Deputy Haughey has 37 minutes left.
Vote 49: Health (Resumed).
Debate resumed on the following motion:
That a sum not exceeding £177,022,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of December, 1975, for the salaries and expenses of the Office of the Minister for Health (including Oifig na Ard-Chláraitheora), and certain services administered by that office, including grants to Health Boards, miscellaneous grants, and certain grants-in-aid.
—(Minister for Health.)
An extraordinary omission from the Minister's speech was the complete absence of any reference to the Voluntary Health Insurance Board. It is quite incomprehensible to me that the Minister would not make some reference to the work of that board and its achievements and I want to inquire from the Minister if there is any particular significance in this omission on his part. In my view this is one of the most successful institutions ever established. It is making a really worthwhile contribution to our health services. Its affairs are conducted with efficiency and, at the same time, the board's approach is sympathetic and flexible. It certainly demonstrates the value of the insurance approach in health matters. I wonder if that is the reason why the Minister has not adverted to the work of the board.
As we extend and develop our health services we must, I believe, make the fullest possible use of the voluntary health insurance principle wherever that is appropriate. I believe it would be tragic and disastrous if the Minister were to permit any doctrinaire approach on his part to militate against the maximum possible development of a system of voluntary health insurance. One of the lessons we can learn from the experience in other countries, countries which have tried different approaches to health matters, is that no matter what system is adopted a system of insurance can make a useful contribution in any overall situation. I would hope the Minister will be able to reassure us, when he comes to reply on this matter, that there is nothing of great significance or importance in his omitting any reference in his opening statement to the Voluntary Health Insurance Board.
On the administration of the health services in general we should always keep in our minds the fact that any service is only as good as those who provide it make it. It is essential that everybody in the administration of the health services be encouraged to give of his or her best. That places a premium on good staff relationships and on the creation of a good atmosphere, an atmosphere of co-operation. The Minister should take positive and definite action to promote the best possible relations he can between himself and all those engaged in the administration of the health services, whether they be professional bodies, trade unions or unorganised groups. It is very easy in the administration of a public service in modern times to let things deteriorate into sterile, antagonistic attitudes. It is essential that that sort of situation be avoided because, if it is not, everything will suffer. No matter what moneys we provide and no matter what mechanisms we make available, if the atmosphere and the spirit of co-operation is lacking, then to a large extent our efforts will be nullified. The real role of a Minister for Health is, perhaps, in providing inspiration to all those engaged in the provision of health services. Perhaps that is the best contribution a Minister can make.
Arising out of that, I should like now to comment on a criticism the Minister made of this Party in regard to our Private Members' motion. In his opening statement the Minister said:
Consequently before any major increase in the percentage of the population covered is brought about I must have discussions with the professions concerned and reach agreement with them.
This would be normal industrial relations practice, apart from anything else. I do not think the Opposition took sufficient account of these two major constraints, when they put forward the motion in this House recently to increase the percentage of the population covered by medical cards from 35 per cent to about 60 per cent.
First of all, I want to rebut that criticism because naturally, in putting forward the motion, we assured, if the Minister were to adopt this proposal and put it into operation, we would have the consultations to which he refers. His apparent adherence to the principle of having discussions with the professions concerned and reaching agreement with them before making some substantial change in the health services is at complete variance with what he did in the case of the extension of the hospital consultancy services.
In that case, for some party political reasons of his own, he announced unilaterally an extension of these services without any prior consultation. Of course, the results are to be seen in the fact that all he can say in his Estimate speech on this occasion, in regard to the extension of those services, is that he still hopes some time something will be done about them.
I would like to ask the Minister if he is satisfied about the situation in regard to registration in the country. I understand some people have very considerable doubts about the effectiveness of our registration system. This may seem a technical and administrative matter of very little significance but it has an importance in relation to our planning and deciding on objectives. I recently asked the Minister a question about hypothermia and the number of deaths which occurred from it. He gave me figures of one in one year, two in another year, one in another year and so on. They were very minor figures which would indicate that the number of deaths from this ailment were negligible.
A medical practitioner of my acquaintance, when he saw the Minister's answer, told me it must be completely erroneous, that in the practice of his own profession he had personally come across three or four cases whereas the Minister gave me figures for one, two or three as being the total for the whole country in particular years. He might look into that aspect of the administration of his Department.
The Minister supplied us with a very comprehensive supplementary brief. I want to express my appreciation of his doing that, but I also want to indicate that at this stage it is of no use to me in helping me to make a useful contribution to this debate. If that brief, which the Minister's department obviously took a great deal of trouble to prepare, is to be of use it should be published with the Book of Estimates or as near as possible to its publication. It certainly should be issued to Deputies at least a week in advance of the inauguration of the debate in the House.
The Estimate for the Department of Health, as published in the Book of Estimates, does not give us any scope really for debating health policy and health administration because the bulk of the expenditures are incurred by the health boards. It is the accounts and reports of the health boards that are of importance in relation to this debate. Therefore, we should have the information brief well in advance of the discussion on the Estimate. I merely mentioned that as something the Minister might keep in mind on future occasions if he occupies the position of Minister for Health much longer.
