I intervene in this debate because I realise the importance of the Estimate for the Department of Health. With the most imaginative thinking possible no Minister for Health could possibly realise his visions or dreams in so far as the health services are concerned. This is something which must be linked up closely with the Departments of Social Welfare and Local Government. Of the number of people who are seeking medical care and hospital beds a big percentage need this attention because of bad housing. As a first step towards a general improvement of health standards we should ensure that every family lives in an airy and properly equipped home. Until such time as all families live in healthy homes we cannot hope to see any improvement in the health of our people. It is alarming to see the number of people who have a medical problem because of their housing conditions. If the Minister is to realise his ambitions he must have close contact with the Department of Local Government. If necessary he should establish an inter-departmental committee in an effort to improve housing conditions.
We should ensure that the public are properly educated with regard to health matters. The greatest gift is good health but there are very few people who make a study of it and who take the necessary steps and precautions to retain good health. If we had a proper educational system that put a proper emphasis on health and good living it would considerably relieve the financial strain on the State with regard to the provision of hospitals and the necessary services and it would also ease the strain on the medical profession. No matter what the Department of Health may do, it will be to no avail until the people are educated on the real essentials of life. They must know what steps to take to safeguard their health.
There should be a campaign in every area to advise people on the type of food to eat and what to avoid. The major diseases in this country are cancer and heart diseases. Many people say there is no cure for cancer but early diagnosis and treatment together with care and attention will reduce the number of deaths. I do not know what is our contribution to cancer research but it could never be enough. The amount of money spent on this research throughout the world is money well spent. We should use some of the EEC funds for this purpose, although I admit they are not extraordinarily large at the moment. An international effort should be made, in conjunction with the United States and other countries who are experiencing high death rates from cancer, to pool financial resources and to examine all possible means to conquer the disease.
As a matter of urgency, this country should have hospitals that would cater exclusively for cancer patients. Outstanding work has been done by existing hospitals but their resources are not sufficient to cope with the problem. Sooner or later the Department of Health will have to provide large, well equipped hospitals to take the strain from the existing hospitals treating cancer patients. At present many patients are on waiting lists because they cannot be accommodated in our hospitals.
In the late thirties and the forties this country had a serious problem with regard to tuberculosis but, as a result of a major drive in the provision of hospital accommodation, that problem was overcome to a great extent. However, we should not make the mistake of thinking tuberculosis is a disease of the past. Statistics show that there are still quite a number of people suffering from that disease and we must not be under the impression that we have completely solved the problem.
When people are in good health it is vital that they be educated on the best way to retain it. It is astonishing to realise that many thousands of people are living on tablets and drugs of all kinds. What has happened to this country? There has been an extraordinary change in recent years. People in all walks of life seem to take tablets and drugs four and five times a day. Do they really know what they are taking? Have all these drugs been prescribed by doctors? Is it the situation that some medical people are pushing these drugs on the public in an effort to relieve pressure on their surgeries and consulting rooms? The indiscriminate use of drugs and tablets is wrong and the sooner our people realise that the better. Many of the people who are taking these tablets are walking around in a daze. It will be a problem to break them from the habit of continually taking drugs and medicines. Years ago people lived to a ripe old age without the assistance of these drugs. They knew what good, wholesome food they should eat and they knew how to guard against infection and disease.
I have never understood why health foods were subject to tax. These foods are of a very good quality. I do not know why the various brands of imported health foods were subject to tax. I would ask the Minister for Health to consult with the Minister for Finance regarding this tax in relation to health foods and ensure that so far as natural foods are concerned they will not be subject to tax.
I want to pay tribute to those who have been associated with the blood transfusion service and to all those responsible for keeping a blood bank. I also want to express appreciation of voluntary blood donors. I trust that whoever is responsible in this particular sphere is satisfied we have sufficient blood in stock at all times to meet any great emergency that might arise. One is always hoping that catastrophe and disaster will be avoided but it is absolutely essential that the blood bank should be built up to the very maximum so that, should tragedy befall us, there will be ample supplies of blood readily available. The people involved in the blood transfusion service are doing an excellent job.
Our aim should be—it is the aim of the Minister—to treat people outside of hospital rather than in hospital. Steps have been taken in that direction. Well over 1,000,000 people are now covered by medical cards and are entitled to completely free health services. I do not describe myself as a 1975 socialist—I emphasise the 1975 —but I am a believer in free health services for all of the very best kind that can be made available. Those who have no free health services are paying through the nose to subsidise those who have these services. In the case of those who have to pay for services, particularly where large families are concerned, hospital charges and the cost of specialist treatment are outrageous. I know not one, not dozens, but scores of people who deliberately avoid going to a doctor because they are afraid they will have to go into hospital and, not being covered by free health services, they fear the financial consequences. That is a shocking situation. No human being should be in the position of putting his or her health at risk because of fear of financial stringency.
