I think—and I adverted to this in a superficial way the last day—the present difference of opinion or, as I would rather say, difference of view about the numbers who will be affected by the extension of eligibility for free hospitalisation is something which should be clarified immediately by the Minister for Health, because the Minister says that unless he takes action immediately an estimated 85,000 workers who are at present eligible may become ineligible by the end of the year, whereas the medical organisations say that extension of the limit of eligibility will mean an extra 10 per cent of the population becoming eligible, that is, an extra 300,000 people. This raises the whole question of the adequacy of the hospital services to cope with this increasing number, if what the medical organisations say is true.
As regards the grievance of the doctors involved, the Minister is being blamed, rightly or wrongly—I cannot say—for making decisions without adequate consultation and agreement with them. Their argument is that, as a staunch trade unionist, the Minister should appreciate the need for such consultation and agreement with those working the service. This is one sore point with them, and understandably so. I would ask the Minister to examine urgently the whole question of hospitalisation and out-patient services and find out the cause of the present long waiting lists. If he could do this, it would be of inestimable benefit because he might be able to seek out areas of priority where these waiting lists could be reduced considerably. There are vital areas where the waiting lists is abominably long, for example, for eye examinations, for essential operations, in many cases operations which would restore people to full-time work and normal living within their community. This would call for extra work in the Department of Health, and this is where the big bottleneck occurs. I would ask the Minister to examine these waiting lists because this is one aspect that is getting rapidly out of hand.
The Minister might be well advised to pay more attention to primary health care and to try to case off the demand for hospital services, especially where investigation or treatment for minor ailments arises. However, I would feel very concerned if the Minister were to change the present system of contribution towards the cost of drugs. If the Minister increases the limit at which people become ineligible, as is suggested and as the Minister stated in one of his speeches, this would be a retrograde step, because people would too readily opt for hospitalisation in preference to being treated at home, and this is one area where it might be false economy.
Considering that a greater number of people are becoming ineligible for medical cards, I begin to wonder if the guidelines have not been extended sufficiently in line with the rapid rise in inflation. Evidence of this is forthcoming in the number of people who are now being refused renewal of their medical cards. This, again, is an area which needs priority.
In view of the inadequate facilities in our hospitals, I would ask the Minister to make a declaration as to what he proposes to do about free hospitalisation. Is it a firm commitment on his part to proceed with this? Among those working the service there is a fear that he is trying to bring in free hospitalisation by stealth and this is causing considerable disquiet. He should make a firm declaration on whether he proposes to extend the free hospitalisation to all. It is incumbent on him to clarify this point. He should state what is happening to the practically moribund review body which has been in operation since August, 1974 and which is looking into the methods of payments to those operating the service. There was talk about the members of the review body going to Scotland, Canada and Europe to examine methods there. That body should have made their report by now and the Minister should call for an interim report. As the review body was set up by the Minister, he should ask for and receive an account of their activities to date. This is vital.
People operating the hospital service at present are very frustrated by the appalling conditions under which they work. The Minister should spell out the time table for his national hospital plan. At the moment there is a growing uncertainty in the hospitals and there is talk of bringing the service to a halt in protest at the Minister's procrastination. If this were to happen, it would create a chaotic situation. It is important that we restore confidence to the people working the service and give them hope that new hospitals will be provided. The publication of the plan without the time table is a serious matter which calls for positive action. If the Minister were to publish the plan and the time table, he would be sure of the co-operation of the profession and there would not be confrontations which have been occurring since he took office. More consultation and agreement with the medical people would ensure harmonious relations between the Minister and the profession and this is very important. It has been said that relations between the Minister and the profession have never been worse since Mr. MacEntee was Minister for Health. The Minister, as a staunch trade unionist, should appreciate the value of prior consultations with affected interests.
The financing of the health services should be looked into. The Irish Independent brought to light that the Minister mentioned in December, 1974, that a review of the methods of financing the health services was being undertaken. What has happened since? Apparently, nothing has happened to indicate if the Department are still working on this. Again, it is incumbent on the Minister to tell us if any action has taken place in this field or are the Department leaving matters in abeyance? I hope to see some major changes in the Department of Health because of programme budgeting, output budgeting. I expect there will be some effort at rationalisation within the Department This is necessary if we are to have a proper health service.
It is also incumbent on the Minister to spell out exactly what he means when he says that 85,000 people will become ineligible. How did he arrive at this figure? I have been unable to ascertain who would and who would not be eligible under the proposed extension. It is important that he spell out where he got the figure of 85,000. It would be proper to extend the health service if the hospitals were capable of coping with the extended service. If the service were extended at present, we might end up by making the situation for the most disadvantaged members of our community more difficult. We might find that those at the end of the queue for admission or investigation will be relegated further down the list. This is a real possibility which we should bear in mind. It would be disastrous if, in our efforts to extend the hospitalisation scheme, we were to make the most disadvantaged members of the community worse off. That is not the purpose for which we would be improving our health services and this is what we would have to spell out. We would want assurances that those people will not be adversely affected by any proposal put forward by the Minister.
The Minister has an opportunity here to spell out his thoughts on the health services, what he proposes to do, whether he intends to meander along increasing the health contributions to cope with inflationary trends or if he has active proposals for helping those in need. We should know which the Minister considers more important, primary health care or free hospitalisation. In Britain they realise that primary health care is the pivot on which the health service revolves. They realise that they made mistakes when they planned their major hospital schemes and an extension of the hospital services without looking at the health needs of the nation. I would like to hear the Minister's priorities in this regard. Then we will be in a better position to know in what direction the Department are going.
In his reply, would the Minister state unequivocally if it is his intention to set up an all-party committee of the Dáil to carry out a cost benefit analysis of the health boards? If the Minister made a statement to that effect, it would be a great help, especially at present when there appear to be runaway inflationary trends in expenditure by the health boards.