Will the Deputy be in health for long?
I have no idea. He who would command must first learn to obey.
I would say the Deputy has not very long there.
I spoke yesterday at some length, and the Minister also adverted to it in his Estimate speech, about the need to improve our services for the mentally handicapped and our psychiatric services generally. There is need for a major comprehensive development of our services in these areas. I would like the Minister to take an immediate interest in the provision of a psychiatric service in our prisons. It is abundantly clear to all of us that there is something radically wrong with the situation which prevails in our prisons in regard to the provision of psychiatric services and perhaps of health services generally. I would like the Minister to interest himself in that situation. People do not cease to be citizens because they are sent to jail. The Minister has responsibility for the health of the inmates of our prisons just the same as he has responsibility for the health of any other citizens. I hope he will immediately, because I think it is an urgent problem, do something about this.
The establishment of a comprehensive geriatric service in every area of the country must be pressed ahead. I believe the Minister accepts that and I want to avail of the debate on the Estimate to emphasise to him that, as far as the Opposition are concerned, we afford a very high priority to the provision of that particular service. There is fairly unanimous agreement about the approach which should be adopted in relation to this service. The elderly, as far as possible, must be provided for socially and medically in their own homes. If it is not possible to provide for them fully and adequately there then they should be provided for medically and socially in circumstances as closely resembling their own homes as possible in their own local communities.
The first step in relation to this is the appointment of a geriatrician with an appropriate team. That is the basic requirement. There is no doubt that a community based geriatric service availing to the greatest possible extent of the wonderful abundance of voluntary effort which is available in our communities can make a significant contribution to the Minister's hospital accommodation problem. I believe it is generally recognised that if we had a comprehensive geriatric community service the problem which exists at the moment of valuable hospital medical beds being occupied by old people, who could be otherwise provided for, would be solved. This in itself would make a significant contribution to our hospital accommodation problem. Once the basic structure—the geriatric leader and his team—and the basic service had been provided, further support services could be grafted on—social centres, chiropody treatment, outings and holidays, a home accident prevention service and so on.
All these things could, in the course of time, be grafted on to the basic service in the local community. In that way we would ultimately arrive at a situation where we could have easy consciences about the way in which we treat the elderly members of our community. In that way also quite a percentage of hospital beds would be freed for other purposes. I want to emphasise that that would have to be done gradually and without any sudden disruptions. It is very important that the old people would not be caused any anxiety or be given any impression that they were going to be callously uprooted from their present surroundings. This is something which would have to take place over a period. The exclusion of geriatric patients from our general medical hospitals should be effected over a period in a humane fashion and should only be undertaken as adequate facilities are provided for their treatment and attention elsewhere. There is an important job of co-ordination also to be done in correlating the services which are provided for older people in the community with the medical services in the hospitals which must be available to them as and when required. There is quite a job of fairly sophisticated co-ordination necessary in that regard.
I was interested to hear a report that at the seminar in Waterford the pharmacists offered to be of any possible assistance in this regard. I understand they were anxious to make a contribution to the community care of the aged and offered to make their premises available as information centres or in any other way they could be helpful. I am sure that offer by the pharmacists' profession will not be ignored by the Minister.
I want to emphasise that on the health estimate we are dealing with something that fundamentally affects people's lives, something which will decide whether many of these lives will be spent pleasantly and happily or in misery and discomfort. There are very few other ways in which we as legislators, can make such a significant contribution to the physical and mental well-being of our citizens as we can through providing them with a good, reliable, easily accessible structure of health services. The resources at our disposal to do this are limited and always will be limited unfortunately.
That means that we must use such resources as are available to us wisely, judiciously and cleverly to see that we get the best possible return from them in terms of human happiness and wellbeing. We believe that the broad lines along which this objective of getting the best possible return from the resources available to us should be pursued are reasonably clearly defined. They are, a much greater concentration on preventive medicine, a building up of the general medical service, the provision of the highest possible level of services in the local community with a corresponding reduction in the need for institutional care, the development to the greatest extent possible, of the voluntary insurance system and, perhaps the most important of all, the promotion of a satisfactory working atmosphere throughout the whole administration of the health services.
In preventive medicine we would urge on the Minister immediate and positive action in a number of areas but in particular in regard to alcoholism. It is manifestly clear to all of us that there is a need for educational and rehabilitation measures. These we see as urgent and imperative. I become more and more convinced that none of us fully appreciate the damage, material damage and emotional damage, for which alcoholism is responsible throughout our community. I believe most of us think of it superficially as a social evil but the more one delves into this area the more one becomes convinced of the deep-rooted, far-reaching results that it has in terms of human misery, unhappiness, frustration and despair.
There is fairly widespread disappointment with the Minister in his failure to get on with the Misuse of Drugs Bill. I would urge the Minister to get that piece of legislation enacted and brought into operation as soon as possible. Again, it is something that deals with a very important and very humanitarian area of administration. Whatever the parliamentary pressures are, there is no excuse for not getting that piece of legislation on to the Statute Book.