I implore the Minister to ensure that all our people will be treated equally and that the best free medical services will be provided for every man, woman and child in the State. Where, the Minister may ask, will the money come from? Whatever happened to the free-for-all health services, we were told some years ago would be available to all for the price of a packet of cigarettes? If everyone were contributing it would be possible to provide all our people with proper free health services. Then no one would enjoy better treatment than another. Let there be no question whatever about it, the man who can pay will always be sure of the very best treatment. We should drop the pretence that there is no difference as between those who can pay and those who cannot. There is a vast difference. The man with the financial resources can get the best treatment available inside or outside the country. I implore the Minister and the Government, whatever difficulties may have arisen with any branch of the medical profession, to make use of the conference table to resolve the difficulties. We are always talking about negotiation and reconciliation in other spheres. Why can there not be negotiation and co-operation where problems relating to health are concerned? If the conference table is utilised and there is goodwill any difficulties that exist should be capable of being resolved satisfactorily.
Ministers change and Governments change but the personnel in Departments do not change. It is there we want a real change of heart. I remember being on numerous deputations to various Ministers for Health right from the late Dr. Ward to the present day. The deputations invariably ended up with the civil servants making suggestions and proposals instead of the deputation telling them exactly what they wanted done. Deputations do not visit Departments to find out what the official departmental view is; they go with the intention of convincing the bureaucrats of a particular course of action they want the civil servants to take. Where there are fixed ideas, many of them emanating from Victorian times, it is impossible to make progress. There must be a change of heart at both governmental and local level. I know it is hard to cure an old dog of his trot and it is hard indeed to convince highly qualified, professional civil servants; that is why I say an effort must be made to bring about changes right through. I hope an effort will be made now to embark on free for all health services. I am a believer in them. I have seen the hardship middle class people undergo, people whom we regard as well off until they fall into the hands of those charged with responsibility for curing ill-health.
I do not know if any speaker has drawn the attention of the Minister to the standard of clinics. There is an obligation on health boards to provide spacious, airy clinics and it should be the duty of the Department to see that the clinics are inspected frequently. I have seen clinics where outpatients were packed like sardines in a tin, where there was no proper seating accommodation or proper ventilation or a reasonable standard of comfort. I cannot understand why the consultants send for so many patients at the one time. Is it due to transport problems?
It would be interesting to know the amount of the sum voted for Health that is spent on the transportation of patients from clinic to clinic and from hospital to hospital. I do not intend to be critical of those who earn a livelihood in transporting patients. It should be open to health boards to give a petrol allowance to a neighbour who would be prepared to transport a patient who had not a car. There have been cases where patients have been brought around the country for miles and for hours while other patients were being picked up or set down. This is an unsatisfactory arrangement. It must be replaced.
A survey of clinics should be undertaken and they should be visited frequently to ensure that they are not overcrowded, that proper accommodation is provided, that there is a proper way of receiving patients and that the clinics are fully staffed and equipped. I would have preferred not to have seen some of the clinics that have come under my notice.
We may be critical of our hospitals but we have a great deal to be grateful for. I want to express appreciation, especially to the religious who have devoted their lives to the care of the sick. I would also like to express gratitude to the wonderful girls who take up a nursing career, which is the finest vocation that any girl can follow. It is regrettable that such a large number of Irish girls cannot be trained at home as nurses. Our training hospitals are of the highest possible standard but they have the maximum number of trainees that they can accommodate and the prospect of getting girls into them for training is practically nil. I should like to ask what practical steps have been taken in recent years to ensure a greater intake of Irish girls into Irish hospitals where there are training facilities or to establish new training hospitals so that girls will not have to emigrate to be trained in England and elsewhere. It is a serious problem from the point of view of administration that so many girls have to emigrate to train abroad. I trust that the Department will take note of this matter.
The Elm Park Hospital is one of the finest hospitals in the world. Another fine hospital is the regional hospital in Limerick. I have not been in many hospitals except to see patients but I realise what it is to be in hospital, having been a patient many years ago for a much longer period than I care to remember.
Most of our hospitals could do with a general overhaul to bring them up to modern standards but when our hospitals are compared with hospitals that we visit abroad we realise how very well off we are. I visited a hospital in Copenhagen to see a patient and a hospital in Paris, to see a patient. I was not impressed. I certainly was not impressed when I visited the Bellevue Hospital in New York to see a patient. That hospital left a lasting impression. When one visits hospitals abroad one realises that some of our major hospitals are much more advanced. In the Bellevue Hospital in New York there are wards in which there are over 100 patients of all creeds, classes and nationalities. In the clammy atmosphere of New York city this is not a very pleasant experience. Because of location, the hospitals in this country are superior to many of the hospitals I have visited abroad. I have only visited two hospitals in England and that was in the city of Manchester. Any Dublin hospital impressed me more.
