When I reported progress I was pointing out to the Minister that it would have been better had he told us honestly that he was short of money and that he would have to cut down on the services we had last year. However, instead of this he told us that he will be able to provide the same services although we have pointed out this is not possible in view of the amount of money given to the health boards. I mentioned that the health board in my area is short £500,000 if they are to provide the same level of services as last year. When the Minister allocated money to the health boards did he take into consideration the inflation factor and also the fact that increments are payable to the staff? There has been no mention of this. The shortfall is greater than we anticipated. If the Minister had admitted frankly that he had not the money and that it would be necessary to cut, we might have been more sympathetic. However, I would not agree with any cuts being made at the bottom of the scale, as the health boards are doing. It is the unfortunate people at the bottom of the ladder who are being hit most severely.
On the last occasion I referred to the question of medical cards. Even in the short period since then many more people have been told that they are not entitled to medical cards. The health boards are adhering strictly to guidelines that are all wrong. A question was asked in the Dáil recently and the Minister admitted that it is possible for a couple drawing the old age pension to be deprived of a health card. I have heard that a single person with an old age pension of £10 can have £6 income from another source, making a total of £16, and in this case the guideline for eligibility for a medical card is £19, but some people in this situation have been refused medical cards.
I should like the Minister to tell us the criteria used for determining eligibility for a medical card. Why is it different from that applying to an old age pension? A single man can have £6 and get a full old age pension and the guideline for obtaining a medical card is £19. Under the guidelines he can have £19 and still get a medical card. A man and a wife in receipt of the old age pension would be getting £20 together with the £12 they are entitled to and that would mean that they would be over the guidelines because the figure is £28.25. I cannot understand the system of finding out a single person's means. A person is not entitled to the old age pension if he it getting more than £6 per week but if one adds that £6 to the old age pension he is brought to £16 per week while the guidelines are £19 per week. The whole medical card system will have to be looked into. The Western Health Board asked that the guidelines for man and wife without children should be set at £35 instead of the unrealistic figure of £28.25.
The Minister, when I questioned him about this, told me that such people were out because of the good pensions being given by the Government but does anybody consider that a man and his wife, with the huge increase in the cost of living, can live on anything less? Surely people with £32 per week cannot be considered to be in the middle income group. I appeal to the Minister to look into this matter of medical cards. I know the hardships caused in this regard.
I should now like to deal with a live issue in my area at present, the question of amalgamation and federation of hospitals. The people of my area were complimented by the Minister for keeping quiet on this matter for so long. We did not shout about the Portiuncula hospital in Ballinasloe, one of the finest hospitals in the country, or the nurses training school in that town because we expected it would retain full status as a general hospital but we understand that under the new set up it is to be federated with Roscommon County Hospital which is 25 miles away. Without saying anything against Roscommon County Hospital, I believe a federation between that hospital and Ballinasloe cannot work. The fact that two important appointments which have been approved by the Ballinasloe hospital board have not been sanctioned by the Department has made the people in that area concerned. Deputy Hogan O'Higgins and myself are trying to keep the people quiet by telling them that they will continue to have their hospital but the people are concerned because the appointments have not been sanctioned. Such an arrangement is not considered satisfactory by Roscommon and we will make a lot of noise if anything happens to Ballinasloe hospital which is run by an Order of French Sisters.
There is rethinking on the question of amalgamation and federation of hospitals in England. They are more inclined now to revert to the smaller hospital because they feel it can provide a better service. I never agreed with the Fitzgerald Report because I felt it was unsuitable for this country. The people of Ballinasloe did not kick up a fuss about their hospital because they did not think there was any necessity to do so; it was easy to see that the facilities were there. The services available at that hospital are not available elsewhere but we have been told that there is a danger of the hospital being downgraded because appointments are not being sanctioned.
Another important matter in my area concerns the treatment of the mentally handicapped. Those involved in that work in Galway are very short of money and have written to local representatives about the matter. Last year there was a shortfall of £20,000 and if they experience a shortfall this year they will not be able to provide many of the facilities for the mentally handicapped. At St. Joseph's special school for moderately handicapped children 75 children are being looked after while at the unit in Galway for severely handicapped 22 are looked after. At St. Dympna's Centre at Portumna eight are cared for while 12 are catered for at the Tuam Centre. At the St. Joseph's Training Centre in Galway for school leavers 20 are catered for. We have been informed that the amount agreed for this work in 1974-75 was £27,000 but the amount given was £12,000 while in 1975, £28,000 was agreed but only £20,000 granted. I believe they have been promised £20,000 this year but that is not enough. The health board have not the money. The fact that this money is not made available is not the fault of the officials of that board. There will be severe curtailment in all essential services run by that board. I am not saying that a better service should be provided this year but if the Minister honestly told us that it was not possible to provide the same services as last year we would help him. The same cuts made at the bottom should be made at the top because, unfortunately, it is the under-privileged who will suffer. I believe the health services will be cut drastically this year.
I believe there will also be a severe cut in the home care allowance. It is a shame that because a person who is looking after an old person lives with a husband or family that that person is not given an allowance. I should like to point out very forcibly to the Minister that if I were Minister for Health I would gamble on giving more money to those looking after old people and providing community care in the belief that we would have fewer hospital problems and fewer cases of beds being occupied which were badly needed by others. At present there are too many in hospital who could be kept at home. It is a matter of money. If a married woman with a family has an old relative in the house the chances are that if there is something wrong with the old person the doctor will be asked to get a bed in hospital for him or her on the ground that he or she cannot be looked after at home. I believe that if the woman were paid pretty well, under proper supervision, for taking care of the old relative this situation would not arise. One could ensure that the old people would be well cared for. I have been emphasising this since I came to the House.
I can assure the Minister that we in the Western Health Board cannot provide anything like the services we gave last year with the budget we have this year. I do not believe the Minister made any provision for the increments which normally arise. In this regard the various health board allocations are completely unrealistic. I know the officials of the Western Health Board and there are no more conservative people in bringing in estimates and I cannot understand the Minister suggesting that we can run the show for £500,000 less than estimated. Is he accusing the officials of introducing excessive estimates? This is not on. I hope the Minister for Education will convey what I have said in all sincerity to the Minister for Health. If it were a Minister of my own party who was sitting opposite, I would have to make the same criticisms because I am in constant contact with the hardships endured by the people I represent. The health cards are being withdrawn: we are being hit on the lowest level. I make a final appeal to the Minister to reconsider these health board allocations because they are completely unrealistic.