We also urge the Minister to accept as an urgent priority the extension of the general medical service to a much wider section of our community. We urge him to press on with the provision of a comprehensive range of home care and community medical services. We urge him to announce the hospital development programme as soon as possible and get it under way, to take immediate positive steps to restore morale and a spirit of enthusiasm and co-operation throughout the health services, to get everybody involved in the administration of those services dedicated to achieving the objective which the Minister and this House lays down.
There is more devotion, zeal and dedicated selflessness in our health services and in our health institutions than in any other section of the community. There is an abundance of that spirit of dedication throughout the health services. Let the Minister provide the buildings and the facilities but, above all else, let him create an atmosphere in which this dedication can flourish. I attribute more importance to that than to anything else. If he does that and if he provides the guiding leadership, then, no matter what the financial limitations on us are, we can provide for ourselves here an adequate, satisfactory health service which will be as good as that of any country in Europe.
I have listened with interest to the previous speaker and must compliment him on the eloquence with which he dealt with the health services. The reference to laboratory health was of great interest to me because some time ago I felt that instead of an extension of the medical card service there should be an extension of the voluntary health insurance scheme. The Minister is providing us here with a very excellent, comprehensive, complete service in so far as it represents the wishes of himself and his Department but I can remember the debate on an Estimate for Education where nothing whatsoever was mentioned about physical education, either by the Minister or the spokesmen for the Opposition. So, things can be overlooked and I admit that I would be the first to overlook things.
Instead of an extension of the general medical services, it would be far more practical and more popular if we were to consider an extension of the voluntary health insurance scheme down to the general practitioner. This is what people want. In addition, they want a less bureaucratic system of obtaining a refund of money they have spent on medicines, as distinct from GP fees. I would ask the Minister to consider that matter.
It does seem strange that people can demand from a doctor a prescription for a bottle of Dettol that costs the State 100p in a fee to the doctor, plus 40p in a fee to the chemist—twice the cost of the bottle of Dettol. We want the health services and the money spent on them to benefit those who need them. This is what other speakers have referred to. Why should a bottle of Dettol be an item that must be prescribed by a medical practitioner? Why should a person have to spend eight or ten years in a university in order to prescribe bottles of Dettol? The line must be drawn somewhere. Why should a medical practitioner have to prescribe hair shampoo? When I was on those benches opposite I asked the Minister ad nauseam what dispensary doctors were for. Why should a doctor have to write a prescription for hand cream, for Dettol, for hair shampoo?
I shall criticise the Minister very severely on this: he was premature when he told general practitioners to cut down their visits by 25 per cent. Admittedly, the media misinterpreted to an extent what the Minister was saying. It looked bad because the implication was that the doctors were over-visiting by 25 per cent. I would ask the Minister, how can doctors in Cork, Galway, Limerick, Waterford, Dublin stop patients from coming in? We must have assistance from the health board in the form of somebody who will be responsible for saying that a particular person is not sick and does not need medical attention. Anyone here can suddenly become ill.
The health boards as set up by the previous Government are an absolute disaster. They are chaotic; they are not capable of being administered; they are bureaucratic; they are the most expensive things that this State ever set up. We warned the previous Minister that that might happen. It has happened to such a degree that it is frightening. They are so impersonal, it is unbelievable. The biggest health board in the Republic of Ireland and the United Kingdom is the Eastern Health Board. Any of us in the Dublin area knows how difficult it is to get attention, despite the very sincere efforts of the employees.
I want the Minister to give urgent attention to the question of the emergency card. Under the old dispensary system a doctor was obliged and entitled to treat a patient who had not got a medical card and who had not any money. Under the fee per item, choice of doctor, service there is no way in which a general practitioner can do this. Consider the case of a person who is waiting for a medical card to be produced. There is no way in which a general practitioner can prescribe medicine for a patient whose medical card has not gone through or whom he sees on a Saturday or Sunday or in the evening time when the health board offices are closed.
I have said that I would like the Minister, when the money is available, to give priority to cases of serious illnesses of a chronic nature that require special treatment, such as rheumatism, asthma, bronchitis and heart disease. There are instances where people who have heart disease or who have suffered heart attacks and who have bought the necessary tablets are not familar with the system of obtaining a refund. I have expressed the view on previous occasions that it takes some time for people to become accustomed to the refund method.
I should like to praise the Epileptic Society of Ireland. I would hope that the Minister would approve a grant to that society. Perhaps with a little bit of foresight they may be able to set up a register of people who suffer from epilepsy and diabetes and it might not be over-imaginative to suggest that we might have a register of drug addicts. One simple case is the case of hip joint replacement which is carried out in Cappagh hospital. It is estimated by one of the medical experts that over 50,000 people need this treatment. It would be no harm if the Department, apart from administering the health services, took the initiative now and then.
I agree with the previous speaker with regard to the Misuse of Drugs Bill. This could be speeded up. We have had many hair-raising and very frightening problems. Recently we have had even worse problems. Even before they reach their teens children are taking drugs. We knew this would happen. We saw examples of it in other countries and we knew it would happen here. Why should we be any different here? What ethnic qualities have we got which divorce us from other societies?