Our hospital staffs are dedicated people. I should like to express appreciation of our doctors, physicians, surgeons, psychiatrists for their wonderful devotion to duty and their loyalty to their patients. These people are extremely proud of the high standards of their profession.
I do not suppose that there will be many Deputies doing it but I want to express appreciation of the doctors in this country who have taken a certain stand against abortion and who have clearly and openly expressed their opinions in no uncertain terms. I have not heard a single utterance from the Department of Health advising people of the dangers of abortion. I have not seen one practical step taken to have a proper investigation about the means by which thousands of Irish girls are being ushered out of the country to have abortions performed in Britain and elsewhere. The Department of Health are closing their eyes to this problem. Do they know what is going on and are they happy it is going on? Have they taken any steps to investigate who is responsible for sending those girls out of the country to have abortions? Who is making the arrangements? It is very easy for them to say that it is a matter for the Garda and the Department of Justice. This matter calls for explanation and also warning of the dangers in relation to these activities abroad.
I want to pay a very special tribute to the Pharmaceutical Society of Ireland and to the chemists for the stand they took in relation to the contraceptive campaign. They acted correctly and wisely. If there is no other voice in the House to express appreciation for the stand taken by the chemists of Ireland I want to do so now. I want to express thanks for the firm stand they took at the time and which they conveyed to the responsible authorities.
I want to make a very special reference, as a member of a health board since health boards were established, to a matter of vital concern to any constituency. My constituency is within the midland region, which comprises four counties. I know the Minister for Health, like most Ministers from time to time, has to make some very difficult decisions but he will be faced very shortly with a decision, when considering the hospitalisation of the midland region, on the provision of a general hospital for that region. I have made a number of submissions on various problems from time to time to the Government and I am glad to say that many of them have been acted on.
I made a submission to the Minister for Health on 9th March, 1974 based on my dealings with the public, my knowledge of the midlands and my practical experiences as a public representative for over 30 years. I was not concerned with the political aspect of it because if I was I probably would have given greater choice to my own county. I wanted to make a submission which I felt was in the interests of health, the interests of the midlands and the provision of proper health services. I refer to page 125 of the Fitzgerald Report, a much talked about document. I do not know what has happened to that report, whether it is still active reading for the Department of Health or whether it is lying on the shelves of the Custom House covered with dust and cobwebs.
This report dealt with the problem of the midlands. I do not know if the officers of the Department of Health have goggles on when it comes to reading page 125 of the Fitzgerald Report. It states:
In the Central Midlands areas there are at present county hospitals in Portlaoise, Tullamore and Mullingar. All these hospitals are modern buildings, they are comparable in size and the towns in which they are located are also comparable in size. The three towns are situated on a line running roughly South to North: Tullamore is 20 miles north of Portlaoise while Mullingar is 22 miles north of Tullamore. In our consideration of this area it was clear to us that the development of General Hospitals in more than one of these centres would be difficult to justify.
I understand there is a sub-committee of the Cabinet already dealing with this matter. Have the Department submitted to each member of the Cabinet on this sub-committee my submission of 9th March, 1974 so that I cannot be told later on they did not know anything about it? I want that on the record of this House. If the Department of Health have that submission I am sure it can be conveyed to the Ministers in the Cabinet sub-committee dealing with this and other problems.
I want the House and the Minister for Health to understand clearly the problem in relation to hospitalisation in the midlands. Whatever is done now is unlikely to be undone and whatever decisions are taken now will have an effect on the livelihood and the health of the people of the midlands for over 100 years from now. The Fitzgerald Report further states on that page:
In considering the merits of the different centres we had regard to the impact of our selection on the areas to the north and to the south. If, for example, Portlaoise was to be developed as a General Hospital centre it would infringe on the area which one would expect might be served by Waterford General Hospital while Mullingar, if chosen for development, might be expected to draw patients from Cavan without adequately catering for the Cavan/ Monaghan area.
I want to draw the attention of the House to this part of the report in particular. I presume it has already been done by other Deputies for the constituency. I want to go on record as strongly recommending the submission in the Fitzgerald Report on this matter. Tullamore is roughly half way between Mullingar and Portlaoise. It is reasonably close to both and it is centrally located. The entire area is now served by three hospitals. We feel that Tullamore has a strong claim for a regional hospital.
