matter for regret to find him coming in here advocating the status quo. We are spending £72 million a year and a mere £5 million of that will represent health contributions which works out at a mere 6 or 7 per cent. In 1975 we propose that this should be a mere 10 per cent. I would appeal to Deputy O'Malley to read the statement made by the late Mr. Erskine Childers when he was Minister for Health and also the statements of the late Donagh O'Malley when he was Minister for Education. Deputy Desmond O'Malley takes a completely different view, a view not held by the former Minister for Health, Deputy Childers.

Mr. O'Malley

What about Deputy O'Connell? Would the Deputy deal with his speech?

Mr. B. Desmond

He is unique and Deputy O'Malley knows that.

Mr. O'Malley

He repudiated his leader.

Mr. B. Desmond

Deputy O'Malley's opposition to this measure is spurious.

Mr. O'Malley

The Deputy approves of more taxation on the workers.

Mr. B. Desmond

The price of half a pint of stout or six or seven cigarettes.

Mr. O'Malley

Or a pint of petrol.

Mr. B. Desmond

More is expected from Deputy O'Malley. He has the capacity for leadership and he may yet be leader of Fianna Fáil now that Deputy Haughey is not going to be on the front bench. He is good at gut politics but he will want to mature. One sign of maturity is playing it soft in opposition and, in government, to walk softly, as Deputy Lynch said. We walk softly in government but, in conscience, we could not take the nonsense we heard from Deputy O'Malley today.

Minister for Health (Mr. Corish)

Some speakers may possibly have thought that we were discussing the Health Estimate. I do not dispute their right to cover a wide range of health services or to make general comments but I shall confine my remarks to the proposals contained in this Bill. I do not think any of us will ever become complacent about our health services. I understand the concern about improving health services and I think I covered most of the matters raised here on the Estimate which started on 28th November. All the indications are that our health services are being improved. I shall not attempt to answer all the various points raised in regard to local or individual matters but I assure Deputies that, as far as possible, specific matters will be dealt with.

Deputy O'Malley's speech was, of course, predictable. He should not be the one to talk about repudiating a leader because there were about four or five in the Fianna Fáil Party in May, 1970, who openly repudiated their now leader. I do not know what game Deputy O'Malley is at. He is very fond of quoting Deputy John O'Connell. I have a greater appreciation of what Deputy John O'Connell said in this debate than I have of what Deputy O'Malley said.

As I said, his reaction was predictable. He gave no good reasons as to why the Bill should be opposed. He interspersed his speech with such phrases as "hypocrisy" and "patronage socialism". He criticised the fact that this Bill was introduced prior to the budget. When the original Bill was introduced it was introduced in June, 1971, and passed and that was only a few weeks after the Fianna Fáil budget of that particular year. I do not think there are any points to be scored by that sort of criticism.

This Bill will commence on 1st January. I want now to refer in more specific terms to something Deputy Desmond said. As far as Fianna Fáil were concerned, the original Bill was meant to be a permanent Bill. That Bill was introduced in 1971 by Deputy Erskine Childers, Minister for Health. He made it abundantly clear at that time that this would be a permanent feature for the future financing of the health services. Contrary to what Deputy O'Malley has said and contrary to the amendments he has tabled, the late Minister for Health specifically said that these contributions would not remain static, that they were bound to increase. Deputy O'Malley will find confirmation of that at column 334 of Volume 255 of the Official Report.

Mr. O'Malley

Would the Minister not agree the country at that time was in a prosperous state?

Dáil Éireann debate - Tuesday, 17 Dec 1974

Health Contributions (Amendment) Bill, 1974: Second Stage (Resumed).

Tá

Níl

Dáil Éireann debate -
Tuesday, 17 Dec 1974