I would ask the Minister to bring this Bill forward and put it through the House to give the Drug Squad teeth and to give the psychiatrists in Dundrum teeth. I happen to know some of them personally. We must help them to help the addicts, the abusers. We must give the Garda teeth to deal with the drug pushers. If action had been taken in the past the situation might not be what it is now. People sat and did nothing. They even went so far as to say there was no drug problem in this country.
I wonder could anything be done about the amplification. It is very difficult to hear Deputy Byrne. I am serious about this. Strangely enough I am interested in what he is saying and I find it very difficult to hear him. Perhaps he could address his remarks more directly into the microphone.
I want to thank Deputy Haughey for drawing my attention to the fact that I was not projecting my remarks through the microphone. I should like to refer to something which happened recently in an area with which I am very familiar, an area which the previous speaker also has the privilege of representing. We have had an influx of hippies from Dun Laoghaire, Blackrock, Booterstown and from the gate lodges of big houses which have been knocked down. They come into centrally heated units of accommodation and squat and bring with them this dreadful disease which has been called contagious and which is known as drug addiction. We have had deaths from drugs in an area which used to be one of the best areas in the city. There must be greater co-operation between the Minister for Health and the Minister for Local Government to get these people out. For some reason they are inclined to percolate into the Achilles tendon of our society. We must take steps to deal with this problem.
I should like to refer now to community and home care. This is an excellent idea and I should like to see as much attention given to it as is possible. We must do what we can in the area of prophylactic medicine. I know steps have been taken in that direction and a lot of money has been spent.
Where is the vast majority of the money covered by this Estimate? It is with the health boards. We do not discuss them here. The previous Minister for Health made them as autonomous as they could be. A Deputy could ask a question about a health board but it would not be answered under the previous Administration. If you ask a question about all the health boards you get a reply. I should like the Minister to take a serious hard look at the health boards to see if something can be done. This was the most bureaucratic autocratic action ever taken in the medical field since the foundation of the State.
The ambulance service in the large urban areas is an excellent service. A qualified medical doctor should travel in an ambulance going to deal with a casualty. I know the cardiac ambulance carries a doctor. I should like to see casualty ambulances carrying a doctor towards the scene of an accident. Anti-shock therapy could be initiated immediately before complications set in. I know there is a problem about insurance and that doctors are not insured to work outside the perimeter of the hospital. The Minister should take a practical look at this question.
Perhaps a look could also be taken at the stations where the ambulances are sited. It might be no harm to allow a few ambulances to work from the major casualty hospitals. There again there is the problem of the ambulances being the responsibility of the Department of Local Government and the hospitals being the responsibility of the Department of Health. In the middle there is the massive morass of the health boards.
I called before on the Minister, and I do so again, to set up a health commission to investigate ill health associated with high rise centrally heated flats. There are eight pieces of research which have come back from the United Kingdom and the Continent which show a 33? per cent minimum increase in ill health, due to living in high rise centrally heated flats. My contention is that it may even be higher where one has a higher percentage of the population as children and also where the central heating is compulsory and there is no control. Since 1969 I have asked for this and if we are talking about community care in a sincere way we should be in a position to instruct the families as to how best to avoid the types of ill health which apparently are associated with high rise centrally heated flats and perhaps houses with no other forms of heating but hot air or gas.
I suggest that the health centres in certain areas which have a population large enough to support them be given diagnostic facilities and X-ray units, blood test facilities and technicians and a more excellent type of para-medical workers so that instead of sending people to hospital in taxis, paid for by the health board, to have a blood test taken and ending up with a bill of perhaps £20 for the one blood test, it will be done on the spot. Bring health out to the people rather than bring people in to the hospital. We all know the astronomical cost of hospitalisation at present and it would be my one message to the Minister today to encourage the care of people at home by general practitioners and nurses, because we are a race who are getting older and older with regard to the breakdown of a section of the population. Whereas 100 years ago man in these islands lived to the age of 40 he is now living to the age of 72.
We must pay great attention to the fact that not only are the elders of our society increasing in percentage of population but those being born into it regarding handicap and illness are also increasing. There are children now surviving who 30 years ago would not have survived the first week of life. All the illnesses with which children were born that were fatal can be treated successfully now. In so far as a child can be kept alive, or increasing the section of our population that needs help and medical care, these are two factors which must be taken into account in any extension of the health services in a long-term programme. They are the two vital factors in our health services in relation to long-term planning—the two ends of the scale.
I want to ask the Minister if he could increase the amount of time and money being devoted to the educational section of the health services on diseases, in the schools and possibly some seminars in relation to the dangers of alcoholism and drugs. It is also very important that a lot of co-operation exist between his Department and others regarding the rehabilitation of people following accidents—the psychic rehabilitation by which they will get the ability within themselves to go back to work in the confidence that they need. It is vitally important that the Minister should take a cold, hard look at some of the laws of this land, laws whereby you may have a patient who the moment the members of the legal profession get their hands on him and take him to court can be ruined and can come back as a vegetable.