The alternative to that is to have hospitals in Portlaoise and Mullingar. We are of opinion that the development of major hospitals in both those towns, which are relatively close to each other and which are within easy reach of Dublin, would not be justified. Accordingly, we recommend the selection of Tullamore as the centre for a regional hospital. Tullamore has been recommended in the Fitzgerald Report. I am not an Offaly man. I am a Laois man. Has the Fitzgerald Report gone down the spout or up the spout? Is it covered with dust and cobwebs and placed in safe keeping in the vaults of the Custom House?
Anybody who wants to cater properly for hospitalisation in the midlands region knows that there must be a hospital in Portlaoise and a hospital in Mullingar but, for major hospital treatment and attention, both of these hospitals can feed a regional hospital in Tullamore. The Mullingar hospital and the Portlaoise hospital send patients to every hospital in Dublin. There is enough pressure on the Dublin hospitals from the tremendously growing population in the city. Nobody suggested, and the Fitzgerald Report did not suggest, that the hospitals in Mullingar and Portlaoise should be closed down or downgraded. If they were expanded and extended they could function effectively and efficiently and, at the same time, they could feed the central hospital in Tullamore with patients who otherwise would have to be sent to Dublin.
I am not happy with the attitude of the Minister's advisers on this matter. I am not happy with the attitude of Custom House bureaucrats telling us where the Minister should decide our sick people should be treated. We are public representatives with knowledge and experience. We have the capacity to know and understand this matter. We are members of health boards. Our advice and guidance should be of more importance than those of a civil servant who, apart from an occasional holiday, was probably never more than a quarter of a mile from the Custom House. We know what we want.
In a general hospital various units are required for general surgery, general medicine, ear, nose and throat treatment, casualty services, out-patient services, radiology, pathology, nursing training schools, and so on. Are these to be attached to what are described as the mini-scale hospitals in Portlaoise and Mullingar? Is the midlands region to be the poor relation? All the other regions will have their central regional hospitals but we are to have two mini-scale hospitals.
A mini-scale hospital has not been defined but the fact that the word "mini" is used means that something will be lacking. The Minister's advisers are being penny wise and pound foolish. I want to go on record as uttering a warning against the provision of mini-scale hospitals in an area where experts have recommended that a general hospital should be provided to cater for the entire area but not at the expense of closing down the hospitals either in Mullingar or Portlaoise.
What will happen in Offaly if the supposed mini-scale hospitals are approved by the Department? Tullamore and the surrounding area has a population of 22,000 people. It should be selected without question for a general hospital. This country has not benefited from blessings from the present Government or from previous Governments. Is it to be denied the solemn right which professional gentlemen recommended to the Department after an examination and a survey were carried out? If these mini-scale hospitals are provided, possibly they will not be fully staffed and they will not be able to give the services which will be sought. The people of Offaly resent this.
I strongly and sincerely recommend that the idea of mini-scale hospitals for the midlands should be dropped. If a job has to be done we should not consider halfpennies and pennies. We should do the job properly or not do it at all.
The establishment of such mini-scale hospitals will rob for all time the region of its own central and general hospital. Or is it intended to depart from the regions altogether, to abolish the idea of regionalisation? My understanding was that each region was to be an independent unit, with full health facilities of every kind, ensuring that the region was adequately catered for so far as hospitalisation was concerned. There will not be a round the clock service in such mini-scale hospitals because the staff will not be available. The highly skilled medical men will go to the general hospitals in preference. As a result, we in the Midlands will be the victims of an ill-conceived and speedily taken decision. I beg of the Minister to remain calm and not allow himself to be rushed into anything in this regard. The future must be considered when perhaps none of us will be here. Let us not do anything which would be a hindrance to hospitalisation in the Midlands. That is why I plead with the Minister to adhere to the decision of providing a general hospital for Tullamore. Mini-scale hospitals, in my opinion, are nothing more than a doubling-up of the consultancy staffs of the present county hospitals. I want to know are people of some areas to lose their county hospitals so that this doubling up can be implemented, or can they be guaranteed any better service than they receive at present by so doing?
At present 40 per cent of patients residing in the Midlands are treated outside the Midlands area. This must and will continue if the suggestion of the mini-scale hospitals is implemented. There is an onus, not alone on the health boards but on the Department of Health, to provide the necessary services and cater for the 40 per cent at present being catered for outside the Midlands area. I make this plea for the sake of raising the standard of medicine in the Midlands but, more particularly, for the health and welfare of patients. Cannot it be argued in sane and financially wise terms that the best, surest and safest line of action is the provision of a central hospital for Tullamore, which I strongly recommend?