Now that the Law Reform Commission has been set up I think the Minister should make representations in this regard. The amount of humiliation, stress and strain that young people in this city are being put under by members of the legal profession— legal luminaries, and perhaps some of them are here in this House—is nothing short of scandalous. It is scandalous going on tranquilisers and sedatives before going into court. It is a dreadful thing. I see it in my own area where I practice as a general practitioner. I see the best of people being taken in under this free legal aid and "don't do this and don't do that", where the State is paying for the legal men, the barristers and solicitors and coming back wrecks. They probably should never have been in court in the first place and with a little push over the hill might have been in a place where they might have been able to carry on their own affairs. This is shocking and scandalous, and I want to say to the Minister that he make firm representations, through the Attorney General, to the Law Reform Commission that this aspect of both criminal and civil law be looked at severely with a view to humanitarianising the treatment meted out to the poor souls brought in for the purpose of administering justice.
With regard to that, I want to speak about the health services in the prisons. This is a very sensitive subject at the moment, but I do not think the Minister for Health should, in so far as he can, accept a certain amount of responsibility in what would primarily be a function of the Department of Justice.
The recent tragedies could possibly have been prevented and I should like the Minister for Health to have consultation with the Minister for Justice regarding the health services in the prisons. It is important that this should be done immediately. It is easy to do certain things in the medical field but it is very difficult to save four lives, and the loss of four lives in our prisons could possibly have been prevented.
Another important matter I should like to raise is the danger of certain substances produced by manufacturers. Paraquat is one. The Minister should give serious consideration to this matter. I will send him a detailed and well-researched private memo regarding the feasibility of the retailer breaking the seal on certain toxic substances and putting in identification additives. Under present law there is difficulty in regard to this because it would be interfering with the product. It may be possible, as was done with regard to the free school meals, to put an addendum to the Misuse of Drugs Bill to see that a fully qualified chemist can put in an identification substance into certain poisons he is retaining.
I should like to pay tribute to the officials of the Minister's Department for the excellent job they did with Dundrum Mental Hospital. There was a time when only elderly people worked there but now there is an interested young staff who are doing excellent work. They have a very difficult task. I should also like to pay tribute to Irish Hospitals Trust Limited for the great job they have done since the 1930s. Brilliant men initiated the programme of fund raising for the voluntary hospitals at a time when there was no money and when the Administration was going in a direction which turned out to be most impracticable in the hospital services. Everybody connected with Irish Hospitals Trust Limited deserves the appreciation of the citizens of Dublin.
The nursing profession carry out excellent work on our behalf. I should like to record our appreciation of their dedication. I give the Minister the optimum credit for what was done for the thalidomide children. I should also like to express the appreciation of the ratepayers of the fact that the Minister has not increased the health charges on the rates. We all hope that in the future the health charges will drop a little more.
I consider this to be one of the most important estimates because it concerns everybody. I should like to pay tribute to the doctors and nurses in our hospitals. These dedicated people look after the patients in our hospitals very well. Like Deputy Haughey I was disappointed that the Minister did not tell us of his hospital development plan. I am interested in a particular hospital which I know will be sanctioned by the Minister as a general hospital, but what worries me about the health services is that the Minister set his sights very high and he has not the money; it is not possible to take blood out of a turnip.
Two weeks ago the Minister told me there was no scarcity of money for homehelp, but if one goes to any of the health boards one will find that there is a scarcity. We have to cut our cloth according to our measure at present. For this reason the Minister should have accepted the suggestions contained in the motion introduced by our spokesman on health, Deputy Haughey. We would all like to see everybody being included in the free health service but our first concern must be for the less privileged people. The suggestion by Deputy Haughey that the income limit for qualification for medical cards should be increased to take in more of the middle income group was good and was a step in the right direction.
Because of the present economic situation we must concentrate our energies on providing a good service for people in the lower and middle income groups. We should also look into the question of voluntary health insurance for the higher income group. In general, hospitals are over-crowded and when this matter is mentioned we hear a lot of talk about community care and home care. This interests me because I face the problem daily. The real care should take place in the home but at present a relative of an aged or sick person is discriminated against. Under existing regulations any stranger who makes a cup of tea for a person who is indisposed qualifies for the home care allowance but a relative who looks after that person does not qualify unless the indisposed person is bed-ridden. I know of a person who gave up employment in order to care for her mother but the fact that her brother was visiting the house twice weekly meant that she was disqualified. She did not meet the condition that there should be nobody else in the house except the old person and the person caring for that person. This is discrimination.
If some stranger walked in and made a cup of tea for that old person, that person could receive it, but the prescribed relative could not receive it. I have heard now that the prescribed relative allowance is to be abolished altogether; that there will be nothing in future except home assistance. If we want hospital beds held for those in need of them I would ask the Minister to seriously consider that aspect. The place to tackle that problem is in the homes. Let me take the example of a son who marries; his wife comes into the house—probably they have five or six children—and she has to care for an old person. Unless that old person is bedridden the son and his wife receive nothing. When that old person gets a cold and the doctor is called, the obvious thing for that woman to do is to say to the doctor: Listen, doctor, I have five children here; will you please get this woman into a hospital. Then that old person is put into a hospital bed which should be kept for more needy people. We are living in a materialistic age; we have to be practical; I believe that were that young woman receiving a reasonable amount of money with which to look after that old person, we could keep at home an awful lot of people at present taking up hospital beds. I am all for community care but I feel it would help if the person looking after the old relative at home received a reasonable amount of money for so doing. I would ask the Minister to consider seriously what it is costing this State in hospital beds, keeping those type of people in them rather than having them looked after at home. The Minister should seriously investigate how much per day it costs to keep such people in hospitals, county homes and so on. I feel it would pay the State very well to give a reasonable contribution to the relative at home. I can assure the Minister that were such relatives receiving a contribution, in addition to the old age pension to which the aged relative is entitled, every effort would be made to keep the person at home.
Money talks all kinds of languages and those are the facts whether or not we like to admit them. If such payments were made to relatives of aged people in an endeavour to have them kept at home, I believe the Minister would make money out of such an exercise. I put that proposition seriously to the Minister, particularly when one considers the cost of keeping these people in hospitals and elsewhere.
I am astonished to learn that the prescribed relative allowance is to be discontinued and that in the future there will be only a home assistance allowance. Therefore, people will qualify for home assistance or nothing. We have had a dispute in that area which has continued over the past few months. I have been travelling backwards and forwards to the Western Health Board in Galway, making applications for prescribed relative allowances. I do not know whether or not this dispute has been resolved but certainly it delayed decisions being made with regard to prescribed relative allowances.
I could not over-emphasise the injustice of giving that allowance to non-relatives rather than relatives. I should qualify that by saying that the relative can receive it if the old person is bed-ridden. I put it to the Minister that it is more difficult for a woman to take care of an aged person who is not bedridden, who might be not as alert mentally as formerly, who is moving about subject to all types of dangers— such as falling into the fire. At least the younger woman can get out if the patient is bedridden but, otherwise, she must watch him or her constantly. I would strongly urge the Minister to consider that aspect of home care and to grant some allowance to relatives of older people, in addition to the old age pension. I hear of such hardship cases all over my constituency.
I come now to the medical card aspect with which Deputy Haughey dealt with very effectively. In this respect we have not kept in line with inflation at all with regard to the guidelines for health. The advisory committees and the health boards work very well together. I am now on the Western Health Board—I was formerly a member of the advisory committee—and I must say that any time we did press for a revision of the guidelines, we were somewhat successful. At one time it was £15 only for a man and his wife. We had that raised to £17, £20 and, as far as I know, it is now £24, that is for a man and his wife, with so much for each child over and above that. I think there was mention of a figure of £40 a week. In this day and age a man and his wife with £40 a week should be entitled to free medical services.
I would appeal to the Minister also with regard to the middle income group, which should be moved up as well. Farmers' valuations should be raised to £100. I feel we should move up the lower income group into the health card system and bring more people also into the middle income group. Naturally, we would all like to have everybody included but we have not got the money to do so.
There is another point I should like to bring to the Minister's attention from practical experience. I am sure the Minister knows, from his long practical experience, that there will be faults to be found in any system. For example, a person receiving social welfare benefit who becomes ill is far worse off financially. I heard of the most astonishing case in my area of a farmer who had been drawing social welfare. Taking his children into account he was entitled to £12.50. That farmer had a heart attack and, when he left hospital, he went to sign on again. Of course, one of the conditions of eligibility for social welfare is that one must be available for work. But that man was told he could not sign on until he got a doctor's certificate.
Of course, the doctor told him he could not certify him as being fit for work; the only course open to him was to apply for disability benefit, which he did immediately to the health board. As the Minister is aware, the maximum disability allowance at present is something over £8. That particular farmer had to manage on that amount, losing £4. I want to further illustrate the hardship involved in that case. Last year that man was drawing small farm social welfare; he was able to look after his stock, sow his little crop; was available for work and, therefore, received £12.50. Then he had the heart attack; he is unable to work at all now—he has to pay for everything—and is £4 less well off because he happened to fall ill. When I checked with the health board I was told that disability benefit is geared at the applicant himself, with no account being taken of any dependants, whereas in social welfare the dependants are taken into account.
I would ask the Minister also to seriously consider the question of disability allowance and ensure that no person, through no fault of their own —because of falling ill—will lose benefit. No man wants to become ill. People might chance anything else but I think any man would value his health above anything else. But if a man falls ill, he will find that he is less well off receiving disability benefit from his health board than when he was receiving social welfare benefit from the Department.
There is one other point I should like to make with regard to the question of medical cards. I feel it is a shame that social welfare should be taken into account as income for eligibility for medical cards. I read in the papers the other day that the all-over average farm income is £1,500. As everybody knows very few farmers will qualify as development farmers. That is not relevant to this Estimate but is to the question of medical cards. Practically every one of those farmers would be well below the income were they married, were it not for social welfare. That is what is disqualifying a lot of small farmers from eligibility for medical cards—the fact that their social welfare benefit is taken into account as income.
I have always held—and I have been arguing this about cottage rents and so on—that if a person has to get social welfare it means the State is giving money to somebody who has not a reasonable income in order to bring him up to a standard at which he can live. Therefore it is most unfair to take social welfare into account in deciding the income for a medical card. If a man has off-farm employment and if the income from both the farm and the other employment brings him above the guideline, then by all means take it into account, but if it is income from social welfare that is responsible for making him ineligible, I would ask the Minister to consider that. I would like to see the Minister taking into consideration this whole question of the issue of medical cards, the allowances for people who are ill and who would be better off well and drawing social welfare benefits. The prescribed relative allowance is another matter the Minister should take into account.
As regards the hospital development plan, I come from the town of Ballinasloe where there is an excellent private hospital, Portiuncula. It has a bed complement of 204; the average daily occupancy is 168; percentage of occupancy 82.5; the number of patients treated, 5,178; average duration of stay, 11 to 12 days. This hospital has a nurses' training school. It is the most modern equipped hospital in the country. I know that eventually this hospital will have the status of a general hospital but what I am concerned about is the delay. It needs only two major appointments to make it a full general hospital. I do not know whether it is possible or not, but I would ask the Minister to consider— this is in the eastern part of the Western Health Board—sanctioning this hospital as a general hospital without waiting for the final decision as to what the new hospital organisation programme will be. We thought 12 months ago a decision would have been made. The Minister may have good reason—and I do not intend to press him in that regard—for not having it in this year's Estimate, but in view of the present economic position, I hope he will consider raising this excellently equipped hospital to the status of a general hospital.
I was never in favour of the regional health boards, but I always like to be fair and I will say that the staff and the members of the health boards are very co-operative with public representatives. We have not got much authority. I think it is wrong to take authority from local representatives because there is no one who knows the problems of the ordinary people better than the representatives who live with them. The people who talk down to them do not know their problems. The public representative tries to get across to the powers that be, whether they be regional health boards or anything else, the problems he sees and the discrimination that occurs without the authority being fully aware of it in its administration. The advisory committees to the health boards are doing great work.
As regards the one I am on, there are very few recommendations put forward—and I want to compliment the Western Health Board on this— by our advisory group, which comes from the grass roots, which were not adopted by the board. This is an indication that some thought is given to the proposals put up by these advisory committees. Public representatives would be very slow to propose something that would not be practical or economically possible. What we are trying to do is not to condemn the regional health boards or other such institutions but to point out what we see wrong and suggest improvements.
I am greatly disappointed that there is not one word about the reorganisation of the whole hospital services. This is a very fine brief from the Minister, and it gives a very full account of what is happening within the services, but, as Deputy Haughey says, it refers only to what is already there. The Minister is doing his best with the limited resources at his disposal, but we are disappointed that there is no indication as to the future of the health services.
They are the few points I wanted to make on the Estimate. I have dealt with community care, home help and the prescribed relative's allowance. There are just a few other points I would bring to the Minister's attention before I finish. They relate to the drugs and alcoholic problems. Before I come to them, however, I should like again to emphasise the need to keep people out of hospitals.
In my area recently there was no bed in Portiuncula Hospital and a man had to be sent to St. Brendan's psychiatric hospital although he had not the slightest psychiatric symptoms. That man should have been treated at home. The trouble is there is no money to provide a proper scheme of home care. Apparently strangers can get paid to look after old people in their homes but relatives cannot. If a girl marries into a house her mother-in-law is a stranger to her—her loyalty is to her husband. However, from the home care point of view she is treated as a relative and cannot get money. If this service were properly financed valuable space would be available in hospitals for people who need it.
I hope the Minister will soon introduce improved legislation to deal with drug addicts and alcoholics. I have many friends who are on the verge of alcoholism. Some people can take a good deal of drink and not have this problem but others simply cannot take drink. Some of the latter have the best brains in the country, the best ideas on how the country should be run. I appreciate that there has been a lot of publicity on the subject of alcoholism but the service provided is not within reach of the people who need it most.
I mentioned earlier the situation in regard to my local hospital. I will not go into detail on it again because there is a cut and dried case for it and I hope the Minister's decision will be favourable.
There is one more point I should like to re-emphasise and that is in regard to the £1,400 income qualification for a medical card. As well as his estimated income from his farm and his possible outside earnings, a small farmer also has his social welfare benefits taken into consideration.
Is the Deputy talking about social welfare or social assistance?
I am talking about social welfare. The qualifying income, including social welfare assistance, is only £15 a week. A man and his wife are allowed only £24.50.
It is nearer to £30 a week.
A man and his wife are allowed only £24.50 per week and then there is some allowance for each child. I urge the Minister when he is reviewing the position in January to increase that figure by at least £5 a week to take account of wage inflation and the higher cost of living. I know the Minister is anxious to provide the best service possible and, having regard to the economic situation, he is doing as much as he can in the circumstances. Some of the suggestions I have made will save money, particularly the suggestion that people should be cared for in their homes as far as possible. This could be done if financial assistance were provided for those who would care for them.
I should like to compliment the Minister but, at the same time, more imagination could have been shown in the area of the health services. Unfortunately I was not able to be present in Waterford at the recent seminar on community services but I am told it was very successful and that many excellent suggestions were made in the group sessions. However, I wonder how many people left the seminar feeling somewhat disappointed, despite all the discussion that took place on the health services and on community care. The Minister had a golden opportunity to encourage the development of community services. I realise the economic situation prevents any dramatic changes but the Minister should know by now what kind of health structure he has in mind, which can be implemented when the economy improves.
I was somewhat surprised that the Minister did not mention the blind to any great degree. I am asking him to give very serious consideration to the establishment of a national training centre for mobility and the rehabilitation of the blind who number more than 7,000 persons and thus release many from being prisoners in their own homes.
The greatest help to a blind person is independence and mobility, either with the help of a dog, with a stick or some of the other modern aids being used. There is need for a national institution for this kind of training and I would ask the Minister to consider it seriously. I am from Cork and we have heard much talk recently about Fota Island. There is a wonderful house there and a considerable green area. It would be an ideal place for a national institution for the blind. I attended a conference of the blind in Cork recently and I was most impressed by and appreciative of the tremendous work being done. It was wonderful to see the joy of the blind people who could move about with the aid of dogs.
I would ask the Minister to clarify one matter relating to the National Social Services Council. I had the honour of being a member of that council for a number of years when it was established by the Minister's predecessor, the late Erskine Childers, and I know of the wonderful work being done by them. However, I should like clarification of one of the council's functions. In his statement the Minister said:
The council is now acting as a central agency to encourage the setting up of information centres, to set standards for registration and to provide information, training and financial support to local staffs.
From my experience of the council unless I am misinterpreting the Minister—there is a danger here. The council were established to encourage and develop voluntary involvement in community work. If a function which the Minister has suggested is given to the national council, they will fall foul of community associations throughout the country. We always avoided that kind of practice and we never singled out any one association above another. We considered it important to maintain the national council in an advisory capacity, to encourage and make available all relevant information needed for the setting up of community associations, for meals on wheels and other services. The day the national council make a decision to finance one association or community development above another I will be worried about their functions thereafter.
The national council have done excellent work. They have compiled tremendous documentation which is a great help to community development associations. Let us not endanger this by giving the national council power to recommend the payment of grants or moneys. The council were not established for that purpose.
I am glad the Minister put such emphasis on community services. More emphasis could have been and should have been placed on voluntary involvement. The Minister should review the whole structure of health services and he should bear in mind in particular the services administered by the Department of Social Welfare.
Deputy Callanan made an appeal to keep people out of hospital. Over the years we have been spending millions on institutions when we should have been spending millions on keeping people out of institutions. Consider the cost of keeping an old person in a hospital or institution. I am sure it would be anything up to £35 a week. We offer a relative who is prepared to look after an old person at home the meagre sum of £7 a week. This is an aspect deserving serious consideration. That meagre payment of £7 per week saves the health board almost £30 a week. The policy should be to keep old people out of institutions. In order to achieve that aim we will need massive support services—the public nurse, the social worker, meals on wheels and so on. Most old people would like to die in their own homes. They ask little at the end of their days. I cannot speak too highly of the relatives who devote their lives to keeping the aged in their own homes, with little or no compensation. When the Minister is looking at the whole structure of health he should have a serious look at these services which come within the scope of the Department of Social Welfare. I would ask the Minister—this is really relevant to social welfare but it has a bearing on the Department of Health—to continue the free fuel scheme the whole year through for the aged. I doubt if it would cost the State a great deal to do that. The aged need heat.
Community care is so broad that it is bound to impinge on other Departments. I believe it covers health, education, housing and so on. I am particularly interested in the education of the physically handicapped. This is an area for which the Minister should be responsible. These people are often deprived of education because of long periods of hospitalisation. Later on they spend their lives sitting in wheelchairs unable to read or write. Surely it is not beyond the capacity of the Government or the Minister to establish courses of education for these people. The voluntary associations could help because they have buildings from which they provide services. These voluntary associations should be encouraged in this direction and they should be properly financed. If the Minister adopts that suggestion he will be doing a tremendous amount of good for the less fortunate.
Recently the Minister said that young offenders will come under his Department. I understand there is talk about day centres. These are good but they do not go far enough. There is need for residential care services. Money should be provided for residential centres for both boys and girls. These young people do a great deal of damage roving around the place and ratepayers have to pay thousands of pounds to make good the vandalism. Justices are powerless because there is nowhere in which to put these young people. These young boys and girls are in need of care and that care can only be given in residential centres. If this is not done we shall find ourselves faced with a very serious problem.
Another problem is the preschool facilities under health boards. There are people setting up preschool nurseries and there is no advertence to hazards. This service should be operated only under licence in order to safeguard the children. I mentioned this recently at a health board meeting and I think there was a recommendation to the Minister asking for careful consideration of this kind of service. It could be a wonderful service because it would relieve frustration in the home, but all safeguards must be taken in the interests of the children. Special attention should be paid to health and fire hazards. This will have to be seriously considered without delay.
Debate adjourned.